The Association Between Helicobacter Pylori Infection and Liver and Biliary Tract Disorders.

Helicobacter Pylori (HP) persistently colonizes the stomach in about 50% of the globe population and it is the main risk factor for peptic ulcer, as well as for gastric adenocarcinoma and MALT gastric lymphoma. The treatment for HP revolutionized the management of the peptic ulcer disease, providing permanent healing in many cases. Preventing colonization of HP would be the primary prevention of gastric malignancy and peptic ulceration. At the same time, the presence of HP provides protection for some diseases (gastroesophageal reflux disease and its complications, esophageal adenocarcinoma, asthma), the eradication of the microorganism having negative repercussions. HP has an increasingly recognized role in other extragastric pathologies. Thus, immune thrombocytopenic purpura has improved after treating HP infection. There are controversial association with ischemic heart disease and cerebrovascular disease. The current article highlights an important association between HP infection and a range of hepatobiliary disorders such as biliary lithiasis (where even an etiological role is involved), cholestatic syndromes (primary sclerosing cholangitis and primary biliary cholangitis), chronic hepatitis B virus, chronic hepatitis C virus, with an evolution towards cirrhosis and hepatocellular carcinoma.

MANAGEMENT OF BILATERAL FEMORAL NECK FRACTURE IN A NONAGENARIAN PATIENT--CASE REPORT.

Simultaneous bilateral femoral neck fracture is rare injury. Cases with this type of fracture have been reported in the literature since the 1950s, following the introduction of electroconvulsive therapy which generates violent hip muscle contractions. In young patients' simultaneous bilateral femoral neck fracture results from high energy trauma (car accident or fall from height) in a normal bone. Pathological changes in bone structure occurring in chronic kidney disease, vitamin D deficiency, osteomalacia, osteoporosis, metabolic imbalances and administration of corticosteroids explain the occurrence of this particular type of fracture following low-energy trauma. We present the case of a 90-year-old female patient who suffered a simple fall from her own height resulting in a Garden IV bilateral femoral neck fracture. Our therapeutic option in this patient was bilateral uncemented bipolar hemiarthroplasty in a single session using a single tray of sterile surgical instruments and two sterile drapes. Postoperative outcome was very good, allowing the initiation of functional recovery on the first postoperative day. Uncemented hemiarthroplasty proved to be a good choice in such a patient in the associated diseases may trigger the risk of cardiovascular disturbances specific to bone cement implantation syndrome.

Proximalize osteotomy of tibial tuberosity (POTT) as a treatment for stiffness secondary to patella baja in total knee arthroplasty (TKA).

INTRODUCTION: Stiffness after a total knee arthroplasty (TKA) is one of the most common post-operative complications. The purpose of this study is the evaluation of the effectiveness of TT proximalization osteotomy of improving a lack of flexion and secondary pain in patella baja (infera) post-TKA. MATERIALS AND METHODS: Between April 2007 and July 2012, TT proximalization osteotomy was performed on 21 patients. The average preoperative flexion was 70° (in a range of 60-80). Clinical pre- and post-operative evaluations were performed with Knee Society Score, Western Ontario and McMaster Universities Arthritis Index scales and a satisfaction survey. Modified Blackburn-Peel index and Portner angle were used to evaluate patellar height. RESULTS: After an average follow-up of 35 months (range 18-48), an average flexion of 100° (range 90-100) and an overall satisfaction were obtained. Clinical scores improved significantly. The Blackburn-Peel index and Portner angle improved significantly from 0.3 (range 0.1-0.5) to 0.4 (0.3-0.5) and from 9 (3-15) to 12 (9-18), respectively. Three patients showed no signs of osteotomy consolidation. However, this was not linked to a lack of extension or an increase in local pain. CONCLUSION: TT proximalization osteotomy provides satisfactory results in improving a lack of flexion and pain in patella baja post-TKR.

TRAUMATIC SCAPHOLUNATE DISSOCIATION--CASE REPORT.

Perilunate injuries occur after an impact trauma to the wrist. The recognition of these lesions and immediate treatment are the two essential conditions to ensure the best possible outcome. The first therapeutic step is the restoration of anatomical joint relationships of the carpus followed by percutaneous pinning or internal fixation required for maintaining the congruence this segment. Despite correct diagnosis and approach in these cases the prognosis is often encumbered by decreased range of motion, loss of grip strength and finally the onset of osteoarthritis. Scapholunate dissociation is the most frequent pattern of carpal instability. We report the case of a 53-year-old woman diagnosed with scapholunate dissociation resulting from an injury caused by fall from the same level on the outstretched right hand (dominant hand). Surgery was performed 48 hours post-injury and consisted in external reduction followed after the restoration of the anatomical joint relationships in the right wrist by percutaneous pinning. Postoperatively the wrist was immobilized in brachipalmar cast for 8 weeks and arthrosynthesis pins were removed. The patient was reassessed at 6 months postoperatively by clinical and radiological evaluations and the functional outcome was good.

Low complications after minimally invasive fixation of calcaneus fracture.

Calcaneus fractures are still a delicate point regarding the indication for osteosynthesis. Knowing the skin's poor vascularisation of the back foot, the purpose of this study is to present the benefits of proper surgical options between an open and invasive osteosynthesis with anatomical reduction and internal fixation or minimally invasive approach preserving the quality of the soft parts. 66 interventions that targeted reduction and internal fixation of calcaneus fractures were performed between 2009-2012, in the Orthopaedic and Traumatology Department of Bucharest Emergency University Hospital. 29 cases underwent open reduction and internal fixation with plates and screws or Kirschner wires, and 37 cases underwent a minimally invasive reduction and Essex Lopresti osteosynthesis technique. No patient who underwent a minimally invasive reduction had skin lesions, but showed pain due to osteoarthritis lesions that appeared in the subtalar joint. 4 of them, who underwent open reduction and internal fixation had postoperative wound infections and skin necrosis.

[Use of trabecular metal in total knee arthroplasty in severely and morbidly obese patients (BMI > 35 kg/m2)]. / Utilización del metal trabecular en artroplastía total de rodilla en pacientes obesos graves y mórbidos (IMC >35 kg/m2).

The use of trabecular metal in the tibial surface may increase prosthetic survival in the population with severe or morbid obesity (BMI > 35 kg/m2). A prospective, descriptive study was conducted of patients with a BMI > 35 kg/m2 who underwent total knee replacement with a prosthesis with trabecular metal. Minimal follow-up was two years. The statistical analysis was done with Student's t test; the Knee Society Score and the Western Ontario and McMaster Universities Osteoarthritis Index were applied preoperatively and postoperatively. The chi2 test was applied to the BMI values relating them with more or less radiolucent images. The total number of patients was 39, but three were excluded for not having the radiographic follow-up. Mean follow-up was 34 months (25-43); 35 were females, mean age was 69.4 years (57-81), mean BMI was 39.43 kg/m2 (35-55). All patients had grades 3 and 4 tricompartmental arthrosis. The KSS (R and F) and WOMAC scales, with a 95% confidence interval, showed a statistically significant improvement in the assessment of preoperative results and at the end of the followup. Only a few studies measure long-term implant survival. Most authors define survival as the absence of the need to revise prosthetic implants. The end point of survival is the removal or exchange of prosthetic components. Trabecular metal (TM) is currently used in orthopedic surgery and its clinical applications are increasing more and more with good results.

Secondary patellar resurfacing in the treatment of patellofemoral pain after total knee arthroplasty.

PURPOSE: This paper reports a prospective review of patients who, between 2004 and 2007, underwent secondary patellar resurfacing (SPR) due to anterior knee pain after a primary total knee arthroplasty (TKA). The aim was to evaluate the clinical outcomes obtained with the SPR and to compare them with radiological findings. METHODS: A total of twenty-seven consecutive patients met the inclusion criteria. There were twenty-three (85%) women and four (15%) men with a median age of 70 years. The patients were evaluated before and after the surgery with the same functional scores and radiological parameters. Bone scintigraphy was also used in the assessment, and a CT-scan was performed in order to evaluate the femoral component rotation. The median time between TKA and SPR was 18 months. RESULTS: With a median follow-up of 23 months, seventeen patients (63%) reported a clear subjective improvement after SPR, and patellofemoral scores (primary outcome measure), KSS and WOMAC (secondary outcome measures) showed a statistically significant improvement following the procedure. There were no significant changes after SPR in the Insall-Salvati ratio, the lateral patellar displacement or the lateral patellar tilt. The mean time between TKA and SPR had no statistically significant effect on outcome. The bone scintigraphy revealed increased patellar uptake in seven cases, but this was not related to subsequent improvement after SPR. Rotational computed tomography showed a median internal rotation of the femoral component of 1º. The complications observed were a patellar component loosening and an acute post-infection. CONCLUSION: No clinical or radiological parameter was found to be related to the final outcome after SPR. There was a discrepancy between functional scale scores and the patient's subjective satisfaction.

Long-standing pain in a 25-year-old patient with a non-diagnosed cervical osteoblastoma: a case report.

Benign osteoblastomas are infrequent tumors, representing less than 1% of all bone tumors. The spinal location accounts for 40-50% of all osteoblastomas from which only 20% are located in the cervical spine. The majority of the spinal osteoblastomas arise from the posterior elements: pedicles, laminas, transverse or spinous processes. We present a case report of a young male that due to the lack of specific symptoms was diagnosed of a cervical osteoblastoma 14 months after the first symptoms. The tumor was located in the right C7 pedicle. We then operated, resected the tumor and a posterior C6-T1 bilateral instrumentation was performed to stabilize the spine. Nowadays, this delay in diagnosis may be avoided by the routine use of MRI or CT for unspecific cervical symptoms. The treatment of this lesion is the complete surgical resection based on a correct preoperative planning with CT and MRI in order to define precisely the location, size and extension of the tumor. Currently, percutaneous or minimally invasive surgery is not commonly used in the treatment of this lesion.

Usefulness of teicoplanin for preventing methicillin-resistant Staphylococcus aureus infections in orthopedic surgery.

In order to gather more data on the use of teicoplanin for reducing MRSA infections in high-risk populations, the present study was conducted. At a hospital in Barcelona, Spain, there was a high prevalence of MRSA infections among patients who underwent surgery for femoral neck fracture during the first 5 months of 2002 (period A) when cefuroxime was the antibiotic prophylaxis. During the following 12 months (period B) 600 mg of teicoplanin was added to cefuroxime. The rates of overall and MRSA infection during period A were 5.07 and 2.73%, respectively. Pulsed-field gel electrophoresis demonstrated there was no clonal relationship among MRSA strains. No nasal carriers of MRSA were detected among health workers. During period B the rates of overall and MRSA infection were 2.36 and 0.19%, respectively. Both rates were statistically significantly lower than those in period A (p<0.05). These results suggest teicoplanin may be useful in patients undergoing orthopedic surgery when the prevalence of MRSA is high.

Intrapelvic protrusion of a dynamic hip screw.

The sliding hip screw, sometimes called the dynamic hip screw (DHS) has been a successful method for treating hip fractures. Nevertheless, mechanical complications of this system have been reported from time to time. They are mainly the result of instability of the fracture, bone quality and technical errors occurring during surgery. We report a case of an intrapelvic protrusion of a sliding screw after a basicervical fracture was treated with a DHS and a 6.5 mm cannulated screw, and its surgical solution using a hybrid total hip arthroplasty. In our case we think the mechanical failure was due mainly to technical errors during surgery. Despite that, we believe the sliding hip screw is the implant of choice for basicervical fractures. Using an additional K-wire during the technique is sufficient to avoid rotation of the proximal fragment and no additional fixation is necessary.;

Abnormalities of platelet aggregation in chronic myeloproliferative disorders.

A large variety of platelet dysfunctions has been described in chronic myeloproliferative disorders. These abnormalities may be due to deficiency of platelet granules, arachidonic acid metabolism defects or platelet membrane glycoproteins abnormalities. In this study we intend to detect the incidence of platelet function defects in 76 patients with various types of chronic myeloproliferative disorders. The platelet activity was studied in vitro by measuring platelet aggregation in response to ADP, epinephrine, collagen, arachidonic acid and ristocetin. These results were subsequently correlated with bleeding time and clinical aspects (bleeding or thrombosis). We found complex changes in platelet response with all agonists, in varied proportions. These abnormalities include absent, decreased or abnormal platelet aggregation response. In a few cases we found a markedly decreased, almost absent platelet response to all agonists while in some patients a normal platelet aggregation was noted. The correlation between these results and template bleeding time, thrombotic or hemorrhagic events and the type of diseases was difficult to establish and sometimes conflictual. Despite this fact, we consider that investigating platelet aggregation may be useful not only for the assessment of the hemostatic balance in chronic myeloproliferative disorders but also for a better insight into cell abnormalities occurring in these pathologic conditions.

Esophageal porto-caval anasthomosis. Critical view of the hypothesis of F.C. Carvalho.

The apparition and the breakage of esophageal varices et the level of cardioesophageal junction in the portal hypertension still represents a problem of pathological surgery. The presence of these varicose dilatations in this region is due to an important zone of porto-caval anastomoses. Angioarhitectonical study of lower abdominal esophagus represents a disputed problem in the specialty literature. The hypothesis of south American anatomist F. C. Carvalho (1966) looks to be the best model that could explain the appear of cardioesophageal varices. Studies realized in the past within the Anatomy Department of Medicine "Carol Davila" Bucharest tried to demonstrate the validity of Carvalho's theory, and the results of these researches are exposed in the present paper.

Experimental studies on bacterial product CANTASTIM derived from Pseudomonas aeruginosa. II. Protective effect in Salmonella typhimurium infection.

Stimulation of the host defense system in a nonspecific way may provide effective treatment of recurrent infections. CANTASTIM is a bacterial product that has been successfully used in cancer immunotherapy as well as in chronic infections treatment. The nonspecific protective effect of CANTASTIM was investigated in two models of experimental infection with Salmonella typhimurium in mice. Prophylactic administration of CANTASTIM (three days before challenge) enhanced peritoneal macrophages bactericidal activity and significantly increased survival of treated mice. When CANTASTIM was administered 72 h after bacterial challenge, in a sublethal infection model with Salmonella typhimurium, by activating macrophages, NK and T cells, it increased the survival rate. The cell populations and molecular mechanisms involved in the prophylactic and therapeutic protective effect CANTASTIM seem to be partially different.

[Computer-assisted testing of the sense of color]. / Testarea simtului cromatic asistata de calculator.

The authors used the discrimination method--pseudoisochromatic phases and the comparison-assortment method for the chromatic sense examination in a group of subjects working in the motor transport and chemical textile dying. Computer programs were devised for examination data processing and for diagnosis display. After each testing, the data of each subject are added to the patient's card to be subsequently looked up and used for statistics.

[Emergencies in uveitis]. / Urgenta în uveite.

The authors insist on the emergency state each ophthalmologist has to consider during the diagnosis of uveitis. The key symptoms are shown and the therapy of uveitis is updated.

[Data on the therapeutic management in eyelid wounds]. / Date despre conduita terapeutica în plagile palpebrale.

The authors discuss palpebral reconstruction in simple wounds frequently encountered, showing the types of wounds in which grafts are used, or neighbouring or distal cutaneous flaps, grafts.