Debridement, Antibiotics and Implant Retention for Early Periprosthetic Infections of the Hip: Outcomes and Influencing Factors.

PURPOSE: Debridement, antibiotics and implant retention (DAIR) is commonly performed and widely accepted for the treatment of acute infections following hip arthroplasty. The aims of this study were to: i) determine the DAIR success rate in treating acute postoperative and hematogenous periprosthetic infections of the hip at a tertiary hospital, ii) identify possible outcome predictors, and iii) analyze clinical and radiological outcomes. MATERIALS AND METHODS: We retrospectively reviewed cases of acute postoperative (≤3 months from index procedure) and hematogenous periprosthetic infections following total hip arthroplasty treated with DAIR at our hospital between 2004 and 2015. Overall, 26 hips (25 patients) were included in the study, with a mean age of 72.5 years (standard deviation [SD], 9.4). The mean follow-up was 48.5 months (SD, 43.7). Several variables (e.g., patient characteristics, infection type, surgery parameters) were examined to evaluate their influence on outcomes; functional and radiographic outcomes were assessed. RESULTS: The overall success rate of DAIR was 26.9%. The male sex was associated with treatment failure (P=0.005) and debridement performed by a surgeon in hip unit with success (P=0.028). DAIR failure increased in patients with chronic pulmonary disease (P=0.059) and steroid therapy (P=0.062). Symptom duration of <11 days until DAIR yielded a better infection eradication rate (P=0.068). The mean postoperative Harris Hip Score was 74.2 (SD, 16.6). CONCLUSION: DAIR, despite being used frequently, had a high failure rate in our series. Outcomes improved if an experienced hip arthroplasty surgeon performed the surgery. Patient comorbidities and symptom duration should be considered for decision-making.

Hernia inguinal de contenido vesical: hallazgo cistoscópico / Inguinal bladder hernia: Cystoscopy finding

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Outcomes of Vancouver B2 and B3 periprosthetic femoral fractures after total hip arthroplasty in elderly patients.

INTRODUCTION:: The objective was to evaluate clinical and radiological outcomes of Vancouver B2 and B3 periprosthetic femoral fractures in patients older than 65 years treated at our institution from 2000 to 2014. We compared the most common methods of fixation: a modular tapered rectangular titanium stem versus a monoblock tapered stem. METHODS:: A retrospective review was performed with a minimum follow-up time of 2 years. Patient mobility in the period prior to the fracture and after fracture healing and functional results was assessed according to the Harris Hip Score. RESULTS:: A total of 43 Vancouver B2 and B3 periprosthetic fractures fulfilled the inclusion criteria (31 type B2 and 13 type B3). The mean age was 78 years old (66-88 years). The mean follow-up time was 5 years (range 2-12 years). A Wagner stem was used in 19 patients and a modular rectangular stem was implanted in 24 patients. Although fracture union was achieved in 93% of the cases, the mean Harris Hip Score was 73 (34-87) and 41.9% of the patients did not return to their previous ambulatory levels ( p = 0.0049). Dislocation was the most common complication (16.3%). We have found association ( p = 0.07) between subsidence with a mean of 4.14 mm and dislocation. No difference was observed between B2 and B3 fractures or between modular and monoblock stems. DISCUSSION:: Although we reported good results of fracture healing, there were functional impairment and a high rate of complications, especially dislocation, in Vancouver B2 and B3 periprosthetic fractures in elderly patients.

Chronic Quadriceps Tendon Rupture After Total Knee Arthroplasty Augmented With Synthetic Mesh.

Tear of the quadriceps tendon after revision or primary total knee arthroplasty is a rare complication, but when it occurs, this injury has serious functional consequences. In complete tears, the outcome of direct repair is unpredictable, and several authors recommend that the suture should be reinforced. Several techniques have been described, including the use of autografts, allografts, and synthetic mesh. The goal of this study was to assess the outcomes of a reconstruction technique augmented with synthetic mesh. A retrospective study was performed involving 3 patients who had chronic partial quadriceps tendon tear after total knee revision. In 2 cases, proximal quadriceps release was performed. When conservative management failed, surgical reconstruction with suture reinforced with synthetic mesh was attempted. The knee was immobilized in full extension for 6 weeks after the surgical procedure. A minimum follow-up of 12 months was required to assess results. All reconstructions showed clinical success at a mean follow-up of 19 months. Mean Knee Society Score improved from 55.7 to 87.3, with average postoperative extensor lag of 3.3° (range, 0°-10°). The mean visual analog scale pain score was 2.3 (range, 0-4). No complications were reported. Synthetic mesh has previously been shown to be an effective treatment for patellar tendon repairs after total knee replacement, but there have been few articles on quadriceps rupture. Surgical reconstruction with synthetic mesh is a viable option that provides good functional outcomes in chronic quadriceps tendon rupture after total knee arthroplasty. [Orthopedics. 2017; 40(1):38-42.].

Evaluation and optimization of occupational eye lens dosimetry during positron emission tomography (PET) procedures.

The last recommendations of the International Commission on Radiological Protection for eye lens dose suggest an important reduction on the radiation limits associated with early and late tissue reactions. The aim of this work is to quantify and optimize the eye lens dose associated to nurse staff during positron emission tomography (PET) procedures. PET is one of the most important diagnostic methods of oncological and neurological cancer disease involving an important number of workers exposed to the high energy isotope F-18. We characterize the relevant stages as preparation and administration of monodose syringes in terms of occupational dose. A direct reading silicon dosimeter was used to measure the lens dose to staff. The highest dose of radiation was observed during preparation of the fluorodesoxyglucose (FDG) syringes. By optimizing a suitable vials' distribution of FDG we find an important reduction in occupational doses. Extrapolation of our data to other clinical scenarios indicates that, depending on the work load and/or syringes activity, safety limits of the dose might be exceeded.

Correction for FDG PET dose extravasations: Monte Carlo validation and quantitative evaluation of patient studies.

PURPOSE: Current procedure guidelines for whole body [18F]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) state that studies with visible dose extravasations should be rejected for quantification protocols. Our work is focused on the development and validation of methods for estimating extravasated doses in order to correct standard uptake value (SUV) values for this effect in clinical routine. METHODS: One thousand three hundred sixty-seven consecutive whole body FDG-PET studies were visually inspected looking for extravasation cases. Two methods for estimating the extravasated dose were proposed and validated in different scenarios using Monte Carlo simulations. All visible extravasations were retrospectively evaluated using a manual ROI based method. In addition, the 50 patients with higher extravasated doses were also evaluated using a threshold-based method. RESULTS: Simulation studies showed that the proposed methods for estimating extravasated doses allow us to compensate the impact of extravasations on SUV values with an error below 5%. The quantitative evaluation of patient studies revealed that paravenous injection is a relatively frequent effect (18%) with a small fraction of patients presenting considerable extravasations ranging from 1% to a maximum of 22% of the injected dose. A criterion based on the extravasated volume and maximum concentration was established in order to identify this fraction of patients that might be corrected for paravenous injection effect. CONCLUSIONS: The authors propose the use of a manual ROI based method for estimating the effectively administered FDG dose and then correct SUV quantification in those patients fulfilling the proposed criterion.

[Page kidney: subcapsular haematoma and arterial hypertension. A new case report and review of the literature]. / Ri˜ón de page: hematoma subcapsular renal e hipertensión arterial. Presentación de un nuevo caso y revisión de la literatura.

OBJECTIVE: We present the case of a spontaneous subcapsular renal hematoma with increase of the levels of blood pressure in a patient previously normotensive. METHODS: Patient with abdominal pain, spontaneous without previous trauma. CT showed a right subcapsular kidney hematoma. High levels of blood pressure were noticed at the admission in urology. CONCLUSION: Page kidney is a cause of arterial hypertension due to external compression of renal parenchyma. It could be unnoticed as essential hypertension if high suspicion is not taken into account. Nowadays, the main cause of Page kidney is the renal biopsy in the context of kidney transplantation. The treatment is not recommended in the guidelines although the conservative management is proposed as first option.

Riñón de Page: hematoma subcapsular renal e hipertensión arterial. Presentación de un nuevo caso y revisión de la literatura / Page kidney: subcapsular haematoma and arterial hypertension. A new case report and review of the literature

OBJETIVO: se presenta el caso de un hematoma subcapsular renal espontáneo con elevación de las cifras de tensión arterial en un paciente previamente normotenso. MÉTODOS: paciente que acude por dolor abdominal, de aparición espontánea sin antecedente traumático. El TC demuestra la presencia de un hematoma subcapsular renal derecho. En la planta de hospitalización se registran cifras elevadas de tensión arterial. CONCLUSIÓN: el riñón de Page es una causa de hipertensión arterial debida a una compresión extrínseca del parénquima renal. Sin una alta sospecha clínica podría interpretarse como hipertensión arterial esencial. Actualmente la causa más frecuente de este proceso ocurre en relación con la biopsia renal en pacientes trasplantados. El tratamiento no está consensuado en guías clínicas aunque el manejo médico conservador se propone como primera elección (AU)

OBJECTIVE: We present the case of a spontaneous subcapsular renal hematoma with increase of the levels of blood pressure in a patient previously normotensive. METHODS: Patient with abdominal pain, spontaneous without previous trauma. CT showed a right subcapsular kidney hematoma. High levels of blood pressure were noticed at the admission in urology. CONCLUSION: Page kidney is a cause of arterial hypertension due to external compression of renal parenchyma. It could be unnoticed as essential hypertension if high suspicion is not taken into account. Nowadays, the main cause of Page kidney is the renal biopsy in the context of kidney transplantation. The treatment is not recommended in the guidelines although the conservative management is proposed as first option (AU)

Relative contribution of dispersal and natural selection to the maintenance of a hybrid zone in Littorina.

Habitat preference behavior may play an important role in nonallopatric speciation. However, most examples of habitat preference contributing to differentiation within natural populations correspond to parasites or herbivores living in the discrete environments constituted by their animal or plant hosts. In the present study we investigated migration guided by habitat preference in the intertidal snail Littorina saxatilis in a hybrid zone associated with an ecotone across the shore, which is therefore a continuously varying environment. First, we found evidence for this behavior in one of the two locations studied. Second, we made reciprocal transplants to suppress the phenotypic gradient observed across the hybrid zone and measured the relative contributions of selection and migration to its regeneration. Selection played an important role at the two locations studied, but migration was only important at one, where it accounted for between a third and a half of the regenerated gradient. This overall minor effect of migration was relevant for theoretical models dealing with nonallopatric speciation, because it suggested that variation for habitat preference did not have an important role in the initiation of the differentiation process. The preference behavior observed in the hybrid zone would have evolved secondarily, as a consequence of habitat-dependent fitness differences between phenotypes.

Bioavailability of two dermal formulations of S(+)ibuprofen in rabbit.

Ibuprofen (CAS 15687-27-1) is widely used in painful situations and, usually, is administered in the racemic form. Since enantiomers may exert different pharmacodinamic and pharmacokinetic effects, the pharmaceutical industry has placed new emphasis on the preparation of new formulations of enantiomerically pure drugs that must be pharmacokinetically characterised prior to their administration in human beings. In this study, the absorption kinetics of two topical formulations of S(+)ibuprofen in rabbits was investigated. The S(+)ibuprofen levels in rabbit plasma were determined by a non-chiral HPLC method, whereas the absence of the R(-)ibuprofen enantiomer in plasma was confirmed by a chiral HPLC method. The results showed that S(+)ibuprofen was absorbed through the rabbit skin upon administration and the obtained levels varied with the formulation.