Comparison of minimally invasive approach versus conventional anterolateral approach for total hip arthroplasty: a randomized controlled trial.

BACKGROUND: It is a general belief among hip surgeons that minimally invasive surgical (MIS) approach for implantation of a total hip arthroplasty (THA) allows an improved and faster postoperative rehabilitation because of reduced muscle and soft-tissue damage, less postoperative pain and blood loss, and shorter hospital stay compared with conventional approaches. In the published relative literature though, there are controversial reports and debates on this matter. To our knowledge, there is no study on the medium-term functional results comparing MIS and traditional approaches for total hip replacement. The purpose of this prospective comparative controlled study was to compare MIS with conventional approach, on terms of pain, blood loss, and functional recovery over a follow-up period of 4 years. METHODS: In a total of 90 consecutive randomly selected adult patients, who suffered from unilateral primary hip osteoarthritis, a cementless Zweymüller-Plus THA (SL-Plus stem, Bicon screw socket) was implanted by a single senior orthopedic hip surgeon in one institution in the same period. Forty-five patients (group A) were operated using an MIS anterolateral, short incision, muscle-sparing approach and 45 (group B) with a conventional (anterolateral modified Watson-Jones) approach under partial detachment of gluteus medius and minimus. Anthropometric data, blood loss, short-form 36 questionnaire, visual analog scale pain score, and walking endurance were included in the analysis. Approach-related surgical complications (trochanter major fracture, Bicon malposition) were recorded. Data were collected postoperatively and at 4-year follow-up. RESULTS: Two patients of group A and eight patients of group B were excluded from the final analysis. Thus, 80 patients were eligible for the final evaluation 4 years postoperatively. Postoperative pain score was less in the MIS group. However, no differences in perioperative blood loss, functional outcome, and walking endurance were shown between groups. No difference in Bicon cup implantation angle was measured in postoperative roentgenograms between group A and B patients, no intraoperative trochanter fracture occurred in any patient of both groups. CONCLUSIONS: The present prospective randomized study revealed no significant mid-term clinical and functional benefit for patients who underwent a THA through an MIS in comparison with those who were managed with a conventional open approach.

Low aseptic loosening and revision rate in Zweymüller-Plus total hip arthroplasty with ceramic-on-ceramic bearings.

UNLABELLED: A recent comparative study reported lower revision rate and higher survival in ceramic-on-ceramic (CoC) than in metal-on-metal (MoM) coupling in Zweymüller-Plus THA. We retrospectively studied 87 consecutive patients (94 hips), who primarily received Zweymüller-Plus THA (SL-Plus stem, ceramic 28-mm ball head, Bicon cup) with third-generation CoC bearing surfaces for osteoarthritis. Survival, revision and osteolysis rate were studied and compared to those observed in historical series from this institution with the same THA and MoM articulation. The mean ± SD follow-up was 7.4 ± 1.7 years (range 6-10 years). Four hips (4%) in four patients were revised 1-6 years following primary implantation: one (1%) for aseptic loosening of SL-Plus stem and Bicon 5 years after index surgery; one (1%) for malpositioning of the Bicon and recurrent dislocations 1 year following implantation; and two (2%) for septic loosening 1 and 6 years postoperatively. Intraoperatively on inspection, there were neither findings for impingement in the revised hips, nor fracture of the Bicon ceramic inlay and ball head. Expansile osteolysis was shown around SL-Plus stem and Bicon in the revised for aseptic loosening hip. With revision of any component for aseptic loosening as the endpoint, the survival was 99% (95% CI 91-100%), while for revision for any reason, it was 95% (95% CI 87-98%) at 10 years. Zweymüller-Plus THA with CoC bearings showed, at mid-term follow-up, high survival and low revision rate for aseptic loosening. These rates were better than the historical series of the same THA with MoM articulation performed by the same surgeon. LEVEL OF EVIDENCE: Level IV.

Effect of wastewater chlorination on endocrine disruptor removal.

Endocrine disrupting chemicals (EDCs) are compounds of mainly anthropogenic origin that interfere with the endocrine system of animals and humans thus causing a series of disorders. Wastewater treatment plants are one of the major routes for transporting such chemicals to the water courses. In the context of this study, several chlorination batch tests were performed in order to assess the effectiveness of chlorination to remove bisphenol A (BPA), triclosan (TCS), nonylphenol (NP) and its ethoxylates (NP1EO and NP2EO) from secondary effluent. According to the results, an appreciable removal of NP, BPA and TCS to the order of 60-84% was observed as an effect of moderate chlorination doses. This was not the case for NP1EO and NP2EO as even at high chlorine doses, removal efficiencies were lower (37% for NP1EO and 52% for NP2EO). Removal efficiencies of NP, BPA and TCS are practically independent of contact time, although this was not the case for NP1EO and NP2EO. Based on toxicity experiments, it is anticipated that following chlorination of the target chemicals, production of more toxic metabolites is taking place. Therefore the effectiveness of chlorination to remove EDCs is questionable and more research is needed to guarantee safe wastewater reuse.

Cervical disc, mimicking nerve sheath tumor, with rapid spontaneous recovery: a case report.

The study design includes a case report and clinical discussion. The potential of acute disc herniations to regress spontaneously has been previously reported. However, the initial radiological presentation can be misleading, leading to therapeutic pitfalls, especially when the presence of myelopathy calls for early intervention. We present the case of a 46-year-old woman with a cervical intraspinal enhancing mass, associated enhancement of the C6 root and myelopathy, leading to the presumptive diagnosis of a nerve sheath tumor. The patient was offered surgery, which she denied. The patient returned 7 weeks later with significant clinical improvement. A subsequent magnetic resonance imaging depicted a herniated cervical disc and regression of myelopathy. Although spontaneous regression of disc prolapse and myelopathy have been previously reported, the initial radiological presentation and the short period of regression in this case highlight the need for a thorough understanding of the natural course of cervical disc herniations. Nonsurgical conservative observation should be considered an option for treatment for some cervical disc herniations that are likely to regress for very specific and predictable reasons.

Delineating the epithelial hierarchy in the mouse mammary gland.

Reconstitution assays have shown that mouse mammary stem cells reside within the mature mammary gland in vivo. Single cells could be prospectively isolated and shown to regenerate an entire mammary gland that exhibited full developmental capacity. The more recent identification of luminal progenitor populations has indicated that the mammary epithelium is organized in a hierarchical manner. Further definition of epithelial cell types in both mouse and human mammary glands will provide insight into the "cells of origin" in the different subtypes of breast cancer, as well as the nature of cancer-propagating cells. Here, we review the known characteristics of mammary stem and progenitor cells, their steroid receptor status, and the pathways that have thus far been implicated in regulating their self-renewal and differentiation.

Recurrence of trigeminal neuralgia due to an acquired arachnoid cyst.

We present the case of a 55-year-old female with pain recurrence after microvascular decompression for trigeminal neuralgia due to development of an arachnoid cyst. Radioimaging studies were inconclusive for vascular compression but showed evidence of fifth nerve distortion. The patient underwent surgical re-exploration, and a cystic lesion of thickened arachnoid containing cerebrospinal fluid was identified and excised. Postoperatively, the patient obtained pain relief. Arachnoid cyst formation may be a possible reason for pain recurrence after microvascular decompression for trigeminal neuralgia, especially when repeat neuroimaging does not show clear evidence of fifth nerve vascular compression. Direct compression from the cyst or arterial pulsation transmission through the cyst to the nerve may be the cause of recurrence.

Symptomatic syringomyelia secondary to clinically obscure infratentorial tumour.

The formation of a cervical spinal cord syrinx as a result of an infratentorial mass, even though uncommon, has been reported in international literature. In such cases, syringomyelia is usually asymptomatic, while the tumour-related symptoms and signs predominate. We report a patient with a posterior fossa tumour and secondary syringomyelia. In this patient, syringomyelia symptoms and signs were present, and a cervical spine Magnetic Resonance Imaging (MRI) showed a large cervical syrinx. A more careful clinical examination though, revealed a sub-clinical posterior fossa syndrome and brain MRI revealed a large infratentorial meningioma. A posterior fossa craniotomy was performed, followed by complete tumour resection and almost complete remission of the syrinx and its related symptoms. The authors discuss the role of posterior fossa tumour induced tonsillar herniation in the development of secondary syringomyelia, the mechanisms leading to syrinx formation and the conditions that must be fulfilled for that to happen.

[D-Dimer determination combined with clinical probability for the diagnosis of leg venous thrombosis]. / Association en pratique clinique du dosage des D-Dimères et d'une probabilité clinique pour le diagnostic de thrombose veineuse des membres inférieurs.

OBJECTIVE: To evaluate the results of combination of D-Dimer test and simple clinical model for the diagnosis of deep vein thrombosis (DVT). MATERIALS AND METHODS: Inclusion: clinical suspicion of DVT. Non inclusion criteria were Clinical model performed by the referring physician included probability varying from high to low. D-Dimer test was performed by five different rapid techniques. Standard of reference was Doppler ultrasonography (DU) performed by a senior radiologist. RESULTS: Eight hundred and fifty-four DU were performed on a 14 months time period, including 206 suspicion of pulmonary embolism, 109 postoperative time period, 120 non-included or excluded patients, 278 incomplete observations, 141 complete observations. DVT was present in 33 cases and absent in the other 108 cases (prevalence 23%). Sensitivity and negative predictive value of the five tests were between 82 and 97% and 90 et 97%. The most sensitive test had a specificity of 36% and a positive predictive value of 32%. Combination of clinical model and D-Dimer test did not improve the diagnostic accuracy. CONCLUSION: None of the test evaluated in the present study, even when combined with the clinical model results, did allow the exclusion of DVT.

Overexpression of the steroid receptor coactivator AIB1 in breast cancer correlates with the absence of estrogen and progesterone receptors and positivity for p53 and HER2/neu.

The gene for the steroid receptor coactivator amplified in breast cancer 1 (AIBI), located on chromosome 20q12, is overexpressed at the mRNA level in up to 60% of primary breast carcinomas; however, only 5% of these tumors show DNA amplification. The transcription factors and signaling pathways relevant to breast cancer, which in the absence of DNA amplification are responsible for and targeted by elevated levels of AIBI mRNA, are unknown. In the present study, in situ hybridization was used to examine AIB1 mRNA expression in 93 breast carcinomas of varying histological grade and immunohistochemical profile. AIB1 mRNA was overexpressed relative to normal breast tissue in 26 of 83 (31%) invasive tumors. This was found to associate with high tumor grade (P = 0.0006), lack of immunohistochemical staining for the steroid receptors estrogen receptor (P = 0.002) and progesterone receptor (P = 0.002), and strong protein staining for p53 (P = 0.01) and HER2/neu (P = 0.002). These findings suggest that AIB1 overexpression may impact on breast cancer by a mechanism not wholly dependent on steroid receptor coexpression and which may involve other oncogenic events, such as p53 protein stabilization and HER2/neu overexpression.

Expression of the prostate cancer metastasis suppressor gene KAI1 in primary prostate cancers: a biphasic relationship with tumour grade.

The KAI1 gene, isolated from human chromosome 11p11.2, has been implicated as a prostate cancer metastasis suppressor gene. Recent studies have demonstrated that the expression of KAI1 protein is reduced in metastases of human prostate cancers and is inversely correlated with tumour grade. The objectives of the present work were to determine whether alterations of KAI1 at a genetic level in localized prostate cancers correlate with degrees of differentiation. This paper reports the application of semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) and Southern analysis to two different regions of the KAI1 gene on 35 microdissected primary prostate cancer specimens and demonstrates a biphasic pattern of KAI1 expression according to histological grade. KAI1 mRNA, relative to the housekeeping gene beta -actin, was elevated in low-grade primary prostate cancer (2.7+/-0.4) compared with non-malignant (hyperplastic) prostatic tisues (0.92+/-0.02, p< 0.05), yet reduced in high-grade primary cancers (0.61+/-0.11, p< 0. 05). These data demonstrate, for the first time, that KAI1 is biphasically expressed in primary prostate cancers and suggest that hyperexpression of KAI1 in low-grade prostate cancer may be associated with restraint of tumour progression, whereas a relative decrease in KAI1 gene expression may accompany more aggressive cancers through loss of such restraint. This differential expression of the metastasis suppressor gene KAI1 in primary prostate cancers may have important prognostic implications for the development of subsequent metastases. Should the level of KAI1 in primary prostate cancer be correlated with patient outcome such information may, in the future, enable more intensive adjuvant therapy to be directed to those patients identified to be at greatest risk of metastasis.

Diffuse cavernous hemangioma of the rectosigmoid colon: imaging findings.

Diffuse cavernous hemangioma of the rectosigmoid colon (DCHR) is an uncommon disease that affects mainly young adults. As the main symptom is non-specific chronic rectal bleeding, the clinical diagnosis is difficult and often delayed. In this essay, we illustrate the imaging features of DCHR, including plain radiograph, barium enema, CT and MR study, and echoendoscopy. Pitfalls in diagnosis and the role of imaging study in the diagnosis, in the preoperative staging, and in the follow-up of the patients are defined.

MR imaging of diffuse cavernous hemangioma of the rectosigmoid colon.

OBJECTIVE: We retrospectively reviewed five pathologically proven cases of diffuse cavernous hemangioma of the rectosigmoid colon to define the MR imaging features of this entity. CONCLUSION: Diffuse cavernous hemangioma of the rectosigmoid colon is revealed as rectosigmoid wall thickening with high signal intensity on T2-weighted MR images. Such wall thickening is associated with abnormal perirectal fat. The extent of bowel involvement and extrarectal locations are well shown on T2-weighted MR images.

[Imaging of symptomatic giant hemangioma]. / Imagerie d'un angiome géant symptomatique.

A case of symptomatic giant hemangioma of the liver with fever, anemia, and increased erythrocyte sedimentation rate is reported. Spontaneous hyperdense areas at CT, and high signal-intensity areas at T1-weighted MR images were demonstrated within the hemangioma. Marked hemorrhagic zones demonstrated at pathologic examination may explain these uncommon clinical and imaging features.

[Interventional radiology and abdominal emergencies]. / Radiologie interventionnelle et urgences abdominales.

Interventional radiology used in acute abdominal diseases has demonstrated its efficacy in most emergency cases especially in patients at high risk for surgery. Percutaneous drainage is a reference standard for abscesses located within the abdomen and pelvis with high success rates of up to 80%. The diagnosis and treatment of gastrointestinal hemorrhage have changed over the past two decades, with decreased diagnostic examinations and advances in pharmacologic therapy and improved endoscopic techniques. On the other hand, embolization techniques and new procedures such as trans jugular intra hepatic porto systemic shunt have been developed. Arterial embolisation in many situations such as blunt or direct trauma, obstetric or post operative hemorrhage, can be used as an effective easy and relatively safe technique with high success rates to stop bleeding and save the organ. Percutaneous drainage and angiographic techniques adapted to biliary and urinary tree have also been developed as well as endoscopic procedures, allowing treatment of stenoses by balloon dilatation, or plastic or metal prostheses. Indications, technical aspects, complications and limits of these various procedures are presented.

[Abdominal injuries]. / Traumatismes de l'abdomen.

Radiologic evaluation of abdominal trauma must provide a quick and accurate assessment of the lesions in order to improve the management of the patient. The technique used varies depending on the mechanism of the trauma (blunt trauma or stab wounds) and the hemodynamic status. Radiologic evaluation is usually performed in blunt trauma whereas stab wound trauma is usually explored surgically. The various techniques available are standard radiographs, ultrasonography, computed tomography and arteriography. The role of magnetic resonance imaging in the immediate evaluation is still not well defined. It appears to be a useful method in the delayed evaluation of diaphragmatic trauma. Computed tomography is the method most commonly performed in trauma patients. This technique is accurate and allows correct assessment of the lesions. The disadvantages are the radiation induced and the need for a hemodynamically stable patient. The aim of the radiologic evaluation is to provide the clinicians with an accurate description of the lesions. It can help in the management of the patient usually in association with clinical and laboratory data. It can also guide interventional procedures (drainage, embolization...). Finally, it allows radiographic follow-up when conservative treatment is performed.

[Imaging of hepatic tuberculoma]. / Imagerie du tuberculome hépatique.

We describe a case of localized macronodular tuberculosis of the liver, the so-called hepatic tuberculoma. Liver US scan demonstrated an hypoechoic well-delineated lesion of the left liver lobe. Liver CT scan demonstrated a hypodense lesion before and after contrast enhancement. Liver MR scan demonstrated a lesion hypointense to liver on T1-weighted images and isointense to liver on T2-weighted images.