Outcome of lumbar spinal fusion surgery in obese patients: a systematic review and meta-analysis.

The aim of this study was to determine whether obesity affects pain, surgical and functional outcomes following lumbar spinal fusion for low back pain (LBP). A systematic literature review and meta-analysis was made of those studies that compared the outcome of lumbar spinal fusion for LBP in obese and non-obese patients. A total of 17 studies were included in the meta-analysis. There was no difference in the pain and functional outcomes. Lumbar spinal fusion in the obese patient resulted in a statistically significantly greater intra-operative blood loss (weighted mean difference: 54.04 ml; 95% confidence interval (CI) 15.08 to 93.00; n = 112; p = 0.007) more complications (odds ratio: 1.91; 95% CI 1.68 to 2.18; n = 43858; p < 0.001) and longer duration of surgery (25.75 mins; 95% CI 15.61 to 35.90; n = 258; p < 0.001). Obese patients have greater intra-operative blood loss, more complications and longer duration of surgery but pain and functional outcome are similar to non-obese patients. Based on these results, obesity is not a contraindication to lumbar spinal fusion.

Modelling the natural history of Huntington's disease progression.

BACKGROUND: The lack of reliable biomarkers to track disease progression is a major problem in clinical research of chronic neurological disorders. Using Huntington's disease (HD) as an example, we describe a novel approach to model HD and show that the progression of a neurological disorder can be predicted for individual patients. METHODS: Starting with an initial cohort of 343 patients with HD that we have followed since 1995, we used data from 68 patients that satisfied our filtering criteria to model disease progression, based on the Unified Huntington's Disease Rating Scale (UHDRS), a measure that is routinely used in HD clinics worldwide. RESULTS: Our model was validated by: (A) extrapolating our equation to model the age of disease onset, (B) testing it on a second patient data set by loosening our filtering criteria, (C) cross-validating with a repeated random subsampling approach and (D) holdout validating with the latest clinical assessment data from the same cohort of patients. With UHDRS scores from the past four clinical visits (over a minimum span of 2 years), our model predicts disease progression of individual patients over the next 2 years with an accuracy of 89-91%. We have also provided evidence that patients with similar baseline clinical profiles can exhibit very different trajectories of disease progression. CONCLUSIONS: This new model therefore has important implications for HD research, most obviously in the development of potential disease-modifying therapies. We believe that a similar approach can also be adapted to model disease progression in other chronic neurological disorders.

The relationship between Developmental Co-ordination Disorders, child's perceived self-efficacy and preference to participate in daily activities.

BACKGROUND: Developmental Co-ordination Disorder (DCD) may negatively impact children's self-efficacy and limit their performance and participation in school as well as in leisure activities performed after school hours. However, a lack of information exists regarding the relationships between DCD, child's self-efficacy and participation. Moreover, the literature about the way children with DCD experience these limitations and report about them is scarce. This study aimed to compare the perceived self-efficacy and the preference to participate in leisure activities of children with DCD and typical peers and to illuminate the relationship between self-efficacy, activity preference and DCD severity. METHODS: Participants were 37 children with DCD and 37 typical peers, aged 5.08-9.83 years. All children performed the Movement Assessment Battery for Children, the Perceived Efficacy and Goal Setting System and the Preference for Activities of Children. RESULTS: The scores of the Movement Assessment Battery for Children confirmed the motor gaps between the two groups. Children with DCD scored significantly lower in self-efficacy on all the Perceived Efficacy and Goal Setting System subscales and demonstrated a lower preference to participate in leisure activities according to all scales of the Preference for Activities of Children. The lower their self-efficacy, the lower their motor performance and their preference to participate in activities. CONCLUSIONS: Children's preference to participate in activities may be limited by motor difficulties, but further hindered by low self-efficacy. Early identification of DCD and associated negative outcomes, also based on child's self-reports, should receive special attention in intervention programmes in order to enhance children's self-confidence, feelings of belonging, optimal development and participation in daily activities.

Co-existing fractures of the proximal humerus and humeral shaft without shoulder dislocation--a rare injury.

Multiple fractures of the humerus are a rare injury and usually associated with high-energy trauma. We report an unusual injury with co-existing fractures of the proximal humerus and humeral shaft without shoulder dislocation. We discuss our experience in the diagnosis and treatment of a 39-year-old man with co-existing fractures of proximal humerus and ipsilateral humeral shaft with radial nerve deficit. He was successfully managed with open reduction and fixation of the fractures. At follow-up 1 year after injury, he is back at work and has a good range of shoulder movements. The radial nerve injury is showing signs of recovery. In high-energy trauma to the shoulder, unusual fracture patterns with associated neurovascular deficits may be seen and this case report describes our experience with one such rare injury.

A radiological study of 3M Capital femoral hip prostheses: an analysis of factors predisposing to failure.

We conducted a radiographic assessment of 180 flanged modular titanium alloy Capital femoral hip replacements. Six significant factors associated with failure are identified. The mean follow-up period was 7.9 years (2.1-16 years) and there were 26 (14%) radiographic failures irrespective of whether these were symptomatic or led to revision. Failure, if it is going to occur, is initiated early, within an average of 1.4 years, and becomes clinically evident very quickly; the remainder appear to sustain more likelihood of stable survival. This is the longest published follow-up and it suggests that the survival is better than indicated in some other series. If the identified prejudicial aspects of surgical technique had not been present, it follows that the results would have been better. Comparison with other published series is attempted.

Outcome after foot and ankle deformity correction using circular external fixation.

BACKGROUND: External fixation is the method of choice for correction of chronic severe foot and ankle deformities. We report our experience and outcomes of circular external fixation. METHODS: Fifty-five patients (60 feet) were treated with circular external fixation. The mean age at surgery was 36 (range 16 to 65) years. The mean followup was 4.4 (range 1 to 10) years. The mean time spent in external fixation was 2.1 (range 1 to 12) months. RESULTS: There were six excellent, 35 good, eight fair, and six poor results, five of which had below knee amputations. All the patients who had an amputation were treated for infected nonunion of the ankle. CONCLUSION: Circular external fixation was found to be an effective method for treating a variety of complex foot and ankle problems. The complications were more common in patients with infected nonunions.

An unusual cause of ventricular tachycardia.

Inflammatory pseudotumour (IP) of the heart is an extremely uncommon and potentially fatal lesion which presents a challenging diagnosis even for the experienced pathologist, cardiologist and cardiac surgeon. This spindle cell tumour is known to be present in virtually every anatomical region but, in adults, has only previously been found in the heart at postmortem. We report the case of a 27-year-old man who presented with ventricular tachyarrhythmias and a right ventricular mass which was subsequently shown to be an IP.

[Intestinal cystic duplication in infants and the etiology of intussusception].

2 infants, 3 months old and 8 months, respectively, with restlessness and vomiting were each found to have ileocolic intussusception with barium filling defects. Laparotomy disclosed in each a dome-shaped structure, 2 cm and 0.6 cm in greatest diameter, respectively, on the antimesenteric side of the ileal wall. Histological examination showed cystic duplication of the ileum. It is suggested that manual reduction generally fails when cystic duplication is an etiological factor, and surgery is then mandatory.

Perinatal mortality in hypertensive disorders of Jewish and Bedouin populations.

The aim of this study was to retrospectively compare the perinatal mortality of Jewish and Bedouin hypertensive patients in the Southern area of Israel. Since almost 100% of the deliveries took place in the Soroka Medical Center, the sole hospital of the area, the computerized files of our department during 5 years (1986-1990) were used in the study. Data on the frequency of hypertensive disorder types, rates of stillbirths and neonatal deaths, maternal age and parity, pre-term and term deliveries, prenatal care, intrauterine growth retardation, mode of delivery and fetal sex, were analysed according to ethnicity. Among a total of 40,780 deliveries, 2343 were of hypertensive pregnancies. No difference in the prevalence of hypertensive disorders was found between Jewish and Bedouin women. Perinatal mortality in Jewish hypertensive women was 16.8/1,000 compared with 11.8/1,000 in normotensive, while among the Bedouins the rates were 44.4/1,000 and 22.9/1,000, respectively. In both populations half the rate of perinatal deaths were stillbirths, except among the Jewish hypertensive patients whose fetal deaths reached 72%. Of the risk factors examined the rate of inadequate prenatal care was higher among Bedouins than in Jews. Among women without prenatal care the Jewish hypertensives had a relative risk of 5.29 for perinatal mortality, compared to normotensive pregnant women, whereas in the Bedouins the relative risk was 2.54. Ethnicity was found not to have influence on the prevalence of hypertensive disorders among Jewish and Bedouin pregnant women.(ABSTRACT TRUNCATED AT 250 WORDS)

Reduced frequency of hypertensive disorders in placenta previa.

The isthmic segment of the uterine artery's ascending branch has a freer course and wider diameter than distal parts of the vessel. Therefore, we assumed that this arterial segment would provide better blood flow and prevent hypoxia of the trophoblast. As a result, placenta previa pregnancies would be complicated by hypertensive disorders less often than are pregnancies with normally implanted placentas. To test this hypothesis, 491 placenta previa pregnancies, among a population of 106,866 pregnant women, were compared with pregnancies with normally implanted placentas. Clinically meaningful and statistically significant reductions in the rates and risks of hypertensive disorders were found in placenta previa pregnancies (P = .002, relative risk = 0.44, 95% confidence interval 0.25-0.78). The differences persisted when primiparous and multiparous women were examined separately and when preterm and term deliveries were separated. In a multivariate logistic regression analysis, patients with placenta previa had a third of the risk for hypertensive disorders compared with pregnant women with normally implanted placentas (relative risk = 0.36, 95% confidence interval 0.20-0.64), even after controlling for parity and preterm or term delivery. In the same model, primiparity and preterm delivery were each associated with a doubling of risk for hypertensive disorders, regardless of the placental implantation site. Thus, regardless of parity and preterm or term delivery, placenta previa and hypertensive disorders are inversely related.