Haematocrit and haemoglobin decrease following image-guided percutaneous core needle biopsies.

AIM: To determine the clinical significance of variation in haematocrit (Ht) and haemoglobin (Hb) values before and after image-guided percutaneous core needle biopsies (PCNBs) and evaluate its clinical significance. MATERIALS AND METHODS: This single-centre, retrospective study included all the patients who underwent image-guided PCNBs between November 2012 and September 2018. In total, 105 cases (56 male; 53.3%; mean age 72±8 years) were available for analysis. Biopsies included lesions of the liver, lung, kidney, bone, paravertebral and soft-tissue masses, peritoneal implantations, and retroperitoneal neoplasms. The study's primary outcome was to compare the pre- and post-procedural Ht and Hb values and to evaluate their clinical significance. RESULTS: A significant decrease of the mean Hb and Ht values was detected post-biopsy (12.79±1.85 g/dl versus 12.03±1.72 g/dl and 38.75±4.93% versus 36.49±4.73%; p<0.0001). A decrease in the Ht and/or Hb level was noted in 93/105 (88.6%) and 94/105 (89.5%) of the patients; respectively. Four minor bleeding complications were noted (4/105; 3.8%), which resolved without any further treatment. An >4% decrease in Ht value was noted in 17/105 cases (16.2%) and an Hb decrease of ≥1.5 mg/dl was noted in 10/105 cases (9.5%), all without any haemodynamic compromise. CONCLUSIONS: A moderate post-PCNB decrease in Ht and Hb values compared to baseline should be expected, but should not raise concerns regarding an ongoing bleeding event, if not correlated with haemodynamic and clinical signs of haemorrhage.

Topical use of tranexamic acid in primary total knee arthroplasty: a comparative study.

INTRODUCTION: Perioperative blood management represents a major issue in knee arthroplasty. The aim of the present observational study is to compare two different methods of topical tranexamic acid (TXA) administration (periarticular and intraarticular) in primary knee arthroplasty. PATIENTS AND METHODS: The present is an observational comparative study. A total of 66 consecutive patients receiving topical injection of TXA after unilateral primary knee arthroplasty due to osteoarthritis were recorded. Patients were divided into two groups: group 1; periarticular injection of TXA and group 2; intraarticular injection. RESULTS: Transfusion rate in group 1 was found to be 15%, compared to 44% in group 2 (p-value= 0.015). In transfused patients the mean received blood units were 1.2 (SD=0.44) in group 1, compared to 1.06 (SD=0.24; p-value=0.34) in group 2. The mean hospital stay of group 1 patients was 7.94 days (SD=2.79), compared to 9.58 days (SD=3.26; p-value=0.03) in group 2. DISCUSSION: The main findings of the study are that statically significant higher transfusion rates, as well as longer in-hospital stay were found in the intraarticular group, when compared to the periarticular group. According to these two parameters the present study has shown that the topical periarticular TXA injection is superior to the intraarticular one. Further research is of utmost importance in order to conclude to the optimum combination of knee arthroplasty perioperative blood management.

The use of thoracoplasty in the surgical treatment of idiopathic scoliosis.

INTRODUCTION: Rib prominence on the convex side results from vertebral rotation. The cosmetic deformity of the back in scoliosis is only partially corrected by operations on the spine itself, whilst costoplasty addresses the problem directly, and improves the cosmesis. PURPOSE: Our experience in convex and concave side thoracoplasty is discussed. PATIENTS AND METHODS: The selection of the patients for thoracoplasty was done primarily taking into consideration the cosmetic disturbance of the rib hump and the consequences to the psychism of the patient. A total of 35 scoliotic patients (32 females and 3 males) with mean age 18.8 years underwent thoracoplasty in combination with posterior spinal fusion. In 23 patients (3 males and 20 females) convex side thoracoplasty (rib resection at the site of the hump) was done as a first stage procedure (18 patients) or a second stage procedure (5 patients). In the patients with spinal fusion at the same time, the resected ribs were used as bone graft. 12 female patients were treated with concave side thoracoplasty (osteotomies of the medial part of the ribs and elevation of the ribs on the instrumentation rod) as a first stage procedure combined with spinal fusion, while in one 22 female patient both side thoracoplasty was done as a second stage procedure. CONCLUSION: Either form of thoracoplasty was an effective and impressive way to improve the patient's appearance although it was not possible to quantify the results. The complications that were presented viz. 4 haemopneumothorax, 2 pneumothorax, 2 pneumonia) were treated successfully.

Instrumentation loosening and material of implants as predisposal factors for late postoperative infections in operated idiopathic scoliosis.

INTRODUCTION: Instrumentation loosening and metal corrosion are predisposal factors under investigation for late Postoperative infections. PURPOSE OF THE STUDY: To investigate the contribution of the instrumentation material (stainless steel versus titanium implants) and the mechanical loosening in the development of late postoperative spinal infection. PATIENTS AND METHODS: The first group of patients involves 50 idiopathic scoliotic patients who were treated with first generation posterior stainless steel spinal segmental multihook instrumentation. The minimum post operative follow up was 4 years. Five patients presented with late infections 1 to 5 years post operatively. Removal of instrumentation was the effective solution to this problem. Common intraoperative findings were some degree of instrumentation loosening and corrosion. The second group involves 40 idiopathic scoliotic patients who were treated with newer generation posterior titanium spinal segmental multihook-multiscrew instrumentation system. More extensive use of pedicle screws was performed to the second group resulting in a more stable mechanical construct. Follow up ranged from 2 to 5 years. None of those patients presented late postoperative infection or any evidence of instrumentation loosening or failure. CONCLUSION: We believe that newer multihook-multiscrew titanium spinal instrumentation systems have smaller incidence of late postoperative infections because they provide a more stable construct (pedicle screws) with fewer tendencies for micro motion or failure, and they may give the advantage of greater bone adhesion on the implant resulting in the production of thinner biofilm, thus decreasing the chances of infection.

Electric stimulation and hyperbaric oxygen therapy in the treatment of nonunions.

Up to 10% of the fractures occurring annually in the U.S. end up in non-union or delayed union. Classical treatment with osteosynthesis and bone grafting is not always successful. Alternatives in treatment have long ago been considered. This article presents current concepts in treatment with electrical stimulation and hyperbaric oxygen, the mechanisms of action, experimental and clinical evidence of their application.