Age at adiposity rebound in childhood is associated with PCOS diagnosis and obesity in adulthood-longitudinal analysis of BMI data from birth to age 46 in cases of PCOS.

BACKGROUND: Adiposity rebound (AR), the second BMI rise in childhood at around the age of 6 years, is associated with obesity and metabolic alteration in later life. Given that polycystic ovary syndrome (PCOS) has a strong metabolic component, early life growth patterns could reveal a risk of PCOS. Thus, we aimed to investigate the associations between age at AR and PCOS diagnosis and BMI later in life. MATERIALS AND METHODS: This study is part of a prospective, population-based longitudinal study, where women with PCOS diagnosis by age 46 (n = 280) were compared with asymptomatic women (CTRLs, n = 1573). Weight and height data from birth to age 13 years, at age at menarche, and at ages 31 and 46 years were analyzed RESULTS: Women with PCOS had lower birth weight (3357 ± 477 vs. 3 445 ± 505 g, p < 0.001), earlier age at AR (5.2 ± 1.0 vs. 5.6 ± 0.90 years, p < 0.001) and higher BMI from AR onwards compared with controls. Early timing of AR was associated with PCOS diagnosis independently of BMI (OR 1.62, 95% Cl 1.37-1.92). Women with PCOS and early AR had higher BMI at 31 and 46 years when compared to controls with early AR. The age at AR did not associate with T levels at ages 31 or 46 years. CONCLUSIONS: Early AR was associated with PCOS diagnosis and high BMI in adulthood. Adolescent girls with early AR and persisting obesity should be screened for PCOS symptoms, such as persistent irregular cycles and hirsutism.

Intraoperative Complications and Mid-Term Follow-Up of Large-Diameter Head Metal-on-Metal Total Hip Arthroplasty and Hip Resurfacing Arthroplasty.

BACKGROUND AND AIMS: Large-diameter head total hip arthroplasty and hip resurfacing arthroplasty were popular in Finland from 2000 to 2012 for the treatment of hip osteoarthritis. The aim of this retrospective study was to investigate the mid-term survival of large-diameter head total hip arthroplasty patients operated on in three university hospitals and to compare these results to the survival of hip resurfacing arthroplasty patients. MATERIAL AND METHODS: A total of 3860 hip arthroplasties (3029 large-diameter head total hip arthroplasties in 2734 patients and 831 hip resurfacing arthroplasties in 757 patients) were operated on between January 2004 and December 2009. The mean follow-up was 4.3 years (range: 0.3-8.0 years) in the total hip arthroplasty group and 5.1 years (range: 1.7-7.9 years) in the hip resurfacing arthroplasty group. Cox multiple regression model and Kaplan-Meier survival analysis were used to study the survival of the total hip arthroplasties and the hip resurfacing arthroplasties. Intraoperative complications and reasons for revisions were also evaluated. RESULTS: In Cox regression analysis, the hazard ratio for revision of hip resurfacing arthroplasty was 1.5 compared with large-diameter head total hip arthroplasty (95% confidence interval: 1.0-2.2) ( p = 0.029). The cumulative Kaplan-Meier survival rate was 90.7% at 7.7 years for the large-diameter head total hip arthroplasty (95% confidence interval: 86.8-94.6) and 92.2% at 7.6 years for hip resurfacing arthroplasty (95% confidence interval: 89.9-94.6). There were a total of 166/3029 (5.5%) intraoperative complications in the large-diameter head total hip arthroplasty group and 20/831 (2.4%) in the hip resurfacing arthroplasty group ( p = 0.001). Revision for any reason was performed on 137/3029 (4.5%) of the arthroplasties in the large-diameter head total hip arthroplasty group and 52/831 (6.3%) in the hip resurfacing arthroplasty group ( p = 0.04). CONCLUSION: The mid-term survival of both of these devices was poor, and revisions due to adverse reactions to metal debris will most likely rise at longer follow-up. There were more intraoperative complications in the large-diameter head total hip arthroplasty group than in the hip resurfacing arthroplasty group.

Perioperative complications after cemented or uncemented hemiarthroplasty in hip fracture patients.

BACKGROUND AND AIMS: Both cemented and uncemented hemiarthroplasties are acceptable methods for treating displaced femoral neck fractures. Cemented hemiarthroplasty has traditionally been recommended as being more safe and reliable. However, the cementing process carries a risk of fat embolism and cardiovascular problems. This study attempted to determine whether these complications can be avoided when using a modern uncemented stem. MATERIAL AND METHODS: We retrospectively compared 222 hip fracture patients treated with hemiarthroplasty in our hospital. A total of 100 of these patients were treated with a hydroxyapatite-coated uncemented hemiendoprosthesis (Bi-Metric BFx) and 122 patients with a cemented hemiendoprosthesis (Lubinus SPII). Information on mortality and complications during the first 18.7 months was retrieved from patient files. RESULTS AND CONCLUSIONS: Nine perioperative fat-embolic events were found in the cemented group and none in the uncemented group. During the initial hospital treatment, there were five deaths (4.1%) in the cemented group and one death (1%) in the uncemented group. There were significantly more perioperative fractures in the uncemented versus cemented group (7% versus 0.8%). We conclude that uncemented hemiarthroplasty is associated with more perioperative fractures than cemented hemiarthroplasty. However, perioperative cardiovascular disturbances may be less frequent with uncemented hemiarthroplasty, and early mortality may be lower with uncemented hemiarthroplasty.

Obesity has a negative impact on clinical outcome after total knee arthroplasty.

BACKGROUND AND AIMS: Obesity has been linked to the development of osteoarthritis of the knee and since the incidence of obesity is increasing, the need for total knee arthroplasty (TKA) is likely to increase. Conflicting findings have been reported concerning the relationship between obesity and TKA. It has been shown in several studies, that obese patients have poorer clinical results after operation. On the other hand it has also been reported similar results for obese and non-obese patients. The purpose of this study was to analyze clinically and radiologically the results of total knee artrhoplasty in obese patients. MATERIAL AND METHODS: The study consisted of 48 patients who had a TKA. The patients were divided in two groups according their body mass index. Patients of BMI over 30 were regarded as obese. RESULTS: The obese patients had poorer clinical success at the final follow-up, their WOMAC scores were significantly higher compared to non-obese (pain 20.7 vs. 11.6; p = 0.021, stiffness 26.9 vs. 13.4; p = 0.006, physical function 26.5 vs. 14.4; p = 0.003). Differences were also found in the Knee (KS) and Function (FS) scores and a long-term postoperative ROM and (KS: 83.6 vs. 88.9; p = 0.01, FS: 63.6/76.3; p = 0.051, ROM: 104.6 vs. 109.6; p = 0.016). Non-obese patients reached better percentage improvement in the KSS compared to obese patients (KS change + 194.5% vs. + 59.5%, p = 0.03; FS change + 51.5% vs. + 14.9%, p = 0.19). CONCLUSIONS: Obesity has a negative impact on the outcome of TKA, assessed by patients' clinical function and satisfaction level.

Obesity may impair the early outcome of total knee arthroplasty.

BACKGROUND AND AIMS: Obesity has been linked to the development of osteoarthritis of the knee and increases the probability to fall into total knee arthroplasty. In this study we compared short-term outcome of total knee arthroplasty (TKA) in non-obese and obese patients. MATERIAL AND METHODS: A total of 100 patients underwent TKA between October 2006 and March 2007. They were divided into two groups based on the body mass index: 52 of the patients were obese (BMI = 30 kg/m2) and 48 non-obese (BMI < 30 kg/m2). The short-term out-come was studied using clinical, functional and radiological analysis. The mean of the follow-up period was 3 months. RESULTS: There were five complications (2 wound infections, phlebitis, nerve injury and massive edema) in obese patients group compared with no complications in non-obese (p = 0.028). The obese patients had also worse postoperative range of motion (110 degrees vs.118 degrees , p = 0.001) than non-obese and the number of technical errors was 17 in obese and 5 in non-obese group, respectively (p = 0.007). CONCLUSIONS: We suggest that obesity may impair the early outcome of total knee arthroplasty and obese patients should be informed about the increased risk of complications related to TKA. Key words: Total knee arthroplasty; body mass index; obesity; complications; range of motion; mechanical axis.

Gamma probe localization in the surgical treatment of osteoid osteoma.

BACKGROUND: Osteoid osteoma is a benign bone tumor typically inducing night pain. It has traditionally been treated with operative excision. An accurate localization and complete removal of the small lesion is difficult resulting in high recurrence rate and reoperations. AIMS: The purpose of the present study was to examine the applicability of a hand-held gamma probe in the intraoperative localization of an osteoid osteoma. MATERIAL AND METHODS: Five patients were examined and operated for osteoid osteoma. Dose of 740 MBq Technetium 99m was injected 3 hours before operation, and hand-held gamma probe was used for the intraoperative detection of the lesion. RESULTS: All patients were relieved their symptoms. A histologically confirmed, complete removal of the lesion was achieved in 4 of 5 patients. No recurrences has been seen in the follow-up of 6 years. CONCLUSIONS: The gamma probe is an useful tool in the surgical treatment of osteoid osteoma. The technique is rapid and simple resulting in more accurate excision of the small lesion.

Pedicled gastrocnemius flap in complicated total knee arthroplasty.

BACKGROUND AND AIMS: The aim of this study was to evaluate the results of complicated total knee arthroplasty operations treated with radical wound revision and a pedicled gastrocnemius muscle flap. MATERIAL AND METHODS: Retrospective analysis in a university hospital during a five-year-period. RESULTS: Wound revision, debridement of the knee joint, replacing tibial plastics and a unilateral pedicled gastrocnemius muscle flap operation was performed to 10 patients after complicated total knee arthroplasty. After a median follow up time of 11.5 months 8/10 total knee arthroplasty joints were saved. CONCLUSIONS: As much as 80% of patients could save their knee joint with this treatment protocol. Treatment of this problem needs good collaboration with orthopaedic and plastic surgeons.

Dislocation of the proximal tibiofibular joint.A new method for fixation.

We introduce a new method for fixation of a rare, isolated, proximal tibiofibular dislocation. One third of the biceps femoris muscle tendon was used for fixation of the dislocated proximal fibular head. The fixation was achieved by using a soft threaded interference ACL screw.

Proliferation potential of human lumbar disc after herniation.

To investigate the regenerative potential of human disc tissue, the disc samples were obtained during surgery from 24 adult patients with first lumbar prolapses and from 14 patients with recurrent lumbar prolapses. Preoperative magnetic resonance imaging (MRI) confirmed prolapse and disc degeneration in all cases. The proliferation activity of the sampled connective tissue cells was studied with the immunohistochemical expression of Ki-67(MIB-1) antigen. The antigen was positive in 6 of 24 (25%) specimens from first prolapse and in none of the 14 specimens from the recurrent prolapse. The amount of proliferative cells did not correlate to the degree of disc degeneration in MRI. Our results indicate that connective tissue cells in adult degenerative disc may show proliferation activity after the first herniation and thus regenerative potential. The enhanced matrix proliferation may not be a significant reason for recurrent prolapses because none of the recurrent disc specimen showed proliferation activity.

Emergency abdominal surgery in the elderly.

We reviewed 201 consecutive patients aged over 65 years who were operated on for acute abdomen during the period 1986-89. Emergency procedures were most commonly performed on the biliary tract (24%), the appendix (20%), bowel (15%) and abdominal wall (12%). The postoperative morbidity was 26%, and the mortality rate of 22% was related most commonly to mesenterial thrombosis and intestinal obstruction. In fatal cases, 44% of the patients were over 80 years old and 64% were placed into the ASA classes IV-V. Eighty-four patients (42%) underwent postoperative intensive care, and 22 re-operations (9.0%) were performed. The mean hospital stay was 12 days and 70% of patients returned home after surgery. In conclusion, the outcome of emergency abdominal surgery in patients under 80 years of age and with no serious co-existing diseases has improved. Very old patients in ASA classes 4-5 still have a poor outcome.

Emergency appendectomies in patients over 80 years.

The outcome of 100 consecutive emergency appendectomies between 1985 and 1991 in octogenarians was compared to an unselected group of equal size, composed of patients between 60-79 and under 59 years. The frequency of appendectomies in the elderly did not increase during the study period. Negative explorations were performed in 28%-33% of the three age groups. The mortality was 0%, 3%, and 7%, and the complication rates 10%, 23%, and 40% in the patients aged under 59, between 60-79, and over 80 years, respectively. Appendiceal perforation was found in 49% of octogenarians, and it was associated with the mortality rate of 21%. In conclusion, patients under 80 years with emergency appendectomy had acceptable low mortality and morbidity rates that were comparable to the results of elective abdominal surgery of the same age, but the octogenarians had higher risk of poor outcome.

Clinical value of serum tumour markers TPA, TPS, TAG 12, CA 15-3 and MCA in breast cancer diagnosis; results from a prospective study.

The aim of this study was to assess the clinical value of five serum tumour markers, TPA, TPS, TAG 12, CA 15-3 and MCA, in the diagnosis of breast cancer. The serum values were measured in a prospective series of patients with breast cancer (n = 82) and benign breast disease (n = 25). The cut-off levels (90% specificity) determined for each test were 109.0 U/1 for TPA, 156.0 U/1 for TPS, 52.5 kU/1 cut-off level for TAG 12 and 24.9 kU/1 cut-off level for CA 15-3, and at the 12.0 kU/1 cut-off level for MCA. Using these cut-off levels the diagnostic sensitivity of the TPA test was 0.23, for the TPS test 0.15, 0.44 for the TAG 12 test, 0.13 for the CA 15-3 test and 0.10 for the MCA test in detecting breast cancer. When the cut-off levels were determined at 95th percentile level for each test, the cut-off level for TPA was 143.0 U/1, 279.0 U/1 cut-off level for TPS, 105.0 kU/1 cut-off level for TAG 12 and 36.7 kU/1 cut-off level for CA 15.3, and at the 15.3 kU/1 cut-off level for MCA. Using these cut-off levels the diagnostic sensitivity of the TPA test was 0.12, 0.01 for the TPS test, 0.06 for the TAG 12 test, 0.06 for the CA 15-3 test and 0.06 for the MCA test in detecting breast cancer. The correlation coefficients in breast cancer patients between TPA and TPS measurements was 0.82, between TPA and TAG 12 measurements it was 0.09, between TPA and CA 15-3 measurements it was 0.08, and 0.11 between TPA and MCA measurements. None of the serum markers studied were significant predictors in breast cancer diagnosis in a logistic regression analysis or in the discriminant analysis. Thus it seems that TPA, TPS, TAG 12, CA 15-3 and MCA have only limited value in breast cancer diagnosis, but their role in the follow-up and prediction of prognosis of breast cancer patients is a subject for further investigation.

Spontaneous peripelvic extravasation of urine as a cause of acute abdomen.

In eight patients with sudden onset of flank pain, urography showed extravasation of urine. The cause of peripelvic leakage was verified ureteral stone in four cases, stricture of the ureteropelvic junction in one, and unknown in three cases. Treatment was symptomatic in four cases, drainage in two and surgery in two cases. Seven patients recovered uneventfully, but one required nephrectomy. The prognosis in spontaneous urinary extravasation is usually good without drainage. Open surgery is seldom indicated.