Why are patients dissatisfied following a total knee replacement? A systematic review.

BACKGROUND: Although total knee replacement (TKR) is an effective intervention for end-stage arthritis of the knee, a significant number of patients remain dissatisfied following this procedure. Our aim was to identify and assess the factors affecting patient satisfaction following a TKR. MATERIALS AND METHODS: In accordance with the PRISMA guidelines, two reviewers searched the online databases for literature describing factors affecting patient satisfaction following a TKR. The research question and eligibility criteria were established a priori. Any clinical outcome study that described factors relating to overall satisfaction after primary TKR was included. Quality assessment for the included studies was performed by two accredited orthopaedic surgeons experienced in clinical research. RESULTS: The systematic review identified 181 relevant articles in total. A history of mental health problems was the most frequently reported factor affecting patient satisfaction (13 reportings). When the results of the quality assessment were taken into consideration, a negative history of mental health problems, use of a mobile-bearing insert, patellar resurfacing, severe pre-operative radiological degenerative change, negative history of low back pain, no/less post-operative pain, good post-operative physical function and pre-operative expectations being met were considered to be important factors leading to better patient satisfaction following a TKR. CONCLUSION: Surgeons performing a TKR should take these factors into consideration prior to deciding whether a patient is suitable for a TKR. Secondarily, a detailed explanation of these factors should form part of the process of informed consent to achieve better patient satisfaction following TKR. There is a great need for a unified approach to assessing satisfaction following a TKR and also the time at which satisfaction is assessed.

Biomechanical and histological comparison between the cryopreserved and the lyophilized Gracilis tendon allograft for MPFL reconstruction, a cadaveric experimental study.

BACKGROUND: Medial patellofemoral ligament (MPFL) is the main restrictor of lateral shifting of the patella, contributing by 60 % in the first 20° flexion of the knee. MPFL reconstruction has been performed in order to restore the stability of the patella with good results.Lyophilized Gracilis tendon allograft (LGA) compared to Cryopreserved Gracilis tendon allograft (CGA) has a lower cost, does not require to maintain cooling chain or preparation. The purpose of this study is to compare the histological and biomechanical characteristics of an experimental model of reconstruction of the MPFL in porcine patellas with LGA versus CGA. METHODS: Randomized controlled experimental study in porcine model conducted on 36 porcine patellas in which 18 were intervened with LGA and 18 were intervened with CGA. The confluent tunnel technique was used for MPFL reconstruction. Maximum tensile force, allograft elongation and stiffness of the construct were measured. The cellularity and collagen tissue distribution were evaluated in the allografts. The histological and biomechanical characteristics of the LGA were compared to those of the CGA. RESULTS: The median of the maximum tensile force for the LGA group was 299.63 N and 280.86 N for the CGA group (p = 0.45). The median of the stiffness was 57.86 N/mm for the LGA and 54.23 N/mm for the CGA (p = 0.2). The median of the elongation for the LGA was 5.95 mm and 6.12 mm for the CGA (p = 0,29). The bone bridge failed in 88.88 % of the constructs with LGA and 94.44 % in those with CGA (p = 0.5). CONCLUSIONS: No differences were observed between the LGA group and the CGA group in maximum tensile force, elongation, stiffness, site of rupture and histological characteristics. The use of a lyophilized Gracilis tendon allograft for MPFL reconstruction confers the same histological and biomechanical characteristics as a cryopreserved Gracilis tendon allograft.

Effect of a single dose of pamidronate administered at the time of surgery in a rabbit posterolateral spinal fusion model.

Spinal fusion is usually performed on patients who receive bisphosphonates (BP); however, limited data on their action on spinal fusion are available. Previous studies in animal models have shown that chronic administrations of BP reduced spinal fusion rates, and only one study has shown that a single dose administration of zolendronic acid increased fusion rate. The objective of the present study was to evaluate if pamidronate (PA), which was previously demonstrated to reduce spinal fusion rate when administered continuously for 8 weeks, would increase the spinal fusion rate if administered in a single dose at the time of surgery in a rabbit model. Thirty-two New Zealand rabbits underwent an L5-L6 posterolateral intertransverse fusion with iliac crest autograft. Animals were randomized to receive either PA 3 mg/kg in a single dose immediately after surgery, or normal saline. Animals were killed 8 weeks after surgery and fusion was determined by manual palpation and radiographic analysis. Fusion healing was obtained in eight rabbits (50%) in the PA group and in four animals (25%) in the control group, p = 0.137. In a rabbit model, a single dose of PA did not decrease lumbar spinal arthrodesis consolidation rates, but it obtained a nonsignificant higher spinal fusion rate.

Diagnostic significance of clinical and laboratory findings to localize site of urinary infection.

The aim of this study was to define in children younger than 2 years of age the diagnostic significance of clinical and laboratory findings to localize site of febrile urinary tract infection. We reviewed the records of 185 children younger than 2 years of age admitted to hospital with febrile urinary tract infection. Patients were divided into having either acute pyelonephritis or acute cystitis according to the presence or absence of acute lesions on dimercaptosuccinic acid (DMSA) renal scintigraphy. Clinical and laboratory [white blood cell count (WBC), urinalysis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] findings were compared between the two groups using Student's t test, chi-square test, and multivariate analysis. Patients with pyelonephritis had statistically significant higher age, WBC, ESR, and CRP than those with cystitis. Although the sensitivity of the tests was 80-100%, their specificity was <28%. On multivariate analysis, 33% of patients with cystitis were diagnosed as having pyelonephritis, whereas 22% of those with pyelonephritis were considered to have cystitis. Given the low specificity of clinical findings and available laboratory tests to define the site of urine infection in this age group, we recommend DMSA renal scintigram as the test of choice to make the diagnosis of acute pyelonephritis in these patients.

Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study.

OBJECTIVES: To evaluate the role of primary vesicoureteral reflux (VUR) in increasing the frequency and severity of urinary tract infections (UTIs) and renal parenchymal damage among patients with acute pyelonephritis and to determine whether urinary antibiotic prophylaxis reduces the frequency and/or severity of UTIs and/or prevents renal parenchymal damage among patients with mild/moderate VUR. METHODS: Patients 3 months to 18 years of age with acute pyelonephritis, with or without VUR, were assigned randomly to receive urinary antibiotic prophylaxis or not. Patients were monitored every 3 months for 1 year. Dimercaptosuccinic acid renal scans were repeated at 6 months or if there was a recurrence of febrile UTI. Urinalysis and urine culture were performed at each clinic visit. Renal ultrasound scans and voiding cystourethrograms were repeated at the end of 1 year of follow-up monitoring. RESULTS: Of the 236 patients enrolled in the study, 218 completed the 1-year follow-up monitoring. Groups were similar with respect to age, gender, and reflux grade distribution for those with VUR. No statistically significant differences were found among the groups with respect to rate of recurrent UTI, type of recurrence, rate of subsequent pyelonephritis, and development of renal parenchymal scars. CONCLUSIONS: After 1 year of follow-up monitoring, mild/moderate VUR does not increase the incidence of UTI, pyelonephritis, or renal scarring after acute pyelonephritis. Moreover, a role for urinary antibiotic prophylaxis in preventing the recurrence of infection and the development of renal scars is not supported by this study.

Hemangioma vaginal en la infancia: presentación de caso clínico / Vaginal hemangioma in childhood: presentation of clinical case

La genitorragia en la infancia puede llegar a ser un problema diagnóstico si no se enfrenta apropiadamente. El objetivo de esta comunicación es presentar un caso clínico de una paciente con genitorragia a repetición cuyo diagnóstico final fue un hemangioma vaginal

Excreción urinaria de calicreína en recién nacidos / Urinary excretion of kallikrein in newborn infants

Se estudió la excreción urinaria de calicreína y algunos parámetros de función renal en 20 recién nacidos (12 RNPT y 8 RNT) de sexo masculino, durante las 24 y 48 horas de vida. Con respecto a los RNT, los RNPT tuvieron excreción urinaria de calicreína más baja (p < 0,05), menor depuración de creatinina (p < 0,02) y más baja osmolaridad urinaria (p <0,03). Los RNPT tuvieron un volumen urinario más alto (p < 0,01), mayor excreción fraccional de sodio (p < 0,01), menor excreción fraccional de potasio (p < 0,05) y mayor depuración de agua libre (p < 0,02). La excreción urinaria de calicreína se correlacionó directamente con edad gestacional (p < 0,01) y peso corporal (p < 0,03), e inversamente con excreción fraccional de sodio (p < 0,04) y volumen urinario (p < 0,01). Al corregir la excreción urinaria de calicreína a superfície corporal, las relaciones pierden significación estadística, excepto con edad gestacional (p < 0,04). Los valores de calicreína urinaria en recién nacido fueron bajos comparados con los de población adulta. Dado que la síntesis de calicreína ocurre en el túbulo distal, se plantea la hipótesis que esta menor excreción en la edad neonatal está relacionada con inmadurez funcional del túbulo, o menor respuesta del nefrón distal a hormonas que se sabe estimulan la excreción urinaria de calicreína en el adulto, como aldosterona y hormona antidiurética, o ambas

Función renal en recién nacidos de término y pretérmino durante el segundo día de vida / Renal function in at term and preterm newborn infants during the 2d day of life

Se estudiaron 42 recién nacidos normales de ambos sexos y diferentes edades gestacionales (rango: 26 a 41 semanas) entre las 24 y 48 horas de vida con el propósito de evaluar la velocidad de filtración glomerular y la excreción renal de agua y electrolitos. La depuración de creatinina se relacionó directamente con edad gestacional (r:0.67). La excreción fraccional de sodio se relacionó inversamente con la edad gestacional (r: - 0.84). No hubo correlación entre excreción urinaria de potasio y edad gestacional, pero se encontró correlación inversa entre esta última y los niveles de potasio plasmático (r: - 0.67). El volumen urinario y la excreción de agua libre presentaron una correlación inversa con la edad gestacional (r: - 0.83 y r: - 0.54). Las diferencias encontradas entre el grupo de recién nacidos de término y pretérmino para estos parámetros reflejan fundamentalmente diferencias en el gradiente madurativo funcional renal, aunque a las 24 horas de vida factores hemodinámicos postnatales pudieran influenciar estos resultados