Concurrent Pathology Research Articles

High frequency of labral pathology in symptomatic borderline dysplasia: a prospective magnetic resonance arthrography study of 99 patients.

Labral pathology is seen in both dysplastic and borderline dysplastic hips. Periacetabular osteotomy (PAO) is the treatment of choice for dysplasia. However, some authors have suggested that borderline dysplastic hips with concurrent labral pathology should be treated arthroscopically. The purpose of this study was to investigate the frequency of labral pathology between dysplastic and borderline dysplastic hips, whether centre-edge (CE) angle is associated with labral pathology, and finally if pain and labral pathology are associated. Ninety-nine symptomatic patients (104 hips) scheduled for PAO were examined. Five patients were excluded due to complaints from multiple joints and four failed to show at 2-year follow-up. Five patients did not fill out questionnaires preoperatively. Hips were characterized as dysplastic (CE angle <20°) and borderline dysplastic (CE angle 20° ≤ 25°). A magnetic resonance arthrography was performed, and labral pathology was classified according to the Czerny classification. Association with the CE angle, the acetabular index (AI) and preoperative WOMAC pain score was tested by multiple linear regression. There was no significant difference in frequency of labral pathology when comparing the two groups. Across the cohort, 86 of 99 patients had labral pathology. The CE angle was associated with increasing severity of labral pathology, whereas the AI angle and preoperative pain were not associated with labral pathology. Decreased lateral coverage adversely loads the labrum, predisposing it to tears. We advocate reorienting the biomechanical forces through PAO, not arthroscopic treatment. Level of pain was not associated with labral pathology, suggesting that labral pathology may not alone explain the dysplastic pain complex.

Le rétrécissement aortique de la personne très âgée : la révolution du TAVI

TAVI is currently recommended for severe symptomatic aortic stenosis in patients at prohibitive, high or intermediate surgical risk as estimated by surgical risk scores (STS score and EuroSCORE II). Comorbidity, technical feasibility of TAVI and concurrent pathology with need for complementary surgical correction are conditions to be considered to choose between open surgery and TAVI. The decision is often made by the "Heart Team". The transfemoral access must be favored. Conduction disturbance, stroke, bioprosthesis thrombosis and durability are the main setbacks of TAVI. Double antiplatelet therapy with aspirin and clopidogrel during 3 to 6 months is currently recommended after TAVI, followed by long-term aspirin single therapy.

Association of Fasciola gigantica Co-infection With Bovine Tuberculosis Infection and Diagnosis in a Naturally Infected Cattle Population in Africa.

Bovine tuberculosis (bTB), caused by Mycobacterium bovis, remains a major livestock and public health problem in both high and low-income countries. With the current absence of an effective vaccine, control in cattle populations is reliant on regular testing and removal of positive animals. However, surveillance and control are hampered by imperfect diagnostic tests that have poorly described properties in naturally infected populations. Recent research in cattle co-infected with the temperate liver fluke, Fasciola hepatica, has raised concerns about the performance of the intradermal skin test in high fluke incidence areas. Further, recent studies of parasitic co-infections have demonstrated their impact on Th1 and Th2 responses, concurrent disease pathology and susceptibility to mycobacterial infections. Here we report for the first time the association of co-infection with the tropical liver fluke, Fasciola gigantica, with the presence of bTB-like lesions and the IFN-γ response in naturally infected African cattle. After adjusting for age and sex we observed a complex interaction between fluke status and breed. Fulani cattle had a higher risk of having bTB-like lesions than the mixed breed group. The risk of bTB-like lesions increased in the mixed breed group if they had concurrent evidence of fluke pathology but was less clear in the coinfected Fulani breed. Further, we observed a slight decline in the IFN-γ levels in fluke infected animals. Finally we explored factors associated with IFN-γ false negative results compared to the presence of bTB-like lesions. Fulani cattle had a higher risk of having a false negative result compared to the mixed breed group. Further, the mixed breed cattle had an increased risk of being false negative if also co-infected with fluke. Interesting, as with the risk of bTB-like lesions, this association was less clear in the Fulani cattle with weak evidence of a slight decrease in risk of having a false negative test result when fluke pathology positive. This interesting interaction where different breeds appear to have different responses to co-infections is intriguing but further work is needed to confirm and understand more clearly the possible confounding effects of different other co-infections not measured here, breed, management or exposure risks.

Cerebrovascular disease influences functional and structural network connectivity in patients with amnestic mild cognitive impairment and Alzheimer\u2019s disease

BackgroundPatients with amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD) show functional and structural connectivity alterations in the default mode network (DMN) while cerebrovascular disease (CeVD) shows functional and structural connectivity changes in the executive control network (ECN). Such disruptions are associated with memory and executive function impairment, respectively. Concurrent AD and CeVD pathology is associated with a higher rate of cognitive decline and differential neurodegenerative patterns. Together, such findings are likely reflective of different underlying pathology in AD with and without CeVD. However, few studies have examined the effect of CeVD on network functional connectivity (task-free functional magnetic resonance imaging (fMRI)) and structural connectivity (diffusion MRI) of the DMN and ECN in aMCI and AD using a hypothesis-driven multiple seed-based approach.MethodsWe examined functional and structural connectivity network changes in 39 aMCI, 50 aMCI+CeVD, 47 AD, 47 AD+CeVD, and 65 healthy controls (HCs) and their associations with cognitive impairment in the executive/attention and memory domains.ResultsWe demonstrate divergent DMN and ECN functional connectivity changes in CeVD and non-CeVD subjects. Compared with controls, intra-DMN hippocampal functional connectivity reductions were observed in both AD and AD+CeVD, while intra-DMN parietal and medial prefrontal-parietal functional connectivity was higher in AD+CeVD and aMCI+CeVD, but lower in AD. Intra-ECN frontal functional connectivity increases and fronto-parietal functional connectivity decreases occurred in CeVD but not non-CeVD subjects. Such functional connectivity alterations were related with cognitive impairment in a dissociative manner: intra-DMN functional connectivity changes were associated with worse cognition primarily in non-CeVD groups, while intra-ECN functional connectivity changes were associated with worse cognition primarily in CeVD groups. Additionally, CeVD and non-CeVD groups showed overlapping and distinct alterations in inter-network DMN-ECN functional connectivity depending on disease severity. In contrast to functional connectivity, CeVD groups had greater network structural connectivity damage compared with non-CeVD groups in both aMCI and AD patients. Network structural connectivity damage was associated with worse cognition.ConclusionsWe demonstrate differential functional and structural network changes between aMCI and AD patients with and without CeVD through diverging and deleterious network-based degeneration underlying domain-specific cognitive impairment.

Safety and utility of direct laryngoscopy and bronchoscopy in patients hospitalized with croup.

Acute croup is a common admitting diagnosis for pediatric patients. If a patient is not responding to medical management for presumed croup, the otolaryngology team is occasionally consulted for direct laryngoscopy and bronchoscopy (DLB) to rule out tracheitis or another airway pathology. We conducted a study to determine if inpatient DLB in acute croup is safe and efficacious and to correlate preoperative vital signs with intraoperative findings. We reviewed the charts of 521 patients with an admitting diagnosis of acute tracheitis, acute laryngotracheitis, or croup. Of this group, 18 patients-11 boys and 7 girls, aged 1 month to 3.3 years (mean: 1.3 yr)-had undergone inpatient DLB. Comorbidities, complications, and level of care were also analyzed. Five patients (28%) had gastrointestinal reflux disease (GERD), and 4 had previously undergone intubation (22%). Eleven patients (61%) had concurrent airway pathology, 7 of whom (39%) required operative intervention. Preoperative mean body temperature and the increase in mean temperature were significantly higher in tracheitis patients than in the non-tracheitis patients. Preoperative change in respiratory rate was elevated when another airway pathology was present (p = 0.047). Only patients who were in the intensive care unit (ICU) preoperatively were intubated in the operating room, and only 1 patient required a postoperative escalation in the level of care. Our study found that performing inpatient DLB in patients hospitalized with croup is reasonably safe and provides a sufficient yield for identifying tracheitis or other airway pathology in selected populations. Preoperative vital signs can be suggestive of tracheitis or additional unexpected airway pathology. Recurrent croup, a history of GERD or previous intubation, and preoperative admission to the ICU increase the yield of DLB.

Association of specific meniscal pathologies and other structural pathologies with self-reported mechanical symptoms: A cross-sectional study of 566 patients undergoing meniscal surgery

ObjectivesWe explored associations between specific meniscal pathologies and other concurrent structural knee pathologies with presence of self-reported mechanical symptoms in patients undergoing meniscal surgery. DesignCross-sectional study. MethodsWe included patients undergoing surgery for a meniscal tear from Knee Arthroscopy Cohort Southern Denmark (KACS). Pre-surgery, patients completed online questionnaires including self-reported presence of mechanical symptoms. At arthroscopy, surgeons recorded information about specific meniscal pathologies and other concurrent structural knee pathologies. Relative risks (RR) were estimated to assess associations between specific meniscal pathologies and other structural knee pathologies with preoperative mechanical symptoms from multivariable logistic regression. Results566 of 641 patients (mean age 48.6[SD 12.9] years, 57% men) with complete data were included. 386 (68%) patients reported mechanical symptoms of knee catching/locking and/or extension deficit. Most evaluated joint pathologies were not associated with mechanical symptoms of any kind with RRs close to 1.0. Meniscal tears involving both the posterior and anterior horn (n=22) were associated with knee catching/locking (RR: 1.49[95%CI:1.15–1.93]), and a tear in both menisci (n=49) was associated with extension deficit of the knee (RR: 1.32[95%CI:1.01–1.73]). A partial (n=29) and total ACL rupture (n=37) were each associated with extension deficit (RR: 1.83[95%CI:1.47–2.28] and RR: 1.44[95%CI:1.05–1.98], respectively). ConclusionsLimited associations between specific meniscal pathology and other concurrent knee joint pathologies with presence of self-reported mechanical symptoms were found in patients undergoing meniscal surgery. The findings question the clinical importance of mechanical symptoms as an indicator for arthroscopy for specific meniscal tears with the specific aim to relieve such symptoms.

Vitreopapillary Tractions

Vitreo-papillary tractions develop in the posterior vitreous detachment (PVD) development process that vitreous cannot pass the separation process from the papilla. Distortion of the nerve fiber layer and microvascular structures in the papillae by the posterior hyaloid traction causes deterioration of visual functions. Conditions causing local ocular anatomic variations, such as small crowded papillae, previous trauma, intraocular surgery, intraocular inflammations, intraocular vascular problems may be predisposing for abnormal PVD. Vitreopapillary tractions (VPT) can be classified as primary if there is no other ocular pathology that can lead to abnormal PVD, and secondary, if there is a concurrent pathology that can lead to abnormal PVD. Three types of VPT's are defined according to the Optical coherence tomography (OCT) based classification. Type 1: vitreous band traction on the optic disc Type 2: prominent vitreous condensation at the optic disc surface and cup, Type 3: elevation of the anterior optic disc cup border above the level of the retina pigment epithelium/Bruch's membrane. Diagnosis is made by clinical examination ultrasonography and OCT findings. Vitrectomy is performed in situations that threaten visual functions in the treatment.

Predictors of substance use in youth with borderline personality disorder.

Concomitant substance misuse in adults with borderline personality disorder (BPD) is associated with a more severe course of illness and poorer outcomes. Previous research has found an association between the number of borderline personality features and substance misuse in community samples. This study examined the relationship between substance use and severity of BPD in youth presenting for the first time for treatment (first presentation) of BPD. Participants were 117 help-seeking youth aged 15-25 years (93 females; Mage = 19.0 years, SD = 2.8) with BPD. Hierarchical logistic regression was used to investigate whether the severity of BPD predicted substance use. After adjusting for demographic factors and concurrent mental state pathology, BPD independently predicted alcohol dependence, amphetamine use in the previous month, or use of 2 or more illicit substances in the previous month but not daily tobacco use or cannabis use in the previous month. BPD might increase the probability that an individual will engage in higher-risk behaviors, such as amphetamine and polysubstance use, or problematic alcohol use. These findings support the need for assessment of youth with BPD for alcohol, amphetamine, and polysubstance use along with the need for routine screening in drug and alcohol services for BPD features. (PsycINFO Database Record

Concurrent occurrence of acute bovine pulmonary edema and emphysema and endocardial fibroelastosis in cattle: A case history and literature review.

Aim:The aim of this study was to describe the clinical and pathological findings of acute bovine pulmonary edema and emphysema (ABPEE) and left endocardial fibroelastosis in an adult dairy cow. In addition, a review of recent literature of these two conditions is provided.Materials and Methods:Necropsy and histopathological examination were performed using conventional techniques. A review of the literature was carried out using internet search engines such as PubMed and Google Scholar. Only published papers in scientific and refereed journals were reviewed.Results:Concurrent pathologies of ABPEE and left endocardial fibroelastosis were described in an adult Holstein Friesian cow. A review of recent literature concerning ABPEE and endocardial fibroelastosis revealed seven and two scientific reports of these conditions in cattle, respectively.Conclusion:Although rare, combined pathologies involving multiple organs such as the lungs and heart can be diagnosed in animals on careful clinical and histopathological examinations.

Greater magnitude tibiofemoral contact forces are associated with reduced prevalence of osteochondral pathologies 2-3years following anterior cruciate ligament reconstruction.

External loading of osteoarthritic and healthy knees correlates with current and future osteochondral tissue state. These relationships have not been examined following anterior cruciate ligament reconstruction. We hypothesised greater magnitude tibiofemoral contact forces were related to increased prevalence of osteochondral pathologies, and these relationships were exacerbated by concomitant meniscal injury. This was a cross-sectional study of 100 individuals (29.7 ± 6.5years, 78.1 ± 14.4kg) examined 2-3years following hamstring tendon anterior cruciate ligament reconstruction. Thirty-eight participantshad concurrent meniscal pathology (30.6 ± 6.6years, 83.3 ± 14.3kg), which included treated and untreated meniscal injury, and 62participants (29.8 ± 6.4years, 74.9 ± 13.3kg) were free of meniscal pathology. Magnetic resonance imaging of reconstructed knees wasused to assess prevalence of tibiofemoral osteochondral pathologies (i.e., cartilage defects and bone marrow lesions). A calibrated electromyogram-driven neuromusculoskeletal model was used to predict medial and lateral tibiofemoral compartment contact forces from gait analysisdata. Relationships between contact forces and osteochondral pathology prevalence were assessed using logistic regression models. In patients with reconstructed knees free from meniscal pathology, greater medial contact forces were related to reduced prevalence of medial cartilage defects (odds ratio (OR) = 0.7, Wald χ2(2) = 7.9, 95% confidence interval (CI) = 0.50-95, p = 0.02) and medialbone marrow lesions (OR = 0.8, Wald χ2(2) = 4.2, 95% CI = 0.7-0.99, p = 0.04). No significant relationships were found in lateral compartments. In reconstructed knees with concurrent meniscal pathology, no relationships were found between contact forces and osteochondral pathologies. In patients with reconstructed knees free from meniscal pathology, increased contact forces were associated with fewer cartilage defects and bone marrow lesions in medial, but not, lateral tibiofemoral compartments. No significant relationships were found between contact forces and osteochondral pathologies in reconstructed knees with meniscal pathology for any tibiofemoral compartment. Future studies should focus on determining longitudinal effects of contact forces and changes in osteochondral pathologies. IV.

Updates on Prevention of Hemorrhagic and Lacunar Strokes.

Intracerebral hemorrhage (ICH) and lacunar infarction (LI) are the major acute clinical manifestations of cerebral small vessel diseases (cSVDs). Hypertensive small vessel disease, cerebral amyloid angiopathy, and hereditary causes, such as Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), constitute the three common cSVD categories. Diagnosing the underlying vascular pathology in these patients is important because the risk and types of recurrent strokes show significant differences. Recent advances in our understanding of the cSVD-related radiological markers have improved our ability to stratify ICH risk in individual patients, which helps guide antithrombotic decisions. There are general good-practice measures for stroke prevention in patients with cSVD, such as optimal blood pressure and glycemic control, while individualized measures tailored for particular patients are often needed. Antithrombotic combinations and anticoagulants should be avoided in cSVD treatment, as they increase the risk of potentially fatal ICH without necessarily lowering LI risk in these patients. Even when indicated for a concurrent pathology, such as nonvalvular atrial fibrillation, nonpharmacological approaches should be considered in the presence of cSVD. More data are emerging regarding the presentation, clinical course, and diagnostic markers of hereditary cSVD, allowing accurate diagnosis, and therefore, guiding management of symptomatic patients. When suspicion for asymptomatic hereditary cSVD exists, the pros and cons of prescribing genetic testing should be discussed in detail in the absence of any curative treatment. Recent data regarding diagnosis, risk stratification, and specific preventive approaches for both sporadic and hereditary cSVDs are discussed in this review article.

Eating disorders risk among medical students: a global systematic review and meta-analysis.

Medical students appear to be a high-risk group to develop psychological problems including eating disorders (ED). The prevalence estimates of ED risk vary greatly between studies. This systematic review and meta-analysis was done to estimate the prevalence of ED risk among medical students. An electronic search of EMBASE, MEDLINE, ProQuest and Google Scholar was conducted. Studies that reported the prevalence of ED risk among medical students and were published in English peer-reviewed journals between 1982 and 2017 were included. Information about study characteristics and the prevalence of ED risk were extracted by four investigators. Each article was reviewed independently by at least two investigators. Estimates were pooled using random-effects meta-analysis using the DerSimonian-Laird method. The main outcome of interest was the prevalence of ED risk in medical students. The prevalence of ED risk among medical students was extracted from nineteen cross-sectional studies across nine countries (total participants n = 5722). The overall pooled prevalence rate of ED risk was 10.4% (497/5722 students, 95% CI 7.8-13.0%), with statistically significant evidence between-study heterogeneity (Q = 295, τ2 = 0.003, I2 = 94.0%, P < 0.001). Prevalence estimates between studies ranged from 2.2 to 29.1%. In this systematic review and meta-analysis, the summary prevalence of ED risk among medical students was 10.4%. Further research is needed to identify and prevent ED in this population. Studies are also needed to investigate concurrent pathologies associated with ED risk. Level I, systematic review and meta-analysis.

Serum IGFBP2, IGFBP4, and sTNFR2 are predictive of concurrent clinical and histological nephritis in SLE

Abstract Background Systemic Lupus Erythematosus (SLE) is an autoimmune disorder that targets various body systems, including the kidneys, leading to Lupus Nephritis (LN). Present diagnostic methods for LN include the renal biopsy, which is invasive. This project takes advantage of a large cohort of LN samples where the serum samples were obtained at the time of renal biopsy. Our goal is to identify serum protein markers that are predictive of concurrent clinical and histological nephritis. Methods Serum samples from 10 healthy controls and 66 SLE patients with active renal disease obtained at the time of renal biopsy were ELISA-tested for levels of IGFBP2, IGFBP4, and sTNFR2, selected because they were elevated in LN patients in previous screening studies. Results Serum sTNRF2 (p &amp;lt; 0.0001), IGFBP2 (p &amp;lt; 0.0001) and IGFBP4 (p &amp;lt; 0.05) were all elevated in LN patients compared to healthy controls. Concurrently measured Glomerular Filtration Rate was negatively correlated with serum IGFBP4 (p &amp;lt; 0.0001), IGFBP2 (p &amp;lt; 0.05) and sTNFR2 (p &amp;lt; 0.001). Serum IGFBP4 correlated with SLEDAI (p &amp;lt; 0.01), and Renal SLEDAI (p &amp;lt; 0.01). All 3 serum proteins showed a positive correlation with Renal SLICC scores with IGFBP4 being the strongest (p &amp;lt; 0.0001). There was also a significant correlation between various concurrent renal biopsy pathology lesions with the assayed serum proteins, notably IGFBP4 (p &amp;lt; 0.0001). Conclusion Serum IGFBP2, IGFBP4, and sTNFR2 are predictive of concurrent clinical nephritis activity in LN as well as histological changes on renal biopsy. Whereas the biopsy is subject to sampling errors, the assayed proteins may represent more stable biomarkers of renal pathology changes in LN.

STEREOTACTIC RADIOTHERAPY FOR THE TREATMENT OF CLINICAL STAGE I-IIA LUNG CANCER PATIENTS. THE EXPERIENCE OF N.N. BLOKHIN NATIONAL MEDICAL RESEARCH CENTER OF ONCOLOGY

Introduction: Nowadays the stereotactic radiotherapy (SRT) of clinical stage I-II lung cancer patients is the choice of the treatment modality for functionally inoperable patients. It shows safety and high efficiency in achieving local control. Though there is a range of unsolved issues connected with the prediction of the treatment efficiency and frequency of complications, an integration of new technologies in the planning and treatment process allows widening the search of the predictive factors. Material and methods. Since 2014, 39 patients (17 T1N0M0 patients, 22 T2N0M0 patients) with clinical stage I-IIa lung cancer have undergone SRT. The majority of patients (35) have been recognized as functionally inoperable due to the concurrent broncho-pulmonary pathology, 4 conditionally operable patients have refused an operation. 11 patients had the primary multiple tumors in their anamneses. 36 patients had a peripheral tumor. The options for the fractionation were: 10 Gy × 5 fractions (n = 26) and 7 Gy × 8 fractions (n = 13) - BED = 100 Gy. Results. The median follow-up was 26 months (range: 3-38 months). The 2-year local control was 94%. The isolated local recurrences were not registered. Overall and 2-year recurrence-free survival rate was 84% (95% CI, 70-99) and 83.2% (95% CI: 70.5-99) respectively. During the first year, 4 patients (10%) had the locoregional and distant progression and 3 of them died. 7 patients had experienced pulmonary toxicity of grade 2 or more. One patient with central tumor died from pulmonary hemorrhage (toxicity of grade 5). Grade 3 chest pain was observed in 2 patients, one of them had a rib fracture. One-factor analysis, revealed a reliable influence of the fractionation regimen (р = 0.04) and, close to reliability, the initial SUVmax level (р = 0.07) on the prognosis. A reliable relationship between the radiation toxicity level and dosimetric radiation index (V10, V5, MLD) was not registered. There was a tendency to reliable correlation with the total lung capacity indices (р = 0.058). Conclusions. A search for additional treatment efficiency and toxicity predictors of SRT treatment should include modern approaches to planning and delivery. The total dose delivery regimen and initial tumor SUVmax can be predictive efficiency factors, while the pulmonary tissue volume can be a predictive toxicity factor.

Sleep Quality in Patients With Rotator Cuff Disease

Little is known about the influence of rotator cuff pathology on sleep. The purpose of this study was to determine which patient-reported factors correlate with sleep disturbance in patients with rotator cuff disease. A nonrandomized, cross-sectional cohort study was performed to evaluate the effects of rotator cuff disease on sleep quality. Data collected at time zero (before any treatment) included the Single Assessment Numeric Evaluation rating, the American Shoulder and Elbow Surgeons score, the Pittsburgh Sleep Quality Index, patient demographics, and medical comorbidities. Statistical analysis included the Pearson correlation and multiple regression analysis to determine which patient-reported factors were associated with sleep disturbance. Nocturnal pain was reported by 91% of the 391 participants (274 with tendinitis and 117 with rotator cuff tears). Participants had a mean age of 57 years. Pearson correlation coefficients determined that poor sleep quality in one group or both the tendinitis and the rotator cuff tear groups was associated with higher pain visual analog scale scores (0.27 and 0.31; P = 0.004 and P < 0.0001, respectively), depression (0.27 and 0.30; P < 0.01), female sex (0.24 and 0.27; P < 0.001), presence of low back pain (0.25 and 0.27; P < 0.01), diabetes mellitus (0.24 in the rotator cuff tear group; P < 0.01), and increased body mass index (0.22 and 0.27; P = 0.02). The status of the rotator cuff did not correlate with increasing symptoms of shoulder pain or with worse sleep quality as measured by the Pittsburgh Sleep Quality Index. These results support the theory that worsening symptoms of shoulder pain may not be clearly associated with rotator cuff disease severity. Worse sleep quality scores in patients with rotator cuff disease are associated with pain, depression, female sex, low back pain, diabetes mellitus, and high body mass index. Overall, sleep quality did not differ among patients with varying rotator cuff disease severity. Only hypertension (in patients with rotator cuff tears) and concurrent cervical pathology (in patients with tendinitis) were uniquely related to the disease classification. Further investigation is needed to better define how these factors interact and influence nocturnal shoulder pain and sleep quality in patients with rotator cuff disease. Level III prognostic cohort study.

Сравнительная оценка результатов различных хирургических бариатрических операций

Цель. Сравнить результаты выполнения за 5 лет бариатрических хирургических операций у пациентов с ожирением среди населения Азербайджана.&#x0D; Материалы и методы. Бариатрические хирургические операции выполнены у 104 пациентов с ожирением среди населения Азербайджана. Средний возраст пациентов - 33,1 года, средний индекс массы тела (ИМТ) - 57,5 кг/м2. Проведен сравнительный анализ различных технических модификаций, послеоперационных осложнений. Больных обследовали до и через 1, 3, 6 и 12 мес после операции. В динамике исследовали ИМТ, проявления диабета, гипертонии, синдрома апноэ во сне и жировой дистрофии печени.&#x0D; Результаты. У 88 (84,6%) пациентов, которым выполнена стандартная лапароскопическая слив гастрэктомия (ЛСГ), в течение первых 6 мес масса тела уменьшилась в среднем на (39,5 ± 11,5) кг. У 12 (11,5%) больных после желудочного шунтирования (2 (1,9%) выполнено желудочное шунтирование по Ру, 8 (7,6%) - желудочное минишунтирование, 2 (1,9%) - СЛИВ и шунтирование по Ру) масса тела уменьшилась на (46 ± 14) кг, а в течение 6-12 мес наблюдали эффективное ее увеличение, в среднем на (33,5 ± 8,5) кг. У 1 (1%) больного была выполнена в другой клинике дупликация желудка. Масса тела за год уменьшилась на 20 кг и остановилась. В связи с этим больной обратился в нашу клинику. Ему выполнена операция уменьшения желудка. Масса тела уменьшилась на 36 кг. У 3 (2,9%) больных, которые по истечении 2 лет после операции набрали массу тела, повторно выполнили СЛИВ гастрэктомию. В последующем у этих больных отмечено удовлетворительное уменьшение массы тела.&#x0D; Выводы. После ЛСГ уменьшение массы тела у больных с тяжелым ожирением наиболее удовлетворительное, также отсутствуют нарушения витаминного баланса, динамика сопутствующей патологии положительная, что дает основание считать этот способ наиболее надежным. Однако после операции шунтирования упомянутые показатели выше и при диабете II типа эта методика наиболее эффективна. Но с учетом анатомии и физиологии слив гастрэктомия является идеальной операцией, поскольку при неэффективном снижении массы тела в будущем есть возможность применить другую методику, кроме того, эта операция также приемлема для больных, у которых нет диабета II типа.

What do we know about osteitis pubis in athletes?

Osteitis pubis is a common cause of chronic groin pain. Due to high clinical uncertainty and varying etiopathology, the diagnosis is often delayed. Especially athletes suffer from this disease, but patients with orthopaedic, traumatological, neurological, urological, gynaecological, and rheumatic complaints can also be affected. Osteitis pubis can be treated by conservative as well as surgical techniques. Systematic literature research, descriptive presentation of the studies, and interpretation of evidence-based medicine results. The scientific level of studies about osteitis pubis and the number of athletes included are low overall. A statistical comparison is methodically difficult due to the heterogeneity of publications. The leading clinical symptom of osteitis pubis is an aching symphysis pubica. Unfortunately, there are no characteristic clinical pathognomonic signs. The medical diagnosis is based on an exclusion of various differential diagnoses (e. g. sports hernia, femoroacetabular impingement, adductor lesion) and a comparison of medical history, clinical examination, and imaging methods. After a period of rest, osteitis pubis is quite often a self-limiting disease and will initially be treated conservatively. If this fails, surgical intervention has to be considered depending on concurrent pathologies. Specific guidelines for the diagnosis and treatment of osteitis pubis do not exist as yet. But there is consensus that a surgical intervention should only be performed if conservative treatment fails. The level of evidence for the studies is low. A meta-analytical evaluation based on the existing publications is not possible as yet. The number of recorded athletes in relation to the socio-economic consequences of the disease, especially in professional sport, is low.

Clinical Application of 3D-CISS MRI Sequences for Diagnosis and Surgical Planning of Spinal Arachnoid Diverticula and Adhesions in Dogs.

Abnormalities within the spinal arachnoid space are often treated surgically, but they can be challenging to detect with conventional magnetic resonance imaging (MRI) sequences. 3D-CISS sequences are considered superior in evaluating structures surrounded by cerebrospinal fluid (CSF) due to the high signal-to-noise ratio, high contrast-to-noise ratio and intrinsic insensitivity to motion with minimal signal loss due to CSF pulsations. Our objective was to describe findings and advantages in adding 3D-CISS sequences to routine MRI in patients affected by spinal arachnoid diverticula (SAD) or arachnoid adhesions. This article is a retrospective review of medical records of 19 dogs admitted at Fitzpatrick Referrals between 2013 and 2017 that were diagnosed with SAD and confirmed surgically. Inclusion criterions were the presence of clinical signs compatible with compressive myelopathy and an MRI diagnosis, which included the 3D-CISS sequence. Our database was searched for additional 19 dogs diagnosed with other spinal lesions other than SAD that had the same MR sequences. All MR images were anonymized and evaluated by two assessors. 3D-CISS sequence appears to improve confidence in diagnosing and surgical planning (Mann-Whitney U-test: p < 0.0005), delineating SAD from other changes associated with abnormal CSF hydrodynamics and providing more anatomical details than conventional MRI sequences. The clinical data in combination with imaging findings would limit over interpretation, when concurrent pathology within the arachnoid space is present.

STRENGTHENING THE GLUTEUS MAXIMUS IN SUBJECTS WITH SACROILIAC DYSFUNCTION

Case series. The literature has emphasized the use of exercise as an intervention for individuals with lumbopelvic pain. However, there is limited information to guide clinicians in exercise selection for those with sacroiliac (SI) joint dysfunction. Altered function of the gluteus maximus has been found in those with SI joint dysfunction. The objective of this case series was to assess the effectiveness of an exercise program directed at increasing gluteus maximus strength in those with clinical tests positive for SI joint dysfunction. The eight subjects in this series presented with lumbopelvic pain and clinical evidence of SI joint dysfunction. Each subject underwent 10 treatments over five weeks consisting of five exercises directed at strengthening the gluteus maximus. Radiological assessment and clinical examination were performed to rule out potential concurrent pathologies. Visual analog pain scale, the Oswestry Disability Index, and strength assessed via hand held dynamometry were measured pre- and post-intervention. A significant (p<0.001) weakness in gluteus maximus was noted when comparing the uninvolved and involved sides pre-intervention. After completing the strengthening exercise program over 10 visits, statistically significant (p<0.002) increases in gluteus maximus strength and function were found, as well as a decrease in pain. All subjects were discharged from physical therapy and able to return to their normal daily activities. The results of this case series support the use of gluteus maximus strengthening exercises in those with persistent lumbopelvic pain and clinical tests positive for SI joint dysfunction.

The role of peritoneal washings in the diagnosis of endometriosis.

Endometriosis, the presence of endometrial tissue outside the uterine corpus, is a common finding in reproductive age women. It is classically diagnosed based on the presence of at least two of the following elements: endometrial glands, endometrial stroma, and hemosiderin-laden macrophages (HLMs). Although a common finding in surgical pathology specimens at the time of gynecologic surgery, there is little literature on the role of pelvic washings in diagnosing endometriosis. Our study aimed to examine the characteristics of endometriosis in pelvic washings at the time of gynecologic surgery. We report nine cases of endometriosis diagnosed on pelvic washing. Two had a reported history of endometriosis. Four had endometriosis on the concurrent surgical pathology specimen. Liquid-based cytology was diagnostic of endometriosis in seven patients, including five with glandular cells and HLMs and two with glandular cells, HLMs, and endometrial stromal cells. Cell block was diagnostic of endometriosis in eight patients, including four cases with intact fragments of endometrial glands and stroma. Three cases showed glandular cells and HLMs, while one showed separate fragments of glandular cells and stromal cells. Pelvic washings increased the diagnostic yield for endometriosis at the time of gynecologic surgery, as only four out of nine cases had endometriosis diagnosed on surgical pathology. Cell block in particular aids in the diagnosis, since intact glandular and stromal fragments frequently can be identified.