Trends in slipped capital femoral epiphysis: is the rate declining?

PURPOSE: Slipped capital femoral epiphysis (SCFE) is an adolescent hip condition with a high risk of complication. The purpose of this study was to evaluate trends in treatment using a prospectively collected paediatric nationally representative database. METHODS: A total of 9034 patients undergoing treatment for idiopathic SCFE were selected by querying the Healthcare Cost and Utilization Project's Kids' Inpatient Database for the years 1997, 2000, 2003, 2006, 2009 and 2012. The selected patients were separated based on operative approach and these cohorts were analyzed based on temporal and categorical differences in operative approach, patient demographics and clinical characteristics. Univariate and multivariate analyses were used when appropriate and the Mantel-Haenszel test for trend was used in temporal analysis. RESULTS: Overall SCFE procedures have decreased 27.5% (p < 0.001). Closed procedures have decreased 28.5% (p < 0.001), while open procedures have decreased 44.8% (p < 0.001). Bilateral closed procedures have increased 7.2% (p < 0.001). The ratio of open to closed procedures decreased in patients aged nine to 12 years and increased in patients aged 13 to 16 years (p < 0.001). CONCLUSION: Here we report age stratified trends in treatment for idiopathic SCFE using nationally representative data and show an overall decrease in admissions and procedures over time. LEVEL OF EVIDENCE: Level III, retrospective comparison study.

Primary synovial osteochondromatosis of the hip: report of two cases with long-term follow-up after synovectomy and a review of the literature.

Primary synovial osteochondromatosis of the hip joint is rare. Two cases treated successfully by open synovectomy of the hip joint and removal of loose bodies, with a follow-up of 7 years in one case and 5 years in the other, are described. A review of all published case reports in the English language suggests that an open synovectomy of the hip will relieve pain and may prevent or delay the progression of degenerative changes.

The relationship between alveolar macrophage TNF, IL-1, and PGE2 release, alveolitis, and disease severity in sarcoidosis.

A mononuclear cell alveolitis, comprised in part of activated macrophages, is thought to precede granuloma formation and fibrosis in pulmonary sarcoidosis. Tumor necrosis factor-alpha (TNF), interleukin 1-beta (IL-1), and prostaglandin E2 (PGE2) are potent mediators released by activated alveolar macrophages. To determine if alveolar macrophage TNF, IL-1, and PGE2 release was associated with clinically progressive pulmonary sarcoidosis, we obtained alveolar macrophages from bronchoalveolar lavage of 68 patients with biopsy specimen-confirmed sarcoidosis, cultured the macrophages in the presence and absence of lipopolysaccharide (10 mg/L) for 24 h, and measured TNF (enzyme-linked immunosorbent assay), IL-1 (enzyme-linked immunosorbent assay), and PGE2 (radioimmunoassay) release. Alveolar macrophages from most patients with sarcoidosis spontaneously released TNF, IL-1, and PGE2. The amounts of these mediators released (either spontaneously or following lipopolysaccharide stimulation) did not positively correlate with the numbers of any of the cells in bronchoalveolar lavage fluid, the clinical status of disease (stable vs deterioration), steroid usage, or cigarette smoking. The relative release of each of the individual mediators, however, was highly correlated with the release of the other mediators. The studies suggest that these markers of alveolar macrophage activation from a single bronchoalveolar lavage are poor indicators of clinically progressive disease.

Outcome of subjects with idiopathic pulmonary fibrosis who fail corticosteroid therapy. Implications for further studies.

To evaluate the outcome of subjects with idiopathic pulmonary fibrosis (IPF) whose conditions clinically deteriorate while receiving corticosteroid therapy, we studied 12 of these subjects (7 male, 5 female) who received subsequent therapy with intravenous (IV) pulse cyclophosphamide (CPX). Seven of the 12 study subjects died during the course of therapy. Six of these subjects died of respiratory failure, and one died of cholecystitis. Among those who died, the mean age at diagnosis was 63 years compared with 57 years in those who have continued to survive (p = 0.29). Smoking status and pack-years of cigarette smoking were similar between those subjects who died and those who continue to survive. However, subjects who died received CPX for a mean of 6 months, while subjects still living have received CPX for a mean of 16 months (p = 0.01). Subjects who died were given a CPX a mean of 64 months after the onset of symptoms, compared with a mean of 50 months for subjects who are still alive (p = 0.57). Interestingly, there were no significant differences in measures of pulmonary function between living and dead subjects. In fact, measures of lung function and gas exchange remained stable in both groups throughout the period of observation. These data suggest that (1) measures of lung function may not be a reliable indicator of patient mortality in end-stage IPF, and (2) while not statistically significant, these data raise the possibility that duration of symptomatic disease may play a role in the outcome of IPF patients receiving alternative therapeutic agents after failure of corticosteroid therapy. In future intervention trails, controlling entry criteria for duration of disease may prove helpful in determining the effects of these agents on the disease process. These data do not permit a determination of the effect of CPX in patients with IPF.

The influence of cigarette smoking on lung function in patients with idiopathic pulmonary fibrosis.

The purpose of this investigation was to quantify the effect of cigarette smoking on standard measures of lung function in patients with idiopathic pulmonary fibrosis (IPF). Our study population consisted of 73 patients in whom IPF had been clinically diagnosed; in 67% the diagnosis was confirmed by open lung biopsy. The average age was 63 yr; 62% were men, and 70% were either former or current cigarette smokers. Current cigarette smokers were found to have a greater percent predicted residual volume. Interestingly, in a univariate analysis, pack-years of cigarette smoking was found to be directly associated with increased measures of lung volumes (TLC, FRC, and RV) and diminished gas exchange (DLCO). Linear multivariate regression models demonstrated that current cigarette smokers have greater measures of RV and FRC and that increasing pack-years of cigarette smoking is associated with diminished gas exchange. Importantly, the FEV/FVC ratio was not significantly related to either smoking status or pack-years of cigarette smoking. Results from our study indicated that among patients with IPF, current cigarette smokers will tend to trap air (higher RV and FRC), and that cigarette smoking appears to adversely alter gas exchange. Moreover, IPF appears to reduce the likelihood of developing physiologic correlates of airflow obstruction among cigarette smokers. However, this does not imply that IPF prevents the development of cigarette-induced lung disease. In fact, the association between cigarette smoking and both increased lung volumes and diminished gas exchange suggests the presence of both emphysema and interstitial fibrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Localization of adrenal and extra-adrenal pheochromocytomas by magnetic resonance imaging.

We found magnetic resonance imaging helpful in the localization of both an adrenal and an extra-adrenal pheochromocytoma, since these tumors produced a high-intensity "light bulb" image. MRI is an excellent method for localizing pheochromocytomas because it detects adrenal and extra-adrenal pheochromocytomas missed by computerized tomography and adrenal-renal ultrasonography, and because the high-intensity MRI signal generated by pheochromocytomas is useful in differentiating them from nonfunctioning adrenal masses in hypertensive patients.

Appendicitis in children.

Six hundred and fifty-one patients with appendicitis were reviewed and an over-all perforation rate of 36.5 per cent accompanied by a major complication rate of only 3.38 per cent and an over-all complication rate of 9.06 per cent was reported. This low complication rate despite a high level of perforation can be attributed to the use of antibiotic regimens effective against both aerobic and anaerobic organisms. A thorough irrigation and flushing of debris and exudate from the abdominal cavity of patients with ruptured appendicitis may improve these rates.