bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Outcomes in Developmental Dysplasia of the Hip
Authors: Petra M. , Benson M. K. D. 
Published: March 2018

Developmental dysplasia of the hip (DDH) encompasses conditions ranging from irreducible neonatal dislocation to asymptomatic acetabular dysplasia in the adult. The age at diagnosis and the severity of displacement influence the procedures selected by the treating surgeon. Treatment modalities include abduction splintage, closed or open reduction with casting, pelvic osteotomies, femoral osteotomies, complex reconstruction and salvage procedures. The consequences of management of children with DDH affect our patients for a life time. Sadly, there are few long-term outcome studies of DDH management published. A literature review reveals only nine well documented and clinically relevant studies, which follow patients beyond the age of 30 years. Several classification systems have been used to assess functional and radiological outcomes which makes comparison of the results unreliable. Most studies report 70% of good or excellent radiographic and functional results where the study period is less than 20 years. When the average follow-up is 30 years, however, the percentage of good or excellent radiographic results decreases to 45%. Natural history studies have shown that untreated congenital hip dislocation is not invariably associated with a poor functional result. Children we treat for DDH must have an outcome better than if we had not treated them.
Proximal Femoral Reconstruction for Revision Hip Arthroplasty with Severe Bone Loss: A New Technique Using Autologous Bone Graft and a Proximally Loading Femoral Component
Authors: Adrian J. Alfaro , Emerton M. , Murray D.W. , Mclardy-Smith P. 
Published: March 2018

We report the results of a new method of reconstructing the femur in 22 patients with severe bone loss having revision hip arthroplasty. The calcar and metaphysis were reconstructed with cortico-cancellous autograft around a new modular hip replacement. The metaphyseal portion of the implant is free to slide on the stem and therefore loads the graft and, we believe, encourages bone graft incorporation. The stem gains cementless fixation distal to the area of bone loss, thus preventing fractures and allowing the areas of bone loss to heal. At the time of review at a mean of 3 years follow-up there had been no revisions (since then there has been one re-revision due to recurrence of infection). The modified D'Aubigné and Postel hip score improved from 7.3 to 15. In 17 patients the graft has incorporated, in 5 it has partially resorbed but the prosthesis remains secure. We conclude that this is a relatively simple and successful technique for overcoming the problem of major femoral bone loss.
Radiological Assessment of Bone Graft in Revision Acetabular Arthroplasty
Authors: Abols I. , Olivier H. 
Published: March 2018

The purpose of this study was to describe the radiological appearance of moulded cancellous bone graft used for acetabular reconstruction in revision arthroplasty of the hip. We reviewed retrospectively 48 cases with a mean follow-up of 3.5 years. The radiological study was based on: the density of the graft, the delineation line between the graft and the host bone or the presence of trabecular continuity between the graft and the acetabular bone, and the position of the cup. Increasing density of the graft was observed in 35 cases. Trabecular continuity between the graft and the host bone appeared in 9 cases, in Zone I, with a mean delay of 2.6 years. This finding was associated with the disappearance of the dense line separating the graft from the acetabular bone in 8 hips (16.6%). At a mean follow-up of 2.5 years, 4 patients showed migration of the cup; this was secondary to graft resorption in 3 cases. Only one of these patients had been reoperated on. From these observations we have made an attempt to describe the evolving appearance of the bone graft and the radiological signs that may be used to assess graft incorporation.
A New Procedure for Revision for Fracture of the Stem in Total Hip Replacement
Authors: Houshian S. , Hvass I. , Riegels-Nielsen P. 
Published: March 2018

A new system for antegrade removal of fractured femoral stems, the Anspach Extractor III®, is described. A conical hole is made in the fracture surface of the stem with a high speed drill. An extractor rod is then fixed into the hole with a malleable sleeve. We have used the system in eight cases of a broken Charnley stem and removed the distal hip in 6 cases without problems. 2 cases were unsuccessful and needed femoral fenestration for retrograde removal. This system is easy to use and we have found it to shorten operation time in case of broken stem revision.
Patterns of Osteolysis in Two Different Cementless Total Hip Arthroplasties
Authors: Hubble M.J. , Eldridge J.D. , Smith E.J. , Learmonth I.D. , Harris W.H. 
Published: March 2018

The incidence and pattern of distribution of osteolysis around two different cementless total hip arthroplasties, the Harris Galante Porous (HGP) and the Porous Coated Anatomic (PCA), were compared. The HGP femoral component has a straight, collared, titanium alloy stem with non circumferential titanium mesh pads. The PCA has a collarless cobalt chrome stem with an anatomical bow and a circumferential proximal porous coating. Ninety-four HGPs and 104 PCAs were followed for an average of four and a half years. Both groups were well matched for age, sex and primary diagnosis. Each group was operated on at seperate, single, institutions by a single surgeon at each centre. The incidence of osteolysis around the acetabular components (1%) was the same. The incidence of femoral osteolysis was 31% with the HGP and 23% with the PCA. The pattern of femoral osteolysis was very different, being predominantly around the mid and distal stem with the HGP, and restricted to the proximal with the PCA. The presence of osteolysis was clinically silent unless the femoral component was also loose. Prosthetic design, in particular the presence or absence of a circumferential ingrowth mesh or porous coating, will influence the effective joint space and the distribution of wear debris particles. This may explain the prosthesis specific pattern of osteolysis seen.
Femoral Perforation during Cement Removal in Revision Hip Arthroplasty
Authors: Williams P.R. , Maheson M.V.S. 
Published: March 2018

Eighty two cemented femoral revision hip arthroplasties were reviewed to assess the incidence of intraoperative perforation of the femur and subsequent periprosthetic fracture using a high speed pneumatic burr for the removal of acrylic bone cement with an extensile exposure. There was one case of intraoperative femoral perforation; this patient did not go onto fracture postoperatively. There were no cases of intraoperative femoral fracture. There were 3 cases of periprosthetic femoral fracture all of which occurred more than 12 months after their impaction grafted femoral revision arthroplasty using a standard length cemented stem. The pneumatic high speed burr was extremely effective in the removal of acrylic bone cement in femoral revision arthroplasty. The incidence of subsequent femoral fracture in the impaction grafted revised population was low and did not appear to be related to intraoperative femoral perforation.
The Histology of Impacted Cancellous Allograft in Acetabular Reconstruction
Authors: Singer G.C. , Muirhead-Allwood S.K. 
Published: March 2018

Reconstruction of the acetabulum in the presence of severe bone loss presents challenging problems. Ideally, the acetabulum should be reconstructed with a stable component placed in the anatomical position with reconstitution of bone stock. The clinical and radiological results of using impacted morselised allograft for acetabular reconstruction appear satisfactory in the short term but there is little histological evidence in humans that the bone chips are revascularised and incorporated into the host. We present two cases of histology of retrieved bone samples, obtained at two years and three years following impaction allografting of the acetabulum. Both samples were taken from cases of aseptic failure, and were obtained during the revision surgery. It showed that the bone was viable, and undergoing the process of creeping substitution, where new bone was being laid down on dead bone. At three years this process was not yet complete, which indicates that the process is significantly slower than that described by Sloof in his animal experiments.
Wear and Migration of Harris-Galante II Acetabular Cups
Authors: Olofsson A. , Kesteris U. , Önnerfält R. 
Published: March 2018

We performed a 3–6 years radiographic follow-up of 28 patients (29 hips) operated on with a Harris-Galante II uncemented acetabular component and a cemented ScanHip® femoral stem. The patients average age when operated on was 50 (36–59) years. The primary aim was to measure wear of the plastic liner, but migration and radiolucency were also evaluated. In all hips the mean linear wear rate was 0.17 mm/year and the mean volumetric wear rate was 116 mm3/year. The wear rates in hips with a 28 mm head (n=6) were 0.14 mm/year and 83 mm3/year, and in hips with a 32 mm head (n=22) the rates were 0.18 mm/year and 130 mm3/year. The total volumetric wear was significantly higher in hips with 32 mm head than in hips with a 28 mm head. No acetabular component was radiographically loose, but 3 femoral components were radiographically loose and in need of revision.
Placement of Tunnelled Hemodialysis Catheters across Stenotic and Occluded Central Veins
Authors: Falk A. , Alomari A. , Silberzweig J.E. 
Published: March 2018

Purpose The purpose of this study was to evaluate the efficacy of placement of tunneled hemodialysis catheters in patients with occluded or stenotic central veins. Materials and Methods Data were prospectively collected for 26 patients (11 male, 15 female, mean age 52 years) referred for placement of tunneled hemodialysis catheters with central venous stenoses or occlusions. The central venous occlusions or stenoses were recanalized using traditional interventional catheter and guidewire techniques. Results Thirty central venous access procedures were performed of which 28 (93%) procedures resulted in successful tunneled catheter insertion. Twenty-one internal jugular venous (13 right, 8 left) and 7 subclavian venous (3 right, 4 left) catheters were placed. Eighteen stenotic and 10 occluded venous segments were crossed including the brachiocephalic vein (n = 22), subclavian vein (n = 2), and the superior vena cava (4). One patient required insertion of a metallic stent to facilitate passage of the hemodialysis catheter across an occluded brachiocephalic vein. No procedure-related complications occurred. No episodes of upper extremity swelling or superior vena cava syndrome occurred following catheter insertion. Conclusion Insertion of tunneled hemodialysis catheter across occluded or stenotic central veins is technically feasible and safe. The use of occluded or stenotic central veins for catheter access preserves patent central veins for future shunt access.
No Association between Hyperhomocysteinemia and Vascular Access Thrombosis in Chronic Hemodialysis
Authors: Lévesque R. , Dumont M. , Leblanc M. 
Published: March 2018

Purpose Hyperhomocysteinemia, recognized as a risk factor for cardiovascular diseases, has also been related with controversy to vascular access thrombosis in hemodialysis. Our objective was to determine if such an association could be found in our hemodialysis population. Methods The survey was conducted in a cohort of 165 chronic hemodialysis patients. Their vascular access history was considered from hemodialysis initiation until November 1999, including the number of vascular accesses created (either native or synthetic fistulae), focussing on vascular access thrombotic events, and excluding primary vascular access dysfunction. Diabetes, hemoglobin, erythropoietin dose, anticoagulation, and methyltetrahydrofolate reductase (MTHFR) status were considered. Serum total homocysteine (tHcy) measures were sampled for all patients in June 1998 and repeated yearly. Patients had not been supplemented routinely with hydrosoluble vitamins until June 1998, after which all received DiaVite® (R&D Laboratories, CA, USA) daily. Results Median survival of native fistulae was significantly longer (81 months, 95%CI 35–127) than for synthetic fistulae (31 months, 95%CI 27–51). Median vascular access survival was reduced for diabetics vs non diabetics (28 vs 57 months) (P<0.05), whereas sex, age and smoking had no impact. No correlation was found between tHcy concentration and the number of vascular access thrombotic events; homozygotes for MTHFR had higher tHcy but no more vascular access thrombotic events. The 38 patients with a mean vascular access survival of less than 12 months (6±3 months) were compared to the 127 patients with a mean vascular access survival of ≥ 12 months (39±25 months) (P<0.05): no difference in their respective tHcy concentrations before and after DiaVite® introduction was found (31±13 and 20±8 vs 34±17 and 22±6 μmol/L), but the first group presented more numerous synthetic fistulae (p<0.0001), lower hemoglobin levels, and higher erythropoietin doses. Conclusions No significant association between hyperhomocysteinemia and vascular access thrombosis could be found in our population. DiaVite® introduction allowed a significant reduction in tHcy, but had no impact on vascular access survival, except for a slight but not significant reduction in the prevalence of vascular access thrombotic events during the year on DiaVite®. Potential benefits of approaches to reduce tHcy for vascular access time-life prolongation remain to be demonstrated.
Hepatic Abscess and Umbilical Venous Catheter: One Cannot be Cavalier about Proper Position
Authors: Fusaro F. , Piccolo R. LO , Scarpa M.G. , Orzali A. , Trafojer U. , Zanon G.F. 
Published: March 2018

Purpose The umbilical venous catheter (UVC) is routinely used in neonatal intensive care. Incorrect placement may expose the patient to some dangerous complications (i.e. thrombosis, abscesses, etc). We report a case of an hepatic abscess due to incorrect positioning of this device. We describe how the abscess was treated and we emphasize that one cannot be cavalier about proper positioning of the UVC
Advantages of Totally Implanted Port over Impromptu Short-Term Central Venous Catheter in Oncological Pain Therapy
Authors: Reale C. , Vernaglione E. , Reale C.A. , Mancini A. , Prologo M. , Campisi C. 
Published: March 2018

The aim of this paper is to determine if patient controlled analgesia (PCA) by means of programmable pumps improves patients' autonomy and to verify if the short-term central venous catheter - implanted when pain is first evident - makes the quality of life worse in comparison with an early implanted port. Forty non-terminally ill patients affected by urinary malignant pathologies with visceral and bone metastases were enrolled in a prospective and randomised study at the Urology Department of “La Sapienza” University in Rome, Italy. Intensity of pain and tolerability of venous access were assessed for the first 7 days, and weekly for 3 months. Such data were used to adjust drug therapy. In this study we hypothesized that a delayed central venous catheter implant, when the pain is at first considerably evident, can interfere negatively with drug treatment. The visual analogue scale (VAS) and the brief pain inventory (BPI) were administered to the patients, and these showed good levels of analgesia in both groups and a greater comfort to the patients with the previously implanted port in comparison with a short-term central venous catheter. In conclusion, PCA achieves a constant level of drugs and enables the patient to voluntary control the pain by means of supplemental boluses. Both central devices seem to provide similar technical benefits, but the port is much more easily tolerated and the quality of life is increased if it is already available when pain is first evident.
Challenges of Hemodialysis Access for High Risk Patients: Impact of Mesenteric Vein Bioprosthetic Graft
Authors: Glickman M.H. , Lawson J.H. , Katzman H.E. , Schild A.F. , Fujitani R.M. 
Published: March 2018

Objective The purpose of this study is to compare in a prospective fashion the performance of a new bioprosthesis, the mesenteric vein bioprosthesis (MVB), in patients who have had multiple failed ePTFE grafts. Performance measures include primary patency rates, assisted-primary patency rates, secondary patency rates, complications, and the number of interventions required to maintain graft patency. Study: From October 1999 to February 2002, 276 hemodialysis access grafts were implanted in a multicenter study. Of those grafts, 74 were placed in patients with a prior history of ≥ 3 failed prosthetic grafts (mean = 3.5 grafts, range = 3–6 grafts). Fifty-nine grafts were constructed with MVB, and 15 grafts with ePTFE as a concomitant control. Mean follow-up was 11.5 months. In the MVB group, 79.7% were African-Americans, 61% were females, and 23.7% were hypercoagulable. Of the ePTFE group, 86.7% were African-Americans, 46.7% were female, and 13.2% were hypercoagulable. Results Per Kaplan-Meier curves, the primary patency rate of the MVB group at 12 months was 33% vs the ePTFE group of 18% (p=0.120); the assisted-primary patency rates at 12 months were 45% MVB vs 18% ePTFE (p=0.011). The secondary patency rates at 12 and 24 months for the MVB group were 67% and 59%, respectively, vs 45% and 15% for the ePTFE group (p=0.006). During the follow-up time period, 80% of the ePTFE grafts were abandoned compared to 34% of the MVB group. Infection and thrombosis rates in the MVB group were lower than the ePTFE group. The infection rate for the MVB group requiring intervention was 0.07 events/graft year (gt/y) compared to 0.30 events/gt-y for ePTFE (p=0.04). A thrombosis rate of 0.69 events/gt-y occurred in the MVB group whereas 2.50 events/gt-y presented in the ePTFE group (p<0.01). Conclusion: In this study, high-risk patients (defined as those having multiple failed prosthetic grafts for hemodialysis) in whom the MVB conduit for hemoaccess was implanted, showed significant improvement in assisted-primary and secondary patency rates compared to the ePTFE cohort. The MVB group, however, did not have a statistically better primary patency rate compared to the ePTFE group. The MVB patient also had fewer thrombotic and infectious events and an overall reduction in the number of interventions while maintaining a permanent access site. This new bioprosthesis should be the conduit of choice in the complex group of patients as it offers assisted-primary and secondary patency rates similar to those commonly experienced by patients without a history of multiple graft failures.
A porcine Model of Intimal-Medial Hyperplasia in Polytetrafluoroethylene Arteriovenous Grafts
Authors: Baig K. , Fields R.C. , Gaca J. , Hanish S. , Milton L.G. , Koch W.J. , Lawson J.H. 
Published: March 2018

Purpose Vascular access polytetrafluoroethylene (PTFE) graft failure is a major cause of morbidity in the hemodialysis population. The most common cause of graft failure is thrombosis secondary to stenosis at the venous outflow tract. Venous outflow stenosis is characterized by intimal-medial hyperplasia. We have developed a porcine arteriovenous (AV) graft model that may be used to investigate this proliferative response and aid in the development of new therapies to prevent intimal-medial hyperplasia and improve graft patency. Methods Left carotid to right external jugular vein PTFE (6 mm) grafts were implanted in the necks of swine. Immediately following anatomosis, flow rates were recorded. In one group of animals (n = 4) the venous outflow tract was harvested after 7 days and morphometric analysis of intimal and medial area was performed. In a second group (n = 8) the graft patency was monitored until 28 days. Results All porcine PTFE fistula grafts were patent at 7 days and 100% patency was maintained until 14 days. After 28 days, 75% of the grafts failed due to thrombosis. The venous outflow tract developed a significant proliferative response. After 7 days the intimal and medial areas were 469 ± 9 μm2 and 875 ± 26 μm2 respectively. At 28 days the intimal and medial areas were 913 ± 55 μm2 and 1437 ± 182 μm2 respectively. Luminal flow rate of the venous outflow tract was reduced significantly (344 ± 11 ml/min at Day 0 to 129 ± 14 ml/min at Day 7, p < 0.05). Conclusions This porcine model rapidly, reliably and robustly reproduces the flow reducing stenosis and intimal-medial hyperplasia at the venous outflow tract of PTFE arteriovenous fistula. It represents a promising tool for investigating the mechanisms of intimal-medial hyperplasia, evaluating therapeutic interventions and new graft materials.
Latis™ Catheter: New Technology for Thrombectomy of Vascular access Grafts
Authors: Schild A.F. , Baltodano N.M. , Elias R. , Livingstone J. , Raines J. 
Published: March 2018

Purpose The most common complication of vascular access surgery is thrombosis. This study compared the gold standard Fogarty Thrombectomy Catheter, to the new latis Catheter with an advanced monofilament matrix. Methods 30 patients with thrombosed access grafts were randomly assigned to undergo thrombectomy with the Fogarty or latis catheter. An angioscope measured remaining graft thrombi. Results Twenty-nine of 30 subjects were successfully thrombectomized. No statistical differences in age, gender, race, or extension graft requirements were found. Catheter use in the latis group was: 1 in 14 procedures, and 2 in 1 procedure; Fogarty group: 1 in 10 procedures, 2 in 3 procedures, and 3 in 2 procedures. The average number of catheter passes was: latis 3.06 (1–6 passes) and Fogarty 4.13 (1–9 passes). A trend in favor of the latis catheter was demonstrated; however, statistical significance was not reached (p = 0.067). The overall 6-month primary patency rates were latis (40%) and Fogarty (30%). The estimated patency at the 50th percentile for latis is 120 days and Fogarty 108 days. Statistical significance was not reached with a p-value of the Log-Rank statistic of 0.68 and a p-value of the Wilcoxon statistic of 0.78. Conclusions The latis and Fogarty catheters are very similar. However, the latis balloon is more rugged with fewer catheters used and reduced number of passes. A difference in primary patency could not be demonstrated. The angioscope identified significant residual thrombus despite no returning thrombus from the catheter. Consequently, our protocol is modified to include the angioscope.