4th Postoperative Week Research Articles

Assessment of quality-of-life outcomes after surgery for nasal polyposis with the DyNaChron questionnaire.

This prospective study assesses outcomes at 6 weeks and 7 months after radical ethmoid surgery in 65 patients with nasal polyposis using a new and detailed instrument, the DyNaChron questionnaire, which was filled in the day prior to surgery and at 6 weeks and 7 months after surgery at follow-up visits. Before surgery, the leading bothersome symptoms were olfactory disturbances (7.74 ± 2.81) and nasal obstruction (6.66 ± 2.28). After surgery (6th week and 7th month), there was a clear improvement of all symptoms including nasal obstruction, olfactory disturbances, anterior rhinorrhea, postnasal discharge, facial pain/headache and cough in comparison to baseline (p < 0.0001). Nasal obstruction was the most improved symptom (effect size of 2.24). At 7th post-operative month, the sense of smell continued to improve slightly. By contrast, the postnasal discharge score that was significantly improved at 6th post-operative week tended to worsen at 7 months (p = 0.0045). Before surgery, strong psychosocial impacts were observed in association with nasal obstruction and anterior rhinorrhea. The physical impacts of each symptom were proportionally correlated to the symptom score before and after surgery. The quality of life (QOL) related to each symptom was clearly better at 6 weeks and remained steady at 7 months after surgery. In conclusion, olfactory disorders and postnasal rhinorrhea were the main remaining symptoms after sinus surgery despite a global improvement of symptoms and quality of life. The earlier time point to stabilize QOL outcomes of endoscopic sinus surgery could be suggested at 6 weeks after surgery.

Cultivated oral mucosal epithelial transplantation for persistent epithelial defect in severe ocular surface diseases with acute inflammatory activity.

PurposeTo assess the clinical efficacy of cultivated oral mucosal epithelial transplantation (COMET) for the treatment of persistent epithelial defect (PED).MethodsWe treated 10 eyes of nine patients with PED (Stevens–Johnson syndrome: three eyes; thermal/chemical injury: five eyes; ocular cicatricial pemphigoid: two eyes) with COMET at Kyoto Prefectural University of Medicine, Kyoto, Japan from 2002 to 2008.ResultsPreoperatively, PED existed on over more than 50% of the corneal surface in seven eyes. Severe ocular surface inflammation with fibrovascular tissue surrounded the PED in all 10 eyes. At 24-weeks postoperative, PED had improved in all cases except 1 in which the patient was unable to return to the hospital (95% CI, 55.5–99.7; Wilcoxon signed-rank test, p = 0.0078). The preoperative median of logarithmic minimum angle of resolution was 1.85 (range 0.15–2.70), and 1.85, 1.85, and 1.52 at the 4th, 12th, and 24th postoperative week, respectively. The mean total preoperative ocular surface grading score was 7.0 (range 4–17). At 4 and 12 weeks postoperative, the total ocular surface grading score had improved significantly (p = 0.0020, p = 0.0078), and at 24 weeks postoperative, it was 3.0 (range 2–12, p = 0.0234). During the follow-up period (median 23.3 months, range 5.6–39.7 months), no recurrence of PED was observed in any eye, and long-term ocular surface stability was obtained.ConclusionCOMET enabled complete epithelialization of PED and stabilization of the ocular surface in patients with severe ocular surface disease, thus preventing end-stage cicatrization and vision loss at a later stage.

Evaluation of pulsed electromagnetic stimulation for the enhancement of femoral fracture healing in dogs

The clinical study was conducted on twelve dogs of either sex having midshaft oblique fracture of right femur and divided into two groups comprising of six animals in each group. Under anaesthetic combination of atropine sulphate, xylazine hydrochloride, diazepam and ketamine hydrochloride, the fractured fragments were reduced and stabilised with stack pinning and two cerclage wiring. Group I animals were treated as control and received only postoperative care and management. Group II animals were treated with pulsed electromagnetic field (PEMF) stimulation of 75 Hz for 20 min daily for 15 days for enhancement of fracture healing along with postoperative care and management. The clinical union of cutaneous wounds were observed on 9th and 7th day in animals of group I and II. Full weight bearing was observed on 50th day and 29th day in Group I and Group II animals respectively. Radiographically there was abundant periosteal callus with persistence of fracture line on 8th postoperative week in animals of group I and complete union of fracture with minimal periosteal callus on 6th postoperative week in animals of group II. Positive osteomedullographic signs and clearance of contrast medium in all the animals of group I and II on 60th postoperative day indicated reestablishment of intraosseous and extraosseous network. Pulsed electromagnetic stimulation was found to be an effective non invasive technique in enhancement of femoral fracture healing without any complication and can be used as an adjunct to internal fixation for fracture treatment

The Effects of Systemic IGF-I on the Arterial Anastomosis in Rats

Objective: In this study, we aimed to document the effects of a well-known agent — “insulin-like growth factor (IGF-I)” — on the microvascular anastomosis site. Methods: Sixteen Sprague-Dawley rats were used in this study. The rats were classified randomly into two equally numbered groups (eight rats each): the control (Group 1) and the experiment group (Group 2). The femoral artery was dissected completely in all rats. Following division of the artery, anastomoses were conducted with microvascular techniques. Forty-five minutes after the anastomoses, an Acland milking test was performed in order to check the patency and the first surgical session was terminated. In the second stage, LONG® R3 IGF-I human (Sigma-Aldrich, St. Louis, Missouri, United States) solution was introduced to Group 2 (experimental group) intraperitoneally in doses of 2 mg/kg on the day of the surgery in addition to the third and seventh days postoperatively. On the 4th postoperative week, the patency of the anastomoses was evaluated with the Acland milking test. In addition, one centimeter of a vascular segment including the anastomosis site was excised and stained with hematoxylin-eosin. They were evaluated for edema, inflammation, vascular wall injury, intimal hyperplasia, medial atrophy, thrombus, calcification, foreign body reactions, and the endothelial proliferation. Results: The Acland milking test showed a 100% vascular patency in both groups. A statistically significant difference was found between the experimental and control groups in terms of edema and vascular wall injury (p0.05). Conclusion: Under the light of the obtained data, IGF-I was effective in preventing the edema and vascular wall injury at the anastomosis site. However, the net positive clinical effect on anastomosis patency necessitates further studies.

Role of subcutaneous closure in preventing wound complications after cesarean delivery with Pfannenstiel incision: a randomized clinical trial.

The aim of this study was to evaluate the role of suture closure of the subcutaneous tissue in preventing wound complications after cesarean section with a Pfannenstiel incision, and to investigate factors associated with wound complications. Patients undergoing cesarean delivery were randomly assigned to either suture closure or non-closure of the subcutaneous tissue. The participants were invited to two follow-up examinations at the 1st and 4th postoperative weeks for the detection of wound complications. The two main outcomes were composite wound complication and superficial wound separation. Factors associated with wound complications were analyzed using multiple logistic regression. During the study period, a total of 361 patients (176 in the closure group, 185 in non-closure group) were analyzed. Composite wound complication occurred in 23.3% (41/176) of the closure group, and in 20% (37/185) of the non-closure group with no significant difference (P = 0.44). Wound separation occurred in 2.3% (4/176) of the closure group and 1.6% (3/185) of the non-closure group without any significant differences (P = 0.64). None of the factors were found to be associated with the rate of composite complication. The significant factors found to be associated with wound separation were subcutaneous tissue thickness of 4 cm or more (P = 0.01) and maternal diabetes mellitus (P = 0.01), however they lost their significance in multivariate analyses. The rate of wound complications, including superficial wound separation, did not differ according to the subcutaneous closure in cesarean delivery with Pfannenstiel incision. It is not possible to predict wound complications using previously defined clinical and operative risk factors, including subcutaneous tissue thickness.

Radiodensitometric Assessment of the Effect of Pulsed Electromagnetic Field Stimulation Versus Low Intensity Laser Irradiation on Mandibular Fracture Repair: A Preliminary Clinical Trial.

Closed reduction of mandibular fractures usually entails a relatively long period of immobilization, with the subsequent delay of rehabilitation. Therefore, shorter immobilization period with various approaches to protect or enhance bone healing have been investigated. The aim of this study was to analyze the effects of pulsed electromagnetic field (PEMF) and low intensity laser irradiation (LILI) on the fracture healing process, through radiodensitometric assessment of the bone callus. Eighteen patients with mandibular fractures at the tooth bearing area participated in this prospective study. They were treated by closed reduction using maxillo-mandibular fixation (MMF) and were consecutively assigned into 1 of 3 groups. In group A, the fracture sites were exposed to PEMF for 2h daily for 12days. In group B, the fracture sites were exposed to LILI on the tenth and twelfth postoperative days (2 sessions of 6min per day 2h apart). The fracture sites in group C acted as controls. MMF was maintained for 2weeks in group A and 4weeks in groups B and C. The bone fracture healing was evaluated clinically by investigating the union of the fractured segments and radiographically using computerized densitometry. The union of the fractured segments was tested by manual manipulation and the occlusion was assessed upon removal of MMF. Standardized digital panoramic radiographs were performed for each patient, immediately postoperatively as well as at 2 and 4weeks. The digital images were manipulated using the IDRISI software. A rectangular area of 10×15mm was drawn along the center of the fracture line. The obtained densitometry values were expressed in gray levels from 0 to 256. The collected data were then tabulated and statistically analyzed. After releasing the MMF, the bimanual mobility test of the fractured segments in all patients showed stability of the segments. The preinjury occlusion was maintained in all patients. The postoperative radiographs of all patients revealed good bony alignment of the bony segments. In all groups, comparison between the study intervals with respect to both means and changes percentages of the bone density values showed insignificant differences. At 2nd postoperative week, the mean bone density at the fracture sites decreased by 4.74, 6.6 and 27.89% in groups A, B and C respectively. The period from the 2nd to the 4th postoperative weeks showed increase in the bone density by 1.49, 1.95 and 14.12% in groups A, B and C respectively. Insignificant difference was found between the means of bone densities of group A and B throughout the study intervals. On the other hand, both groups showed insignificant difference with group C immediately postoperative and significant increase in bone density at the 2nd and 4th postoperative weeks. Short period immobilization of mandibular fractures for 2weeks supplemented with PEMF is recommended. Further studies are needed to evaluate the efficacy of LILI as a supplement to reduce the mandibular fracture immobilization period.

In vivo hip joint loads during three methods of walking with forearm crutches

BackgroundPatients with osteoarthritis, joint implants or fractures use crutches in order to reduce lower limb loading. However, insufficient information exists on how much the loading is then in fact reduced. This situation was studied by using seven patients who had instrumented hip implants. MethodsPart I: To investigate the effectiveness of forearm crutches, crutch and hip joint contact forces were measured in seven patients with instrumented hip prostheses. Additionally, the bending moments in the implant neck and torsion around its stem were determined. Reductions of peak loads during 3, 4, and 2-point gaits were compared with loads present when walking without crutches.Part II: This examines joint load reduction during a 4-point gait from one to 12weeks post-operatively. FindingsPart I: During a 3, 4, and 2-point gait, the joint force was 17, 12, and 13% lower than it was while walking without crutches. The corresponding reductions of the bending moment were 16, 11, and 12%, while the maximum torque decreased by 19, 21, and 10%.Part II: The reductions of contact forces in comparison with walking without crutches were highest during the first 4weeks after surgery. One and 4weeks post-operatively, the force maximum was 21 and 8% lower than it was after 3months. When compared with the initial values of the 1st week, crutch forces decreased by 28% in the 4th week and by 38% in the 3rd month. InterpretationAverage reductions of the joint load by more than 20% are achieved only during the first 4 post-operative weeks. Because fractures are in most cases relatively stable after 6weeks, and bone ingrowth into implant interfaces is nearly finished after this time, a single crutch and a 2-point gait can be prescribed during the 5th and 6th post-operative week.

Incidence of Post-Operative Venous Thromboembolism Using Compression Ultrasonography Following Trauma to Spine and Long Bones of Lower Extremity

Background: Venous thromboembolism is an important and potentially a fatal complication if not suspected and treated promptly. Various diagnostic modalities are available to detect Deep Vein Thrombosis (DVT), but each has its merits and demerits. Compression ultrasonography is a non-invasive method to diagnose DVT. This study was undertaken to evaluate the incidence of DVT using compression ultrasonography in the patients who underwent surgery of the spine and long bones of lower extremity following trauma. Material & Methods: All patients who underwent surgery following trauma to the spine and long bones of lower extremity were screened using Venous B-mode ultrasonography and color Doppler imaging. None of the patients received prophylaxis against DVT. The patients were selected on the basis of the following findings: 1) Immediately in patients found to have clinical DVT following surgery; 2) Every odd number of patients who underwent surgery and did not show signs and symptoms of DVT on the 7th, 14th post operative day and 6th post operative week. Results: The incidence of DVT using compression ultrasonography in the patients who underwent surgery of the spine and long bones of lower extremity following trauma was 17 percent. The incidence of DVT has no correlation with various clinical variables. Conclusion: The observed incidence of DVT is reasonably high and it is a potential risk factor for the development of pulmonary embolism.

Visual Improvement after Cultivated Oral Mucosal Epithelial Transplantation

To report the effectiveness, disease-specific outcomes, and safety of cultivated oral mucosal epithelial sheet transplantation (COMET), with the primary objective of visual improvement. Noncomparative, retrospective, interventional case series. This study involved 46 eyes in 40 patients with complete limbal stem cell deficiency (LSCD) who underwent COMET for visual improvement. These LSCD disorders fell into the following 4 categories: Stevens-Johnson syndrome (SJS; 21 eyes), ocular cicatricial pemphigoid (OCP; 10 eyes), thermal or chemical injury (7 eyes), or other diseases (8 eyes). Best-corrected visual acuity (BCVA) and ocular surface grading score were examined before surgery; at the 4th, 12th, and 24th postoperative week; and at the last follow-up. Data on COMET-related adverse events and postoperative management were collected. The outcomes in each disease category were evaluated separately. The primary outcome was the change in median logarithm of the minimum angle of resolution (logMAR) BCVA at the 24th postoperative week. The secondary outcome was the ocular surface grading score. Median logMAR BCVA at baseline was 2.40 (range, 1.10 to 3.00). In SJS, logMAR BCVA improved significantly during the 24 weeks after surgery. In contrast, the BCVA in OCP was improved significantly only at the 4th postoperative week. In 6 of the 7 thermal or chemical injury cases, logMAR BCVA improved after planned penetrating keratoplasty or deep lamellar keratoplasty. Grading scores of ocular surface abnormalities improved in all categories. Of 31 patients with vision loss (logMAR BCVA, >2) at baseline, COMET produced improvement (logMAR BCVA, ≤2) in 15 patients (48%). Visual improvement was maintained with long-term follow-up (median, 28.7 months). Multivariate stepwise logistic regression analysis showed that corneal neovascularization and symblepharon were correlated significantly with logMAR BCVA improvement at the 24th postoperative week (P=0.0023 and P=0.0173, respectively). Although postoperative persistent epithelial defects and slight to moderate corneal infection occurred in the eyes of 16 and 2 patients, respectively, all were treated successfully with no eye perforation. Long-term visual improvement was achievable in cases of complete LSCD. Cultivated oral mucosal epithelial sheet transplantation offered substantial visual improvement even for patients with end-stage severe ocular surface disorders accompanying severe tear deficiency. Patients with corneal blindness such as SJS benefited from critical improvement of visual acuity. The author(s) have no proprietary or commercial interest in anymaterials discussed in this article.

Effect of ginkgo biloba extract on recovery after facial nerve crush injury in the rat

Background and objectiveMany pharmacological agents have shown successful results in experimental crush injury of the peripheral nerve. To date, therapeutic effect of ginkgo biloba extract (GBE) on the peripheral nerve crush injury of rats has been rarely reported, moreover, neuroprotective effect on the facial nerve crush injury has not been reported. Materials and methodsProspective functional recovery, using a vibrissae movement and electrophysiological analysis of recovery 4 weeks after the facial nerve crush in adult rats, and comparison with randomized intraperitoneal injection of either GBE or control phosphate buffered saline. ResultsRelative to the control group (26 days post operation), administration of GBE significantly accelerated the recovery of vibrissae orientation to 11.7 days post the operation. A significant functional recovery was observed by postoperative 2nd week in the experimental group. The recovery of threshold and conduction velocity, postoperative 4th week in the experimental group, showed statistically significant difference compared to that of the control group. ConclusionFrom this result, intraperitoneal injection of GBE has been found effective in promoting the regeneration of the nerve in an experimental facial nerve crush rat model. Further studies, including morphological and molecular analyses, are necessary to clarify the mechanisms of GBE on the facial nerve crush.

Étude prospective chez 100 patients des résultats de la technique d’anastomose urétéro-iléale en double cheminée dans la néovessie de Hautmann

We attempted to determine the results of the ureterointestinal anastomosis in the Hautmann orthotopic ileal neobladder. This study was conducted prospectively and focused on ureteral stricture, which occurs mainly during the 2 years after surgery. Between January1999 and June 2009, a total of 100 consecutive patients (five women and 95 men) with bladder cancer underwent cystectomy followed by construction of a Hautmann neobladder. The median age of the patients was 62 (36-78) years. The mean follow-up was 63 (±28) months and included physical examination, serum creatinine values, urine cytology, CT scans and renal ultrasonography. A total of 197 renal units (RU) were included. In eleven RU, hydronephrosis was present preoperatively and improved postoperatively. In ten others RU, hydronephrosis persisted postoperatively without symptoms. The anastomotic stricture rate was 4%, concerning eight RU by seven patients. Five inflammatory strictures (2.5%) occurred early on the 5th, 6th, 8th and 13th postoperative weeks and were revealed by pyelonephritis. Three strictures were tumors in nature and were revealed by urine cytology and radiology on the 6th, 7th and the 14th month respectively. The five inflammatory strictures were treated with percutaneous nephrostomy, balloon dilatation and ureteral stenting. For three of these four patients, surgical reimplantation was necessary on the 4th, 5th and 7th months, like in the case of the three tumoral strictures. With a minimal 2 years follow-up, ureterointestinal anastomosis with double chimney had, in this study, a 4% rate of anastomotic stenosis. The surgical modification avoiding tension seemed to preserve ureteral vascularization.

Mechanical testing and osteointegration of titanium implant with calcium phosphate bone cement and autograft alternatives

The purpose of this study was to evaluate the osteointegration of a titanium (Ti) implant with the calcium phosphate cement (CPC) and autograft prostheses by pull-out test and histological examination. Stems of sixty Ti cylinders were bilaterally inserted into femoral medullary canals in 30 rabbits at the 1st, 4th, 12th, 26th and 70th postoperative weeks. The bone autograft and CPC were filled into the pre-trimmed bone marrow cavity with a polymethyl methacrylate retarder in the distal end, and then a Ti cylinder was inserted into femurs. The CPC group was significantly ( p < 0.05 ) associated with a larger pull-out force at 4th (37%) and 12th (62%) weeks compared to the autograft group. The bone area and the bone-to-implant contact ratios of the CPC groups were significantly higher than that of the autograft groups at early healing stage. The histological exams suggest that the CPC enhanced the earlier bone formation around the implant at a period not longer than 12 weeks postoperation. We conclude that CPC graft has the higher ability to facilitate the osteointegration and stabilize the Ti implant at a relatively early stage than the autograft in vivo.

重组大鼠胰岛素样生长因子－1聚（乳酸－羟基乙酸）共聚物缓释微球对2型糖尿病GK大鼠种植体周围骨形成的影响

To evaluate the effect of sustained release of recombinant rat insulin-like growth factor-1(rrIGF-1) from poly (lactide-CO-glycolide) (PLGA) microspheres on bone formation in the peri-implant areas in Goto-Kakizaki rats with type 2 diabetes. Type 2 diabetes models were successfully established in 20 male Goto-Kakizaki rats, which were then randomly divided into treatment group (sustained release of rrIGF-1 from PLGA microspheres were loaded on the peri-implant areas, n=10) and diabetic group (loaded with isodose placebo from PLGA microspheres, n=10). Another ten male SD rats served as control group (did not sustain any loading). Titanium implants were inserted into the tibias of 30 diabetic and normal animals. Four, 5, and 8 weeks after implantation, local blood samples around the implants were obtained for the determination of serum osteocalcin (OCN), serum bone specific alkaline phosphatase (B-ALP), and serum procollagen I carboxyterminal propeptide (PICP) with enzyme linked immunosorbent assays. Four weeks after implantation, OCN, B-ALP, and PICP were significantly lower in both treatment group and diabetic group than in control group(both P<0.05). Five weeks after implantation, serum OCN and B-ALP levels of the diabetic group were significantly lower than those of the other two groups (all P<0.05). Serum PICP levels of both diabetic group and treatment group were significantly lower than that of control group(both P<0.05). The OCN level in the trealment group was significantly higher in the post-operative 5th week than in the post-operative 4th week, while the PICP levels in the diabetic group were significantly lower than those in the treatment group and control group in the post-operative 8th week (both P<0.05). Sustained release of rrIGF-1 from PLGA microspheres loaded on the local peri-implant areas can promote bone formation in the peri-implant areas in Goto-Kakizaki rats with type 2 diabetes.

Microscopic evidences that bone marrow mononuclear cell treatment improves sciatic nerve regeneration after neurorrhaphy

Cell therapy constitutes a possibility for improving nerve regeneration, increasing the success of nerve repair. We evaluate the use of mononuclear cells in the regeneration of the sciatic nerve after axotomy followed by end-to-end neurorrhaphy. Forty adult male Wistar rats (250-300 g) were divided into four groups: (1) sham, (2) neurorrhaphy: the sciatic nerve was sectioned and repaired using epineural sutures, (3) culture medium: after the suture, received an injection of 10 μL of culture medium into the nerve, and (4) mononuclear cell: after the suture, a concentration of 3 × 10(6) of mononuclear cell was injected in epineurium region. Mononuclear cells were obtained from the bone marrow aspirates and separated by Ficoll-Hypaque method. The histological analyses were performed at the 4th postoperative day. The sciatic functional index, histological, and morphometric analyzes were used to evaluate nerve regeneration at the 6th postoperative week. Six rats were used for immunohistochemical analysis on the 4th postoperative day. In the group 4, on the fourth day, the histological analysis demonstrated a more accelerated degenerative process and an increase of the neurotrophic factors was observed. In the 6th week, all the morphometric results of the group 4 were statistically better compared with groups 2 and 3. There was a statistically significant improvement in the sciatic functional index for group 4 compared with groups 2 and 3. Mononuclear cells stimulated nerve regeneration, most probably by speeding up the Wallerian degeneration process as well as stimulating the synthesis of neurotrophic factors.

Late Results of a Simple Closure Technique and Helicobacter Pylori Eradication in Duodenal Ulcer Perforation

Background and aim: The aim of this study is to determine the incidence of Helicobacter pylori (H. pylori) in patients operated on for duodenal ulcer perforation and to evaluate the late results of a simple closure technique in patients positive and negative for H. pylori.Methods: The data of 84 patients who underwent simple closure for duodenal ulcer between 2003–2007 were retrospectively studied. Antral biopsy material taken from all patients during laparotomy was studied with the rapid urease test and the patients were then separated into 2 groups. Group 1 (H. Pylori positive) received postoperative H. pylori eradication treatment, and Group 2 (H. pylori negative) received only lansaprasol treatment after surgery. All patients were evaluated with upper gastrointestinal endoscopy on the 6th and 14th postoperative weeks. Primary treatment failure was considered in patients who had non-healing ulcers after 14 weeks. Patients with healed ulcers were scheduled for annual examinations. The results were compared between the groups.Results: The rate of H.pylori infection in duodenal ulcer perforation was found to be 80.9%. Ulcer healing rates on the postoperative 6th and 14th weeks were 88.2% and 97.5% in the first group, and 68.8% and 81.2% in the second group, respectively. Mean postoperative follow-up was 41.28 ± 17.63 (range 17–73) months. Ulcer recurrence rate was found to be 4.54% in Group 1 and 30.76% in group 2 (p = 0.012).Conclusions: All patients with a perforated peptic ulcer should be treated with simple closure of the perforation followed by medical therapy aimed at healing the ulcer. We believe that H. pylori negative patients have more risk of recurrence and such patients require close postoperative follow-up.

The Standard Implantation of a Total Hip Prosthesis Via Two Incisions (the Yale Technique)

Implantation of a total hip endoprosthesis with minimal trauma to the soft tissue. The need for visual aids (e.g., navigation or X-rays) during the procedure is frequently avoided. All kinds of coxarthrosis for every age group, for every variation of bone construction, and even in obese patients. Extremely dysplastic hip joints involving the development of a secondary socket and the necessity of reconstruction of the acetabular socket (e.g., in the Harris method). Using a fixed lateral position, a small entry incision is made between the tensor fasciae latae and the sartorius muscles and the prosthesis socket is put into place. Via a second dorsal incision, after stripping the exterior rotators, the prosthesis stem and ball are implanted and the two parts of the prosthesis are attached. Full weight bearing allowed immediately. A luxation prophylaxis, in the form of a self-developed hip bodice (the so-called Yale bandage), is used until the end of the 4th postoperative week. Discharge from hospital is possible after just a few days. Upon discharge, the patient is sent to a rehabilitation facility, either as a resident or as an outpatient, for approximately 3 weeks. Return to the workplace, with only light physical activity, is possible once the wound has healed completely; this could be as soon as 14 days after the operation. Checkups are made after 4 weeks, 6 months, 1 year and then every year; these checkups include a full examination, X-rays and laboratory tests. Full exposure to sport or heavy manual labor is usually approved after the 6-month checkup. Between October 2004 and April 2006, a total of 221 patients underwent surgery using this new technique (of these 15 patients underwent two-stage bilateral hip joint replacements). Patients were followed up for a minimum of 12 months and a maximum of 30 months. The Harris Hip Score improved from an average of 45.25 preoperatively to 96.4 postoperatively.

Minimally Invasive Locked Plating of Distal Tibia Fractures is Safe and Effective

Distal tibial fractures are difficult to manage. Limited soft tissue and poor vascularity impose limitations for traditional plating techniques that require large exposures. The nature of the limitations for traditional plating techniques is intrinsic to the large exposure required to approach distal tibia, a bone characterized by limited soft tissue coverage and poor vascularity. The locking plate (LP) is a new device for treatment of fractures. We assessed the bone union rate, deformity, leg-length discrepancy, ankle range of motion, return to preinjury activities, infection, and complication rate in 21 selected patients who underwent minimally invasive osteosynthesis of closed distal tibia fractures with an LP. According to the AO classification, there were 12 Type A, 5 Type B, and 4 Type C fractures. The minimum followup was 2 years (average, 2.8 years; range, 2-4 years). Two patients were lost to followup. Union was achieved in all but one patient by the 24th postoperative week. Four patients had angular deformity less than 7 degrees . No patient had a leg-length discrepancy more than 1.1 cm. Five patients had ankle range of motion less than 20 degrees compared with the contralateral side. Sixteen patients had not returned to their preinjury sporting or leisure activities. Three patients developed a delayed infection. We judge the LP a reasonable device for treating distal tibia fractures. The level of physical activities appears permanently reduced in most patients. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Experimental study of reservation flaval ligament on prevention of peridural adhesion after operation on lumbar disc

Through an experiment in rabbits, to evaluate the role of reservation flaval ligament using different methods to prevent the epidural adhesion by observing the morphological changes and provide experiment evidences for clinic. 45 adult rabbits were divided into three groups: Group A (treated with no reservation of flaval ligament), Group B (treated with reserving half flaval ligament), and Group C (treated with reserving the complete flaval ligament). Every group has 15 rabbits. At the 2nd, 4th and 8th weeks, the samples were obtained for gross observation, histological examinations, and the images were analysed by computer. The data were processed using SPSS11.5. Gross Observation and Histological Examinations, at the 2nd, 4th and 8th postoperative week, there was significant difference between the group A, B and C (gross observation: F2w=4.660, F4w=8.591, F8w=31.858, P<0.05; histological examinations: F2w=5.190, F4w=9.561, F8w=34.658, P<0.05). Images analysis: the difference was very significant in the groups at 2nd, 4th and 8th weeks (F2w=30.783, F4w=47.350, F8w=25.544, P<0.01). With time passing, the ratio became larger and larger in the same group. Reserving the complete flaval ligament can significantly prevent the peridural adhesion from the back as a barrier, and can reduce the adhesion formed.

Treatment of supracondylar fractures of the humerus in children through an anterior approach is a safe and effective method

In this prospective case series we evaluated the effectiveness and safety of using an anterior approach to paediatric supracondylar humerus fractures. We gathered data on 46 children that had a displaced supracondylar fracture of the humerus. All the patients had sustained a Gartland type III extension fracture that could not be reduced by closed means. Open reduction through an anterior approach was performed and two Kirschner wires were used to fix the fracture to the medial and lateral sides. Patients were recalled for follow-up and were evaluated using Flynn's radiological and clinical criteria. Loss of extension and flexion was noted by clinical assessment and carrying angle measured on radiograms. A follow-up examination performed in the 24th postoperative week showed that all fractures had healed; the patients' outcomes were rated as excellent or good according to Flynn's criteria. As a result the anterior approach for open reduction of paediatric supracondylar humeral fractures is a safe and reliable method with very good results.

Endoscopic bougienage of benign anastomotic strictures in patients after esophageal resection: the effect of the extent of stricture on bougienage results

The aim of our retrospective study was to determine the incidence of benign anastomotic strictures (BAS) in patients after esophageal resection and to examine the influence of the extent of BAS on the results of bougienage therapy. From January 2001 to July 2006, 79 patients at risk of BAS development were included in the study. BAS was diagnosed with a median delay of 8 weeks (4-26) postoperative in 23 patients (29%). A median of 4 bougienage sessions (2-20) was needed for success (success rate 100%). The mean follow-up time was 22 months [range 3-47]. There were no late recurrences of BAS. Five patients had an anastomosis diameter <5.5 mm and 14 patients >5.5 mm. There was no difference in median number of bougienage procedures in these subgroups (4.5 [2-9] vs. 4 [2-20]). Patients who presented with BAS earlier than 6 weeks postoperative had more procedures (median 8 [2-20] vs. 4 [2-9]) than those presenting later. Patients in whom first bougienage was possible to only 16 mm diameter needed more procedures than patients in whom first dilation was possible to more than 16 mm (median 5.5 [3-20] vs. 3 [2-9]). In conclusion, both early BAS development and the diameter of bougienage at first endoscopy, but not the extent of stricture, seem to be predictive factors for longer bougienage therapy. In order to influence the BAS formation early, we now routinely examine every patient after esophageal resection endoscopically in the 6th postoperative week.