Octyl-2-cyanoacrylate tissue adhesive without subcuticular suture for wound closure after total hip arthroplasty: a prospective observational study on thirty-two cases with controls for 3 months follow-up.

BACKGROUND: Whether using tissue adhesive alone after subcutaneous suture can close the skin incision with safety as well as cosmetic appearance after total hip arthroplasty was not clear. METHODS: A prospective study was conducted. The same surgical methods were consistent throughout the entire study. After implanting prosthesis, the joint capsule was reconstructed. Fascial and subcutaneous layer were respectively closed by continuous running barbed suture. Patients were randomized allocated to group A with octyl-2-cyanoacrylate tissue adhesive alone, to group B with tissue adhesive after continuous subcuticular suture, or to group C with skin staples. Time of closure, drainage, pain, wound complications, and cosmesis were compared. All data were analyzed statistically. RESULTS: There was no significant difference in drainage, Visual Analog Scale score or early wound complications between the three groups. However, there was significant difference in time of closure (P = 0.013). In pairwise comparison, time of closure in groups A and B was significantly longer than those in group C (P = 0.001 and P = 0.023, respectively); time of closure in group A was significantly shorter than those in group B (P = 0.003). Patient and Observer Scar Assessment Scale total scores were not significantly different at 6 weeks and 3 months postoperatively (P = 0.078 and P = 0.284, respectively). CONCLUSION: Tissue adhesive without subcuticular suture was similar with a combination of subcuticular suture and tissue adhesive as well skin staples in terms of safety and cosmetic appearance after total hip arthroplasty.

Slipped capital femoral epiphysis in an adult with congenital hypopituitarism: A case report.

RATIONALE: Slipped capital femoral epiphysis (SCFE) is a common hip problem in adolescents, usually individuals between 8 and 15 years old. Because of the frequent finding of growth abnormalities in affected children, various endocrine disturbances have been reported as the cause of the disease. However, there are few case reports of older patients in previous literature. To the best of our knowledge, congenital hypopituitarism with normal growth hormone (GH) level has not been reported. PATIENT CONCERNS: We describe a 29-year-old man who had a 3-month history of pain in the left hip with tall stature and unobvious secondary sexual characteristics. Laboratory testing showed low thyroxine, low cortisol, low follicle-stimulating hormone, low luteinizing hormone, low testosterone, but normal GH. DIAGNOSES: Brain magnetic resonance imaging showed pituitary hypoplasia. An anteroposterior pelvis radiograph showed severe varus SCFE in the left hip, it was also confirmed with computed tomography scans. INTERVENTIONS: The patient was treated with levothyroxine, hydrocortisone, and testosterone replacement therapy before surgery. We performed open reduction and anatomical reduction by Dunn's procedure. OUTCOME: We have followed this patient for 6 months, the left hip mobility gradually improved. No slip in the contralateral proximal femoral physis has been observed. LESSONS: When unobvious secondary sexual characteristics and body abnormalities were found in clinical practice, endocrine condition should be evaluated, since the contralateral side may prone to slip due to the lack of endocrine therapy.

The Protective Effects of Sufentanil Pretreatment on Rat Brains under the State of Cardiopulmonary Bypass.

This study aimed to observe the protective effects of sufentanil pretreatment on rat cerebral injury during cardiopulmonary bypass (CPB) and to explore the underlying mechanism. Twenty-four male adult Sprague Dawley (SD) rats were divided into 4 groups. Then, the rat CPB model was established. A 14G trocar was inserted into the atrium dextrum. For rats in S1 and S5 groups, sufentanil (1 µgKg(-1) and 5 µgKg(-1)) were applied before CPB process. After the operation, rat brain samples were harvested for measurement of the water content of the brains, total calcium in brain tissue and the level of serum S100ß. Compared with the Sham group, the water content and the total calcium of the brain tissue, and the expression of S100ß in serum were significantly increased in the CPB group (P<0.05). Compared with the CPB group, sufentanil treatment significantly reduced the water content of the brains, the total calcium and S100ß expression (P<0.05). The blood pressure and heart rate were significantly decreased in groups CPB, S1, and S5 compared with Sham group during CPB. Compared with the Sham group, the levels of pH and blood lactate in other groups were decreased and increased, respectively, in the post-CPB period. During the CPB and post-CPB periods, the hematocrit levels were significantly down-regulated in groups CPB, S1, and S5 compared with Sham group. In conclusion, sufentanil pretreatment was effective in reducing the cerebral injury during CPB. Reduction in calcium overload may be a potential mechanism in such process.