bluuebunny/crossref_metadata_2025 huggingface dataset:
In Vivo Polyethylene Wear of Bilateral Total Hip Replacements - Cemented versus Uncemented Modular Sockets
Authors: Kampa Rebecca J. , Hacker Andrew , Griffiths Emmett , Rosson John W.
Published: January 2018

We assessed polyethylene wear and osteolysis in 15 patients (30 hips) undergoing staged bilateral total hip arthroplasties, who had a cemented arthroplasty on one side and a hybrid arthroplasty on the other. All factors apart from mode of acetabular component fixation were matched. Wear was measured radiographically using Livermore's technique.

The mean clinical and radiological follow-up was 11.2 years for the cemented and 10.7 years for the hybrid arthroplasties. Mean annual linear wear rate was 0.09mm/year in the cemented sockets and 0.14mm/year in the uncemented sockets. This difference was statistically significant (p=0.03), confirming previous reports that the rate of polyethylene wear is increased in uncemented sockets. No periacetabular osteolysis was noted. Femoral osteolysis in zone 7 occurred in 3 hybrid arthroplasties. It appears not all patients are equally affected. These results are further discussed.
A Comparison of Harris and Oxford Hip Scores for Assessing Outcome after Resurfacing Arthroplasty of the Hip: Can the Patient Tell us Everything we Need to Know?
Authors: Parsons Nick R. , De Souza Ruth-Mary , Oni Tofunmi , Achten Juul , Krikler Stephen J. , Costa Mattew L.
Published: January 2018

We have compared the Harris hip score with the Oxford hip score in a population of 358 patients (213 men and 145 women) aged between 19 to 74 years (median 55 years), after resurfacing arthroplasty of the hip (between September 1995 and October 2006) with a median follow-up of 6 years. The Oxford hip score was related to the age of the patient (Mann-Whitney test; p = 0.015), the hip lifetime (p = 0.030) and body mass index (p < 0.001). Correlation analysis indicated a good correlation between overall Harris and Oxford hip scores (Spearman's rank correlation = -0.70; p < 0.001). An analysis of correlations between individual items in the Oxford score and functional domains of the Harris score showed that the range of movement domain of the latter score was correlated with two items from the former score (–0.40 and –0.38; p < 0.001 and p < 0.001). Based on the correlation analysis, this study provides good evidence that the Oxford score can be substituted for the Harris score for long-term assessment of hip function, without significant loss of information.
Correlation of Technetium-99m Scintigraphy, Progressive Acetabular Osteolysis and Acetabular Component Loosening in Total Hip Arthroplasty
Authors: Geerdink Carel H. , Grimm Bernd , Rahmy Ali I. A. , Vencken Wendy , Heyligers Ide C. , Tonino Alphons J.
Published: January 2018

In total hip arthroplasty (THA) Technetium scintigraphy can help to diagnose a loose implant by detecting elevated osteoblastic activity. It has been used for timing the revision of cemented implants. In uncemented cups progressive radiological acetabular osteolysis can be present before loosening accurs, but it is probably unwise to await cup loosening before embarking on revision. We explored the possible relationship between such osteolysis and positive findings on technetium scintigraphy, to see if the technique could predict the need for revision.

Between 1990 and 1996 500 hydroxyapatite-coated hip prostheses were implanted (follow-up range: 9–15 years), and technetium scintigraphy and plain radiography were performed annually postoperatively. 32 cups were revised for progressive acetabular osteolysis. We compared the introperative findings at revision with the pre-operative scintigraphic and radiographic results.

The sensitivity and specificity for diagnosing progressive acetabular osteolysis by technetium scintigraphy were 34% and 0% respectively. The sensitivity and specificity of the technique for detecting loosening were 38% and 73% respectively.

The sensitivity and specificity of technetium scintigraphy for detection of a either loosening or progressive acetabular osteolysis are worse than reported for plain radiography. Despite negative scintigraphy, there may be progressive bone loss at a critical level. Scintigraphy has no additional value to plain radiography as a reliable indicator for timing cup revision in the process of progressive acetabular osteolysis.
Avascular Necrosis of the Femoral Head in Patients with Hodgkin's Disease
Authors: Renedo Raúl J. G. , Sousa Mario M. , Pérez Salvador F. , Zabalbeascoa Juan R. , Carro Luis P.
Published: January 2018

Avascular necrosis of the femoral head (ANFH) is a rare complication that may occur in patients diagnosed with Hodgkin's Disease (HD), as a result of treatment. A review was made of 315 cases of HD treated with systemic chemotherapy associated with high doses of steroids and radiation therapy and 18 patients (5.71%) were found to have developed ANFH during treatment. The mean follow-up time for chemotherapy was 40 months (range 20–110 months) with an average dose of prednisone of 8.45 g (range 3.20 – 18.50). The patients were treated by simple forage, simple forage plus IES and total hip arthroplasty (THA). In 8 cases (44.44%) forage associated with IES was performed as the initial treatment option and 6 of these cases were found to be in Ficat stage II (75%), 1 was found to be in stage III (12.55%) and another in stage IV (12.5%). In 2 cases, the central decompression technique was used (Simple Forage); both were in Ficat stage II. In the other 8 cases, a total hip arthroplasty (THA) was chosen as the initial treatment option, with 3 of these patients in Ficat stage III and 5 in Ficat stage IV. The clinical outcomes (time to postoperative pain, time to radiological failure, and time to arthroplasty from the forage) following surgical management using the forage-biopsy technique with and without internal electrostimulation (IES) were recorded. We observed that treatment with Forage + IES was better than simple Forage in stages below III in patients with Hodgkin's Disease. We considered that in Ficat stage III and IV arthroplasty (THA) was the better option. Steroids do not appear to be the only factor that worsens the outcomes of the parameters tested, and, in our opinion, other associated factors exist.
Anterior Approaches to the Hip for the Treatment of Femoro-Acetabular Impingement: A Cadaveric Study
Authors: Malik Ahmad K. , Chou Daud T. S. , Witt Johan D.
Published: January 2018

Femoroacetabular impingement (FAI) may be a cause of early osteoarthritis of the hip. The aim of surgical treatment is to improve the head-neck offset in the presence of a cam lesion and to perform acetabular rim resection when pincer impingement is evident, either by open surgery or arthroscopically. We investigated two mini anterior approaches to the hip joint based on the Heuter and direct anterior approach to assess their potential for treating FAI. The two approaches were employed in 20 hips in 10 human cadaveric specimens. The area of femoral head and the portion of the acetabular rim that could be exposed was documented. We found that the two approaches were easy and reproducible. Both allowed adequate exposure to the femoral head. The area of acetabular rim accessible varied significantly according to the approach (p<0.05). We also found that the position of the anterior inferior iliac spine in relation to the acetabular rim also affected the area of acetabular rim exposed (p<0.05). In summary, cam and pincer impingement of the hip can be treated by either the direct anterior or by the Heuter approach. The choice of approach is dictated by the site of the acetabular pincer lesion identified on pre-operative imaging, with a more medial exposure possible through the direct anterior approach and more anterolateral exposure via the Heuter approach.
Secondary Capsular Laxity of the Hip
Authors: Blakey Caroline M. , Field Michael H. , Singh Parminder J. , Tayar Rene , Field Richard E.
Published: January 2018

We describe a hip condition with a recognisable pattern of clinical signs and radiological findings thought to result from chronic capsular injury.

Between June 2006 and October 2009, ten patients (11 hips), four men and six women, were identified with an abnormality of external rotation at the hip joint. A detailed history and clinical examination was undertaken for each patient. Dynamic magnetic resonance imaging of symptomatic and control hips were evaluated for bony and soft tissue appearances. The relative positions of the femoral head and the acetabulum were assessed through a range of hip rotation.

In affected hips, a loss of normal log roll recoil was observed. Three distortions of the iliofemoral ligament were identified on axial MR images; thinning at the lateral insertion of the ligament, attenuation of the iliofemoral ligament most noticeably on maximum external rotation (60°) and the appearance of laxity despite full external rotation.

Stability of the hip is dependent on the interaction of bony and soft tissue structures. Hip instability is recognised in dysplasia and is known to lead to premature degeneration of the joint. Chronic capsular injury may destabilise previously asymptomatic hips with subsequent development of pain in young, active patients.
Narrowing of the Femoral Neck after Resurfacing Arthroplasty of the Hip: A Comparison of Cemented and Uncemented Femoral Components
Authors: Ho Kevin K. W. , Beazley James , Parsons Nicholas , Costa Matthew L. , Foguet Pedro
Published: January 2018

We performed a radiographic review of a consecutive series of 87 resurfacing arthroplasties of the hip, performed between 2004 and 2006. There were 54 cemented femoral components and 33 uncemented femoral components. All of the procedures were performed by the same surgeon using the same approach.

There was no difference between the groups with regards to gender, age, pre-operative diagnosis and the average diameter of the components. The primary outcome measured was the neck-prosthesis ratio on standard anterior-posterior pelvis radiographs taken post-operatively and at a minimum follow up of two years.

The difference between the immediate post-operative ratio and the most recent radiograph was statistically significant in patients with cemented femoral components (p=0.006), but not in the group with uncemented components (p=0.173).

We have demonstrated a difference in narrowing of the femoral neck between cemented and uncemented femoral components in the first two years following surgery.
Prevention of Unrecognized Joint Penetration during Internal Fixation of Hip Fractures: A Geometric Model Based on Steinmetz Solid
Authors: Mao Yujiang , Song Jie , Wei Jie , Wang Manyi
Published: January 2018

Unrecognized joint penetration (UJP) by screw penetration through the articular surface undetectable on routine anteroposterior (AP) and lateral radiographs can cause serious complications. We have developed a geometric model to analyze UJP, and methods for the prevention of the problem. A Steinmetz Solid (SS) is the overlapping portion between two identical, vertically intersecting cylinders. The AP and lateral radiographs of a femoral head (simplified as a sphere) are projections of two cylinder-shaped images. A screw that appears to be within the femoral head in fact only lies within the cylinder. A screw apparently within the femoral head on both AP and lateral images is only confined to the SS generated by two cylinders, but not necessarily confined to the femoral head itself. We have therefore analyzed UJP using a geometric model based on SS.

The geometric basis of UJP lies in the fact that the SS is larger than the sphere (femoral head) with a volume ratio of 4: π. The theoretical risk of UJP for any screw therefore can be as high as 21.5% ((4-π)/4). In reality, screws are always carefully placed to ensure a distance between the screw's tip and the edge of femoral head (tip-to-edge distance, or TED). This TED effectively lowers the risk of UJP by reducing the size of the screw-confining SS. When the SS entirely fits into (internally tangential to) the femoral head, the risk of UJP approaches zero. A TED fulfilling this requirement can be regarded as safe (approximately 0.29 × femoral head radius). With a femoral head diameter of 5 cm, the safe TED is approximately 7 mm.
Intertrochanteric Femoral Fracture after Hip Resurfacing Managed with a Reverse Distal Femoral Locking Plate: A Case Report
Authors: Baxter Jonathan A , Krkovic Matija , Prakash Udai
Published: January 2018

Metal-on-metal hip resurfacing is a popular procedure for a select group of patients. A variety of surgical approaches are being utilised, each of which may be associated with specific complications. We describe an unusual complication following a Ganz trochanteric osteotomy approach, and the technique used to treat the subsequent periprosthetic fracture.
Less Invasive Fixation of an Interthrocanteric Fracture in an Ankylosed Hip with Cannulated Screws: A Case Report
Authors: Font-Vizcarra Lluís , Carreño Ana María , Prat Salvi , Muñoz-Mahamud Ernesto , Camacho Pilar , Casanova Luis
Published: January 2018

A 68-year-old woman presented following a road accident with an undisplaced intertrochanteric fracture affecting an ankylosed hip and an ipsilateral calcaneal fracture. The interthrocanteric fracture was fixed with four 7.0 mm cannulated screws. The calcaneal fracture was fixed with K wires and immobilized in a plaster. Because of this combination of injuries, although she was allowed to mobilize non weight bearing from the first week, sitting and progressive weight bearing were not permitted for six weeks. Radiographs taken at the one year showed consolidation of the hip fracture without complications. Final functional indices showed an EQ-5D VAS score of 40, EQ-5D health state index adapted to Spanish value sets of 0.493 and an Oxford Hip Score of 31. Screw fixation of an undisplaced intertrochanteric fracture in an ankylosed hip may be sufficient in some instances provided the patient remains non weight bearing for long enough.
Age as a risk factor of nosocomial infection after hip fracture surgery
Authors: Cruz Encarnacion , Cano Juan Ramon , Benitez-Parejo Nicolés , Rivas-Ruiz Francisco , Perea-Milla Emilio , Guerado Enrique
Published: January 2018

Surgery for the treatment of hip fractures is considered the gold standard even among nonagerians with a heavy comorbidity burden. Therefore, a study of an association between surgical complications and some variables in elderly individuals appears to be very important. We designed a transverse study in which we determined patient age at the time of development of a nosocomial infection (NI) in patients who underwent surgery to treat a hip fracture. Univariate and multivariate analyses were performed by simple and multiple logistic regression. We found that age was a determinant in NI after surgical treatment for hip fracture. The older the patient was, the higher the risk of development of an NI after surgical treatment for hip fracture (operative hypothesis). However, the risk of infection changed depending on the treatment. No association with other variables was found.
Epiphyseal femoral tumour resection under intraosseous endoscopic control
Authors: Torres-Eguía Raúl J. , Rolón Carlos A. Colmenero , De Robles Santiago Arauz , García Pedro Guillen
Published: January 2018

We have resected 4 benign cystic femoral head tumours under intraosseous endoscopic control. The resections were completely extraarticular through a tunnel made in the femoral neck from the lateral cortex. The procedures were assessed endoscopically with the help of a standard arthroscope. With a minimum follow-up of 1 year (range 1–16 years), there were no recurrences. Mean age at time of surgery was 23 years (range 19–26 years). Only 1 (fibrous defect) needed prophylactic osteosynthesis with a dynamic hip screw. The lateral approach through a bone tunnel allows preservation of the joint. The creation of a wider tunnel (10–15 mm) avoids the need for an irrigation system, without debilitating the bone structure, and simplifies the surgical procedure.
Clinical results after anterior mini-open approach for femoroacetabular impingement in early degenerative stage
Authors: Ribas Manuel , Ledesma Ruben , Cardenas Carlomagno , Marin-Peña Oliver , Toro Jose , Caceres Enrique
Published: January 2018

We describe our modified anterior mini-invasive technique and results obtained in our first consecutive 117 cases in 105 patients. To assess the influence of preoperative Tönnis degenerative stage, cases were divided into group A (Tönnis 0, 32 hips), B (Tönnis 1, 61 hips), and C (Tönnis 2, 24 hips). The clinical score Dexeus combined score (DCS) was used preoperatively, 3 months, 6 months, and every year after operation. At 3-month follow-up, impingement test results improved significantly in 30 hips of group A (94%; p<0.001) and in 58 of group B (95%; p<0.001), whereas in group C, improvement was observed in only 14 cases (58%; p>0.05). No statistical difference was observed at 3-year visit in all groups. Merle d'Aubigné-Postel and WOMAC scores improved significantly in group A (p<0.001) and B (p<0.001) after 1 year and remained unchanged at subsequent yearly follow-ups. For group C, clinical outcomes scores did not show any significant improvement overall (p>0.05). We concluded that anterior mini-invasive technique is an effective method to treat femoroacetabular impingement, and results are highly influenced by preoperative degenerative state, especially in stage Tönnis 2. Therefore, it seems to be a reasonable early surgical treatment in symptomatic patients.
Alignment guided by computer navigation of the femoral component in hip resurfacing
Authors: Gallart Xavier , Fernández-Valencia Jenaro A. , Riba Josep , Bori Guillem , García Sebastián , Carrillo Sergio
Published: January 2018

Surgical navigation systems are offered to provide more precise implantation of the femoral component in hip resurfacing (HR), allowing to reduce the risk of malpositioning and of femoral neck fracture and notching. We conducted a retrospective analysis of 30 HR divided into two cohorts and compared the results of a nonnavigated group (15 hips) with those of a navigated group (15 hips). The BrainLAB Computer Navigation System was used in all cases. No notching occurred in either group. The femoral component did not show better positioning in the navigated group, but more outlier cases were observed in the nonnavigated group (7, versus 3 in the navigated group). Although there are no long-term studies showing that surgical navigation increases the survival of HR, the avoidance of outlier values justifies its use, especially during the surgical learning curve, which is a difficult and lengthy one.
Learning curve and short-term results with a short-stem CFP system
Authors: Pons Miquel
Published: January 2018

In conservative hip replacement it is important to remove only pathological tissue to preserve as much healthy bone as possible. The collum femoris preserving (CFP) system preserves the femoral neck and metaphyseal cancellous bone. We present our learning curve with this system and our preliminary results and conclusions.

During 2001–2009 we placed 138 CFP prostheses in 90 men and 38 women (10 bilateral). The mean age of the patients was 57.1 years (range 22–76 years) and the mean follow-up 38.3 months. Seventy-three patients were active workers at the time of surgery. All patients began partial weight bearing at 24–36 hours and total weight bearing was allowed at 3 weeks postoperative. We have had 1 infection, 2 intraoperative partial shaft fractures that did not require treatment, 1 acetabular loosening, and 2 periprosthetic traumatic fractures treated by osteosynthesis in one case and femoral revision in the other. All but 3 active workers returned to work and 54.5% of the studied patients practice some sport or physical activity. The stem size was correct in 125 hips. Resorption at the prosthetic rim was found in 9 out of 134 hips. No clinical symptoms were found in these patients. There have been no stem revisions for aseptic loosening in the follow-up study. Although the current follow-up is too short to allow definitive conclusions, the CFP system has provided excellent short-term results.
Hospital at home in elective total hip arthroplasty
Authors: Bori Guillem , Aibar Jesus , Lafuente Sarah , Gallart Xavier , Valls Silvia , Suso Santiago , Hernandez Carme , Riba Josep
Published: January 2018

With the recent trend towards reducing hospital stay, it has become increasingly important to ensure that early patient discharge after total hip replacement is a safe practice. We evaluated complications and length of hospital stay associated with primary unilateral hip arthroplasty in 47 patients undergoing a new early discharge protocol consisting of at home based specialized care after hospital discharge.

The mean length of stay (and standard deviation) in hospital was 4.59±0.68. The mean length of stay of home-based hospitalization was 3.7±1. The prevalence of postoperative complications was 12.8% and the readminssion rate was 6.4%. We saw a reduction of hospital stay with no difference in outcomes in comparison with previous data. On the basis of our findings we recommend the use of the early discharge protocol following elective primary total hip replacement and ongoing evaluation of the process.
Multicentric and prospective study of the Summit cementless stem
Authors: García-Cimbrelo Eduardo , Bru-Pomer Antonio , García-Benítez Boris , Hernández-Blanco Moisés , Vaquero Javier
Published: January 2018

We assess early clinical and radiographic results of a multicentric and prospective study of 485 Summit porous-coated stems implanted in 5 hospitals. Of the patients, 171 had a hydroxyapatite (HA) coating and 314 had non-HA porous-coated stems. The mean follow-up was 4.2 years (range 2.5–6 years). The median size of the stem was 5. A standard femoral offset stem was used in 366 hips (75.5%) and a high femoral offset in 119 hips (24.5%). Dislocation was the most frequent postoperative complication (16 hips). Clinical results according to the Harris scale were 30.17 points (range 10–52) before surgery and 95 points (range 90–100) at the last follow-up evaluation. All stems were radiographically osseointegrated. Femoral stem position was neutral in 395 hips (81.4%), and femoral canal filling was related with implant position. No stem subsidence greater than 5 mm has been found in any hip. No osteolysis was found around the femoral stem. No differences have been found between HA coating and non-HA porous-coated stems. Although the present follow-up in this series is too short to allow definite conclusions, the Summit stem with and without HA coating has provided excellent short-term results.
Estimated survival probability of the Spotorno total hip arthroplasty after a 15- to 21-year follow-up: one surgeon's results
Authors: Terré Ricardo A.
Published: January 2018

We retrospectively assess 171 consecutive total hip arthroplasties (THAs) with a Spotorno CLS uncemented prosthesis implanted through a Hardinge approach. The mean follow-up was 17.9 years. All consecutive operations were performed by 1 surgeon. Eight patients had been lost to follow-up, and 77 had died for unrelated causes. Overall, 4 stems and 19 cups underwent revision. The cumulative survival rate at 21 years was 79.02% (95% confidence interval [95% CI], 45.98–100.00%) for the acetabular component and 96.71% (95% CI, 60.71–100.00%) for the stem. We can conclude that failure of the Spotorno CLS THA is mainly due to its acetabular component (relative risk 4.5). Survival results for the Spotorno CLS stem exceed the patients' life expectancies in the 60- to 70-year-old population in our area. Loosening with or without fatigue fracture of the component and the learning curve for proper implantation have been the main causes for the expansion cup failure.
Fully hydroxyapatite-coated total hip replacement: ten-year results
Authors: Pertegàs Màrius Valera , Vergara-Valladolid Pedro , Crusi-Sererols Xavier , Sancho-Navarro Rogelio
Published: January 2018

We assess 254 consecutive primary total hip replacements (THRs) using a fully hydroxyapatite (HA)-coated stem and socket (Furlong; JRI, London, UK). Minimum follow-up was 10 years. Harris hip score (HHS) increased from 49.8 preoperatively to 86.2 at follow-up. The most remarkable clinical finding was the near absence of thigh pain. After 10 years of follow-up, all stems met stability criteria and none needed revision for aseptic loosening. Three cups (1.2%) were revised for aseptic loosening. Two more cups were revised for recidivant dislocation. Varus placement of the femoral stem was present in 63 hips (24.8%) and valgus in 13 hips (5%). None of these technical defects showed radiologic progression, and there was no measurable correlation between them and the clinical score. Intraoperative femoral fractures occurred in 25 cases (9.8%) with no further influence on implant evolution. These findings strongly support the use of the JRI Furlong system for primary THR because it provides excellent clinical and radiologic results, with 0% and 1.2% cup and stem aseptic loosening, respectively, at 10 years. In addition, its tolerance to technical implantation defects makes it suitable even for less experienced hip surgeons.
Two-Operator Glucose Infusion Test (GIT2) for Vascular Access Recirculation Measurement during Hemodialysis
Authors: Mario Bosticardo Gian , Morellini Veronica , Schillaci Enrico , Battisti Marco , Norza Massimo , Detoma Paolo , Forneris Giacomo , Filiberti Oliviero , Bajardi Pietro
Published: January 2018

Vascular access recirculation rate (AR) monitoring is fundamental to guarantee treatment adequacy and to detect access failure early. We have evaluated the GIT2 test to measure AR unaffected by cardio-pulmonary recirculation (CPR), based on a short glucose infusion in place of the bolus and on a two-operator sampling, differently from the classical glucose infusion test (GIT). The GIT2 test is based on four steps: 1) basal (B) glucose arterial sample; 2) 10% glucose infusion for 1 min, by infusion pump at 600 ml/hr; (or 20% at 300 ml/hr); 3) simultaneous sampling at arterial (A) and venous (V) ports, after 35–40 sec from starting the infusion, taking care to avoid blood pump stop during the test; 4) AR=100*((A-B)/(V-B)). In vitro tests by dialysis on a 40 L tank containing a urea solution, with AR volumetrically simulated at 0, 5, 10, 20%, and in vivo comparison of GIT, GIT2 with stop-flow (SF) urea method. Our results have shown in vitro an almost perfect correspondence of SF urea method and a better reliability of GIT2 than GIT. The methylene-blue test has shown that a single color bolus in V reaches the A port after variable time, depending on blood flow and AR, while the continuous infusion determines a steady gradient after about 30″. In vivo tests (n=24) show good correspondence between GIT2 (4.37 ± 3.36) and SF (4.51 ± 3.62), while GIT data (1.01 ± 0.51) are significantly underestimated. In conclusion, our preliminary results have evidenced a good reliability of the new test, the continuous infusion causing a steady gradient in V and A that more precisely reflects the AR rate.
Totally Implantable Port Management: Impact of Positive Pressure during Needle Withdrawal on Catheter Tip Occlusion (An Experimental Study)
Authors: Lapalu Jordane , Losser Marie-Reine , Albert Odile , Levert Hélène , Villiers Stéphane , Faure Pierre , Douard Marie-Cécile
Published: January 2018

Background

Totally implanted ports (TIP) have become a standard part of patient care, providing long-term central venous access for treatment administration and other procedures. Despite overall the safety and effectiveness of TIP, complications still occur. Negative pressure created during needle withdrawal induces blood reflux and subsequent catheter occlusion. Application of positive pressure during needle withdrawal is thought to largely prevent such reflux, but supporting data are limited.

Purpose of Research

To quantify the role of positive pressure, using a test model designed to simulate physiological conditions.

Methods

Reflux associated with needle withdrawal with and without applied positive pressure was tested using various TIP models from different manufacturers mounted on a specially designed test bench. In addition to the presence or absence of positive pressure during needle withdrawal, study variables comprised of needle type (safety and standard), needle gauge and port septum diameter.

Results

Application of positive pressure during needle withdrawal reduced the incidence of reflux during needle withdrawal by nearly 80% (22% vs. 99%, p<0.001). When reflux did occur, the mean residual volume was half that observed without positive pressure. In the absence of positive pressure, mean reflux increased with septum diameter and needle gauge to a statistically significant extent. None of these variables significantly affected reflux in the context of needle withdrawal under positive pressure.

Conclusion

The results of this study support the use of positive pressure during needle withdrawal to prevent blood reflux potentially leading to catheter tip occlusion.
Hemodynamic Impact of Anastomosis Size and Angle in Side-to-End Arteriovenous Fistulae: A Computer Analysis
Authors: Van Canneyt Koen , Pourchez Thierry , Eloot Sunny , Guillame Caroline , Bonnet Alexandre , Segers Patrick , Verdonck Pascal
Published: January 2018

Purpose

An arteriovenous fistula (AVF) is the first choice vascular access for hemodialysis. The AVF pathway can be seen as consisting of seven segments: proximal artery, distal artery, arterial collaterals, proximal vein, distal vein, venous collaterals, and the anastomosis. While most studies describe access complications without considering the impact of the anastomosis (7th segment), the present mathematical study investigated the hemodynamic impact of anastomosis size and angle on pressure drop and flow distribution.

Methods

A side-to-end AVF model was developed, consisting of an anastomosis with a given cross-sectional area (substudy 1) and angle (substudy 2). Starting from two reference cases (one for each substudy) with fixed flow distribution, pressure drop over the anastomosis was calculated for an arterial inflow in the range 600 to 1200 ml/min. The same reference cases, subsequently with fixed pressure boundary conditions, were further used to assess flow distribution over the proximal vein and distal artery.

Results

Pressure drop decreased with a larger anastomosis cross-sectional area and an angle wider than 43°, while it was almost stable for smaller angles. Although proximal arterial inflow increased for larger anastomosis areas, the overall flow distribution shifted almost totally to the proximal vein. When the anastomosis angle exceeded 58°, the proximal arterial inflow was not sufficient to deliver enough flow, leading to distal arterial flow reversal.

Conclusion

Despite the underestimation of the hemodynamic impact of the anastomosis size and angle in the literature, this study showed major influences on the pressure drop over the anastomosis and, with it, on flow distribution towards the arterial and venous outflow.
Liposuction over a Shielded Arteriovenous Fistula for Hemodialysis Access Maturation
Authors: Ochoa Daniela A. , Mitchell Robert E. , Jennings William C.
Published: January 2018

Vascular access for hemodialysis by arteriovenous fistula (AVF) is broadly recommended. Vein depth in many obese patients makes cannulation of an otherwise successful AVF difficult or impossible. We reviewed the case of an obese patient where liposuction was used to remove adipose tissue resulting in a superficial and easily accessed AVF. An endoscopic vein harvesting device was used to shield the vein during liposuction.
Stent Graft versus Balloon Angioplasty for Failing Dialysis Access Grafts: A Long-Awaited Advance in the Treatment of Permanent Hemodialysis Access
Authors: Dolmatch Bart L.
Published: January 2018

Arteriovenous grafts (AVGs) for hemodialysis have a high failure rate, often due to the development of stenosis at the graft-to-vein anastomosis. Angioplasty (PTA) has been used for over two decades to treat AVG stenosis, with good technical success but limited AVG patency. Results of a prospective multi-center randomized trial, comparing stent graft to PTA in AVGs, has demonstrated superior access circuit patency for the stent graft group. Recent publication of this clinical study brings us into an exciting new era of dialysis access management using covered stents to improve durability of catheter-based therapy.
Maintaining Vascular Access: The Management of Hemodialysis Arteriovenous Grafts
Authors: Schild A. Frederick
Published: January 2018

For the nephrologist and surgeon, maintaining vascular access is a significant challenge in hemodialysis (HD), because the portal is vulnerable to infection, stenosis, and thrombus. Vascular access options for HD include the placement of arteriovenous (AV) fistulas, AV grafts, and double-lumen, cuffed central vein catheters. Catheter use is generally associated with higher rates of infection and could compromise the adequacy of HD. Primary AV fistulas, which are generally recommended and provide excellent HD access, are not always the ideal choice for certain patients, such as the elderly or patients with diabetes mellitus. AV grafts allow for a large surface area available for cannulation, and thrombosed grafts have longer patency rates after revision than do revised fistulas. Although both AV fistulas and AV grafts are vulnerable to thrombosis and/or stenosis, surveillance and techniques such as Doppler ultrasound and intravascular ultrasound can minimize such complications. In addition, pharmacotherapeutic options are being studied to determine whether these complications can be prevented. Studies using a variety of pharmacologic agents have been conducted to determine whether stenosis and graft thrombosis can be prevented and have produced varying results. The use of warfarin can result in significant bleeding, but agents such as fish oil and angiotensin-converting enzyme inhibitors have shown some effect in increasing the patency in AV grafts and fistulas. Additional randomized trials with at least 1 or 2 yrs of follow-up are necessary to assess the long-term use of these pharmacotherapies.
Snare Technique for the Placement of a Peripherally Inserted Central Catheter in the Neonatal and Pediatric Patient
Authors: Monsky Wayne L. , Garza Armando S. , Loh Shaun , Link Daniel P.
Published: January 2018

Purpose

The placement of a peripherally inserted central catheter (PICC) for neonatal or pediatric patients may at times be technically challenging. We describe an alternate method of placing a PICC in neonatal and pediatric patients with difficult venous access.

Methods

An Amplatz gooseneck snare is advanced from the femoral vein to the basilic vein, as a target for puncture and guidewire positioning, allowing PIcc placement. Between 1999 and 2006, 44 PICCs were placed in the manner described. The medical records were reviewed allowing for up to 7 yrs of patient follow-up.

Results

Ninety-five percent of PICCs were successfully placed using the snare technique. Two placements were aborted and two procedural complications occurred. The review revealed no evidence of osteomyelitis, nerve injury, deep venous thrombosis or leg length discrepancy.

Conclusion

this technique offers an alternate method for PICC placement in neonatal and pediatric patients when conventional methods are unsuccessful. The technique avoids the need for intermediate to long-term jugular, subclavian or femoral vein access.
Placement of Central Venous Catheters in Patients Undergoing Major Maxillofacial Surgery - A Retrospective Clinical Audit
Authors: Zochios Vasileios , Gilhooly Michael , Fenner Simon
Published: January 2018

Purpose

The subclavian vein is thought to be the most appropriate route for central venous access in major maxillofacial surgery. Evidence suggests that left-sided central venous catheters should lie below the carina and be angulated at less than 40° to superior vena cava wall. This reduces perforation risk. With this in mind we audited our current practice for placement of central venous catheters for major maxillofacial surgery. The criteria against which we compared our practice were: 1) all catheter tips should lie below the carina and 2) the angle of the distal 1 cm of the catheter should be no more than 40° to the superior vena cava wall.

Methods

Left subclavian central venous catheters placed on a weekly operating list between September 2005 and August 2008 were identified retrospectively: 83 patients were identified; 22 were excluded. The angle of the central venous catheter tip and distance from the carina were measured on the first post-procedure chest-X ray. All central venous catheters used were 16 cm long.

Results

82% of the catheter tips were located above the carina while 61% were angulated at greater than 40°; 11% of central venous catheters met both standards; 14% of central venous catheters placed by a consultant and 12% of catheters placed by a trainee met both standards.

Conclusions

89% of the central venous catheters were not correctly placed. The majority of central venous catheter tips above the carina were at an adverse angle to the superior vena cava wall. We suggest that for left subclavian central lines, 20 cm catheters be used.
The Role of a Vascular Access Surgeon in Ventriculo-Venous Shunts in Difficult Hydrocephalus
Authors: Ayaz Hossain Mohammad , Enver Frampton Adam , Choo Melissa , Morsy Mohamed , Thomas Marsh Henry , Martin Andrew James , Solomon Chemla Eric
Published: January 2018

Introduction

Cerebrospinal fluid (CSF) diversion into the right atrium or peritoneal cavity is the mainstay of treatment for normotensive hydrocephalus. Unfortunately multiple shunt failures can lead to patients returning for repeat interventions, leaving drainage options limited. We present a case series of five patients requiring venous access for shunt placement.

Methods

Using the St Georges technique of axillary vein dissection, a suitable vein draining into the axillary vein was found and a shunt inserted under direct vision into the vein.

Results

Four females and one male were retrospectively followed up from first venous shunt employment in February 2003 to May 2008. Of the 34 revised shunts performed (ventriculo-peritoneal, ventriculo-pleural or ventriculo-venous) in the group, 13 procedures included the use of the axillary vein for CSF diversion. All shunts had a cumulative primary and secondary patency of 50% and 80% at 1 yr, respectively. There was no significant difference in the primary or secondary patency between the three types.

Conclusions

We have presented a series of 35 primary and secondary shunts in five patients with hydrocephalus. All patients had exhausted all CSF diversion options prior to the use of the axillary vein. With comparable survival of the axillary shunts with ventriculo-pleural and peritoneal shunts, we therefore present a favorable outcome in the use of the axillary vein for CSF diversion.
Infection of Hemodialysis Arteriovenous Grafts
Authors: Akoh Jacob A. , Patel Neil
Published: January 2018

Purpose

Prosthetic arteriovenous grafts (AVG) are bedeviled by significant infectious complications. This study was to determine the infectious complications of prosthetic AVG and review the relevant literature.

Methods

All prosthetic AVG inserted between January 2000 to December 2007 were studied. Data on age, sex, date of graft insertion, indication for aVG, site of graft insertion, date of graft related infection, treatment and outcome for graft and patients were analyzed.

Results

There were 84 AVG inserted into 58 patients. Thigh AVG accounted for 55% of cases whereas upper arm AVG was inserted in 39%. Thirteen (17.3%) AVG were associated with one or more episodes of infection. The infection rate for SynerGraft (50%) was statistically significantly different from that of PTFE (12%) - Yates′ x2=6.164; df=1; p=0.013. The rate of infection was higher for thigh grafts (9/37) compared to other sites (4/34), but the difference was not statistically significant (Yates′ x2=1.123; df=1; p=0.289). Only one death was directly related to AVG infection in this series.

Conclusion

Infectious complications of AVG require prompt surgical or radiological intervention to save life or access. The need to excise an infected graft completely is sometimes counterbalanced by the compelling need to provide vascular access for hemodialysis in a patient with limited access options.
Being One’s Own Honoured Guest: Eating Out Alone as Gendered Sociality in Public Spaces
Authors: Goode Jackie
Published: January 2018

For a woman, eating and drinking alone in public is apparently seen as anomalous behaviour. Depending on location and time, there are attendant risks of being subject to negative moral discourses, surveillance, and unwelcome sexual attention. This article uses an autoethnographic account to examine an instance of ‘eating out’ alone as constitutive of the gendered nature of sociality in public spaces. It supplements emerging analyses of lone female dining in a context of ‘single’ women being an increasingly significant demographic category by offering further differentiation in terms of age and venue type.
Is There a Role for Language in Emotion Perception?
Authors: Sauter Disa A.
Published: January 2018

What is the relationship between language, emotion concepts, and perceptual categories? Here I compare the strong Whorfian view of linguistic relativity, which argues that language plays a necessary role in the perception of emotions, to the alternative view that different levels of processing (e.g., linguistic, conceptual, perceptual) are relatively independent and thus, that language does not play a foundational role in emotion perception. I examine neuropsychological studies that have tested strong claims of linguistic relativity, and discuss research on categorical perception of emotional expressions, where the two accounts have been directly tested against each other. As in other perceptual domains, there is little evidence that language plays a foundational role in the perception of emotion.
Comment: Well-Being Can Improve Health by Shaping Stress Appraisals
Authors: Kruse Elliott , Sweeny Kate
Published: January 2018

In this brief comment, we bring together two articles that appear in this special section. Jamieson et al. provide an overview of the biopsychosocial model of threat and challenge and suggest that stress-related arousal can be reappraised as a coping resource to facilitate challenge appraisals. Hernandez et al. review evidence for the link between well-being and health. We see a connection between these seemingly unrelated reviews: Well-being may improve health in part by shaping appraisals of stressors’ demands and appraisals of coping resources.
Comment: Social Integration and Health: Contributions of the Social Sharing of Emotion at the Individual, the Interpersonal, and the Collective Level
Authors: Rimé Bernard
Published: January 2018

Among the four components proposed by Sbarra and Coan (2018) to guide the research aimed at understanding the role of emotion in the connection between social relationship and health, I view the fourth one, labeled “transactional dimensions,” as offering particularly rich promises in this regard. To illustrate, I sketch the example of individual, interpersonal, and collective effects entailed by the process of social sharing of emotion. The example rests on the bidirectional flow of transactions that develops continuously between these three levels.
Capital social de los padres de escolares de una zona vulnerable
Authors: Cornejo Susana , Herrera Ariel , Hilas Elena , Gigena Pablo
Published: January 2018

El capital social supone importantes inversiones materiales, simbólicas y de esfuerzos. Conocer el capital social de una comunidad puede facilitar la comprensión del beneficio de las relaciones comunitarias para la promoción de salud. Con el objetivo de reconocer los componentes del capital social de padres de escolares atendiendo una escuela en una zona vulnerable de la ciudad de Córdoba, Argentina, indagamos a través de grupos focales acerca de elementos esenciales del capital social. La asintonía socio-cultural entre los pobladores originarios y los reubicados, la estigmatización policial y el clientelismo político han generado desconfianza del uno hacia el otro en diferentes aspectos convivenciales, siendo la familia la única red de apoyo. La escuela se reconoce como espacio adonde la gente espontáneamente se organiza para invertir en redes sociales, presentándose así con potencialidad para la promoción de conductas saludables, por el lugar simbólico que ocupa para los padres.
Detection of glucose metabolism disorders in coronary patients enrolled in cardiac rehabilitation: Is glycated haemoglobin useful? Data from the prospective REHABDIAB study
Authors: Tatulashvili Sopio , Patois-Vergès Bénédicte , Nguyen Amandine , Blonde Marie-Cécile , Vergès Bruno
Published: January 2018

Introduction

Diabetes and pre-diabetes are highly prevalent in patients with a history of acute coronary syndrome. This is why screening for glucose metabolism disorders is recommended in patients following an acute coronary syndrome. The aim of our study was to determine whether glycated haemoglobin alone compared with the oral glucose tolerance test could allow effective screening for glucose metabolism disorders in acute coronary syndrome patients undergoing cardiac rehabilitation.

Patients and methods

Among 347 patients with a recent history of acute coronary syndrome enrolled in our cardiac rehabilitation centre, 267 patients without previously known diabetes were recruited for this prospective study with performance of both oral glucose tolerance test and glycated haemoglobin measurement. The patients were divided into three groups: newly diagnosed diabetes mellitus, pre-diabetes and normoglycaemia according to the oral glucose tolerance test and glycated haemoglobin results. The results obtained with glycated haemoglobin were compared with those obtained with the oral glucose tolerance test, considered as the reference.

Results

For the diagnosis of diabetes, glycated haemoglobin had a sensitivity of 72% and a specificity of 100%. Positive and negative predictive values were high at 100% and 96%, respectively. However, for the diagnosis of pre-diabetes the sensitivity of glycated haemoglobin was low at 64% as were the specificity (53%) and the positive predictive values (37%). Glycated haemoglobin overdiagnosed pre-diabetes (52% vs 30%, p < 0.0001). For the diagnosis of normoglycaemia, the sensitivity of glycated haemoglobin was also low (48%).

Conclusion

According to our study, glycated haemoglobin has low sensitivity and specificity for the detection of pre-diabetes in patients with coronary disease enrolled in cardiac rehabilitation, and glycated haemoglobin over-diagnoses pre-diabetes in comparison with the oral glucose tolerance test.