bluuebunny/crossref_metadata_2025_split huggingface dataset:
New Treatment of Idiopathic Necrosis of the Femoral Head
Authors: Marchetti N. , Faldini A. , Barbieri E. , Scaglione M. , Punzi G. 
Published: May 2019

The etiology of idiopathic necrosis of the femoral head is surveyed from the literature and anew surgical treatment is proposed. This treatment aims to create a new blood flow in the necrotic area. The necrotic area, which lies between normal bone tissue and non-vascularized tissue, is broken by means of percutaneous nails. In this paper, treatment strategies are discussed, as well as failures and surgical mistakes. The results obtained with this techniques seem to confirm the theorectical assumptions.
Therapeutic Considerations on Spastic Hip Treatment in Children
Authors: Motta F. , Selva G. 
Published: May 2019

The most recent international literature concerning the natural evolution of the hip in pediatric cerebral palsy has been reviewed by the Authors. Therefore a description of the surgical protocol used by them and other Authors for the prevention and treatment of hip luxation has been performed. From the clinical data, a high incidence of subluxation in cerebral palsy has been pointed out. The importance of orthopaedic screening for this pathology has been underlined.
Hypercoagulability after Total Hip Replacement
Authors: Mcnally M. A. , Kyle A. , Macdonald W.R.G. , Mayne E. , Mollan R.A.B. 
Published: May 2019

Changes in blood coagulation are believed to be involved in the aetiology of postoperative thromboembolism. Antithrombin III (AT III) is the most important natural inhibitor of thrombin activation and hence thrombogenesis. This study investigated the nature of a hypercoagulable state in total hip replacement by measurement of AT III in the perioperative period, giving a quantitative assessment of coagulation. Antithrombin III levels fell in all patients after surgery. However, the degree of the fall and the timing of the fall were variable. Eight percent of patients had abnormally low AT III prior to operation, indicating that this proportion of our patients are in a procoagulant state even before surgery. One third of patients had a clinically significant reduction (below 70% of normal) in AT III level after surgery. In this group the fall in AT III was maximal at 2 hours after division of the femoral neck. Careful correction for haemodilution provided new evidence for active consumption of antithrombin III in the perioperative period. By 24 hours after surgery the level of AT III was not significantly different from preoperative levels (p>0.7), even in the group with a clinically important reduction. These findings support only a transient period of hypercoagulability after total hip replacement. The “at-risk” period of venous thrombosis has been shown to be at least several weeks after surgery and the transient nature of the fall in AT III suggests that venous thrombosis is unlikely to be due to hypercoagulability alone.
Five Year Results of 113 Bipolar, Cementless “Bateman” Hip Replacements for Degenerative Hip Disease
Authors: Robinson A.H.N. , Ayllon-Garcia A. , Hallett J.P. 
Published: May 2019

113 Bateman UPF II arthroplasties with a straight, non-cemented, nonfenestrated, Moore type stem were used in 106 patients with degenerative hip disease. The patients were followed for a mean of 5 years and 8 months (range 48-102 months). 20 patients had died. There were therefore 93 hips available for review. Of these 91 were contacted. Of the 91 hips, 15 had been revised for stem loosening, and 6 more had gross radiological evidence of stem loosening in the absence of symptoms. In contrast to the stem failures, the bipolar acetabular component of this prosthesis gave no clinical problems. Radiologically there were 5 patients who showed evidence of acetabular migration, but in all of these cases the migration was 4 millimetres or less.
Chiari's Pelvic Osteotomy in the Adult. A Long Term Clinical, Radiological and Statistical Evaluation
Authors: Benazzo F. , Pedrotti L. , Giorgi L. , Mora R. , Ceciliani L. 
Published: May 2019

Chiari's pelvic osteotomy, conceived for the surgical correction of congenital dysplasia of the hip, is indicated by some authors for juvenile patients (16 years of age: Graham et al (7); 18 years of age: Hogh and Macnicol (9); 19.8 years of age: Calvert et al (1), while others do not identify any age limit (2, 11). Retrospectively reviewing a series of adult patients, we tried to determine the optimum age range of Chiari's osteotomy, and to evaluate the relative importance of surgical and radiological parameters of the results. We reviewed 74 patients, mean age 38.5 years, for a total number of 80 operations; 72.6% were aged between 31 and 60 years. The follow-up interval ranged from 1.8 to 15 years - mean 6.6, 180 months -. The results, based on a mathematical evaluation of pain, walking, joint mobility, limping and Trendelenburg's sign, were: 31 excellent (38.8%), 25 good (31.3%), 18 fair (22.5%), and 6 poor (7.5%). The best results were numerically concentrated in the 41-50 age group, in terms of percentages, we found a constant decrease of the good results in the different decades. Pain was absent in 61 of 80 cases. Clinical and radiological data, plus the statistical correlation of the different data (17 parameters), showed that Chiari's osteotomy is valid for the treatment of CDH even in older patients, although the best results are obtained in the 21-50 age group.
Cementless Revision for Failed Cemented total Hip Arthroplasty
Authors: Hussell J.G. , Smith E.J. , Learmonth I.D. 
Published: May 2019

Sixty-two consecutive revision hip arthroplasties were carried out in 57 patients between 1986 and 1990 using the long stem Porous Coated Anatomic (PCA) prosthesis. Fifty-two hips were available for clinical and radiological review. The remainder had either died or were lost to follow-up. The average follow-up was 4.8 years (range 3-7.8 years) and the mean age was 56 years (range 25-77 years). Using the Harris Hip Score, 38/53 (73%) were regarded as good/excellent, 6/52 (11.5%) as fair and 8/52 (15.5%) as poor. The incidence of femoral component subsidence (31/52 - 60%) was a cause of concern, and accounted for two cases of late dislocation. Of the remaining six hips regarded as failures, two had been revised for acetabular graft resorption and migration of the cup while four had moderate persistent pain despite fair hip function. The authors are unable to recommend the long stem PCA prosthesis for routine use in revision hip arthroplasty.
Pyomyositis in Babies Presenting with Painful Hip: Clinical and Radiographic Course of Two Cases
Authors: Pazzaglia U.E. , Binda S. , Zatti G. , Sessa V. 
Published: May 2019

Two cases of pyomyositis in babies, one in the ilio-psoas muscle, the other in the quadriceps, are reported. The presenting sign was a painful hip in both, suggesting osteomyelitis of the proximal femur or arthritis. Pyomyositis is unusual in western countries and in healthy, well-nourished children, but these cases suggest considering this pathology in the differential diagnosis of a painful hip in babies. In the first case an upper respiratory tract infection was followed by haematogenous spread to the ilio-psoas muscle; in the second an injection of vaccine in the quadriceps played a determinant role. The latter case was complicated by secondary osteomyelitis; a metaphyseal radiolucent band just below the growth plate appeared in the early stage together with metaphyseal osteopenia and was interpreted as a consequence of altered blood flow in the metaphysis, not specific osteomyelitis, but indicative of some disturbance of the growth plate-metaphyseal complex.
Computerized Tomography and Magnetic Resonance Imaging in Treatment of Congenital Luxation of the Hip
Authors: Lazovic D. , Franke J. , Wirth C.J. 
Published: May 2019

In treatment of congenital dislocation of the hip, a main aim is to achieve concentricity of reduction. Control by plain x-ray lacks accuracy in determining anteroposterior position. Arthrography and sonography cannot be used when a spica cast is in place. After April 1988, therefore, as an alternative in 16 hips, we have used computed tomography to determine femoral head position, acetabular angle, and extent and integrity of posterior rim. However, the presence of any metallic artefacts, unossified cartilage and the general poor-quality imaging of soft tissue associated with the technique reduce its usefulness. Since January 1990, we have instead used magnetic resonance imaging to control treatment. This technique, in 34 hips, proved accurate in determinating the femoral head position. MRI also gave better images than computed tomography of osseous and cartilaginous structures of the acetabulum and the surrounding soft tissue. Spica casting does not affect the quality of imaging. The effect of metal artefacts can be minimized by using, where necessary, implants of titanium alloy.
Fractures of the Femoral Head
Authors: Traina G.C. , Massari L. , Schiavi A. , Marrocco R. , Prosperi L. , Vita F. 
Published: May 2019

Fractures of the femoral head are not frequent and are almost always combined with dislocation of the hip. We reviewed 43 cases of femoral head fractures (33 men, 10 women), mean age 38.6 years. Using Pipkin's classification there were 13 type 1 cases, 5 type 2 and 25 type 4. Twenty-nine patients (67.4%) were seen again after a minimum of two years. Overall, there were ten excellent results, nine good, four fair and six poor. Complications were three cases of ischemic necrosis, eleven secondary arthritis, and three cases of heterotopic ossification. CT is an extremely useful method for assessing these lesions, especially in cases with small intra-articular fragments (Pipkin 1 and 4). Therapeutic indications obtained from this study were a non-invasive approach for Pipkin type 1 lesions, except those with a large intra-articular fragment, surgery for Pipkin type 2 cases, with osteosynthesis of the fragments, mainly using Herbert screws, and surgery particularly for Pipkin type 4, especially for osteosynthesis of the fragments of acetabular wall.
The Initial Stability of Femoral Impaction Grafting
Authors: Smith E.J. , Richardson J.B. , Learmonth I.D. , Evans G.P. , Nelson K. , Lee R. , Dyson J. 
Published: May 2019

Aseptic loosening is the major cause of failure in primary total hip replacements. Loss of bone stock occurs in both cementless and cemented implants. Impaction of morsellised allograft represents a major advance in the restoration of bone loss at revision hip surgery. This study was designed to test the early stability of the femoral impaction construct. Polished double tapered stems were inserted into neomedullary canals within impacted allograft in fibreglass femora. Subsidence was measured during cyclical loading. Four methods of impaction grafting were tested: allograft alone; allograft and heparinised blood; allograft/cement/heparinised blood; allograft/cement/clotted blood. Uncemented impaction grafting failed at low loads and few cycles. The cemented technique supported higher loads. Heparinised blood reduced the strength of the composite. Initial stability was achieved with allograft, cement and clotted blood. There is need for caution in the early post-operative period due to the wide variation in initial stability of the allograft composite. The reliability of this technique has been increased by the use of specialised instruments. Experimental studies and clinical experience suggest that this approach to revision surgery is technique dependent.
Angiogenin Upregulation Independently Predicts Unfavorable Overall Survival in Proneural Subtype of Glioblastoma
Authors: Hu Ji-liang , Luo Wei-Jian , Wang Hao 
Published: May 2019

Objective: Angiogenin is a small protein that exerts potent stimulating effects on angiogenesis. In this study, we aimed to examine the expression of angiogenin in different subtypes of glioblastoma and estimated its independent prognostic value. Methods: The genomic and survival data from The Cancer Genome Atlas-glioblastoma were extracted for a secondary study. Results The expression of angiogenin was upregulated in glioblastoma tissues and varied significantly in different subtypes. Although the proneural subtype had the lowest angiogenin expression, high angiogenin expression was associated with significantly worse overall survival. However, this association was not observed in other subtypes. By performing univariate and multivariate analysis using Cox regression model, we observed that high angiogenin expression was an independent indicator of shorter overall survival in proneural glioblastoma (hazard ratio: 1.669, 95% confidence interval: 1.033-2.696, P = .036), after adjustment of age, gender, isocitrate dehydrogenase 1 mutation, temozolomide chemotherapy and radiation therapy. In addition, we also observed a correlation between elevated angiogenin expression and the hypomethylated status of its DNA. The hypermethylation group had significantly better overall survival. Conclusions: Angiogenin upregulation might serve as a biomarker for unfavorable overall survival in the proneural subtype of glioblastoma.
Reconstructive endovascular treatment of the V4 segment of a vertebral artery dissecting aneurysm with the Willis covered stent: A retrospective study
Authors: Xiang Sishi , Li Guilin , He Chuan , Ren Jian , Zhang Hongqi 
Published: May 2019

Objective Preliminary studies suggest that Willis covered stents may be suitable for the treatment of aneurysms of the internal carotid artery (ICA), but their efficacy and safety in vertebral artery (VA) dissecting aneurysms need further investigation. Methods Consecutive patients who underwent placement of a Willis covered stent for treatment of an aneurysm of the V4 segment of the VA between September 2015 and December 2017 at our institution were retrospectively reviewed. The efficacy, complications, angiographic and clinical follow-up results were collected and analyzed. Results Sixteen covered stents were successfully implanted into the VA in 12 patients with 12 dissecting aneurysms. The technical success rate of stenting placement was 100%. Complete occlusion was achieved in 11 patients immediately after stent placement, with transient endoleak in one aneurysm. Angiographic follow-up (9.9 ± 4.0 months, mean±SD) was performed in nine patients and demonstrated complete stabilization of the obliterated aneurysm. Clinical follow-up (20.1 ± 9.6 months, mean±SD) demonstrated full recovery in 11 patients, and one patient suffered from acute myocardial infarction. Conclusion Reconstruction using a Willis covered stent is an efficient, safe and attractive alternative for the definitive treatment of intracranial VA dissecting aneurysms; longer follow-up and expanded clinical trials are needed for further validation of this technique.
Endovascular treatment of stroke in children under 2 years with heart failure and ventricular assist device
Authors: Jiménez Gómez Elvira , Bravo Rey Isabel , Oteros Fernández Rafael , Delgado Acosta Fernando 
Published: May 2019

Introduction Strokes in children are characterised by a high mortality rate while, at the same time, the low number of cases makes it difficult to gain practical experience. As heart disease is the most common risk factor, and as more and more cardiological interventions are being carried out, an increase in the incidence of paediatric stroke is expected. In some cases a transplant is required. While waiting for a donor, the use of ventricular assist devices may be necessary. These present with a high rate of neurological complications. We present two cases of children under 2 years of age awaiting heart transplantation supported by ventricular assist devices who had a stroke which was treated by endovascular techniques. Case 1: A 16-month-old boy with restrictive cardiomyopathy who was listed for a cardiac transplant. At 20 months he required an implantation of an external biventricular support device (Berlin Heart) and had a left hemisphere stroke at 23 months. An intra-arterial approach was used and produced good clinical results. One month later, a heart transplant was performed successfully. Case 2: An 18-month-old girl with non-compacted dilated cardiomyopathy included in the cardiac transplant programme and in need of a Levitronix Centrimag ventricular assist device presented with an acute left hemisphere stroke at 23 months. An intra-arterial procedure was carried out leading to positive clinical results except for residual right hypertonia. Seven months later she received her transplant. Conclusion As a result of the difficulty in performing arterial puncture, the small vessel calibre and the limitation in the use of iodated contrast, there are certain limitations to endovascular treatment of strokes in children that can lead to complications. A multidisciplinary approach to managing such cases would be helpful.
Trustful communication in the medical encounter: Perspectives of immigrated people with epilepsy
Authors: Andersson Klara , Shadman Alieh , Strang Susann 
Published: May 2019

Background Foreign-born people with epilepsy carry two mutually independent risk factors for poor health. While epilepsy increases the need for trust and clear communication, minority status presents additional barriers in communication, causing misconceptions, inadequate treatment and increased suffering. Objectives This study aimed to explore experiences of communication in the medical encounter from the perspectives of foreign-born people with epilepsy. Methods A qualitative approach was applied. Twenty semi-structured in-depth interviews were conducted, recorded, transcribed verbatim and analyzed using manifest and latent content analysis. Results Within the main theme, “Trustful communication in unpredictable terms of life,” three subthemes appeared: “Social struggle overshadowing the epilepsy condition”; “Reliable health consultations as a key to feeling safe” and “Addressing ‘the real problem’ in the medical encounter.” A reduced social network due to migration, together with fears related to epilepsy, seems to increase the need for immediate access to health consultations and the need to be listened to. Patients’ narratives shed light on multiple social, medical and psychological events that may present reasons for the lack of medical adherence or missed booked appointments. Discussion A respectful approach, listening and confirming the normalcy of epilepsy events seem fundamental for trustful communication in the context of epilepsy, regardless of a patient’s culture or country of origin.
Neurochemical markers in CSF of adolescent and adult SMA patients undergoing nusinersen treatment
Authors: Wurster Claudia D. , Günther René , Steinacker Petra , Dreyhaupt Jens , Wollinsky Kurt , Uzelac Zeljko , Witzel Simon , Kocak Tugrul , Winter Benedikt , Koch Jan C. , Lingor Paul , Petri Susanne , Ludolph Albert C. , Hermann Andreas , Otto Markus 
Published: May 2019

Background: There is limited information on neurochemical markers being used to support and monitor the affection of motoneurons in patients with spinal muscular atrophy (SMA). The objective of this study was to examine neurochemical markers in cerebrospinal fluid (CSF) under treatment with the antisense-oligonucleotide (ASO), nusinersen. Methods: We measured markers of axonal degeneration [neurofilament light chain (NfL) and phosphorylated neurofilament heavy chain (pNfH)] along with basic CSF parameters in 25 adolescent and adult SMA type 2 and 3 patients at baseline and after four intrathecal injections of nusinersen. Neurochemical markers were compared with controls. In addition, neurochemical markers in SMA patients were related to the Hammersmith Functional Rating Scale Expanded (HFMSE). Results: No significant difference in neurofilament (Nf) values was observed between SMA and control group, neither at baseline nor after four injections of nusinersen. NfL, protein and quotients of albumin (Qalb) increased slightly in SMA patients after the fourth injection. The slight increase of NfL could be related to the development of mild CSF flow change. No relations were observed between changes in Nf and HFMSE. Conclusion: We assume that Nf levels in CSF in these patients may result from slow disease progression in this stage of disease, pre-existing loss of motoneurons due to long disease duration besides affection of the LMN only. Therefore, we conclude that Nf levels in CSF do not seem useful as diagnostic and monitoring markers in adolescent and adult SMA type 2 and 3 patients.
Effects of Viscosupplementation on Quality of Knee Joint Arthrokinematic Motion Analyzed by Vibroarthrography
Authors: Bączkowicz Dawid , Skiba Grzegorz , Szmajda Mirosław , Vařeka Ivan , Falkowski Krzysztof , Laudner Kevin 
Published: May 2019

Objective To evaluate the influence of viscosupplementation on osteoarthritic knee arthrokinematics analyzed by VAG. It is considered that intra-articular hyaluronic acid injection may improve the function of synovial joints by recovery of friction-reducing properties of articular environment. Design Thirty-five patients with knee osteoarthritis (grade II according to the Kellgren-Lawrence system) and 50 asymptomatic subjects were enrolled in the study. Patients were analyzed at 3 time points: 1 day before and 2 weeks and 4 weeks after single injection of 1.5% cross-linked hyaluronate. Control subjects were tested once. The vibroarthrographic signals were collected during knee flexion/extension motion using an accelerator and described by variation of mean square (VMS), mean range (R5), and power spectral density for frequency of 50 to 250 Hz (P1), and 250 to 450 Hz (P2). Results Patients before viscosupplementation were characterized by about 2-fold higher values of vibroarthrographic parameters than controls. Two weeks after the procedure, the values of R5, P1, and P2 significantly decreased, in comparison to pre-injection. At 4 weeks post-injection, we noted a significant increase in R5, P1, and P2 values, when compared to 2 weeks post-injection. Finally, at 4 weeks post-injection, the level of VMS, R5, and P2 parameters did not differ from values obtained at pre-injection. Conclusions We showed that viscosupplementation may be effective in providing arthrokinematics improvement, but with a relatively short period of duration. This phenomenon is observed as decreased vibroacoustic emission, which reflects a more smooth movement in the joint.