The role of preoperative aspartate aminotransferase-to-platelet ratio index in predicting complications following total hip arthroplasty.

BACKGROUND: The purpose of this study was to investigate the relationship between preoperative aspartate aminotransferase-to-platelet ratio index (APRI) and postoperative complications following total hip arthroplasty (THA). METHODS: All THA for osteoarthritis patients from 2007 to 2020 within the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database were included in this study. Subjects were subsequently divided into cohorts based on APRI. Four groups, including normal range, some liver damage, significant fibrosis, and cirrhosis groups, were created. Comparisons between groups were made for demographics, past medical history, and rate of major and minor complications. Other outcomes included readmission, reoperation, discharge destination, mortality, periprosthetic fracture, and postoperative hip dislocation. Multivariate logistic regression analysis was performed to determine the role of preoperative APRI in predicting adverse outcomes. Statistical significance was set at p < 0.05. RESULTS: In total, 104,633 primary THA patients were included in this study. Of these, 103,678 (99.1%) were in the normal APRI group, 444 (0.4%) had some liver damage, 256 (0.2%) had significant fibrosis, and 253 (0.2%) had cirrhosis. When controlling for demographics and relevant past medical history, the abnormal APRI groups had a significantly higher likelihood of major complication, minor complication, intraoperative or postoperative bleeding requiring transfusion, readmission, and non-home discharge (all p < 0.05) compared to normal APRI individuals. CONCLUSIONS: Abnormal preoperative APRI is linked with an increasing number of adverse outcomes following THA for osteoarthritis for patients across the United States. LEVEL OF EVIDENCE: Level I.

Cecal bascule: a systematic review of the literature.

BACKGROUND: Cecal volvulus is a rare clinical entity with an average incidence of 2.8-7.1 per million people per year, accounting for 1-2% of all large bowel obstructions. Cecal bascule is the rarest type of cecal volvulus, accounting for 5-20% of all cases. Although several case reports have been published, there is no consensus regarding its diagnosis and treatment. The aim of this study was to review the literature on cecal bascule in order to summarize the etiopathogenesis, clinical features, diagnosis, and treatment options. METHODS: The PubMed, MEDLINE, and Scopus databases were systematically searched by two independent authors. Cecal bascule was defined as anterior displacement of the distended cecum on the ascending colon without any torsion. The etiopathogenesis, clinical features, diagnosis, and treatment options were analyzed. RESULTS: Nineteen previously published papers reporting on 26 patients were included. The mean age of patients from previously reported cases was 55.1 ± 19.2 years, and 54% of all patients were males. Presenting symptoms included abdominal pain in 16 (61%), distension in 22 (84%), and vomiting in eight patients (30%). The mean time to diagnosis was 3.6 ± 2.6 days. The extent of surgery varied from cecopexy to right colectomy. There was no postoperative mortality. Cecal bascule recurred one 1 year after index surgery in one patient. CONCLUSIONS: Cecal bascule is a rare clinical entity, which is mostly encountered in patients with peritoneal adhesions, mobile cecum, bowel dysfunction, and cecal displacement. In patients with recurrent or persistent abdominal pain and distension, cecal bascule should be considered. The majority of these patients require surgical management.

An unusual cause of pacemaker-induced severe tricuspid regurgitation.

Pacemaker (PM) induced tricuspid regurgitation (TR) is a common echocardiographic finding. Although mild or moderate TR is frequently observed, severe TR is rare. We report the exceptional observation of a severe TR due to leaflet malcoaptation occurring late after PM implantation and in the following weeks after an aortic valve replacement. Our hypothesis is that the aortic valve surgery has been responsible for conformational changes between cardiac cavities, tricuspid valve and PM leads resulting in a severe TR.

[A pitfall of transseptal catheterisation for percutaneous mitral commissurotomy: interruption of the inferior vena cava with azygos continuation]. / Piège du cathétérisme transseptal pour commissurotomie mitrale percutanée: l'interruption de la veine cave inférieure avec continuation azygos. A propos d'un cas et revue de la littérature.

Transseptal catheterisation is a widely used technique in interventional cardiology. The authors report the case of a 37 year old woman admitted for percutaneous mitral commissurotomy of a symptomatic rheumatic mitral stenosis in whom transseptal catheterisation was impossible because of a rare congenital anomaly: interruption of the inferior vena cava with azygos vein continuation.

Evaluation of drug usage and expenditure in a hospital diabetes clinic.

BACKGROUND: Diabetes mellitus is a major public health problem and often coexists with hypertension and dyslipidaemia. A prescription-based survey was conducted to examine the use of antidiabetic, antihypertensive and lipid lowering drugs in a hospital diabetes clinic. The expenditure incurred was also evaluated. METHOD: Prescriptions issued from the diabetes clinic were collected for 4 consecutive weeks. Drugs were categorized into three main classes--antidiabetic, antihypertensive and lipid-lowering drugs. The unit cost of each drug and the total amount prescribed were used to estimate the total drug costs. RESULTS: During the 4-week study period, 534 prescriptions were collected, of which 520 contained antidiabetic drugs. Oral hypoglycaemic agents were prescribed in 379 patients (72.9%). Sulphonylurea was used as a single agent in 119 (22.9%) patients, in combination with metformin in 219 (42%) patients and with insulin in 17 patients (3.3%). Among patients treated with sulphonylureas (n=342), glibenclamide (47.7%) and gliclazide (30.7%) were the main drugs prescribed. Metformin monotherapy was prescribed in only 31 patients (6%). Insulin treatment was prescribed in 141 (27%) patients and in combination with oral drugs in 23 patients (4.5%). Of the 534 prescriptions, 225 (42%) contained antihypertensive drugs. Calcium channel blocking agents and angiotensin converting enzyme inhibitors were the most commonly prescribed drugs in both monotherapy (n=155) and combination therapy (n=70). The antidiabetic and antihypertensive drugs accounted for 45% and 39% of the total drug expenditure, respectively. Lipid-lowering drugs were prescribed in 8% of the diabetic patients. Simvastatin and gemfibrozil were the most common drugs prescribed and accounted for 12% of the total drug expenditure. CONCLUSION: The use of antidiabetic drugs represents a major burden on the health care system. The high proportions of patients requiring antihypertensive drugs and lipid lowering drugs further increase drug expenditure. Most of these treatments have been shown to improve clinical outcomes and quality of life, if used appropriately. The impacts of these long-term medications on health care financing require careful evaluation to assess their cost-effectiveness.

[Cardiac abscess in infectious endocarditis. A multicenter study apropos of 233 cases. The Working Group on Valvulopathy of the French Society of Cardiology]. / Abcès cardiaques dans l'endocardite infectieuse. Etude multicentrique à propos de 233 cas. Groupe de travail sur les valvulopathies de la Société française de cardiologie.

The aim of this retrospective multicenter study was to determine present characteristics of infectious endocarditis complicated by abscess and to identifying predictive factors of mortality. The files of 233 patients with infectious endocarditis complicated by perivalvular abscesses between January 1989 and December 1993 were analysed. Two hundred and thirteen patients underwent medico-surgical treatment (175 aortic and 38 mitral abscesses) and 20 patients underwent medical treatment alone (17 aortic and 3 mitral abscesses). The abscess was observed on native valves in 156 cases and valve prostheses in 77 cases. The causative organism was identified in 69% of cases : the commonest organism was the staphylococcus. The diagnostic sensitivity of transthoracic and transoesophageal echocardiography was 36 and 80% respectively. The operative mortality at one month was 16%. Patients over 65 years of age, staphylococcal infection, renal failure and fistulisation of the abscess, were identified as independent predictive factors of mortality at one month. The survival rate three months after surgery was 75 +/- 10% and 59 +/- 11% at 27 months. An age over 65, staphylococcal infection, uncontrolled infection, circumferential abscess and fistulisation were independent predictive factors of global mortality (the first month and after). The mortality rate in unoperated patients was 40%: cardiac failure and fistulisation of the abscess detected by echocardiography were predictive factors of mortality on univariate analysis.

Specifics of technique in percutaneous mitral commissurotomy in a case of dextrocardia and situs inversus with mitral stenosis.

Percutaneous mitral commissurotomy (PMC) was successfully performed in a 48-year-old woman with dextrocardia and situs inversus and a severe mitral stenosis. After PMC, the valve area increased from 0.97 to 1.89 cm2, and no complication occurred. This case shows that PMC is practicable in a case of dextrocardia with situs inversus. The procedure appears to be safer and easier when carried out with the inoue balloon, image inversion on the screen, and under transesophageal echocardiographic monitoring.

Role of calcium channel blockers in reducing acute ischaemia and preventing restenosis in PTCA.

Calcium channel blockers (calcium antagonists) are widely used before, during and after percutaneous transluminal coronary angioplasty (PTCA). When administered during PTCA, calcium channel blockers may be beneficial in decreasing regional ischaemia in patients with proven or suspected variant angina, as a result of their cardioprotective effects, their ability to enhance collateral flow, and their antispastic effects at the epicardial level. More recently, the agents have also proven to be effective in patients who have developed "no-reflow' phenomenon during PTCA. Preliminary findings suggest that calcium channel blockers may also have potential benefits when administered after angioplasty. The combined results of 5 studies, evaluating a total of 919 patients, showed a trend towards angiographic reduction in restenosis. These observations are of interest but may be due to reporting bias. In conclusion, calcium channel blockers are effective in reducing ischaemia induced by PTCA. These agents may, thus, be appropriate in high risk patients. Further large studies examining the effects of calcium channel blockers on restenosis are required to confirm the observations available to date.

[Effects of sublingual nifedipine on the velocity of pulse wave evaluated by Doppler echocardiography of the thoracic aorta]. / Effets de la nifédipine sublinguale sur la vélocité de l'onde de pouls évaluée par échocardiographie Doppler de l'aorte thoracique.

Sublingual nifedipine has a rapid and powerful hypotensive effect. Its action on arterial distensibility can be assessed by measurement of pulse wave velocity (PWV) by Doppler echocardiography (DE). Ten patients were used to evaluate intra-observer reproducibility (Group 1). Fifteen hypertension patients (Group 2), not taking a calcium antagonist, 64 +/- 13 years-old, were studied by DE before and 15 minutes after 10 mg of SL nifedipine. The following were measured: systolic and diastolic blood pressures (SBP and DBP), heart rate (HR), echocardiographic shortening fraction (SF) and PWV, with sternal length (SL) taken as being identical to the length of the abdominal aorta between the isthmus and the coeliac region, and by measuring delta t: time interval for propagation of the pulsed Doppler velocimetric wave between the isthmic aorta and the coeliac aorta located by echocardiography: PWV = SL/delta t. Evidence was found in the nifedipine group (n = 15) of a fall in SBP (159.5 +/- 27.8 cf. 140.9 +/- 21 mmHg; p = 0.002); in DBP (88.6 +/- 13 cf. 79.6 +/- 8.3 mmHg; p = 0.005) and an increase in HR (72.3 +/- 10.7 cf. 76.8 +/- 12.9 bpm; p = 0.04). PWV decreased after nifedipine (10.5 +/- 3.9 cf. 7.15 +/- 12.9 bpm; p = 0.002). There was a linear correlation between the percentage reduction in PWV and left ventricular HR: y = 194x - 53; r = 0.56; p = 0.029.(ABSTRACT TRUNCATED AT 250 WORDS)

Swelling of multicellular spheroids induced by hyperthermia.

EMT6 multicellular spheroids invariably swell by 10 to 50 per cent after incubation at 43 to 45 degrees C for 1 h. Both scanning electron and optical microscopy reveal morphological alterations particularly in the outer region of the spheroids. While the control cells are contiguous to one another and tightly held to the spheroid body, the heated spheroids exhibit partially disrupted contacts among cells. Measurements of intercellular volume and water volume of spheroids with labelled water and inulin show that changes in the spheroid volume are not due to an increase in cell volume, but that they can be explained by a 60-100 per cent increase in the intercellular space within a spheroid. Continuous observation of individual spheroids heated to 43-45 degrees C shows loss of adhesion of cells in the outer region and even detachment of a few surface cells. This 'melting' of the spheroid surface appears to result from a disorder in the extracellular material. Treatment with cell swelling agents such as hypotonic solution, ouabain, excess extracellular potassium ions, or ionophore nigericin, K+/H+ exchanger, each separately causes the spheroids to swell at the control temperature. On the other hand, A23187, Ca2+ ionophore, causes shrinkage of the spheroids. Thus, under hyperthermia, the volume of spheroids increases due to the disruption in the cell organization in their outer region.

Development of seminal vesicles and coagulating glands in neonatal mice. I. The morphogenetic effects of various hormonal conditions.

Seminal vesicles (SV) and coagulating glands (CG) from neonatal mice 1- to 7-days old were observed in whole mount preparations. Untreated, normal SV developed elaborate epithelial branches beginning on day 3 with secondary branches appearing on day 6. Castration (C), estradiol treatment (E), and castration combined with estradiol treatment (C + E) inhibited the morphogenesis of the epithelial branches. Untreated CG formed solid epithelial stalks that developed lateral epithelial buds on day 3 which attained a complex morphological pattern by day 7. Treatment groups (C, E and C + E) displayed a pattern of retarded growth with few epithelial buds appearing even at day 7. The effects of castration on both SV and CG were reversed by the addition of testosterone. Short term in vitro culture of 1-day-old SV and CG glands in control medium or medium supplemented with estradiol did not exhibit visible growth. Culture of SV and CG glands with testosterone or a piece of testis showed pronounced development.

Glandular epithelial induction by embryonic mesenchyme in adult bladder epithelium of BALB/c mice.

Tissue recombinants prepared with epithelium of the urinary bladder of adult mice and mesenchyme of the embryonic urogenital sinus were grown as renal capsular grafts in adult male hosts. Under these conditions the bladder epithelium, which is derived embryologically from the urogenital sinus, was induced to form prostate-like acini. The relevance of this observation to McNeal's (1978) hypothesis, that the formation of prostatic acini during the development of human benign prostatic hyperplasia may be a reexpression of the embryonic inductive capacity of the prostatic stroma, is discussed.

The importance of stroma in morphogenesis and functional activity of urogenital epithelium.

Urogenital morphogenesis and cytodifferentiation are presented in the context of the epithelial-stromal interaction. The essential role of stroma in the processes is reviewed.

The possible influence of temporal factors in androgenic responsiveness of urogenital tissue recombinants from wild-type and androgen-insensitive (Tfm) mice.

Tissue recombinants of epithelium and stroma from embryonic and neonatal urogenital rudiments derived from wild-type and feminized (Tfm/Y) mice sere grown as grafts in intact male hosts and analyzed morphologically for androgenic response. When mesenchyme of embryonic wild-type urogenital sinus (UGS) was associated with epithelium from embryonic wild-type bladder (B), the epithelium developed into glandular structures resembling prostate. In the reciprocal recombinant (B mesenchyme + UGS epithelium) the response was mixed, half of the recombinants exhibited bladder morphology and half exhibited prostatic-like morphology. Vaginal-like histogenesis occurred in UGS recombinants of androgen-insensitive Tfm/Y mesenchyme and wild-type epithelium, while prostatic morphology developed in reciprocal recombinants of wild-type mesenchyme and Tfm/Y epithelium. These observations demonstrate (1) that the presence of wild-type mesenchyme appears essential for expression of androgen-dependent morphogenesis during embryonic periods; and (2) that Tfm/Y epithelium is capable of participating in an androgenic response. Conversely, in similar recombinants prepared with neonatal tissues, the presence of wild-type urogenital stroma may not be required for expression of certain androgen-dependent phenomena since maintenance of the height and cytodifferentiation of ductus deferens epithelium occurs even when this epithelium is associated with Tfm/Y urogenital stroma. It appears, therefore, that the requirement of urogenital epithelium for wild-type (androgen sensitive) stroma may vary temporally.