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PubMed1996

[Postoperative radiotherapy in the prevention of heterotopic ossification after endoprosthetic hip joint replacement].

BACKGROUND: Following total hip arthroplasty high-grade heterotopic ossification occurs with a range of 0.5 to 27%. Local postoperative hip irradiation using different dosage and fractionation schedules reduces the incidence in high-risk cases on an average of 8%. The present retrospective study compares results after conventionally fractionated and high-dose radiotherapy. PATIENTS AND METHOD: A total of 50 hips (46 patients) from 2 different risk groups had complete follow-up. In group I (40 hips [80.0%]) radiotherapy was indicated after surgical excision of pre-existing high-grade heterotopic ossification, in group II (10 hips [20.0%]) for several risk factors (contralateral heterotopic ossification [n = 7], hypertrophic osteoarthritis [n = 2], spondylosis hyperostotica [n = 1]). In 28/50 cases (56.0%) conventionally fractionated irradiation with total doses ranging from 12.0 to 20.0 Gy was given, in 22/50 hips (44.0%) a high-dose irradiation consisting of 10.0 Gy given in 2 fractions on each of the first 2 postoperative days was applied. After a minimal observation period of 6 months (median: 22 months, range: 6 to 56 months) roentgenograms were analysed using a modified Brooker score. RESULTS: At follow-up, 2 hips in group I had recurrence of high-grade heterotopic ossification with the stages IIIA and IVB. In 1 case radiotherapy was interrupted after 3 x 2.0 Gy due to sepsis (IIIA), in the other case ectopic bone recurred from bony islands which layed outside the radiation portal (IVB). In group II, 9 patients had stage 0 and 1 patient stage IA. Statistical analysis using the Wilcoxon test showed a highly significant reduction of the amount of pre-existing heterotopic ossification (p < 0.0001) for both fractionation schedules. The comparison of both fractionation groups with the Whitney-Mann-U-test (p = 0.92) showed no statistical significant difference. CONCLUSIONS: The data about the high therapeutic efficacy of postoperative radiotherapy for prevention of heterotopic ossification were confirmed. Both fractionation schedules led to a sufficient reduction of high-grade heterotopic ossification in the 2 treated risk groups.

Adult↗
PubMed1998

Concussions in athletics: guidelines for return to sport.

Physicians are required to make determinations that affect the health and well-being of their patients on a daily basis. None of these judgements may have as profound an impact as the decisions rendered for athletes who have suffered a concussion. Concussions occur with regularity in sports and vary in severity and appropriate management. Guidelines should be followed and used as a tool to allow safe return to competitive endeavors in the athletic arena. Following guidelines will decrease the likelihood of worsening the condition with potentially fatal consequences.

Athletic Injuries↗
PubMed1996

Preoperative reverse transcriptase polymerase chain reaction for prostate specific antigen predicts treatment failure following radical prostatectomy.

PURPOSE: We previously demonstrated than an enhanced reverse transcriptase-polymerase chain reaction assay for prostate specific antigen (PSA) can predict final pathological stage in radical prostatectomy patients. The potential role of the assay in predicting serum PSA recurrence after radical prostatectomy was explored. MATERIALS AND METHODS: We evaluated 100 radical prostatectomy candidates by reverse transcriptase polymerase chain reaction preoperatively, and status was compared to serum PSA, Gleason score and final pathological results. Potential surgical failure was defined as tumor at the surgical margin or extending into the seminal vesicle. Patients were monitored postoperatively by serum PSA every 4 months. Kaplan-Meier analysis was used to evaluate the correlation between reverse transcriptase polymerase chain reaction and disease recurrence, defined as a PSA of 0.2 ng/ml. or greater. RESULTS: Enhanced reverse transcriptase polymerase chain reaction for PSA had a stronger correlation with potential surgical failure than preoperative serum PSA or Gleason score (relative risks 15.2, 5.9 and 3.2, respectively). The correlation between these modalities and PSA recurrence was evaluated during a mean followup of 13.6 months (range 5 to 26). Of 36 patients with positive reverse transcriptase polymerase chain reactions 9 had failure by PSA compared to 3 of 64 (4.7%) with negative polymerase chain reactions (p<0.0286). The relative risk for failure by reverse transcriptase polymerase chain reaction was 3.6. Gleason score and serum PSA had higher correlations with postoperative PSA elevations (relative risk 13.2 and 7.6, respectively). A Cox regression analysis model demonstrated that reverse transcriptase polymerase chain reaction for PSA can be used in conjunction with Gleason score and provides statistically significant risk information. CONCLUSIONS: Enhanced reverse transcriptase polymerase chain reaction for PSA is a statistically significant predictor of potential failure by pathological analysis and of disease recurrence by PSA. Longer followup data are required to define further the role of the assay in the management of patients with prostate cancer.

Aged↗
PubMed1999

Surgical results for spinal meningiomas.

Among a series of 782 spinal tumors, 130 spinal meningiomas in 117 patients were operated in the Department of Neurosurgery at the Nordstadt Hospital in Hannover, Germany, between 1977 and 1998. Patients were followed postoperatively for up to 13 years (mean 20 +/- 33 months). Comparing the period of 1977 through 1987, before magnetic resonance imaging (MRI) was available, to the period of 1988 to 1998 revealed that the average history until diagnosis shortened by about 6 months during the second decade of this study (24 +/- 33 to 18 +/- 29 months; not significant). Consequently, the preoperative Karnofsky Score increased significantly (59 +/- 15 and 66 +/- 16; p < 0.05). The rates of complete resection and the postoperative neurological outcome, however, remained unchanged. Even though the overall prognosis of neurological deficits is favorable after complete resection of a meningioma, a subset of 18 patients had either en plaque growing or recurrent tumors that were more likely to be removed incompletely and to cause postoperative neurological problems, with a significantly worse Karnofsky Score after 1 year (57 +/- 12 and 77 +/- 12, respectively; p < 0.01) and a significantly higher recurrence rate after 5 years (86.7% and 20.4%, respectively; log rank test p = 0.0014). In conclusion, a favorable postoperative neurological outcome requires complete resection of the spinal meningioma. The advent of MRI has shortened the time until diagnosis and made it possible to perform surgery before severe deficits have occurred, but did not have a major impact on postoperative results. En plaque and recurrent meningiomas remain surgical challenges, as infiltration of surrounding structures and associated arachnoid scarring may render complete resection difficult to achieve.

Adolescent↗
PubMed1988

Revision total hip arthroplasty with titanium ingrowth prosthesis and bone grafting for failed cemented femoral component loosening.

Fifty-seven hips (55 patients) had revision for failed cemented femoral component loosening using titanium ingrowth femoral components and cancellous bone grafting. The patients' average age was 59 years (range, 25-86 years), and the average follow-up period was 2.8 years (range, two to six years). The preoperative hip score averaged 45.5 (range, 10.0-80.7) and the postoperative hip score averaged 82.5 (range, 43.0-100.0). Complications included dislocation (4.0%), infection (4.0%, one recurrence from a previously infected hip and one acute hematogenous infection), and a 4.0% revision rate for loose femoral component. Another patient had a revision for a loose acetabular component. All parameters of hip function (i.e., pain, limp, activities of daily living, use of support, and distance walked) improved with time. Femoral component loosening is classified into four types based on the severity of loosening and instability. In Type I there is minimal endosteal or inner cortical bone loss, i.e., loosening from the cement-metal-bone interface or a broken stem (seven hips). In Type II there is proximal canal enlargement with cortical thinning of 50% or more and sometimes a lateral wall defect with an intact circumferential wall (23 hips). In Type III there is a posteromedial wall defect involving the lesser trochanter (23 hips). In Type IV there is total proximal circumferential bone loss in varying distances below the lesser trochanter (three hips). The Harris hip scores for the four groups were 93.0, 83.0, 80.0, and 78.0, respectively.

Adult↗
PubMedDate not supplied

Functional and magnetic resonance imaging evaluation after single-tendon rotator cuff reconstruction.

The aim of this study was to investigate tendon integrity after surgical repair of single-tendon rotator cuff lesions. In 31 patients, 31 single-tendon repairs were evaluated. Thirty-one patients were available for clinical assessment and magnetic resonance imaging (MRI) at follow-up. A standard series of MR images was obtained for each. The results of functional assessment were scored according to the system of Constant. According to MRI evaluation, 21 (68%) patients had an intact or thinned rotator cuff and 10 (32%) had recurrence of a full-thickness cuff defect at follow-up. Patients with an intact or thinned rotator cuff had a median Constant score of 75.5 points; patients with a full-thickness cuff defect had a median score of 62 points. There was no correlation between tendon integrity on postoperative MR images and functional outcome. Patients with intact or thinned cuffs did not have significantly better functional results than patients with retorn cuffs. Because of the presence of metal artifacts and the difficulty in distinguishing postoperative scar tissue from partial tears or thinning, MRI is of minor diagnostic value in assessing the shoulder after cuff repair. However, full-thickness tears are readily diagnosed after operation with MRI.

Adult↗
PubMed1999

Role of radical prostatectomy in patients with prostate cancer of high Gleason score.

BACKGROUND: The routine use of serum prostate-specific antigen (PSA) testing combined with digital rectal examination has lowered tumor volume and clinical-pathological stage of men undergoing radical prostatectomy. Therefore, we may identify more men with poorly differentiated tumors of early clinical stage. In order to identify those who may benefit from radical prostatectomy, we evaluated known prognostic variables in patients with prostate cancer of high Gleason score (8-10). METHODS: Of 652 patients who underwent a radical prostatectomy as monotherapy for clinically localized prostate cancer between March 1991-December 1995, 84 patients with prostatectomy specimen Gleason score 8-10 tumors were identified. Clinical-pathological data were obtained from our prostate cancer database. Gleason score, PSA level, margin status, pathologic stage, and tumor volume were analyzed as general prognostic variables for disease-free survival (DFS). Follow-up ranged from 13-84 months (median, 36.2). Biochemical recurrence was defined as a postoperative PSA elevation greater than 0.4 ng/ml. RESULTS: The DFS for patients with Gleason score 8-10 and pathologically organ-confined disease was 62.5%. DFS was 56.2% for patients with PSA < or =10 ng/ml, compared to 19.2% for patients with serum PSA >10 ng/ml (P = 0.009). Patients with nonspecimen-confined disease (positive margins) had a DFS rate of 26.6% vs. 55% for patients with specimen-confined disease (negative margins) (P = 0.009). On multivariable analysis, only preoperative PSA < or =10 ng/ml (P = 0.02) and surgical margin status (P = 0.04) were significant predictors of DFS. CONCLUSIONS: Surgical margin status and preoperative serum PSA level are independent predictors of DFS for patients with high Gleason score prostate cancer treated by radical prostatectomy as monotherapy. Patients with poorly differentiated prostate cancer treated surgically at an early stage can have a favorable prognosis, especially if negative surgical margins are obtained. A preoperative serum PSA level < or =10 ng/ml carries the greatest likelihood of achieving prolonged DFS in this group of patients.

Adult↗
PubMedDate not supplied

Risk stratification in patients with remote prior myocardial infarction using rest-stress myocardial perfusion SPECT: prognostic value and impact on referral to early catheterization.

BACKGROUND: Little is known about the prognostic value of myocardial perfusion single photon emission computed tomography (SPECT) in patients with remote prior myocardial infarction (MI). METHODS AND RESULTS: We identified 1413 consecutive patients with remote prior MI who underwent rest-stress myocardial perfusion SPECT. Semiquantitative visual analysis of 20 SPECT segments was used to define the summed stress, rest, and difference scores. The number of non-reversible segments was used as an index of infarct size. During follow-up (>or=1 year), 118 hard events occurred: 64 cardiac deaths (CDs) and 54 recurrent MIs. Annual CD and hard event rates increased significantly as a function of SPECT abnormality. For summed stress scores less than 4, 4 to 8, 9 to 13, and more than 13, the annual CD rates were 0.4%, 0.9%, 1.7%, and 3.5%, respectively (P =.002). Patients with small MI (<4 non-reversible segments) and no or mild ischemia (summed difference score or=4 non-reversible segments) had moderate to high annual CD rates (3.7%-6.6%) regardless of the extent of ischemia. Nuclear testing added incremental prognostic information to pre-scan information. Compared with a strategy in which all patients are referred to catheterization, a strategy that referred only those patients with a risk for CD of greater than 1% by myocardial perfusion SPECT resulted in a 41.6% cost savings. CONCLUSIONS: Myocardial perfusion SPECT adds incremental value to pre-scan information and is highly predictive and cost-efficient in the risk stratification of patients with remote prior MI. Patients with normal or mildly abnormal scan results or small MI in combination with absent or mild ischemia have a low risk for CD.

Adenosine↗
PubMed2004

Prostate cancer with bladder neck involvement: pathologic findings with application of a new practical method for tumor extent evaluation and recurrence-free survival after radical prostatectomy.

BACKGROUND: Recent studies have questioned the high risk for disease recurrence in cases of bladder neck involvement by prostate cancer (pT4 disease). DESIGN: The study was based on 141 patients submitted to radical prostatectomy. PSA-recurrence was defined as 0.5 ng/ml or rising at three different examinations. Bladder neck invasion was correlated to Gleason score (<7 or > or =7), urethral or lateral positive surgical margins, tumor size (extensive or not extensive) using a new simple point-count method, race and preoperative PSA levels (<10 or > or =10 ng/ml). The mean and median follow-up periods were 17.2 and 15 months (range 3-55). Recurrence-free survival curves were constructed using the Kaplan-Meier survival method with tests of significant differences based on the log-rank statistic. RESULTS: Bladder neck invasion was seen in 30/141 (21.27%) patients; 9 (6.38%) had also concomitant positive surgical margins in the sections. Extraprostatic extension was seen in 39/141 (27.65%) and seminal vesicle invasion in 18/141 (12.76%) patients. Patients with bladder neck invasion significantly correlated to Gleason score (P = 0.04), preoperative PSA (P < 0.001), and tumor extension (P= 0.04). No correlation was found to age (P = 0.44), race (P = 0.12) and positive urethral or lateral margins (P = 0.32). The PSA-recurrence relative risk in patients with bladder neck invasion was 0.17 (P = 0.68), with extraprostatic extension 0.53 (P = 0.47) and with seminal vesicle invasion 5.76 (P = 0.02). CONCLUSIONS: Bladder neck involvement correlates with pathologic unfavorable findings on radical prostatectomy specimens as well as to preoperative PSA levels. However, the PSA-recurrence risk associated with bladder neck involvement (pT4) was similar to extraprostatic extension (pT3a) and substantially lower than seminal vesicle invasion (pT3b). The findings favor a need for downstaging of bladder neck involvement in the next version of the TNM system. The method proposed for tumor extent evaluation is simple and accessible to all pathologists working in routine pathology laboratories.

Adult↗
PubMed2001

[Prognostic value of cardiac perfusion scintigraphy associated with the dobutamine test in acute coronary syndromes].

OBJECTIVES: This study aimed to establish the value of myocardial ischemia induced by the dobutamine infusion test associated to 99m technetium isonitrile single photon emission computed tomography in patients with unstable angina or non Q-wave infarction during the first days in the Coronary Care Unit. METHODS: Fifty three patients with unstable coronary syndromes and common medical treatment were studied with a moderate-dose dobutamine test (5 to 20 microgram/Kg/min) using a 99mTc-MIBI SPECT. The results were correlated with the incidence of recurrent angina, infarction, death or revascularization. RESULTS: The dobutamine test induced a reversible perfusion defect in 36 patients (68%) and angina in 12 of them (12/36, 33%). However, the patients who had a positive test had a similar incidence of events as those with a negative test (58% vs 59%). Thus, while the sensitivity of the dobutamine test to identify patients at risk was relatively high (68%), its specificity (32%) and its negative predictive value (41%) were low. The patients with dobutamine-induced angina, however, had a higher scintigraphy score (3.0 +/- 1,7 vs 1.6 +/- 1.8, p < 0.02) and a higher incidence of recurrent angina (8/12, 67% vs 13/41, 31%, p < 0.04) than those without, at a comparable double product. CONCLUSIONS: In conventionally treated patients with unstable coronary syndromes, the specificity of the inducible scintigraphic ischemia with moderate dose of dobutamine performed during the first days is too low to be used as a marker for in-hospital events. However, inducible angina with dobutamine suggests an extensive jeopardized area and/or a particularly reduced ischemic threshold.

Adrenergic beta-Agonists↗
PubMed2006

Liver transplantation for hepatocellular carcinoma in Singapore.

INTRODUCTION: The prognosis of patients with hepatocellular carcinoma (HCC) is poor. Surgical resection offers the benefit of removal of the tumour but is associated with liver decompensation and tumour recurrence, even after successful surgery. Liver transplantation offers the benefits of complete tumour removal with prevention of both decompensation and recurrence post-operation. This paper aims to review results of liver transplantation for patients with HCC in Singapore. METHODS: All adult patients with HCC accepted on the waiting list for liver transplantation (based on the Milan criteria) from 1996 to 2004 in Singapore were reviewed. Patients' HCC were managed with either transarterial chemoembolisation or percutaneous radiofrequency ablation while they were on the waiting list. Post-transplant survival and factors associated with mortality were analysed by Cox regression analysis. RESULTS: 41 patients with HCC were accepted onto the waiting list over the nine-year period. 22 underwent transplantation and 19 did not, with a one-year survival of 91 percent versus 24 percent, respectively. (p-value is less than 0.001). Mean waiting time for transplant was 39 weeks. Post-transplant HCC recurrence was 2/22 (nine percent). Among all patients, mortality was significantly related to baseline white cell counts, prothrombin time, age, alpha-foetoprotein level, Child-Pugh score, and whether patients underwent transplant. CONCLUSION: Despite the relatively long waiting time of a mean of 39 weeks, post-transplant recurrence of HCC was relatively low at nine percent. Liver transplant is an effective treatment for patients with a HCC, with a reasonable long-term survival.

Carcinoma, Hepatocellular↗
PubMed2005

[Correlative factors analysis of recurrence of endometriosis after conservative surgery].

OBJECTIVE: To determine the correlative factors with recurrence of endometriosis after conservative surgery. METHODS: A cohort study was performed on 285 patients who had a minimum of 36 months of follow-up after conservative surgery for endometriosis. All patients underwent clinical interview, physical examination and ultrasonography. The factors measured included: age at surgery, age at onset of disease, gravidity, parity, tenderness nodule at cul-de-sac (yes/no), uterus mobility (movable/fixed), serum CA(125) level, type of operation (laparoscopy/laparotomy), history of operation for endometriosis (yes/no), side of endometrioma (left/right/bilateral), intraoperative revised classification American Fertility Society (r-AFS) scores, post-operative r-AFS scores, highest post-operative temperature, post-operative adjuvant therapy, post-operative gravidity and parity. The recurrent rate and its predictive factors were evaluated and the univariate, multivariate COX regression and Kaplan-Meier analyses were performed to determine the predictive factors for recurrence of endometriosis. RESULTS: The related factors and their odds ratio (OR) by univariate analysis were as follows: history of endometriosis surgery, 13.630 (P < 0.01); nodules with tenderness at cul-de-sac, 6.133 (P < 0.01); post-operative administration of clomiphene, 5.173 (P < 0.01); left endometrioma, 4.503 (P < 0.01); bilateral endometrioma, 3.709 (P < 0.01); post-operative r-AFS scores, 1.831 (P < 0.01); post-operative gravidity, 0.392 (P < 0.05); post-operative administration of progesterone for 6 months, 0.472 (P < 0.01); laparoscopic surgery, 0.567 (P < 0.05); pre-operative parity, 0.640 (P < 0.05); pre-operative gravidity, 0.759 (P < 0.05); age at onset of disease, 0.912 (P < 0.01) and age at surgery, 0.932 (P < 0.05). Meanwhile, the related factors and their odds ratio (OR) by multivariate COX analysis were as follows: history of endometriosis surgery, 8.219 (P < 0.01); bilateral endometrioma, 6.369 (P < 0.01); left endometrioma, 2.682 (P < 0.05); tenderness nodules at cul-de-sac, 2.154 (P < 0.05); post-operative administration of clomiphene, 1.860 (P < 0.05); post-operative r-AFS scores, 1.188 (P < 0.01); post-operative gravidity, 0.253 (P < 0.01); post-operative administration of progesterone for 6 months, 0.518 (P < 0.05); age at surgery, 0.937 (P < 0.01). CONCLUSIONS: The risk factors for recurrence of endometriosis include a history of endometriosis surgery, bilateral endometrioma, left endometrioma, tenderness nodules at cul-de-sac, post-operative administration of clomiphene, post-operative r-AFS scores,whereas the protective factors include the post-operative gravidity, post-operative adjuvant therapy and age at surgery.

Adult↗
PubMed2004

Transperineal repair of obstetric-related anovaginal fistula.

BACKGROUND: To describe an operative technique for the repair of anovaginal fistulae secondary to obstetric injury and to assess its functional outcome and patient satisfaction. METHODS: An operative repair involving division of the anovaginal fistula, closure of rectal and vaginal walls, anterior levatoplasty and overlapping sphincteroplasty is described. Postoperative complications and recurrence were recorded. A telephone interview was carried out to assess the functional outcome and the satisfaction score. RESULTS: Seven consecutive patients had a repair of an obstetric-related anovaginal fistula. Their mean age was 34 years (range: 22-72). They had a mean duration of symptoms of 14 months (range: 1.5-54). Four patients did not have any previous repair and no stoma was necessary in any of the seven patients. There was no significant postoperative complication and only one recurrence. Telephone interviews were conducted for six patients and one was lost to follow-up. The mean follow-up period was 24 months (11-35). The Wexner's continence score improved from a mean preoperative score of 13.4 to a mean postoperative score of 5.6. With satisfaction scores ranging from +3 to -3 (+3 indicating complete satisfaction and -3 indicating complete dissatisfaction), five patients scored 1 and one scored 0. CONCLUSION: This technique is straightforward and effective in healing obstetric-related anovaginal fistula. It achieves improved continence and reasonable satisfaction.

Adult↗
PubMed2006

The role of palliative radiation therapy in symptomatic locally advanced gastric cancer.

PURPOSE: To review the outcome of palliative radiotherapy (RT) alone in patients with symptomatic locally advanced or recurrent gastric cancer. METHODS AND MATERIALS: Patients with symptomatic locally advanced or recurrent gastric cancer who were managed palliatively with RT at The Cancer Institute, Singapore were retrospectively reviewed. Study end points included symptom response, median survival, and treatment toxicity (retrospectively scored using the Common Toxicity Criteria v3.0 [CTC]). RESULTS: Between November 1999 and December 2004, 33 patients with locally advanced or recurrent gastric cancer were managed with palliative intent using RT alone. Median age was 76 years (range, 38-90 years). Twenty-one (64%) patients had known distant metastatic disease at time of treatment. Key index symptoms were bleeding (24 patients), obstruction (8 patients), and pain (8 patients). The majority of patients received 30 Gy/10 fractions (17 patients). Dose fractionation regimen ranged from an 8-Gy single fraction to 40 Gy in 16 fractions. Median survival was 145 days, actuarial 12-month survival 8%. A total of 54.3% of patients (13/24) with bleeding responded (median duration of response of 140 days), 25% of patients (2/8) with obstruction responded (median duration of response of 102 days), and 25% of patients (2/8) with pain responded (median duration of response of 105 days). No obvious dose-response was evident. One Grade 3 CTC equivalent toxicity was recorded. CONCLUSION: External beam RT alone is an effective and well tolerated modality in the local palliation of gastric cancer, with palliation lasting the majority of patients' lives.

Adult↗
PubMed2003

A comparison of risk perception and psychological morbidity in women with ductal carcinoma in situ and early invasive breast cancer.

PURPOSE: To assess how women with ductal carcinoma in situ (DCIS) perceive their risks of recurrence, dying from breast cancer, and psychological distress compared to women with early stage invasive breast cancer (EIBC). PATIENTS AND METHODS: Eligible patients included those with DCIS or EIBC (T1 or T2, N0) referred to one cancer center between November 1998 and June 1999. Participants completed a self-administered survey regarding their views of their risks of developing recurrent cancer, of dying of breast cancer and the presence of psychological symptoms of distress. Responses were scored and compared between the two groups. RESULTS: In total, 495 patients were screened, 240 found ineligible, 228 patients who agreed to participate. No significant difference between the two groups was observed in perceptions of risk related to the likelihood of developing local recurrence (DCIS: 53%, EIBC 45%, P = 0.14), distant recurrence (DCIS: 36%; EIBC: 39%, P = 0.35) or dying of breast cancer (DCIS: 27%, EIBC 27%, P = 0.5). Both groups expressed similar levels of psychological distress (anxiety, DCIS: 56%, EIBC 54%, P = 0.38; depression, DCIS: 41%, EIBC, 48%, P = 0.17). CONCLUSIONS: Despite the excellent prognosis, women with DCIS express serious concerns and report similar psychological morbidity as women with invasive cancer.

Adult↗
PubMed1985

[Indications for the Bankart operation].

This is a clinical and radiological follow-up on 61 patients operated upon between 1973 and 1983 according to the Bankart technique. In 84 per cent of all cases primary dislocation had taken place before the age of thirty. On an average 11 recurrent dislocations occurred before the operative procedure was performed. The radiological follow-up comprised X-rays in a.p. position with internal rotation of 60 degrees, in tangent plane according to Hermodsson as well as in dorsal tangent plane. In the modified score of Caroit and Cyprien 34 operations had excellent, 25 good, 2 moderate and 2 poor results (recurrent postoperative dislocation and deep infection). Neglecting those cases with severe deformation of the glenoid one can state that the Bankart technique offers fair results in the treatment of recurrent dislocation of the shoulder.

Adolescent↗
PubMed2006

Two incision synovectomy and radiation treatment for diffuse pigmented villonodular synovitis of the knee with extra-articular component.

Diffuse pigmented villonodular synovitis (PVNS) of the knee is a rare, locally aggressive disease. Since 1995 the senior author has been treating patients with diffuse intra- and extra-articular PVNS of the knee with a bimodality treatment protocol, consisting of anterior and posterior open synovectomies in conjunction with external-beam radiation. The purpose of this study was to describe the surgical technique, evaluate our protocol's efficacy in limiting local recurrences, and assess its functional implications and associated morbidities. The medical records of nine consecutive patients were analyzed. Functional results were measured using the Knee Society score. The mean follow-up was 67 months (range 37-103 months). Eight patients were disease free and one patient had local recurrence, which was extra-articular, localized and non-progressive. The mean knee rating and functional rating had significantly improved from 65.2 and 70 preoperatively to 93.7 and 96.6 postoperatively respectively. Maximal knee flexion ranged from 90 degrees to 130 degrees, and only 3 patients developed flexion contractures of 5 degrees. In conclusion our bimodality protocol of anterior and posterior open synovectomies, in conjunction with external-beam radiation, limited the recurrence of diffuse intra- and extra-articular PVNS of the knee. All patients showed good-to-excellent functional outcomes and were able to return to their previous level of activity.

Adult↗
PubMed1990

Irreversible tubulointerstitial damage associated with chronic aminonucleoside nephrosis. Amelioration by angiotensin I converting enzyme inhibition.

Chronic aminonucleoside nephrosis is variably associated with tubulointerstitial damage, depending on the route and frequency of drug administration. Recently, different groups have shown this injurious tubulointerstitial process to be reversible, coinciding with the resolution of heavy proteinuria to normal values. The authors have previously shown that a single jugular intravenous administration of puromycin aminonucleoside (PA) to male Munich-Wistar rats produces a triphasic pattern of glomerular injury and proteinuria, which culminates in focal glomerulosclerosis 70 weeks after drug administration. The authors now report the later progression of the tubulointerstitial morphologic abnormalities associated with acute nephrosis (phase I), despite spontaneous resolution of glomerular injury during the intermediate period (phase II) in this model. Although treatment of rats with the angiotensin I converting enzyme inhibitor enalapril (50 mg/l drinking water) over the 70-week period did not affect the magnitude of proteinuria during the acute nephrotic phase, enalapril prevented the recurrence of proteinuria (phase III), as well as significantly reducing the severity of interstitial fibrosis, extent of tubular dilatation, and number of intratubular casts on semiquantitative scoring at the conclusion of the study. In addition, enalapril-treated rats had less low-molecular-weight protein excretion during the recurrent phase of proteinuria, suggesting a preservation of tubular functional capacity to reabsorb these proteins. In vitro cytotoxicity studies showed only the glomerular visceral epithelial cell to be sensitive to PA, in contrast with rat tubular epithelium and other cellular controls. Although the exact pathogenetic mechanism responsible for the development of the tubulointerstitial damage remains unknown, PA in vitro does not adversely affect rat tubular epithelium; there is however a clear correlation between the magnitude of recurrent proteinuria and the severity of tubulointerstitial morphologic abnormalities, as suggested by the beneficial effect of converting enzyme inhibition on both of these untoward processes.

Angiotensin-Converting Enzyme Inhibitors↗