Primary total knee arthroplasty in severe valgus knee.

AIM: Outcome of primary total arthroplasty for osteoarthritis of the knee with valgus deformity. MATERIALS AND METHODS: Between 2005 and 2007, 28 primary total knee replacements were performed for osteoarthritis of the knee with valgus deformity. 21 cases were women and 7 men with a mean age of 66.6 years (extremes 54-81). The clinical and radiological evaluations were done considering the knee range of motion, Knee Society Score (KSS) and femorotibial angle measured on the frontal standing long leg X-rays. Preoperatively, the knee valgus deformity angle was 6 to 15 degrees in 14 cases, 15 to 25 degrees in 10 cases and over 25 degrees in 4 cases. RESULTS: After a mean follow-up time of 14 months (extremes 7-29), the knee range of motion improved from a mean of 71 degrees (extremes 52-87) preoperatively to a mean of 95 degrees (extremes 78-110) postoperatively. The KSS value improved from 21.3 points (extremes 1-33) preoperatively to 80.7 points (extremes 70-92) postoperatively and the frontal femorotibial angle from a mean value of 21 degrees (extremes 11-39) of valgus before surgery, to a mean of 9 degrees (extremes 0-12) of valgus after surgery. CONCLUSIONS: Long leg AP view X-ray examination in standing position is mandatory. The standard medial parapatellar approach is appropriate in this type of arthroplasty even if significant knee valgus deviations are present because it avoids the lateral approach complications. Postoperatively, one can get an aligned and stable knee if a judicious and progressive periarticular soft tissues balancing is achieved, in both flexion and extension position.

Giant-cell tumor of the bone (GCTOB): clinical case.

Giant-cell tumor of the bone is a benign tumor, but with high local aggressiveness, even with risk of distant metastasis. From an epidemiological standpoint, giant-cell tumor of the bone accounts for 4-5% of primary bone tumors and ~20% of benign bone tumors; commonly affects adults between 20-40 years, slightly more common in females. We present the case of a 57-year-old woman, without significant pathological history, which, after clinical, imagistic and anatomopathological investigations, is diagnosed with giant cell tumor of the right distal radius. The patient underwent surgery and segmental resection of the tumor in oncological limits was performed, replacing the remaining bone defect with fibular autograft. The results were good, according to Mayo functional assessment score. This way, the wrist joint mobility and the carpal cartilage were preserved, providing a barrier against distal migration of any remaining tumoral cells, as well. In conclusion, we can state that in aggressive giant cell tumors located at the distal radius, the best therapeutic option is en bloc resection of the formation (lesion) with fibular autograft replacement of the bone defect.

[Anatomo-surgical aspects of the liver in situs inversus]. / Particularitati anatomochirurgicale ale ficatului in situs inversus.

The hepatic veins and the intra-parenchymal branches of the portal vein and of the hepatic artery were dissected in two isolated livers form subjects with situs inversus. As a general observation, the intra-hepatic distribution of the portal vein in these cases represented a "looking-glass image" of the normal liver. The intra-hepatic branches differ from the normal by the presence of a large interarterial anastomotic canal in one of the cases. In the other case branches were found, of the left hepatic artery, for the upper sub-segments of the right lobe, that were irrigated from the venous standpoint, by the right branch of the portal vein.

[Dangerous complication of transtracheal oxygen therapy with the SCOOP(R) system]. / Gefährliche Komplikation der transtrachealen Sauerstofftherapie mit dem SCOOP(R)-System.

A portable oxygen system in combination with transtracheal O2 delivery (SCOOP(R)) permits patients with respiratory failure optimal mobility and facilitates longterm oxygen therapy. This report describes a 70 year old female with COPD that developed acute respiratory distress 18 days after inserting PRESCOOP(R) and 11 days after changing to SCOOP 1 catheter. Catheter stripping had not revealed any pathology. Flexible bronchoscopy showed a mucus ball at the catheter tip leading to a 80% stenosis of the trachea. Trials to remove the ball with forceps and a loop were not successful until a rigid bronchoscop was inserted. Up to 10% of patients develop mucus ball formation with SCOOP 1 catheter which remains in situ for 6 weeks. In patients with high risk of mucus formation (high O2 flow, viscous mucus, low FEV1) the manufacturers of SCOOP recommend catheter stripping. We consider a control bronchoscopy being safer 1 week after changing from PRESCOOP to SCOOP because one patient has been reported to have died of this complication and our patient has developed a near fatal situation.

[Association of a benign renal tumor with renal tuberculosis (author's transl)]. / Association d'une tumeur rénale bénigne et d'une tuberculose du rein

The authors present what seems to be the first case in the world of the association of urinary tuberculosis with a benign tumor of the kidney.