bluuebunny/crossref_metadata_2025_split huggingface dataset:
MicroHip: A Minimally Invasive Procedure for Total Hip Replacement Surgery: A modified Smith-Petersen approach
Authors: Michel M.C. , Witschger P. 
Published: January 2018

In this article we present the surgical technique of our anterior minimally invasive approach to the hip joint. This is aligned along an interneural plane and makes the approach truly minimally invasive. This technique is performed in a lateral decubitus position on a normal operating table; there is no need for a specific orthopaedic or fracture table. As leg traction is not necessary, this enables the approach to be used routinely. Most of the instruments used for this procedure are standard instruments; only the acetabular reamers and positioners are angulated and specifically designed. The angled instruments (MI – minimally invasive) are especially useful when performing hip replacement in obese patients. An excellent view of both the acetabulum and the proximal femur can be obtained through an incision of only 6–8cm, using this MI approach. The approach follows the interval between the tensor fascia lata muscle and the rectus muscle using a section of the anterior iliofemoral approach described by Smith-Petersen. No tendon or muscle is cut or detached. The joint capsule is split and left in place. The hip joint is not dislocated and we perform the osteotomy of the femoral neck in situ. To date we have performed over 500 MicroHip™ operations. We have not observed any nerve lesions or fractures of the trochanter. Our experience to date shows that the method we have developed allows us to operate reliably on virtually any patient. Preliminary results also show that important factors like length of stay, pain, blood loss and return to work can be reduced significantly. The MicroHip™ technique is being used by more and more different clinics all over the world and can be applied with success after suitable training.
Randomised Controlled Trial Comparing two Methods of Acetabular Cup Positioning during Total Hip Arthroplasty
Authors: Vendittoli P.-A. , Ganapathi M. , Duval N. , Lavoie P. , Roy A. , Lavigne M. 
Published: January 2018

Background Acetabular cup positioning is an important technical aspect in total hip arthroplasty. Most surgeons estimate cup abduction angle during surgery with the insertion rod position according to the patient's body anatomical landmarks or other reference points in the operating room. High acetabular component abduction angle is associated with an increased risk of dislocation, premature polyethylene wear and osteolysis. Method To evaluate the potential benefits of a new technique for vertical acetabular cup positioning, 100 acetabular cups were randomised to be inserted with or without an inclinometer. Abduction angles were measured on postoperative radiographs by 2 evaluators blind to the treatment group. Results Of the cups, 57% (27/47) were positioned within the desirable abduction angle range of 40°–49° with the inclinometer, compared with 50% (27/53) by visuospatial perception (p=0.454). The proportion of cups positioned outside a safe angle range of 30°–55° was low in both groups: 6% (3/47) for the inclinometer group versus 4% (2/53) for the visuospatial perception group (p=0.536). Conclusion The use of an inclinometer did not significantly improve the acetabular cup abduction angle obtained by our group of surgeons when compared with visuospatial perception. Newer techniques such as navigation may be useful in further optimising cup positioning and reducing the outliers.
Surgical Treatment of Late Congenital Dislocation of the Hip (after 4 Years of Age)
Authors: Cigala F. , Lotito F.M. , Sadile F. 
Published: January 2018

The goal of the surgical treatment in previously untreated juvenile hip displacement is to achieve a stable and concentric reduction of the femoral head with the best range of motion and without severe complications related to avascular necrosis (AVN) and stiffness of hip joint. In this paper the authors describe their approach in the treatment of the patients affected by neglected high dislocation of the hip joint observed after 4 years of age, when all of them had been ambulant for several years. They point out, on the basis of their experience, the importance of avoiding damage to the vessel supply of the dislocated femoral head, respecting the soft tissue and the use of different surgical techniques to perform acetabuloplasty in relation to skeletal age, in order to obtain good hip stability and congruency good range of motion for 20 years at least, and to prepare the hip joint for further surgical intervention in the best way possible when inevitable osteoarthritis occurs.
Cementless Total Hip Arthroplasty Using Custom Stem and Reinforcement Ring in Hip Osteoarthritis following Developmental Dysplasia
Authors: Flecher X. , Parratte S. , Aubaniac J.M. , Argenson J.N. 
Published: January 2018

The anatomical deformities encountered in osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) may lead to some technical difficulties when performing total hip arthroplasty The aim of this study is to present our experience in anatomical analysis of OA following DDH and its treatment using cementless THA with a customized stem and a reinforcement ring. In anatomic X-rays and CT-scan studies of 83 hips with osteoarthritis following DDH, a great individual variability was shown despite the subluxation class considered with a reduced mediolateral and anteroposterior dimensions of the intramedullary femoral canal in all groups. Greater anteversion (ranging from 2° to 80°) in all the DDH groups and a femoral neck shaft angle increased only for femora of class II were found. Another group of 116 luxations of the hip was clinically followed. Clinical outcome was found to be not correlated with the severity of luxation. The problems encountered to restore the center of rotation in THA for DDH correlated well with the severity of dislocation. The postoperative limp was correlated with a vertical position of the acetabular component of more than 35 mm from the interteardrop line. Taking into consideration hip revision for stem or acetabular replacement, the cumulative survival rate was 94.7% ± 2.7% at 12 years. Cementless custom stem is certainly a step forward in the future of hip arthroplasty in a young and active population with DDH to probably include in a preoperative and intraoperative computer assisted surgery
Acid Etching does not Improve CoCrMo Implant Osseointegration in a Canine Implant Model
Authors: Jakobsen Stig S. , Baas Jorgen , Jakobsen Thomas , Soballe Kjeld 
Published: January 2018

Induction of bone ingrowth by topographical changes to implant surfaces is an attractive concept. Topographical modifications achieved by acid etching are potentially applicable to complex 3D surfaces. Using clinically relevant implant models, we explored the effect of wet etching porous bead-coated CoCrMo. The study was designed as two paired animal experiments with 10 dogs. Each dog received four implants; one in each medial femoral condyle (loaded 0.75-mm-gap model) and one in each proximal tibia (press-fit). The implants were observed for 6 weeks and were evaluated by biomechanical pushout tests and histomorphometry. We found that wet etching porous bead-coated CoCrMo implants failed to improve implant performance. Moreover, a tendency towards increased fibrous tissue formation, decreased new bone formation, and decreased mechanical fixation was observed. Surface topography on implants is able to stimulate bone-forming cells, but the clinical performance of an implant surface perhaps relies more on 3D geometrical structure and biocompatibility. Caution should be exercised regarding the results of wet etching of porous bead-coated CoCrMo and there is a need for more preclinical trials.
Bovine and PTFE Vascular Graft Results in Hemodialysis Patients
Authors: Sert Ş. , Demiroǧullari B. , Anadol A. Ziya , Güvence N. , Dalgiç A. 
Published: January 2018

Purpose There are many reports of patency periods, failure rates, thrombosis and infection attacks connected with vascular grafts. In this article, the results of polytetrafluoroethylene (PTFE) and Bovine grafts were compared in a forty-four month period. Methods 61 vascular grafts (29 PTFE, 32 bovine) were placed in 49 patients. The grafts were compared in different ways, such as survival, complication rates and placement area using life survey analysis. Results Mean survival time was 17 mo (SE ± 2.8) for PTFE grafts and 11 mo (SE ± 1.1) for bovine grafts. A failure rate of 34% due only to graft complications were found in PTFE and 25% in bovine grafts. All graft complications were seen in the first year. Comparison of the cumulative survival rates of the groups were found to be insignificant during the study period and the first year (p>0.05). Regardless of the type, there was no significant difference between the grafts placed in the forearm and the grafts in the thigh (p>0.05). Conclusions There is no survival difference between PTFE and bovine grafts. First year of the grafts is important for developing complications.
Totally Implantable Central Venous Access: 15 Years’ Experience in a Single Unit
Authors: Craus W. , Di Giacomo A. , Tommasino U. , Frezza A. , Festa G. , Cricrì A.M. 
Published: January 2018

The use of Totally Implantable Central Venous Access Systems (T.I.C.V.A.S.) has become an essential aid for those patients requiring extended intravenous infusion treatments or complete parenteral nutrition, and for whom the peripheral venous system may be or may become inadequate for infusions. This paper describes fifteen years of experience in the use of totally implantable systems. It examines the application methods as well as the different systems, complications, patient satisfaction, quality of life, and cost/benefit ratio. We examined 261 patients observed during a period of approximately 15 years. A surgical team carried out the operations for these patients in an operating room under the strictest asepsis conditions. The Port-a-Cath central venous access systems were used in 221 cases (84.6%) and the Pas-Port peripheral venous access systems were used in 40 cases (15.3%). We observed no particular differences between the different types of systems implanted. The total rate of complications was 11.7%, 0.7% of which were positioning complications, 4.2% stability complications, and 6.1% management complications. There were 2 cases (0.76%) of defective performance of the implanted system. We found patient satisfaction with the method average in 19.85% of the cases, good in 70.23% and excellent in 11.9%. Quality of life improved because of reduced total hospitalization time and more convenient treatment management. Regarding the cost/benefit ratio we also found that the benefits outnumbered costs. In connection with the cost of the system the possibility of home management leads to a marked decrease in hospitalization expenditure. Today these systems should be considered as being essential in the correct management of the patient requiring medium-to-long-term infusion treatment. On the whole these treatments are well accepted by the patient and the possibility of home or day hospital management allows a marked reduction in hospitalization, which affects both social life and costs. The incidence of complications was found to be relatively low considering that most of them are the result of poor management of the system by the paramedical personnel or by the relatives of the patients. In this sense, better education in the management of the system would further optimize results.
Vascular Access Type and Changes in Infammatory Markers in Incident Dialysis Patients: A Pilot Study
Authors: Sachdeva Mala , Kovalchuk Oleksander , Bitzer Markus , Mokrzycki Michele Helene 
Published: January 2018

Purpose To determine the association between the initial hemodialysis (HD) vascular access type and short-term changes in inflammation markers. Methods This is a prospective, observational study in incident chronic kidney disease (CKD) (stages 4 and 5) patients receiving their first HD vascular access. Serum samples were obtained pre-access placement, and 1 week, and 1 month post-access insertion. Samples were tested for high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) using ELISA. Patients with known inflammatory states (infection, malignancy, connective tissue disorders, organ transplantation and those on immune modulating agents) were excluded. The hsCRP and IL-6 values were transformed into logarithmic scale. Chi-square analysis, independent and paired t-tests were performed where appropriate, and a two-way ANOVA with time as a repeated measure was also performed. Significance was determined at p=0.05. Results One-month follow-up data was obtained in 48 patients (arteriovenous fistula (AVF), n=10; tunneled catheter (TC), n=28; arteriovenous graft (AVG), n=10). A significant increase in both hsCRP (p<0.05) and IL-6 (p=0.02) occurring 1 week after TC insertion was observed. Elevation of the IL-6 levels appeared to be sustained 1 month after TC insertion, although this finding was not statistically significant (p=0.68), whereas the hsCRP levels returned to baseline within 1 month. After AVG insertion only the hsCRP levels rose significantly (p=0.01) after 1 week and returned to baseline within 1 month. In the AVF group, inflammatory markers did not change for any time period. Conclusions In CKD patients, TC and AVG insertion result in a transient state of inflammation 1 week post-operatively, which is not observed after AVF surgery. Whether this is a persistent phenomenon after TC insertion requires a larger, longitudinal study.
Prognostic Significance of Tissue-Type Plasminogen Activator (tPA) Content in Gastric Cancer and Surrounding Mucosa
Authors: Sanz L. , Vizoso F. , Vérez P. , Allende M.T. , Corte M.G. , Abdel-Lah O. , Martín A. , García-Muñíz J.L. 
Published: January 2018

Aims We analyzed the tPA content in primary gastric carcinomas and surrounding mucosa in order to assess the relationship between tPA content, clinicopathological tumor characteristics, and estrogen and progesterone receptor content. We evaluated the prognostic value of this serine protease in gastric cancer patients. Patients and methods 122 resected gastric neoplasms and 95 adjacent mucosa samples were studied. The tPA content was measured in cytosol by an ELISA method. Cytosolic ER and PgR were measured with a solid phase enzyme immunoassay. Results Cytosolic tPA levels in neoplastic tissues (median 1.0 ng/mg prot) were significantly lower (p=0.002) than those found in paired mucosa samples (median 2.3 ng/mg prot). There was no significant association between tPA levels and clinicopathological parameters or PgR content, but tPA levels were significantly correlated with ER content. The intermediate-tPA-content group, corresponding to samples with between 0.3 and 1.70 ng/mg protein, proved to have a significantly high risk of relapse. Conclusions We found a wide variability in tPA levels in gastric carcinoma and adjacent mucosa samples, with significantly decreased levels in tumors and a significantly positive relationship between tPA levels and ER status. There was a non-monotonic relationship between tPA levels and prognosis in patients with gastric cancer.
Assessment of the Value of Preoperative Serum Levels of CA 242 and CEA in the Staging and Postoperative Survival of Colorectal Adenocarcinoma Patients
Authors: Kim S.B. , Fernandes L.C. , Saad S.S. , Matos D. 
Published: January 2018

Introduction CEA is the most frequently used tumor marker in colorectal cancer. There may be an improvement in its efficacy when used in association with CA 242. Aim The purpose of this study was to evaluate the efficacy of preoperative serum levels of the tumor markers CA 242 and CEA in the staging and postoperative follow-up of colorectal adenocarcinoma patients. Patients and Methods Of a series of 134 patients with colorectal adenocarcinomas 90 underwent radical surgery and 44 palliative surgery. The control group consisted of 22 organ donors. The cutoff serum levels utilized were 5 ng/mL for CEA and 20 U/mL for CA 242. The mortality during follow-up was recorded in order to determine the duration of survival. The data were submitted to statistical analysis using diagnostic tests, the chi-square test, survival analysis (Kaplan and Meier) and ROC curves. A significance level of p ≤ 0.05 was applied. Results The sensitivity of CEA in Dukes’ stages A, B, C and D was 27.8%, 32.4%, 32.1% and 66.7%, respectively. The sensitivity of CA 242 was 11.1%, 16.2%, 30.8% and 50%. When both markers were combined, the sensitivity was 33.3%, 48.6%, 40.7% and 72.5%. In the group of patients who underwent radical surgery the mean survival was 60.47 months for those with high preoperative CEA levels, 52.22 months for those with high preoperative CA 242 levels, and 44.80 months for those with elevated levels of both markers. There was a statistically significant difference in survival between patients undergoing radical surgery with elevated CA 242 levels, especially when CEA was also elevated, and patients without elevated CA 242. Conclusion Preoperative serum levels of CA 242 showed less efficacy than CEA levels for the staging of colorectal adenocarcinoma patients. Elevated preoperative serum levels of CA 242 alone were related to poor survival, especially in association with high levels of CEA.
Cytosolic Levels of Neuron-Specific Enolase in Squamous Cell Carcinomas of the Lung
Authors: Ruibal A. , Nuñez M.I. , Rodríguez J. , Jiménez L. , Del Rio M.C. , Zapatero J. 
Published: January 2018

To study the behavior and possible correlations of neuron-specific enolase (NSE) with other clinicobiological parameters, we measured the cytosolic levels of this marker by means of an immunoradiometric assay (IRMA) in 95 squamous cell lung carcinoma samples. We also analyzed the levels of pS2, tissue-type plasminogen activator (t-PA), hyaluronic acid (HA), free beta subunit of human chorionic gonadotropin (β-HCG), CYFRA 21.1 and CA 125 in cytosol. On the cell surface we analyzed the concentrations of epidermal growth factor receptor (EGFR), HA, erbB-2 oncoprotein, CD44s, CD44v5 and CD44v6. Other parameters considered were clinical stage, lymph node involvement, histological grade (HG), ploidy and the cellular S-phase fraction measured by flow cytometry on nuclei obtained from fresh tissues. In the 95 squamous cell carcinomas the cytosolic levels of NSE varied from 4.5 to 2235 ng/mg protein (median: 267) and were significantly higher (p<0.001) than those observed in 38 samples of normal pulmonary tissue obtained from the same patients (range: 56–657; median: 141.5). When classifying tumors according to the different parameters analyzed, we observed that the levels of NSE were higher in aneuploid than in diploid cases (p=0.046) and in those that were HG3 than in those that were HG2 (p<0.001). Tumors with high NSE levels (>422 ng/mg protein; 75th percentile) were more likely to have high S-phase values (p=0.012) and were more frequently aneuploid (p=0.038) and HG3 (p<0.001) than those with low levels of NSE (<180 ng/mg protein; 25th percentile). These results lead us to the following conclusions: 1) the cytosolic concentrations of NSE are significantly higher in squamous cell carcinomas than in healthy pulmonary tissue, and 2) the cytosolic concentrations of NSE are not correlated with clinical stage or nodal involvement. However, in our study higher levels of the enzyme were statistically correlated with aneuploidy, histological grade 3 and S-phase. This may explain its association with poorer outcome and progression, but also the more favorable response of tumors with elevated NSE to chemotherapy, as suggested by other groups.
Clinical Utility of Hyperglycosylated hCG in Serum Taken before Hydatidiform Mole Evacuation to Predict Persistent Trophoblastic Disease
Authors: Duc H. Ngo , van Trommel N.E. , Sweep F.C.G.J. , Massuger L.F.A.G. , Thomas C.M.G. 
Published: January 2018

Objective Human chorionic gonadotropin (hCG) is widely used in the management of hydatidiform mole and persistent trophoblastic disease (PTD). Studies on hyperglycosylated human chorionic gonadotropin (invasive trophoblast antigen, ITA) in PTD are limited. In serum samples taken before evacuation of molar pregnancies we measured the concentrations of free hCG β-subunit (free hCGβ), “total” hCG (hCG+hCGβ) and ITA, and determined whether ITA, the two other hCG analytes, or the calculated ratios of hCGβ/hCG+hCGβ, hCGβ/ITA and hCG+hCGβ/ITA could predict the later development of PTD. Design A retrospective study based on blood specimens collected in the Dutch Central Registry for Hydatidiform Moles. The study group comprised 97 patients with hydatidiform moles who did not develop PTD after mole evacuation and 33 patients who did develop PTD. Methods Serum samples from 130 patients with hydatidiform mole with or without PTD were assayed using specific (radio)immunoassays for free hCGβ, total hCG, and ITA. From these analytes we also calculated the ratios hCGβ/hCG+hCGβ, hCGβ/ITA, and hCG+hCGβ/ITA. To predict the development of PTD from these analytes and parameters we performed receiver-operating characteristic (ROC) curve analysis, resulting in areas under the curve (AUCs) that represented the diagnostic accuracy which was rated in a range from excellent (AUC >0.9 or <0.1) to poor (AUC 0.4–0.6). Results The diagnostic accuracy of ITA was moderate (0.618) and not different from that of free hCGβ (0.610) and hCG+hCGβ (0.622). Conclusions ITA as well as the other analytes and parameters in serum taken prior to evacuation from patients with molar pregnancies cannot be used to predict the subsequent development of persistent trophoblastic disease.