[Predictive value of cardiac magnetic resonance-derived parameters on the improvement of left ventricular function in patients with acute viral myocarditis].

Objective: To evaluate the predictive value of cardiac magnetic resonance (CMR)-derived parameters on the improvement of left ventricular function in patients with acute viral myocarditis. Methods: Forty patients, who referred for acute viral myocarditis in our hospital from September 2011 to September 2015, were prospectively enrolled in this study.All patients were examined by CMR during hospitalization for acute viral myocarditis (baseline) and after 12 months.The CMR sequences include: two dimension steady state free precession, 2D SSFP; triple inversion recovery, triple IR; early gadolinium enhancement; phase sensitive inversion recovery turbo field echo, PSIR TFE. Results: Thirty out of 40 patients with susceptive acute viral myocarditis met the CMR criteria of acute viral myocarditis (Lake Louise Criteria) (LL+ ) and the other 10 patients did not meet the diagnostic criteria (LL-). Left ventricular ejection fraction (LVEF) values were significantly lower in LL+ group than in LL- group at baseline and at 12 months after discharge (P<0.01 or 0.05, respectively). The baseline left ventricular end-systolic volume index (LVESVI) was significantly higher in LL+ group than in LL- group (P<0.05) and was similar between the groups at 12 months follow up.Left ventricular end-diastolic volume index (LVEDVI )was similar between the two groups at baseline and at 12 months follow up.LVEF was significantly higher during 12 months follow up compared to baseline in LL+ group and remained unchanged in LL- group during the two time points.LVESVI and LVEDVI remained unchanged at baseline and during 12 months follow up both in LL+ and LL- groups (P>0.05). Results showed that LL+ , edema ratio (ER) positive and global relative enhancement (gRE) positive were associated with significant increase of LVEF at 12 months follow up.However, LL-, ER negative, gRE negative, late gadolinium enhancement(LGE) negative and LGE positive linked with unchanged LVEF at 12 months follow up (P>0.05). Patients were further divided into LVEF increase (ΔLVEF≥5%) group and non LVEF increase group (ΔLVEF<5%), the results of Chi-square test showed that LL+ and ER positive were related to the improvement of LVEF (P<0.05), while gRE and LGE were not associated with improvement of cardiac function (P>0.05). Multiple linear regression analysis, using ER, gRE and LGE as independent variables and LVEF as dependent variables, showed that the presence of myocardial edema was the strongest independent predictor of an increase in LVEF at follow up (full model: non-standardized coefficient 0.445, P=0.043; reduced model: non-standardized coefficient 0.442, P=0.12). Conclusion: Cardiac magnetic resonance imaging monitoring is valuable to observe the cardiac function and morphology changes in patients with acute viral myocarditis, and myocardial edema imaging is the most powerful parameter to predict the improvement of LVEF in this patient cohort.

Results of interlocking wire trochanteric reattachment and technique refinements to prevent complications following total hip arthroplasty.

In 3.2% of 712 procedures performed in 668 hips after May 1, 1976, separation and migration of the trochanteric fragment occurred after total hip arthroplasty (THA) through a transtrochanteric approach and an interlocking cruciate two-wire technique of reattachment. Of these hips, 23 trochanters showed separation, and in eight the Trendelenburg test was positive. The abductor weakness was correlated with the amount of separation, especially if it exceeded 2 cm. Trochanteric separation was attributed to technical deficiencies, including a small trochanteric fragment, wire placed around the lesser trochanter, and/or a loose wire loop. Improved technique reduced the separation and migration rate from 4.5% to 2.3% following primary surgery. Trochanteric advancement with impaction against the vastus ridge and repair of the vastus lateralis were major determinants in reducing the migration rate of those that did not unite and were responsible for improved gait in this second series. However, the failure rate remained at 7% following reoperations for failed THA. As a result, a more secure three-wire technique with two vertical wires has been used in 36 revision operations since July 1981 with no incidence of migration.

Identification of hip surface arthroplasty failures with TcSC/TcmDP radionuclide imaging.

The roentgenographic identification of femoral component loosening after hip surface arthroplasty is often impossible because the metallic femoral component obscures the bone-cement interface. The use of combined technetium sulfur colloid and technetium methylene diphosphonate radionuclide imaging has been especially useful in the diagnosis of loosening. In 40 patients, follow-up combined TcSC and TcmDP scans at an average of three, nine, and 27 months postoperation revealed significant differences in the isotope uptakes in patients who had loose prostheses compared with those without complications. Scans were evaluated by first dividing them into eight anatomical regions and then rating the uptake in each region or 'zone' on a five-point scale. Results were compared using the Student's t-test and differences were noted between normal controls and patients who had femoral component loosening. Combining both TcSC and TcmDP studies increased the statistical significance obtained when comparing patients who had complications to those in the control group.

An analysis of roller skating injuries.

This study retrospectively examines 186 patients treated for roller skating-related injuries. The average patient age was 25.3 years, with males comprising 44% and females 56% of the patients. Of the 202 injuries, there were 130 fractures and 72 soft tissue injuries. The majority of the injuries involved the wrist (47%), while the elbow ranked second (14%) and the ankle third (10%). All fractures of the tibia-fibula and ankle involved a rotational mechanism, with 75% of ankle fractures involving the posterior malleolus. Ankle fractures accounted for 46% of all surgical cases. Although inexperienced skaters were involved in 77% of all accidents, experienced skaters' injuries required surgery twice as often. Female roller skaters were more frequently injured, but males had three times more operations. Over 90% of the skaters wore no protection. Skaters who seldom participated in other sports had a higher probability of being injured earlier, especially on their first try. This study indicates that roller skating injuries are influenced by skating experience, surface texture, skate type and quality, and protective equipment.

Surface replacement of the hip with the Tharies system. Two to five-year results.

The two to five-year clinical results of 200 Tharies surface replacements were comparable to those of conventional total hip replacement. The incidence of systemic complications, dislocations, and sepsis was low. There were ten cases of aseptic and one case of septic loosening. Nine minor secondary procedures were required in the series. In two patients the femoral component shifted asymptomatically into varus angulation, but no revision was needed. Fifty-five per cent of patients for whom serial radiographs were available had some progression of radiolucency, but there was poor correlation between the width of the zone and loosening until the patient became symptomatic. Improved techniques of preparation of the interface and of delivery, compression, and containment of the cement have improved the postoperative radiographic appearance of the more recently treated patients.