Wound dressing following primary total hip arthroplasty: a prospective randomised controlled trial.

OBJECTIVE: This study compared three methods of surgical wound dressing in patients undergoing primary total hip arthroplasty to determine their effect on wound leakage. METHOD: Total hip arthroplasties were randomised to 3 groups: 2-octyl cyanoacrylate (Dermabond-Ethicon Inc, G) with Opsite (Smith & Nephew; O) [G+O], 2-octyl cyanoacrylate with Tegaderm (3M; T) [G+T], and Opsite without 2-octyl cyanoacrylate [O]. Postoperative wound leakage was assessed and graded daily until discharge, the frequency of the dressing changes was also recorded. Patients were clinically reviewed at three months to assess cosmesis of their surgical scar and wound complications. RESULTS: In all 211 total hip arthoplasties were included. A greater proportion of patients' dressings remained dry on day 1 postoperatively in the two groups using 2-octyl cyanoacrylate (G+O and G+T) compared to the no glue group (O; p=0.0001). The G+T group had a significantly lower proportion of patients with increased leakage of wounds on days 2 and 3 postoperatively compared with both G+O and O groups (p=0.0043). The overall rate of dressing change for G+O was 8%, G+T 5%, and O 13%. Overall wound cosmesis was similar in all groups (p=0.690). CONCLUSION: The reduction in frequency of dressing changes coupled with low levels of wound leakage observed using the combination of the glue and nonabsorbent dressings (O+T), makes this combination of wound closing products ideal for facilitating enhanced recovery and early discharge programmes in elective hip arthroplasty.

Weight changes following lower limb arthroplasty: a prospective observational study.

The aim of this study was to assess patterns of weight loss/gain following total hip or knee joint replacement. Four hundred and fifty primary lower limb arthroplasty patients, where the current surgery was the last limiting factor to improved mobility, were selected. Over a one year period 212 gained weight (mean 5.03kg), 92 remained static, and 146 lost weight. The median change was a weight gain of 0.50Kg (p = 0.002). All patients had a significant improvement in Oxford outcome scores. Hip arthroplasty patients were statistically more likely to gain weight than knee arthroplasty patients. A successful arthroplasty, restoring a patient's mobility, does not necessarily lead to subsequent weight loss. The majority of patients put on weight with an overall net weight gain. No adverse effect on functional outcome was noted.

Ten testicular trapdoors.

Testicular pathology is difficult and there are a number of areas where diagnostic errors may lead to inappropriate treatment. We therefore describe ten areas of testicular pathology which may cause diagnostic confusion for pathologists: ten testicular trapdoors.

Re-attachment of the tuberosities of the humerus following hemiarthroplasty for four-part fracture.

This study evaluated the effect on movement under load of three different techniques for re-attachment of the tuberosities of the humerus using test sawbones. In the first, the tuberosities were attached both to the shaft and to each other, with one cerclage suture through the anterior hole in the prosthesis. The second technique was identical except for omission of the cerclage suture and in the third the tuberosities were attached to the prosthesis and to the shaft. An orthogonal photogrammetric system allowed all segments to be tracked in a 3D axis system. The humeri were incrementally-loaded in abduction, and the 3D linear and angular movements of all segments were calculated. Displacement between the tuberosities and the shaft was measured. The first and second techniques were the most stable constructs, with the third allowing greater separation of fragments and angular movement. Separation at the midpoint of the tuberosities was significantly greater using the latter technique (p < 0.05). The cerclage suture added no further stability to the fixation.

Peri-prosthetic bone mineral density after total knee arthroplasty. Cemented versus cementless fixation.

We compared peri-prosthetic bone mineral density between identical cemented and cementless LCS rotating platform total knee arthroplasties. Two matched cohorts had dual energy x-ray absorptiometry scans two years post-operatively using a modified validated densitometric analysis protocol, to assess peri-prosthetic bone mineral density. The knee that was not operated on was also scanned to enable the calculation of a relative bone mineral density difference. Oxford Knee and American Knee Society scores were comparable in the two cohorts. Statistical analysis revealed no significant difference in absolute, or relative peri-prosthetic bone mineral density with respect to the method of fixation. However, the femoral peri-prosthetic bone mineral density and relative bone mineral density difference were significantly decreased, irrespective of the method of fixation, particularly in the anterior distal portion of the femur, with a mean reduction in relative bone mineral density difference of 27%. There was no difference in clinical outcome between the cemented and cementless LCS total knee arthroplasty. However, both produce stress-shielding around the femoral implants. This leads us to question the use of more expensive cementless total knee components.

Use of a proximal humeral plate for a paediatric peri-prosthetic femoral fracture.

In this case an 18-year-old female with cerebral palsy sustained a peri-prosthetic femoral fracture adjacent to a blade plate previously inserted for a femoral varus osteotomy. The injury was treated using a long proximal humeral locking plate. The existing blade plate was removed. The fracture was reduced and held, and a 10-hole PHILOS™ plate applied with near anatomical reduction. There were no post-operative complications. Radiographic union was confirmed at 11 months. To our knowledge, this is the first reported use of a PHILOS™ plate in the management of a femoral peri-prosthetic fracture and successfully demonstrated a straightforward method for revision fixation.

Total shoulder replacement in rheumatoid disease: a 16- to 23-year follow-up.

We describe the longer term clinical and radiological findings in a prospectively followed series of 49 rheumatoid patients (58 shoulders) who had undergone Neer II total shoulder replacement. The early and intermediate results have been published previously. At a mean follow-up of 19.8 years (16.5 to 23.8) 14 shoulders survived. Proximal migration of the humeral component was associated with progressive loosening of the glenoid and humeral components, but was independent of the state of the rotator cuff at the time of operation. Despite these changes the range of movement was preserved. Most patients had little or no pain in the shoulder, could sleep undisturbed and could attend to personal hygiene and grooming.

Autopsy pathology of cocaine users from the Eastern district of London: a retrospective cohort study.

AIM: To establish the most frequent pathological findings encountered at postmortem examination during the investigation of a fatality with a history of cocaine abuse. METHODS: Autopsied deaths investigated by the coroner for the Eastern district of London, between 2004 and 2007, in which the decedent had positive toxicology for cocaine were identified (n = 28). The autopsy records and histology of tissue taken at autopsy were retrieved and reviewed. Pathological findings (gross and microscopic, including cardiac, pulmonary, gastrointestinal, hepatobiliary, renal and neurological) were collated. RESULTS: The main pathological findings at autopsy occurring in this cohort (comprising predominantly men, mean age 31 years), were cardiovascular: left ventricular hypertrophy (46%), multifocal myocardial fibrosis (21%), coronary artery disease (29%), cerebrovascular disease (36%) and pulmonary oedema (71%). Hepatic steatosis (29%) and gastrointestinal haemorrhage (18%), due mostly to gastric erosions/ulceration, were also frequent findings. CONCLUSIONS: During a coroner's autopsy of a cocaine user, a thorough cardiac examination combined with cardiac tissue sampling for histology, are valuable investigations, which are most likely to help show pathology relevant to the cause of death.

[Calcification+ of both ends of "double-J catheter", with long staying, without impact on renal unit]. / Calcificación de ambos extremos de "cateter doble J", con larga permanencia de éste, sin repercusión sobre la unidad renal.

We report on a patient who had previously undergone ESWL and had a double-J catheter indwelling for 32 months. Both ends of the catheter were found to be completely calcified. Renal function and morphology were completely recovered following removal of the catheter. Like other authors, we believe that urinary drainage around the double-J catheter will suffice in some cases.

[Calcification of seminal vesicles and deferent duct]. / Calcifición de vesículas seminales y ampolla deferencial.

Herein we describe a chronic diabetic with calcification of both seminal vesicles and the deferent duct which had been disclosed by a plain film of the urinary tract and an IVP. Currently the foregoing condition can be considered to be pathognomonic of diabetes mellitus, although these patients generally do not present urological symptoms or signs.

[Partial nephrectomy for pyelo-renal duplication with pseudocoraliform lithiasis in non-functioning upper pyelon]. / Nefrectomía parcial por duplicidad pielorenal con litiasis pseudocoraliforme en pielon superior afuncionante.

We performed a right heminephrectomy in a patient with pyelorenal duplicity, pseudostaghorn stone in nonfunctioning superior pyelon and a history of right perirenal abscess. The history, indications, variations and complications of this surgical procedure are briefly described. The importance of performing a complete evaluation prior to surgery is emphasized.

[A new cases of transitional cell papilloma of the bladder, inverted type]. / Un nuevo caso de papiloma de células transicionales de vejiga, tipo invertido.

We report on a 75-year-old male patient with inverted transitional cell papilloma located on the right side of the bladder, behind the prostate lobe. It was a large (4 x 4 x 0.9 cm) exophytic, papillary tumor with a wide base and all the gross features of a typical transitional cell tumor of the bladder. The presenting symptom was gross hematuria and treatment was by transurethral resection. The literature is briefly reviewed.

[A giant adrenal mass: the anatomicopathological surprise finding]. / Masa suprarrenal gigante: sorpresa anatomopatológica.

OBJECTIVE: The present study reviews the differential diagnosis of adrenal masses, including the uncommon forms, as the one described herein. METHOD/RESULTS: A patient with a giant adrenal mass that required differential diagnosis from other types of adrenal masses is presented. The diagnosis could only be made following anatomopathological analyses. CONCLUSIONS: The present case demonstrates that the uncommon forms of adrenal masses must be taken into account in the differential diagnosis, which, however, can only be confirmed by the pathological analysis since the findings on diagnostic imaging mimic other forms.

[[Brucellar orchiepididymitis with abscess]. / Orquiepididimitis brucelósica abscesificante.

OBJECTIVE: To emphasize the need to consider Brucella infection in patients presenting with acute scrotum of a possible inflammatory etiology, in endemic areas, as in some Spanish regions. The abscess forming type, although rare, should be considered. One such case is described herein and the literature briefly reviewed. METHODS: A male patient consulted for subacute inflammation and left testicular pain. He had systemic brucellosis four months earlier that had completely remitted following specific therapy. The patient had a physical examination, analytical, blood and urine analyses, specific serological tests and testicular ultrasound evaluation. RESULTS: Physical examination disclosed left testicular pain and inflammation suggesting epididimo-orchitis. The laboratory findings were normal except for high titles against Brucella. Ultrasound disclosed diffuse enlargement of the left testis with several well-defined hypoechoic areas. The foregoing data suggested abscess forming orchitis, although a neoplasm could not be discarded. Empirical antibiotic therapy was instituted initially and specific therapy for Brucella was administered subsequently, but unilateral orchidectomy was decided because of the poor response to therapy. Histopathological analysis of the surgical specimen disclosed acute abscess forming epididimo-orchitis with multifocal chronic granulomatous involvement. CONCLUSION: Brucella epididimo-orchitis must be considered when making the differential diagnosis in acute inflammatory scrotum, particularly in endemic areas, even in the absence of suggestive clinical and/or US findings. Necrotizing orchitis is a rare form of Brucella infection which must be distinguished from necrotizing involvement arising from other pathogens (TB or Salmonella). Above all, this condition must be distinguished from a tumor.

[Pyo-urachal cyst]. / Quiste piouracal.

A case of infected and suppurating pyourachal cyst is described. The rarity of urachal pathology in the adult prompted us to report the present case. The clinical features, diagnosis and treatment of this urachal complication are discussed.

[Urologic iatrogenic disease]. / Yatrogenia urológica.

OBJECTIVE: The purpose of this paper is to emphasize that despite the undeniable advantages of urological instrumentation (insertion of a ureteral catheter, double-J catheter; percutaneous nephrostomy, etc.), it also carries some risks and complications. METHODS: We report three cases of iatrogenic urological complications due to use of endoscopic and percutaneous material. RESULTS/CONCLUSION: Urologists, and particularly the residents, are reminded that iatrogenic complications may occur even in the easiest and routine procedures of the medical activity.

[Prostatic malacoplakia: report of a case and review of the literature]. / Malacoplaquia de próstata: aparición de un caso y revisión de la literatura.

OBJECTIVE: To describe an additional case of malakoplakia of the prostate. The etiopathogenesis, the histological and clinical features of this disease are analyzed and the literature briefly reviewed. METHODS/RESULTS: The pathological features of malakoplakia of the prostate in an elderly man with severe prostatic syndrome and recurrent urinary infections from E. Coli are described. The clinical manifestations disappeared following adenomectomy according to the Millin technique. CONCLUSION: Diagnosis of malakoplakia of the prostate is based on the pathological findings. The importance of the pathologist's role in the diagnosis of this condition, which will determine the treatment to follow, is therefore underscored.