bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modified Ilioinguinal Approach to the Acetabulum and Pelvis from beneath the Inguinal Ligament: A Subinguinal Approach
Authors: Hosseinzadeh Hamid Reza Seyyed , Eajazi Alireza , Yeganeh Mehrnoush Hassas , Besheli Laleh Daftari , Kazemi Seyyed Morteza , Bigdeli Mohammad Reza , Okhovvatpoor Mohammad Ali 
Published: January 2018

The ilioinguinal approach is favoured for fractures of the anterior part of the pelvis, but it is associated with some technical difficulties and it is not suitable for some complex fractures. In 2008, a modified ilioinguinal approach was introduced by Farid Yr which afforded visualisation of the inside and outside of the pelvis. The approach involves retroperitoneal access below the inguinal ligament to preserve the integrity of the inguinal canal and allows exposure of anterior and medial wall fractures as well as the anterior hip capsule. Despite the dimensions of the procedure, closure is anatomical because repair of the inguinal canal floor is not required. We report the use of this approach in 17 patients with T-type fractures of the acetabulum, transverse fractures of acetabulum, Tile C1 pelvic fractures, malunion of the pelvis and acetabular dysplasia. The approach is recommended in complex cases of acetabular surgery (including obese or muscular patients) and complicated or old fractures in which a better exposure is required. It is useful in visualisation of the anterior wall and labrum and intra articular structures, and in viewing the internal anatomy of the pelvis and acetabulum. It may be a suitable approach for periacetabular osteotomy.
Total hip arthroplasty for fractures of the proximal femur in older patients
Authors: Rutz Erich , Leumann André , Rutz Daniela , Schäfer Dirk , Valderrabano Victor 
Published: January 2018

Displaced fractures of the proximal femur are common in older patients. The optimal treatment is still under debate. We retrospectively reviewed the results of 53 consecutive total hip arthroplasties (THA) performed in 12 men and 41 women for treatment of an acute fracture of the proximal femur. Men had an average age of 75.1 years (range, 61 to 90) and women 78.2 years (range, 61 to 91). At time of fracture, 42 patients (79.3 %) had radiological signs of hip osteoarthritis. At time of surgery, 8 patients (15.1%) needed trochanteric reconstruction in addition to the implanted THA. Clinical and radiological follow-up was available for 39 patients (73.6 %). The average follow-up time was 55.5 months. The mean Harris Hip Score was 86.3 points (range, 68–97.7). The 4 month mortality rate was 1.9 % (1 patient). Four patients (7.5%) had had early postoperative complications, including dislocation in 3 patients (5.6%) and one (1.9%) minor reoperation (wound haematoma). One patient (1.9%) had revision surgery because of aseptic stem loosening 67 months after primary implantation. In elderly patients, THA is a safe long-term solution for treatment of displaced fractures of the proximal femur, allowing early weight bearing and assisting with rehabilitation.
Infections after primary and revision total hip replacement caused by enterobacteria producing extended spectrum β-lactamases (ESBL): A case series
Authors: Haenle Maximilian , Podbielski Andreas , Mittelmeier Wolfram , Bader Rainer , Gradinger Reiner , Gollwitzer Hans 
Published: January 2018

Implant infection remains a feared complication after total hip replacement. A higher rate of infection is observed after revision surgery. An additional threat for such patients arises from the fact that bacteria resistant to a multitude of antibiotics are encountered with increasing frequency in the hospital setting. Among them enterobacteria producing extended spectrum β-lactamases (ESBL) are the second most frequent group of multiresistant isolates. ESBLs are enzymes which hydrolyse third and fourth generation cephalosporins resulting in a distinctive resistance against these antibiotics. Even though ESBLs were first described in the early 1980's and now represent pathogens of importance in intensive care units, they have been only rarely encountered in orthopaedic and trauma surgery. We report on three cases of ESBL-associated infections in hip arthroplasty, resulting in 1) resolution of infection after removal of the hip implant, 2) death after developing a nosocomial pulmonary infection due to ESBL-producing bacteria, and 3) resolution of infection after two-stage revision. The infections, caused by multi-resistant ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates, demonstrate the difficulties in managing implant associated infections with resistant bacteria, and emphasize the importance of recognizing ESBL-positive bacteria as increasingly important pathogens that require special precautions and treatment. Our observations suggest that ESBL-expressing bacteria in orthopaedic and trauma surgery are not a rare phenomenon any more.
Heat Generation during Cement Removal in Revision Total Hip Replacement - a Comparison of Three Methods
Authors: Nogler Michael , Mayr Eckart 
Published: January 2018

High speed cutting and ultrasound devices for cement extraction from the femoral cavity in hip revision procedures are frequently used. Such devices generate heat at the cutting interface which may damage osteocytes. One ultrasound device, a manual high-speed cutter and a robot-based high-speed cutter were tested in human cadaveric bone at body temperature. Temperature probes were placed at the cement-bone interface, and data collected from 12 sensors with a digital data-logger during cement removal from the femoral cavity. Peak temperatures from each sensor were recorded and compared by Kruskal-Wallis-H-Test for global effect and Mann-Whitney-U-Test for multiple comparisons. All devices generated mean temperature peaks of over 50°C which is above levels considered safe. A peak temperature of 164°C was reached by the ultrasound system. Significant differences between the three devices exist, with the ultrasound generating the highest median peak temperatures of 107°C. The lowest median peak temperature of 65°C was generated by the high-speed cutting system. Major improvements of the irrigation and cooling systems of the devices seem to be necessary.
Evaluation of Dialysis Access Care by Means of Process Quality Indicators
Authors: Bonucchi D. , Ferramosca E. , Ciuffreda A. , Confessore N. , Grosoli M. , Davoli D. , Cappelli G. , Albertazzi A. 
Published: January 2018

Improvement of dialysis access management depends on technical skill but also on effective choice, construction, monitoring and revision of the access. Surgical procedure is only one step of a complex course, beginning with the referral of patients to nephrologists. Using two process quality indicators, we describe the evolution of access management at our centre, where access surgery and access-related activities are performed by nephrologist. The first process indicator is based on the prevalence of temporary access at first dialysis (TA1st) in end stage renal disease ESRD patients, the second one measures the prevalence of permanent central venous catheters (%CVC) in dialysis population. TA1st increased to 27.1% in 1999, more than twofold compared to the previous year. There was also an increase in %CVC from 20.6 to 26.3%. Native access remained the most utilised, well above 70% of dialysis patients. Our process monitoring suggests a rapid worsening of late referral, as indicated by the increasing use of temporary catheters at the beginning of chronic dialysis. Increasing surgical activity and diagnostic procedures were only partly effective in containing the rise in CVC. Venous sparing, early referral, Continuous Quality Improvement and a multiprofessional access-team coordinated by a nephrologist could be the key-elements in facing the never-ending-story of dialysis vascular access.
Groshong Catheters: Technical Aspects and Clinical Features
Authors: Campisi C. , Camillucci L. , Campopiano A. , Fanizza C. , Sardonio A. 
Published: January 2018

After thousands of Groshong catheter applications over more than twenty years, the cause of blood withdrawal drawbacks is not yet completely understood. This phenomenon – which is not typical of closed-tip catheters since it is also common in open-tip catheters – in the Groshong catheter is attributed to the valve (ball-valve effect). The aim of this work is to understand the relationship between causes and effects in order to provide clinicians with practical solutions. Out of the 16 catheters examined, we observed no clear correlation among electron microscope ultrastructural analysis, valve closing pressure, intraluminal clots and clinical failures after different implantation times up to a maximum of 36 months. The ultrastructural analysis revealed an optimal no-time-related aspect for internal and external surfaces, while the closing pressure in each case was compatible with the efficiency of the working valve (range 22–36 cmH2O). We conclude that the blood withdrawal drawbacks cannot be attributed to a single cause and certainly not to the silicone biostability or directly to the valve. Different studies are suggesting that clinical failures can be the result of several different causes such as slime or clots in the internal catheter surfaces and fibrin sleeve in the external catheter surfaces. These are common causes in open-tip catheters and we believe that the presence of valves on the tip of the Groshong may encourage inferences. Our suggestion is to place the tip of the Groshong catheter in atrium one centimetre after the junction with the vena cava. After the implant, it is possible to remove the causes of drawbacks by strong flushing using a 5-ml syringe and/or postural manoeuvres.
Hemodialysis Vascular Access Thrombosis and Lipoprotein(A)
Authors: Hojs R. , Ekart R. , Dvoršak B. , Gorenjak M. 
Published: January 2018

Background Vascular access remains the Achilles's heel of successful hemodialysis and thrombosis is the leading cause of vascular access failure. Elevated lipoprotein(a) (Lp(a)) levels in hemodialysis patients were reported, and in some studies were also associated with hemodialysis vascular access thrombosis. Patients and Methods In our study 84 hemodialysis patients with native arteriovenous fistula were included. Two groups of patients were defined: group A including 61 patients with their vascular access either never or only once thrombosed, and group B including 23 patients with two or more thromboses of their vascular access. We determined serum concentrations of Lp(a) in all our patients. Results Average serum Lp(a) concentration for all the patients included in the study was 0.273 ± 0.31 g/l. No relationship was found between serum Lp(a) concentrations and age, gender and duration of dialysis treatment. Serum Lp(a) concentrations were higher in group A than in group B patients (0.301 g/l versus 0.198 g/l), but the difference was not statistically significant. There was also no statistically significant difference between group A and group B regarding age, gender and duration of hemodialysis treatment. The use of a cut-off value for Lp(a) of 0.3 g/l and 0.57 g/l also failed to provide a significant difference between group A and B patients. Conclusion We found no significant differences in Lp(a) concentrations between group A (thrombosis-non-prone) and group B (thrombosis-prone) patients. Our results suggest that Lp(a) is not an independent risk factor for vascular access occlusion in hemodialysis patients.
Distal Arteriovenous Fistulas in Elderly Hemodialysis Patients
Authors: Bonforte G. , Zerbi S. , Pasi A. , Sangalli L. , Rivera R. , Surian M. 
Published: January 2018

Dialysis access procedures and complications are an important cause of morbidity and hospitalization for chronic hemodialysis patients. Subjects over 65 years old have a higher incidence of co-morbid factors (diabetes mellitus, atherosclerosis, neoplasms, heart failure), therefore the correct choice in terms of timing and type of permanent access is extremely important. As elbow fistulas are often complicated by heart failure and PTFE grafts have a higher risk of thrombosis, we decided to evaluate the success rate of distal fistula as primary dialysis access in elderly patients. We carried out a retrospective study to identify survival predictors and actual vascular network saving. Between January 1991 and September 2000, 277 vascular access procedures were performed on 198 elderly patients (age 65 or older). The first anastomosis was positioned as peripherally as possible. In cases of patients with poor peripheral vasculature or three co-morbid factors, vascular access was first created at the origin of radial artery (Toledo-Pereyra fistula). Survival (Kaplan – Meyer analysis) was significantly higher for Toledo-Pereyra fistulas compared to wrist and snuff-box ones, in spite of the presence of a high incidence of co-morbid factors. We conclude that Toledo-Pereyra fistula is an efficient primary choice in elderly patients.
“Long-Term” Catheters for Haemodialysis: Malfunction and Management
Authors: Pecorari M. 
Published: January 2018

The purpose of this study is to demonstrate the incidence of dysfunction due to thrombosis of the central venous catheters (tunnelized and siliconic) for haemodialysis. We have also correlated the rate of the thrombotic events to the site of positioning and to the different protocols used in order to prevent these complications. Femorals are more affected by thrombosis, partial or total, than jugular catheters. The mean request of the urokinase-boluses is low: only 10% of the dialytic sessions examined (1200) requires these interventions. A significant reduction is obtained if to the patients are administered ASA. No influence seems to result from the use of the anticoagulants. Our study confirms in our population the advantages of central venous catheters in chronic haemodialysis, the ease of management and the absence of serious complications during the observation period (6 months).
Experience using a New Vascular Port Access Device for Hemodialysis: Preliminary Clinical Results
Authors: Zollo A. , Cavatorta F. , Galli S. 
Published: January 2018

A new subcutaneous device (Dialock®, Biolink Corp, Middleboro, MA) provides vascular access to patients who require hemodialysis. The device consists of a port implanted in a subcutaneous pocket in the thoracic area 10 cm below the clavicle. Interdialytic patency is maintained using a priming antithrombotic solution. The device was implanted in 10 outpatients under local anesthesia, and immediately used for hemodialysis. The catheters have been used up to now for a total of 1,480 days (24- 248 days), the average being 4.8 months (1–8 months). Survival rate of Dialock® was 100% at 8 months. During this period, the device achieved prescription hemodialysis blood flow rates averaging 250–300 ml/min with a venous pressure of 180 ± 25 mmHg. Malpositioning of the catheters due to their excessive length was observed in the first three patients and led to the repositioning of the catheters’ distal tips under local anesthesia. Secondary and delayed hematoma surrounding the Dialock® device were observed in 2 patients one or two days after insertion. In one case, a hematoma was surgically removed under local anesthesia. Antibiotic therapy was administered for safety and prophylactic reasons. In one patient spontaneous catheter fracture and distal tip embolization occurred on the 49th day after repositioning. Percutaneous radiological retrieval of the catheter fragment was performed. No infection of the Dialock® device occurred and only one episode of bacteremia was observed. Blood cultures were positive for Staphylococcus epidermidis. Infection was cured by appropriate systemic antibiotic therapy combined with gentamicin and sodium citrate lock. The device was well accepted by patients and staff. The Dialock® device catheter offers a new vascular alternative for dialysis that deserves further long-term study. In particular, the confidence of structural materials should be tested.
Arteriovenous Cannulation: Differences in Approach among Institutions and Nurses
Authors: Yürügen B. , Erdoğan N. 
Published: January 2018

The aim of this study was to determine how hemodialysis (HD) nurses approach arteriovenous (A-V) cannulation and how a standard for this procedure could be reached. The study group was made up of 50 nurses who had been working for at least 6 months in the HD centers of the Social Insurance Company and university hospitals. Data was collected by means of a questionnaire to ascertain the demographic characteristics of the 50 nurses, and an A-V cannulation procedure checklist in three sections with 47 questions, prepared in the light of the literature. Percentages and Pearson's χ2 tests were used to evaluate the data obtained by this means. The results showed that there were significant differences in pre and post-application stages of A-V cannulation in the medical centers studied. However, the differences found in the application stage in the same centers did not correlate significantly.
Treatment of Pneumothorax as a Complication of Long-Term Central Venous Port Placement in Oncology Patients. An Observational Study
Authors: Biffi R. , Pozzi S. , Pace U. , Cenciarelli S. , Zambelli M. , Andreoni B. 
Published: January 2018

Background and Purpose In percutaneous placement of central venous catheters an inadvertent, direct lesion of the lung parenchyma can occur. This is a cause of iatrogenic pneumothorax, whose incidence is approximately 1 to 4%, largely dependent on the experience of the operator, the site of venipuncture and probably the technique employed. Initial treatment currently ranges from observation alone to formal tube-thoracostomy. In an attempt to define the best initial treatment, if any, we reviewed our personal series and contributions from the literature. As a result we have produced a flow-chart proposing a rational treatment of this frequent complication. Patients and Methods One thousand four hundred twenty-one ports were placed in patients at the Department of Surgery of the European Institute of Oncology in Milan through an infraclavicular standardized percutaneous subclavian approach. They were placed during the 60-month period from January 1, 1996 to December 31, 2000 for long-term chemotherapy treatment of solid tumours. Chest upright X-rays were obtained post-operatively in all cases to check the correct position of the catheter tip and the presence of pneumothorax. Results Twenty-two patients out of 1421 (1.54%) experienced a radiologically-proven pneumothorax, ranging from 5 to 70% of the affected pleural space. Sixteen patients out of 22 (72.7%) with minor portions of affected pleural space received simple observation. In these patients the most common finding was an uncomplicated tachycardia (more than 100 beats/min); 8 of them did not complain of any symptoms. Six patients (27.2%) underwent an additional procedure (3 tube-thoracostomies and 3 aspirations of the pleural space), claiming symptoms of chest pain and various degrees of dyspnea. Tube thoracostomy was mainly adopted at the beginning of our experience, and in patients with a severe degree of pleural involvement (55 to 70% of the pleural space). Aspiration, instead, was used more recently and in patients with varying degrees of pleural space involved, ranging from 40 to 60%. Conclusions Looking at our own series and literature data, patients with iatrogenic pneumothorax following central venous cannulation who do not have a severe underlying pulmonary disease can be reassured, at the time of diagnosis, that surgery is usually unnecessary and tube thoracostomy is rarely needed. Simple aspiration of the pleural air by means of a central venous catheter inserted percutaneously into the pleural space under local anesthesia should be considered, even if the amount of affected pleural space is more than 50%, before opting for a formal tube-thoracostomy using small-bore tubes.
Restoration of Acutely Thrombosed Arterio-Venous Fistulae by rTPA and Percutaneous Angioplasty
Authors: Sarkar R. , Ravanan R. , Birch P.A. , Williams A.J. , Banks R.A. 
Published: January 2018

Acute thrombosis in native arterio-venous fistulae (AVF) results in considerable patient morbidity. Interventional radiology (IR) comprising thrombolysis and percutaneous transluminal angioplasty (PTA) is well established in the management of thrombosed polytetrafluoroethylene (PTFE) grafts. However its role in thrombosed AVF is uncertain. We looked retrospectively at the role of IR in re-establishing blood flow in acutely thrombosed AVF. Between 1992–2000, 21 episodes of acutely thrombosed AVF in 15 patients (9 females; age range 29–80yrs) were referred for intervention. All fistulae were being used for haemodialysis at the time. Diagnosis was established by angiography and thrombolysis with recombinant tissue plasminogen activator (rTPA) was attempted in all patients. Discrete stenoses when present (n=12) were then treated with PTA and resistant or recurrent stenoses were managed by stent insertion (n=3). Patients were then heparinised for 24 hours. Technical success as defined by radiological patency was achieved in 86% cases. Clinical success i.e. the ability to reuse of the fistula for haemodialysis was achieved in 62% of the interventions, where patency rates at 3 and 6 months were 92% and 69% respectively. Five patients had recurrence of thrombosis >3 months after the primary procedure, 3 had successful re-intervention. Minor local bleeding was the only complication. Our retrospective study shows rTPA and PTA is successful in the management of acutely thrombosed AVF. We advocate the routine use of IR as a valuable technique for prolonging the life of native AVF in patients on maintenance haemodialysis.
Pre-Operative Vessel Mapping and Early Post-Operative Surveillance Duplex Scanning of Arteriovenous Fistulae
Authors: Ives C.L. , Akoh J.A. , George J. , Vaughan-Huxley E. , Lawson H. 
Published: January 2018

Purpose To increase the proportion of dialysis patients using native arteriovenous fistulae (AVF), improved selection of the most appropriate procedure must be coupled with early access surveillance to determine which access would likely mature and when intervention might lead to access salvage. This study was aimed at auditing pre-operative vessel mapping and post-operative access surveillance against the primary outcome measure of AVF maturation. Methods Between January 2006 and August 2007, 113 AVF created in 101 patients were studied. Data on pre-operative vessel mapping, type of AVF, post-operative surveillance scans were analyzed against the outcome AVF. Results Pre-operative mapping and post-operative scanning were carried out in 86% and 91%, respectively. A maturing fistula on post-operative scan highly correlated with a satisfactory outcome (p<0.001). The sensitivity and specificity of the post-operative scan were 100% and 85%, respectively. There were 79 brachiocephalic and 34 radiocephalic fistulae with a primary failure rate of 23% and 47%, respectively, giving an overall failure rate of 30%. Nine fistulae had further intervention (angioplasty or thrombolysis) and five (56%) were salvaged. Seventy-two AVF matured satisfactorily giving a primary cumulative patency of 71% (72/102). Conclusion This study shows that preoperative vessel mapping provides useful information regarding the choice of AVF. Access surveillance duplex scanning at 6–8 weeks post-operatively is viable and has a high sensitivity and specificity for final outcome of fistula. Identifying AVF with potential problems early means that further intervention or surgery can be planned earlier, which will have a positive impact on patients.