An effective approach for the treatment of severe punctal stenosis: Bicanalicular silicone tube intubation with pigtail probe.

PURPOSE: To evaluate the results of using a pigtail probe to open the inferior punctum followed by bicanalicular silicone tube intubation in patients with severe acquired punctal stenosis. METHODS: Forty-one eyes of 25 patients with severe inferior punctal stenosis admitted to our tertiary care center were included in the study. The degree of epiphora was determined using the Munk score and the fluorescein disappearance test. The inferior punctum was located and opened by entering the superior punctum with a pigtail probe. Then, bicanalicular silicone tube intubation was performed. The silicone tube was removed after six months. A Munk score of 0 or 1 and a fluorescein disappearance test score of 1 and 2 were considered a complete success. RESULTS: Ten (40%) patients were male, and 15 (60%) were female. The mean age was 60.4±15.5years. One year after the surgery, epiphora was absent in 18 eyes (43.9%) (Munk score grade 0) and rarely seen in 9 eyes (22%) (Munk score grade 1). At the one-year follow-up, the fluorescein disappearance test score was stage 1 (<3min) in 21 eyes (51.2%) and stage 2 (3-5min) in 13 eyes (31.7%). There was a statistically significant difference between the preoperative and one-year postoperative test results (P<0.001). CONCLUSION: In cases with severe punctal stenosis, a pigtail probe is an effective method for locating and opening the punctum, and punctal opening and prevention of restenosis were achieved by a bicanalicular stent.

Dynamic thiol/disulphide homeostasis in patients with hypertrophic cardiomyopathy.

BACKGROUND: In addition to the genetic complexity of hypertrophic cardiomyopathy (HCM), there must be other disease-modifying factors that contribute to its highly variable clinical and phenotypic expression. The authors aimed to investigate serum thiol/disulphide homeostasis as a proxy for oxidative stress using a novel automated assay in patients with HCM. METHODS: This cross-sectional study was conducted on 119 patients with HCM and 52 without HCM. The methods used to measure dynamic thiol/disulphide homeostasis as calorimetric and duplex quantities were developed in 2014. RESULTS: Median serum native thiol levels were significantly lower in patients with HCM than in those without (312.5 µmol/L [285-370 µmol/L] vs 421 µmol/L [349-469.5 µmol/L]; p < 0.001). Serum total thiol levels and disulphide levels were considerably lower than those in the control group ([844.68 ± 195.99 µmol/L vs 1158.92 ± 243.97 µmol/L; p < 0.001], [259.13 ± 65.66 µmol/L vs 375.02 ± 79.99 µmol/L; p < 0.001], respectively). Serum disulphide/native thiol ratios and disulphide/total thiol ratios were significantly lower in HCM patients than in controls (0.80 ± 0.09 vs 0.92 ± 0.05; p < 0.001 and 0.31 [0.30-0.32] vs 0.32 [0.32-0.33]; p < 0.001). Finally, reduced thiol ratios were higher and oxidized thiol ratios were significantly lower in patients with HCM than in controls. CONCLUSIONS: Despite the fact that antioxidant capacity was impaired, the extracellular environment remained in a reducing state by keeping serum disulphide/native thiol ratios low. Therefore, the authors speculate that HCM may behave similarly to tumours with respect to serum thiol-disulphide levels.

The Effect of Pre-emptive Dexketoprofen Administration on Postoperative Pain Management in Patients with Ultrasound Guided Interscalene Block in Arthroscopic Shoulder Surgery.

Background: Postoperative pain is an important problem for patients undergoing shoulder surgery. Our study investigated analgesic efficacy, duration of analgesia, postoperative analgesic use and patient satisfaction with the use of preemptive intravenous dexketoprofen for interscalene block in addition to general anesthesia in arthroscopic shoulder surgery. Methods: 60 patients, scheduled for arthroscopic shoulder surgery were randomized (30 patients each) into either: - control group (Group1) or dexketoprofen group (Group 2). Patients were followed for 48 hours to compare both groups for; post-operative pain scores, effectiveness of postoperative analgesia, duration of analgesia, and analgesia consumption. Duration of postoperative sensory block of the shoulder joint was defined as time to onset of pain at the incision site. Duration of postoperative motor block of the shoulder joint was defined as time to onset of first shoulder movement. Results: While no significant difference was determined for motor block time, sensory block time was significantly longer in the dexketoprofen group (p < 0.05).VAS scores were significantly lower at all times in the dexketoprofen group (p < 0.05).Total PCA fentanyl consumption was 274.16 ± 314.89 (µg) in the dexketoprofen group, and 490.00 ± 408.98 (µg) in the control group, the difference was statistically significant (p < 0.05). No significant difference was observed between the groups' demographic and hemodynamic data. Conclusion: Pre-emptive IV dexketoprofen may be a good option for arthroscopic shoulder surgery and provides effective analgesia.

TP53 polymorphisms in smokers' and nonsmokers' pericoronal follicles of asymptomatic impacted third molars.

BACKGROUND AND PURPOSE: The investigators designed and implemented a prospective cohort study composed of smoking and nonsmoking patients with asymptomatic fully impacted mandibular third molars. The objective of the paper was to evaluate 21 single-nucleotide polymorphisms (SNP) on the TP53 gene in smokers' (S) and nonsmokers' (NS) pericoronal follicles of asymptomatic impacted third molars. MATERIALS AND METHODS: Matrix-assisted desorption/ionization time of the flight mass spectrometry was used for SNP analysis of 21 regions in the TP53 gene. Descriptive statistics and Chi-square tests were computed with a P value of 0.05. RESULTS: : Ten of the 21 SNPs related to oral pathologies according to NCBI dbSNP, were detected; in these, the genotypic frequencies showed no differences between the S and NS groups (P > 0.05). The results showed a high ratio of SNPs without correlation between smoking and TP53 gene status. CONCLUSION: Further studies should examine the entire TP53 gene to elucidate how smoking affects it in larger study populations.

The effectiveness of the low-power laser and kinesiotaping in the treatment of carpal tunnel syndrome, a pilot study.

In mild and moderate cases of carpal tunnel syndrome (CTS), the conservative approach is suggested. The purpose of this study is to assess and compare the effect of low-power laser versus the combination of low-power laser and kinesiotaping on pain, muscle strength, functionality, and electrophysiologic parameters in the patients with CTS. The study was planned as single-blind, prospective, randomized control. 64 hands diagnosed with CTS were included in the study. The patients were randomly divided into three groups by closed envelope method. Low-power laser therapy was applied to Group 1 (21 hands), kinesiotaping and low-power laser therapy in group 2 (22 hands), sham laser therapy in Group 3 (21 hands). All patients were assessed by visual numeric pain scale (VNS), hand grip strength (HGS), finger pinch strength (FPS), the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), before treatment, after treatment (3rd week), and after (12th week) 3 months the treatment with the same physician. Motor and sensory nerve conduction studies were performed with electroneuromyography (ENMG) before the treatment (0th week) and at the end of the 12th week. Comparison of the group 1 with the group 3 showed significantly better improvement in the former in VNS, BCTSQ at 3rd week and 12th week compared to 0th week, and in FPS and HGS at 3rd week. Comparison of the group 2 with the group 3 showed significantly better improvement in the former VNS, BCTSQ, FPS and HGS at 3rd and 12th week compared to 0th week. When Group 1 and Group 2 were compared there was no statistically significant difference in any parameters in the 3rd week, but there was a statistically significant difference in favor of group 2 in FPS and HGS parameters at the 12th week. We have found that the kinesiotaping method applied with low-power laser treatment does not provide any additional benefit to the low-power laser treatment in the short term, however, in the long term, the increase in the HGS and FPS has occurred. In conclusion, low-power laser and kinesiotaping method in the treatment of CTS may be an effective and reliable treatment option in clinical parameters.

Jugular Venous Catheterization: A Case of Knotting.

A 79-year-old woman, diagnosed for cancer of the ovary, had a central catheter that was placed with difficulty through the right internal jugular vein intraoperatively. After oophorectomy, it was realized that the catheter was knotted. Thus, the central venous catheter was removed successfully using a traction technique in the operating room. Central venous catheter use may result in various complications, although it has been used as an invasive method for hemodynamic monitoring and fluid and drug infusion. Here, we present catheter knotting in a case with solutions for this complication, under literature review.

Umbilical cord blood endocan levels according to the delivery mode.

PURPOSE OF INVESTIGATION: The authors aimed to evaluate the endocan levels in the umbilical cord blood regarding the delivery mode. MATERIALS AND METHODS: One hundred six women aged between 20 to 35 years, undergoing delivery at term were studied. Three groups were formed; 37 neonates born by spontaneous vaginal delivery (group 1), 34 neonates born by an elective cesarean section with the general anesthesia (group 2), and 35 neonates, born by an elective cesarean section with spinal anesthesia (group 3). In delivery, umbilical cord blood samples were collected and endocan levels were measured. RESULTS: The endocan levels of cord blood (mean ± standard deviation, ng/ml) were found to be lower in group 2 (1.21 ± 0.46) compared to group 1 (1.52 ± 0.52) (p = 0.011). Cord blood endocan levels were not different in group 1 than those of group 3 (p = 0.49). CONCLUSION: It may be concluded that cord blood endocan levels are affected by the delivery mode.

The effect of intravenous preemptive paracetamol on postoperative fentanyl consumption in patients undergoing open nephrectomy: a prospective randomized study.

AIM: We investigated the efficacy of intravenous (IV) preemptive paracetamol on postoperative total fentanyl consumption and fentanyl-related side effects in patients undergoing open nephrectomy. MATERIALS AND METHODS: A total of 60 patients scheduled for elective open nephrectomy under general anesthesia were included. All patients received Patient-controlled IV analgesia with fentanyl postoperatively. Patients were randomly allocated into three equal groups: The fentanyl group received 100 mL of IV normal saline as a placebo, with the first dose ending 30 min before intubation. In paracetamol group, IV 1 g paracetamol was given to the patients 30 min after extubation with repeated doses every 6 h totally 4 times a day. In preemptive paracetamol group, patients received IV 1 g paracetamol every 6 h, with the first dose ending 30 min before intubation. RESULTS: Postoperative cumulative fentanyl consumption for 24 h was significantly higher in the fentanyl group (1009 ± 139.361 µg) than those of paracetamol (752.25 ± 112.665 µg) and preemptive paracetamol groups (761.10 ± 226.625 µg) (P = 0.001 for both). In early postoperative period (0-4 h); whereas total fentanyl consumption showed no statistically significant difference among groups (P = 0.186), the nausea-vomiting scores were significantly higher in the fentanyl group compared with other groups (P = 0.012). CONCLUSION: In patients undergoing open nephrectomy, use of preemptive or postoperative paracetamol reduces fentanyl related nausea-vomiting without a decrease in total fentanyl consumption in the early postoperative period. Furthermore, use of preemptive or postoperative paracetamol reduces total fentanyl requirements in the first 24 h postoperatively providing a safe and effective postoperative analgesia.

The effect of anesthesia type on stress hormone response: comparison of general versus epidural anesthesia.

AIM: The aim of this study was to investigate the effect of different types of anesthesia on stress hormones. MATERIALS AND METHODS: The study was included 60 ASAI-II cases scheduled for major lower extremity surgery. The cases were randomized into 2 groups: The EA group was administered epidural anesthesia and the GA group was administered standard general anesthesia. In order to evaluate the surgical trauma - related stress response, CRP, TSH, cortisol, and fasting blood sugar(FBS) levels were measured preoperatively, 30 min after surgical incision, and 24 h post surgery. RESULTS: Between-group comparisons; Preoperative values were not significantly different between the groups.( P > 0,05) Pulse rate and cortisol values significantly higher in general group at 30 min. ( P < 0,05), and the FBS values were significantly higher in the epidural group at 24 h.( P < 0,05) There were not found differences for other parameters at evaluation times. CONCLUSION: No differences were observed between the two anesthesia methods, in terms of minimizing the stress response due to surgical trauma during major low extremity surgery.

The effects of different doses of caudal morphine with levobupivacaine on postoperative vomiting and quality of analgesia after circumcision.

The study aim was to investigate the effect of three different morphine doses added to levobupivacaine 0.125% for caudal analgesia after circumcision surgery in children, particularly in relation to the frequency of postoperative vomiting within the first 24 hours following surgery. Two hundred and forty patients aged 5 to 12 years undergoing circumcision were included in the study. Following induction, caudal 0.125% levobupivacaine 0.5 ml/kg was given after adding 7.5, 10 or 15 µg/kg morphine. The postoperative incidence of vomiting was 5%, 12.5% and 17.5% in the groups 7.5, 10 and 15 µg/kg morphine, respectively (P=0.012, 7.5 versus 15 µg/kg groups). Five percent of the 7.5 µg/kg group and none of the patients in the other groups required paracetamol within the first 12 hours, and there was a significantly greater need for rescue paracetamol over the 24 hours in the 7.5 group versus the 15 µg/kg group (P=0.013). Postoperative analgesic durations were long and did not differ between groups (1273±338, 1361±192 and 1426±48 minutes, respectively, P=0.08). In conclusion, because the incidence of vomiting is very low, the duration of postoperative analgesia is long and a dose of 7.5 µg/kg caudal morphine is much lower than doses previously reported to be associated with respiratory depression, this study supports the use of 7.5 µg/kg caudal morphine added to 0.125% levobupivacaine for circumcision surgery.

Use of dynamic wound closure system in conjunction with vacuum-assisted closure therapy in delayed closure of open abdomen.

AIM: Definitive abdominal closure may not be possible for several days or weeks after laparotomy in damage-control surgery, abdominal compartment syndrome and intraabdominal sepsis, until the patient has stabilized. Vacuum-assisted closure (VAC therapy(®), KCI, San Antonio, TX, USA) and abdominal re-approximation anchor system (ABRA, Canica, Almonte, Ontario, Canada) are novel techniques in delayed closure of open abdomen. Our aim is to present the use of these strategies in the management of 7 patients with open abdomen. METHODS: Between August 2010 and December 2011, 7 patients with severe peritonitis were stabilized by laparotomy and treated with either ABRA system or ABRA system in conjunction with VAC dressing. VAC dressing applied to 4 patients initially and followed by ABRA. ABRA was applied alone to remaining 3 patients. Demographic data and patient characteristics, timing of VAC dressing and ABRA system were recorded. ICU and hospital stay and development of incisional hernia were also recorded. Stage of open abdomen, width of abdominal defect, extent to damage to fascia, and pressure sores were staged. RESULTS: The mean duration with VAC dressing before ABRA application was 18 days. The mean duration of ABRA application was 53 days. The average width of the abdominal defect was 18 cm. The average length of defect was 20.8 cm. Delayed primary abdominal closure was accomplished in 6 patients without further surgery. Incisional hernia with a small abdominal defect developed in 2 patients. CONCLUSION: Abdominal re-approximation anchor system and VAC dressing can be used separately or in conjunction with each other for closure of delayed open abdomen successfully.

Turkish community-based palliative care model: a unique design.

An organized palliative care system was lacking in Turkey before 2010. One of the pillars of Turkish Cancer Control Programme is palliative care. The Pallia-Turk project in this respect has been implemented by the Ministry since 2010. The project is unique since it is population based and organized at the primary level. This means, the whole population (>70 million) will have the quickest and easiest way for access to palliative care. This manuscript briefly summarizes the situation before the project and updates what has been done in last 2 years with the project.

Analysis of circadian variation of acute myocardial infarction: afternoon predominance in Turkish population.

BACKGROUND: Although data about circadian variation of myocardial infarction (MI) in western populations reveal morning peak between 06:00 and 12:00 hours, differences have been reported in different regions of the world and ethnic groups. We aimed to evaluate circadian variation of MI in a Turkish cohort. METHODS: A total of 476 patients (mean age 56.7 +/- 11.7; 80% men) with acute st elevation MI were included into the study. Patients were categorised into four 6-h increments (00:01-06:00; 06:01-12:00; 12:01-18:00 and 18:01-24:00 hours). RESULTS: Onset of MI exhibited significant circadian variation among four time periods (p < 0.001), demonstrating afternoon peak (between 12:01 and 18:00 hours) and trough between 00:01 and 06:00 hours. Incidence of MI between 12:01 and 18:00 hours was significantly higher when compared with other three 6-h periods (p = 0.001). Incidence of MI between 00:01 and 06:00 hours was significantly lower when compared with other three 6-h periods (p = 0.001). Incidence of MI between 12:01 and 18:00 hours was 1.64 times that of average frequency of the remaining 18:00 hours of the day and 2.3 times that of frequency between 00:01 and 06:00 hours. When analysed for the subgroups of the study sample, only smoking blunted the afternoon peak. CONCLUSIONS: Instead of early morning peak in western countries, there is afternoon predominance in circadian variation of MI in a Turkish cohort. It may be related with genetic and/or demographic characteristics of Turkish population. Further studies are required to determine underlying pathophysiological mechanisms causing these differences in chronobiology of MI among populations.

Ultrasonographic examination of the scrotal content in the rabbit.

This study was performed to describe a practical technique for ultrasound examination of the scrotal content of the rabbit. The scrotal content of normal rabbits and those with induced lesions (i.e. needle biopsy of the testis and epididymal ligation) were viewed using a portable scanner connected to a 5 or 7.5 MHz real time, B-mode linear array transducer. The effect of frequency (5 and 7.5 MHz), pad material placed under the testicle (rubber, plastic and carton) and the presence of a water sack between the probe and organ were examined to optimize the technique. The best image quality was obtained using a 5-MHz probe when the testicle was fixed on a rubber pad and covered by a water sack. Testicular parenchyma was imaged as homogeneous and moderately echoic. Caput and cauda epididymis were identified as homogeneous and less echoic compared with the testis parenchyma. Variations in the testicular echotexture that occur secondarily to epididymal ligation and testis biopsy could be screened readily. In conclusion, real-time ultrasonography, performed as described in this study, may provide a valuable tool to screen scrotal contents and to identify certain pathological conditions that affect fertility in the rabbit.

To what extent is cyanoacrylate useful to prevent early wound infections in hernia surgery?

BACKGROUND: Prolene graft infection still occurs at an unacceptably high rate, despite many preventive measures with suggested effectiveness against infection. We assessed the efficacy of cyanoacrylate as a tissue adhesive and barrier against early and late contamination through the skin. METHOD: Thirty-two Wistar albino rats weighing between 250 and 300 g were randomised into four groups with eight animals in each. Group I: N-butyl 2-cyanoacrylate and early local contamination; group II: N-butyl 2-cyanoacrylate and late local contamination; group III: prolene suture and early contamination; group IV: prolene suture and late contamination. Prolene graft material 1 x 0.5 cm was implanted in mice above the fascia. Local contamination with 75 x 10(6) cfu/ml Staphylococcus aureus ATCC 25923 was carried out in groups III and VI within a postoperative period of 24 h. On the seventh day, the animals were killed and the grafts were explanted. The microscopic, histological and microbiological evaluation of the graft material and the surrounding tissues were performed. RESULTS: All of the graft cultures from group III (8/8) were positive for S. aureus, whereas all of those from group I (0/8) were negative. This difference was significant (P < 0.001). Histological examination revealed denser inflammatory cell infiltration in group III than in group I. On the other hand, there was no difference between groups II and IV. CONCLUSIONS: Maintaining skin integrity after closure is very significant, as contamination during the first few hours of the procedure may result in prolene graft infection. Cyanoacrylate appears to be a promising molecule within the first few hours of the operations for two reasons, namely, its bacteriostatic effects and ability to seal the barrier effectively and immediately.

Abdominal aortic aneurysm sac behavior following Cook Zenith graft implantation: a five-year follow-up assessment of 212 cases.

AIM: Aneurysm shrinkage is an expected outcome after stent-grafting for abdominal aortic aneurysm (AAA). A worrying problem following repair is progressive enlargement indicating persistent sac pressurization: in this setting not all grafts are equal. The Cook Zenith device (CZ) became available on the European market in 1999. While multicenter studies on the device have shown favorable clinical results at mid-term follow-up, few have focused on sac behavior. This study evaluated AAA sac behavior and predictive factors of its evolution by assessing the five-year results obtained with the CZ graft in a single-institution experience. METHODS: All consecutive elective surgery patients treated with a CZ graft for infrarenal aortic or aortoiliac aneurysm repair from January 2000 to November 2004 in our institution were included prospectively in the study and followed at 1, 6, 12, 18, 24 months and yearly thereafter. Pre-, intra- and postoperative data were recorded in a computerized database. Computed tomography (CT) scans were reviewed by a senior radiologist to identify any abnormalities including endoleak and graft malfunction. Pre- and postoperative maximum sac diameters were derived from measurements of CT findings and then compared. A change of at least 8 mm in sac size was considered significant. Overall results are expressed according to the Committee on Reporting Standards of AAA treatment. Factors that may have influenced sac behavior were analyzed by dividing the patients into 3 groups according to whether the sac diameter remained unchanged (group 1), had increased (group 2) or regressed (group 3). Statistical analysis of the demographic and CT-scan data was then performed. RESULTS: The study sample was 212 consecutive patients (mean age 72.8+/-9.0 years); the mean aneurysm diameter before treatment was 55.5+/-9.8 mm. All stent grafts were successfully implanted. The 30-day mortality rate was 0.94% (2/212); the morbidity rate was 11.7% (25/212). The primary technical success rate was 93.40%; the assisted primary technical success and secondary technical success rates were 96.63% and 99.52%, respectively. The mean follow-up period was 17.7+/-14.7 (1-60) months. The cumulative survival probability was 94%, 84.2%, and 72.9% at 12, 24, and 36 months, respectively. The endoleak-free survival probabilities at 12 and 24 months were 75.7% and 62.8%, respectively. The free of intervention survival rates were 82.1%, 68.9% and 60.6% at 12, 24 and 38 months, respectively. At five years follow-up, the overall clinical success rate was 49.5%. If changes in sac diameter occurred, they were noted at 13 months on average. Sac size remained unchanged in 115 (54.3%) patients (group 1), increased in 9 (4.2%) (group 2), and regressed in 88 (41.5%) (group 3). Neither preoperative patient demographics nor aneurysm characteristics were found to be predictive of sac behavior. Aortouniliac graft configuration was predictive of sac shrinkage (P=0.020). Endoleak was more frequent among patients in groups 1 (27/115; 23%) and 2 (5/9; 56%) than among those in group 3 (9/88;10%) (P=0.001). Reduction in aneurysm sac diameter was less marked in patients with any type of endoleak (P=0.0003). CONCLUSION: The CZ grafts offered satisfactory overall results up to five years of follow-up; nevertheless, sac diameter increased in 4.25% of patients. Endoleak was a predictive factor of a lack of sac shrinkage, while aortouniliac graft configuration was predictive of sac shrinkage.

Evaluation of risk factors in developmental dysplasia of the hip: results of infantile hip ultrasonography.

In this study, risk factors of developmental dysplasia of the hip (DDH) were evaluated. History, clinical examination and risk factors for DDH of the babies were recorded. The hips were evaluated with ultrasonography. Infantile hip ultrasonography is one of the best methods for screening of DDH. Ultrasonography is easy, repeatable and provides visualization of the cartilage part of the hip joint. Graf's method of infantile hip ultrasonography was used to evaluate the hip in this study. Both hips of 371 babies and 32 unilateral hips of 32 babies were included in the study. In 403 babies, 14 (3.4%) had DDH. There were 5 type IIB, 7 type IIC, 1 type D, and 1 type IV hips. Physiological immaturity was present in 81 hips (19% of babies). According to risk factor analysis, the only risk factor in unilateral analysis was presence of oligohydramnios (odd ratio-OR: 11.8, confidence interval-CI: 2.7-52.7). In correlation analysis, there was a correlation between female gender and swaddling. There was overall increase in DDH in female babies who were swaddled compared to those who were not. The results of this study showed that the most important risk factor was oligohydramnios for DDH. Swaddling and female gender increased the risk of the disease, but further studies in larger series are necessary for the confirmation of these results.

Position of the acetabular component determines the fate of femoral head autografts in total hip replacement for acetabular dysplasia.

We have reviewed 54 patients who had undergone 61 total hip replacements using bulk femoral autografts to augment a congenitally dysplastic acetabulum. There were 52 women and two men with a mean age of 42.4 years (29 to 76) at the time of the index operation. A variety of different prostheses was used: 28 (45.9%) were cemented and 33 (54.1%) uncemented. The graft technique remained unchanged throughout the series. Follow-up was at a mean of 8.3 years (3 to 20). The Hospital for Special Surgery hip score improved from a mean of 10.7 (4 to 18) pre-operatively to a mean of 35 (28 to 38) at follow-up. The position of the acetabular component was anatomical in 37 hips (60.7%), displaced less than 1 cm in 20 (32.7%) and displaced more than 1 cm in four (6.6%). Its cover was between 50% and 75% in 34 hips (55.7%) and less than 50% in 25 (41%). In two cases (3.3%), it was more than 75%. There was no graft resorption in 36 hips (59%), mild resorption in 21 (34%) and severe resorption in four (6%). Six hips (9.8%) were revised for aseptic loosening. The overall rate of loosening and revision was 14.8%. Overall survival at 8.3 years was 93.4%. The only significant factor which predicted failure was the implantation of the acetabular component more than 1 cm from the anatomical centre of rotation of the hip.

Interruption of the blood supply of femoral head: an experimental study on the pathogenesis of Legg-Calve-Perthes Disease.

INTRODUCTION: The etiology of LCPD still is not clear. Thrombosis has been accused in the pathogenesis of LCPD but it is not proven until now. The aim of this study is to evaluate the results of single episode of obstruction of blood supply to the femoral heads of dogs. MATERIAL AND METHOD: Blood supply femoral heads of 45 dogs was interrupted with embolisation with gel foam. The radiologic appearances, macroscopic and microscopic specimes of the hips were evaluated and compared with the human specimens of 15 LCPD patients obtained at the time of femoral osteotomies. RESULTS: After one infarct, we demonstrated changes in femoral heads of puppies showing close resemblance to the findings of LCPD in human. CONCLUSION: Obstruction of the femoral head caused by single artificial emboli caused changes in the femoral head similar to LCPD. The cause of the obstruction is obscure, intravascular and/or extravascular pathologies need specific attention, further studies focusing especially on the coagulation system are needed.