Cerclage Breakage in Trochanteric Revision - High Risk for Hip Endoprosthesis?

We report a 72-year-old man who underwent fixation with a multifilament cerclage system after a peri-prosthetic trochanteric fracture (Vancouver A1). Failure of cerclage occurred after 23 month and revision of trochanteric attachment was performed due to non-union. Intraoperatively fragments of the cable were found between prosthesis head and liner. Cup and head were changed and the greater trochanter was re-attached after allograft-impaction. Based on the present case report multifilament cerclage cables should be used with precaution and might require a close and frequent follow-up given the possibility of cerclage breakage and consecutive catastrophic wear by migration of cerclage particles. Key words: cerclage, cerclage breakage, greater trochanter, revision.

Large contribution of human papillomavirus in vaginal neoplastic lesions: a worldwide study in 597 samples.

AIM: This work describes the human papillomavirus (HPV) prevalence and the HPV type distribution in a large series of vaginal intraepithelial neoplasia (VAIN) grades 2/3 and vaginal cancer worldwide. METHODS: We analysed 189 VAIN 2/3 and 408 invasive vaginal cancer cases collected from 31 countries from 1986 to 2011. After histopathological evaluation of sectioned formalin-fixed paraffin-embedded samples, HPV DNA detection and typing was performed using the SPF-10/DNA enzyme immunoassay (DEIA)/LiPA25 system (version 1). A subset of 146 vaginal cancers was tested for p16(INK4a) expression, a cellular surrogate marker for HPV transformation. Prevalence ratios were estimated using multivariate Poisson regression with robust variance. RESULTS: HPV DNA was detected in 74% (95% confidence interval (CI): 70-78%) of invasive cancers and in 96% (95% CI: 92-98%) of VAIN 2/3. Among cancers, the highest detection rates were observed in warty-basaloid subtype of squamous cell carcinomas, and in younger ages. Concerning the type-specific distribution, HPV16 was the most frequently type detected in both precancerous and cancerous lesions (59%). p16(INK4a) overexpression was found in 87% of HPV DNA positive vaginal cancer cases. CONCLUSIONS: HPV was identified in a large proportion of invasive vaginal cancers and in almost all VAIN 2/3. HPV16 was the most common type detected. A large impact in the reduction of the burden of vaginal neoplastic lesions is expected among vaccinated cohorts.