Treatment outcomes of bladder stones in children with intact bladders in developing countries: A systematic review of >1000 cases on behalf of the European Association of Urology Bladder Stones Guideline panel.

INTRODUCTION: Bladder stones (BS) are still endemic in children in developing nations and account for a high volume of paediatric urology workload in these areas. The aim of this systematic review is to comparatively assess the benefits and risks of minimally invasive and open surgical interventions for the treatment of bladder stones in children. METHODS: This systematic review was conducted in accordance with Cochrane Guidance. Database searches (January 1970- March 2021) were screened, abstracted, and assessed for risk of bias for comparative randomised controlled trials (RCTs) and non-randomised studies (NRSs) with >10 patients per group. Open cystolithotomy (CL), transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), extracorporeal shock wave lithotripsy (ESWL) and laparoscopic cystolithotomy (LapCL) were evaluated. RESULTS: In total, 3040 abstracts were screened, and 8 studies were included. There were 7 retrospective non-randomised studies (NRS's) and 1 quasi-RCT with 1034 eligible patients (CL: n=637, TUCL: n=196, PCCL: n=138, ESWL: n=63, LapCL n=0). Stone free rate (SFR) was given in 7 studies and measured 100%, 86.6%-100%, and 100% for CL, TUCL and PCCL respectively. CL was associated with a longer duration of inpatient stay than PCCL and TUCL (p<0.05). One NRS showed that SFR was significantly lower after 1 session with outpatient ESWL (47.6%) compared to TUCL (93.5%) and CL (100%) (p<0.01 and p<0.01 respectively). One RCT compared TUCL with laser versus TUCL with pneumatic lithotripsy and found that procedure duration was shorter with laser for stones <1.5cm (n=25, p=0.04). CONCLUSION: In conclusion, CL, TUCL and PCCL have comparable SFRs but ESWL is less effective for treating stones in paediatric patients. CL has the longest duration of inpatient stay. Information gathered from this systematic review will enable paediatric urologists to comparatively assess the risks and benefits of all urological modalities when considering surgical intervention for bladder stones.

[Stone therapy-use and limitations of the guidelines]. / Steintherapie ­ Anwendung und Limitation medizinischer Leitlinien.

Increase of medical knowledge, technical innovation together with a demographic change, and increase of stone incidence in daily practice challenges guideline preparation and clinical studies. Increasing interdisciplinary collaboration in stone treatment can also be demonstrated in the number of affiliated professional and working groups in the current guideline update. The following case illustrates treatment options in a symptomatic patient harbouring bilateral stones and metabolic risk factors. Decision guidance for treatment and recurrence prevention measures are presented on the basis of expert opinion and available published evidence.

Three critical clinicobiological phases of the human SARS-associated coronavirus infections.

OBJECTIVE: COVID-19 immune syndrome is a multi-systemic disorder induced by the COVID-19 infection. Pathobiological transitions and clinical stages of the COVID-19 syndrome following the attack of SARS-CoV-2 on the human body have not been fully explored. The aim of this review is to outline the three critical prominent phase regarding the clinicogenomics course of the COVID-19 immune syndrome. MATERIALS AND METHODS: In the clinical setting, the COVID-19 process presents as "asymptomatic/pre-symptomatic phase", "respiratory phase with mild/moderate/severe symptoms" and "multi-systemic clinical syndrome with impaired/disproportionate and/or defective immunity". The corresponding three genomic phases include the "ACE2, ANPEP transcripts in the initial phase", "EGFR and IGF2R transcripts in the propagating phase" and the "immune system related critical gene involvements of the complicating phase". RESULTS: The separation of the phases is important since the genomic features of each phase are different from each other and these different mechanisms lead to distinct clinical multi-systemic features. Comprehensive genomic profiling with next generation sequencing may play an important role in defining and clarifying these three unique separate phases for COVID-19. From our point of view, it is important to understand these unique phases of the syndrome in order to approach a COVID-19 patient bedside. CONCLUSIONS: This three-phase approach may be useful for future studies which will focus on the clinical management and development of the vaccines and/or specific drugs targeting the COVID-19 processes. ANPEP gene pathway may have a potential for the vaccine development. Regarding the specific disease treatments, MAS agonists, TXA127, Angiotensin (1-7) and soluble ACE2 could have therapeutic potential for the COVID-19 course. Moreover, future CRISPR technology can be utilized for the genomic editing and future management of the clinical course of the syndrome.

[Update of the 2Sk guidelines on the diagnostics, treatment and metaphylaxis of urolithiasis (AWMF register number 043-025) : What is new?] / Aktualisierung der S2k-Leitlinie zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis (AWMF Registernummer 043-025) : Was ist neu?

The increase of medical knowledge and technical innovations together with the demographic change represent a challenge for the new conception of guidelines and clinical studies. The present S2k guidelines, which are exclusively concerned with kidney and ureteral stones, should support the treatment of urolithiasis in hospitals and private practices and provide information on urolithiasis for patients. Increasing interdisciplinary collaboration in stone treatment is also demonstrated in the number of professional and working groups participating in the update of the new guidelines. The present S2k guidelines emerged from a consensus process and demonstrate the current recommendations in step with actual practice. They provide decision-making guidance for diagnostics, treatment and metaphylactic measures based on expert opinions and available published fundamental evidence from the literature.

Correlative study of lattice imperfections in long-range ordered, nano-scale domains in a Fe-Co-Mo alloy.

Recent advancements in data mining methods in atom probe microscopy have enabled new quantitative chemical and microstructural characterization beyond the standard three-dimensional reconstruction. For example, spatial distribution maps have been developed to enable visualisation of the local lattice occupation of a selected region of interest. However, the precision of such studies yet remains unknown as correlation with complementary methods would be required. Therefore, a correlative study of atom probe microscopy, neutron diffraction and microstructural modelling of long-range ordered, nano-scale domains in a well-researched Fe-Co-Mo Maraging-type steel is presented here. Its microstructure consists of Mo-enriched µ-phase (Fe,Co)7Mo6 particles embedded into a body-centred cubic FeCo matrix. Previous research has shown that under slow cooling conditions, this matrix partially decomposes into nano-scale B2 long-range ordered domains surrounded by disordered regions, resulting in reduced toughness in potential cutting applications. Usually, a long-range order parameter S referring to ideal B2 long-range order is assumed within such domains according to neutron diffraction. However, atom probe microscopy and modelling results presented in the current study indicate lattice imperfections with a partial substitution of atoms on the Fe- and Co-sublattices. After considering preferential retention effects during the atom probe experiment, a model unit cell is presented to define the observed imperfect B2 long-range order as pseudo-D03 long-range order, and the potential impact on the materials properties is discussed.

Bone Loss During the Acute Stage Following Burn Injury: Is It Local or Systemic? / La pérdida ósea durante la etapa aguda después de una lesión por quemaduras, ¿es local o sistémica?

ABSTRACT Objective: To examine post-burn bone loss and determine whether it was local or diffuse. Methods: Thirty-six patients with burn injuries were investigated, and the total body surface area of the burns and their locations were recorded. The bone mineral densities of the lumbar 1-4 vertebrae, bilateral distal forearm, and bilateral proximal femur of the patients were recorded, and these were compared with the measurements of the non-burnt extremity. Results: No statistically significant correlations existed among the total body surface area of the burns, their severity and the z-scores. In addition, when comparing the z-scores of the burnt extremity with those of the non-burnt extremity, no statistically significant difference was found (p > 0.05). Conclusion: In this study, a remarkable decrease in bone mass occurred during the second month following the burn injuries. The post-burn bone loss could not be correlated with the severity of the burns, but these injuries caused systemic bone loss.

RESUMEN Objetivo: Examinar la pérdida ósea después de una quemadura y determinar si era local o difusa. Métodos: Se investigó a 36 pacientes con lesiones por quemaduras y se registró el área total de la superficie del cuerpo con quemaduras y sus ubicaciones. Las densidades minerales óseas de las vértebras lumbares 1-4, del antebrazo distal bilateral, y del fémur proximal bilateral de los pacientes, fueron registradas y comparadas con las mediciones de la extremidad sin quemaduras. Resultados: No existieron correlaciones estadísticamente significativas entre el área total de la superficie corporal de las quemaduras, su severidad y las puntuaciones z. Además, al comparar las puntuaciones z de la extremidad quemada con las de la extremidad no quemada, no se encontró ninguna diferencia estadísticamente significativa (p > 0.05). Conclusión: En este estudio, se observó la ocurrencia de una disminución notable de la masa ósea durante el segundo mes tras las lesiones de la quemadura. La pérdida ósea posterior a las quemaduras no se pudo correlacionar con la severidad de las quemaduras, pero estas lesiones por quemadura causaron pérdida sistémica del hueso.

Atom probe study of B2 order and A2 disorder of the FeCo matrix in an Fe-Co-Mo-alloy.

The physical and mechanical properties of intermetallic alloys can be tailored by controlling the degree of order of the solid solution by means of heat treatments. FeCo alloys with an appropriate composition exhibit an A2-disorder↔B2-order transition during continuous cooling from the disordered bcc region. The study of atomic order in intermetallic alloys by diffraction and its influence on the material properties is well established, however, investigating magnetic FeCo-based alloys by conventional methods such as X-ray diffraction is quite challenging. Thus, the imaging of ordered FeCo-nanostructures needs to be done with high resolution techniques. Transmission electron microscopy investigations of ordered FeCo domains are difficult, due to the chemical and physical similarity of Fe and Co atoms and the ferromagnetism of the samples. In this work it will be demonstrated, that the local atomic arrangement of ordered and disordered regions in an industrial Fe-Co-Mo alloy can be successfully imaged by atom probe measurements supported by field ion microscopy and transmission Kikuchi diffraction. Furthermore, a thorough atom probe parameter study will be presented and field evaporation artefacts as a function of crystallographic orientation in Fe-Co-samples will be discussed.

Novel Drug Delivery System for Dermal Uptake of Etofenamate: Semisolid SLN Dispersion.

BACKGROUND: Semisolid SLNs are novel strategy for dermal drug administration instead of incorporating the SLN dispersions into conventional semisolids. Etofenamate loaded semisolid SLNs were successfully prepared and in vitro characterization of formulations were performed in our previous study. The present study is an attempt to evaluate the dermal behavior of the semisolid SLNs selected on the basis of previous research and investigate the properties in terms of the convenience for topical applications. OBJECTIVE: The objective of this study is to evaluate the skin penetration characteristics of semisolid SLN formulations. The occlusive and mechanical properties of semisolid SLNs were also evaluated because of their impression on the dermal behavior of the formulations. METHOD: The occlusive properties were investigated by in vitro occlusion test. Texture analysis was performed to define the hardness, compressibility, adhesiveness, cohesiveness and elasticity of the formulations. Rat skin was chosen to evaluate the ex vivo penetration of etofenamate loaded semisolid SLNs and commercial gel product. Coumarin-6 was used to visualize the dermal distribution of the semisolid SLN formulations. For monitorizing the penetration of coumarin-6 into the skin samples Confocal Laser Scanning Microscopy was employed. RESULTS: The occlusive and mechanical properties of C1 coded semisolid SLN formulation were found more favorable in comparison with P1. The cumulative etofenamate amount in skin samples was found to be 39.88 ± 1.50 µg/cm2 for C1 and 30.56 ± 2.10 µg/cm2 for P1 coded formulations. According to CLSM images, greater fluorescence intensities and deeper skin penetrations were obtained with both of the semisolid SLNs in comparison to plain Carbopol gel. CONCLUSION: It can be concluded that the semisolid SLNs are promising alternative dermal drug delivery systems to the conventional dosage forms.

[Urolithiasis guidelines: retrospective view and perspectives]. / Steinleitlinie: Rück- und Ausblick.

The first German guidelines on urolithiasis were published in four sections in "Der Urologe A" in 1997 and were listed at The Association of the Scientific Medical Societies in Germany (AWMF) in 1999. The European Association of Urology (EAU) published the first guidelines on urolithiasis in 2000. All guidelines must be updated on a regular basis. Guidelines should represent the highest level of evidence for the best diagnostic and therapeutic procedures, independent of economic pressure. Guidelines should safeguard optimal patient care and also serve as a basis for education and training of healthcare professionals. They are a tool for quality management and for national healthcare structures and strategies as well as for the judicature. Medical guidelines form the foundation for the elaboration of local clinical treatment pathways, which are the bridge to treatment of patients and also take economic and regional circumstances into consideration. In the future information technology (IT) could play an even more important role for both the complex methods of establishing guidelines and their implementation. The contents of guidelines could then be directly integrated into the clinical pathway, if necessary or into electronic patient charts in order to propose a medically and financially optimized treatment pathway. Because of the complexity of producing guidelines, they will in part be produced at a national level and adapted to the regional circumstances. Future technical, medical and genetic developments will lead to a multidisciplinary and multiprofessional cooperation in the production of guidelines.

Biomechanical properties of Achilles tendon in diabetic vs. non-diabetic patients.

BACKGROUND/OBJECTIVES: Structural and functional impairments of the Achilles tendon in diabetic patients has the potential to contribute to ulcer formation through altered foot mechanics. This study aimed to examine the biomechanical and histopathological alterations in Achilles tendon specimens from diabetic vs. non-diabetic individuals. MATERIALS AND METHODS: 42 Achilles tendon samples obtained from patients treated with below-knee or above-knee amputation for chronic diabetic foot ulcers (n=21) or for non-diabetic conditions (n=21) were included. A tensile test was performed for each tendon and a stress vs. strain graft was obtained to calculate following biomechanical parameters: elasticity (Young modulus), load, stiffness, toughness, energy, strain, elongation and tenacity. Groups were also compared with regard to histopathological findings (inflammatory cell infiltration, collagen organization, and degeneration). RESULTS: Non-diabetic tendons exhibited a superior biomechanical profile over diabetic tendons with regard to the following biochemical parameters: elasticity, maximum load, stiffness, toughness, load, energy, strain and elongation at break point, tenacity, and strain at automatic load drop (p<0.05 for all comparisons). Diabetic tendons had mild impairment of collagen organization and focal collagen degeneration, whereas neither diabetic nor non-diabetic tendons had inflammatory cell infiltration. CONCLUSION: The structural and functional alterations associated with diabetes adversely affect the biomechanical properties of the Achilles tendon, potentially acting together with neuropathy and ischemia in the development of diabetic foot ulcers.

Development of etofenamate-loaded semisolid sln dispersions and evaluation of anti-inflammatory activity for topical application.

Dermal application of various active substances is widely preferred for topical or systemic delivery. SLNs consist of biocompatible and non-toxic lipids and have a great potential for topical application in drugs. In this study, semisolid SLN formulations were successfully prepared by a novel one-step production method as a topical delivery system of etofenamate, an anti-inflammatory drug. Compritol 888 ATO and Precirol ATO 5 were chosen as lipid materials for the fabrication of the formulations. In-vitro evaluation of the formulations was performed in terms of encapsulation efficiency, particle size, surface charge, thermal behavior, rheological characteristics, in vitro drug release profile, kinetics, mechanisms, stability, and anti-inflammatory activity. The colloidal size and spherical shape of the particles were proved. According to the results of the rheological analysis, it was demonstrated that the semisolid SLN formulations have a gel-like structure. Stability studies showed that semisolid SLNs were stable at 4°C for a six month period. Zero order release was obtained with Precirol ATO 5, while Compritol 888 ATO followed the square root of time (Higuchi's pattern) dependent release. Semisolid SLNs showed higher inhibitory activity of COX in comparison with pure etofenamate. In conclusion, etofenamate-loaded semisolid SLN formulations can be successfully prepared in a novel one-step production method and useful for topical application.

Preparation and in vitro evaluation of meloxicam-loaded PLGA nanoparticles on HT-29 human colon adenocarcinoma cells.

CONTEXT: The inhibitors of cyclooxygenase (COX)-2 play an important role in cancer chemoprevention. Certain COX-2 inhibitors exert antiproliferative and pro-apoptotic effects on cancer cells. OBJECTIVE: In this study, meloxicam, which is an enolic acid-type preferential COX-2 inhibitor, was encapsulated in poly(D,L-lactide-co-glycolide) (PLGA) nanoparticles (NPs) to maintain local high concentration, and its efficacy was determined. METHODS: NPs were prepared by using salting-out and emulsion-evaporation steps. Meloxicam-loaded NP formulations were evaluated with respect to the drug loading, particle size, polydispersity index, zeta potential, drug release rate, and residual poly(vinyl alcohol) (PVA) percentage. The effects of PLGA and PVA molecular weight variations on the physicochemical properties of NPs were investigated. Stability of meloxicam in NPs was assessed over 3 months. COX-2 expressing human colon adenocarcinoma cell line HT-29 was used in cellular uptake and viability assays. RESULTS: NPs had a spherical shape and a negative zeta potential, and their size ranged between 170-231 nm with a lower polydispersity index. NPs prepared with high molecular weight PLGA were shown to be physically stable over three months at 4°C. The increase in molecular weight of the polymer and emulsifier reduced the in vitro release rate of meloxicam from NPs. Meloxicam-loaded NPs showed cytotoxic effects on HT-29 cells markedly at 800 µM. Cancer cells had high uptake of coumarin-6-loaded NPs. CONCLUSION: The PLGA NPs developed in this study can be a potentially effective drug delivery system of meloxicam for the treatment of colon cancer.

Ethylcellulose-based matrix-type microspheres: influence of plasticizer RATIO as pore-forming agent.

In this study, ethylcellulose (EC)-based microsphere formulations were prepared without and with triethyl citrate (TEC) content of 10% and 30% by water-in-oil emulsion-solvent evaporation technique. Diltiazem hydrochloride (DH) was chosen as a hydrophilic model drug and used at different drug/polymer ratios in the microspheres. The aim of the work was to evaluate the influence of plasticizer ratio on the drug release rate and physicochemical characteristics of EC-based matrix-type microspheres. The resulting microspheres were evaluated for encapsulation efficiency, particle size and size distribution, surface morphology, total pore volume, thermal characteristics, drug release rates, and release mechanism. Results indicated that the physicochemical properties of microspheres were strongly affected by the drug/polymer ratio investigated and the concentration of TEC used in the production technique. The surface morphology and pore volume of microspheres significantly varied based on the plasticizer content in the formulation. DH release rate from EC-based matrix-type microspheres can be controlled by varying the DH to polymer and plasticizer ratios. Glass transition temperature values tended to decrease in conjunction with increasing amounts of TEC. Consequently, the various characteristics of the EC microspheres could be modified based on the plasticized ratio of TEC.

A randomized clinical trial evaluating silicone earplugs for very low birth weight newborns in intensive care.

OBJECTIVE: To determine whether very low birth weight (VLBW) newborns (<1500 g) wearing silicone earplugs grow larger and perform better on developmental exams than controls. STUDY DESIGN: VLBW newborns (n=34) were randomized to wearing earplugs or not. Hospital outcomes were abstracted from medical charts by research staff masked to intervention status. Fourteen extremely low birth weight (ELBW) newborns (<1000 g) were also evaluated at 18 to 22 months. RESULT: After adjusting for birth weight, 11 surviving newborns in the earplug group were 225 g (95% CI: 45, 405) heavier at 34 weeks post menstrual age than the 13 controls. Six ELBW earplug infants scored 15.53 points (95% CI: 3.03, 28.02) higher than six controls on the Bayley Mental Development Index. Their head circumferences were 2.59 cm (95% CI: 0.97, 4.21) larger. CONCLUSION: Earplugs may facilitate weight gain in VLBW newborns. Better outcomes may persist at 18 to 22 months at least in ELBW infants.

[Importance of open and laparoscopic stone surgery]. / Stellenwert der offenen und laparoskopischen Steinchirurgie.

INTRODUCTION: The increasing spread and technical enhancement of endourological methods has led to displacement of the surgical therapy of renal and ureteral calculi. MATERIALS AND METHODS: Based on a review of current literature, we describe indications, technique, and clinical importance of the open and laparoscopic management of urolithiasis. RESULTS: In Europe and North America, the surgical therapy of urolithiasis only plays a role in cases of very large or hard stones, after failure of shock wave lithotripsy, percutaneous nephrolithotripsy, or ureteroscopic stone removal, and in cases of abnormal renal anatomy, i.e., only in a few percent of all stone therapies. However, in developing countries and emerging markets with different structure and funding of the health care system where the methods of endourology are not readily available, these techniques still have a higher importance. Particularly in Europe, laparoscopic surgery is emerging because calculi can be removed from almost all locations in the kidney and ureter using a transperitoneal or retroperitoneal access. Functional outcomes and complication rates are comparable. The benefits of laparoscopy are less postoperative pain, shorter hospital stay, faster convalescence, and better cosmetic results. CONCLUSIONS: Although procedures for open and laparoscopic removal of renal and ureteral calculi are only performed in rare cases in daily urological practice, they are superior to the endourological techniques in some circumstances. Therefore, they should still be part of the urologist's skills.

[New guidelines for urinary stone treatment. Controversy or development?]. / Neue Leitlinien zur Harnsteintherapie. Widerspruch oder Weiterentwicklung?

The new guidelines of the European (EAU), American (AUA), German, and Austrian associations of urology are based on thorough and consistent research and analysis of the published literature. However, the methodology is very diverse. In the case of the EAU-AUA guidelines on ureteral stones, the evidence was generated by a laborious meta-analysis of the entire available published literature on the subject. These guidelines represent the 1A level of evidence. The traditional European guidelines evaluate each statement separately and assign a level of evidence to each. The following aspects are new: the even greater effort to formulate guidelines accompanied by the initiation of international cooperative projects, clarity of presentation and evaluation of the individual statements (including levels of evidence), information on medication-based treatment to facilitate spontaneous passage of ureteral stones as well as stone fragments after extracorporeal shock wave lithotripsy (ESWL), a shift in the value of ESWL and ureterorenoscopy for ureteral stones, retrograde intrarenal surgery for small kidney stones refractory to ESWL or in settings unsuitable for ESWL, the use of laparoscopy in those rare cases that represent an indication for open surgery, and the additional value given to metaphylaxis in diagnosis and therapy. All of the new guidelines take these developments into account, although they differ slightly in the importance they assign to the individual items. The modifications represent the developments secondary to electronic data processing and preparation on the one hand and the rapid development of medical instruments on the other. Although ESWL is still the most important procedure for treating urinary stones, advances in flexible endoscopes, intracorporeal lithotripsy, and extraction instruments have led to a shift in the range of indications. These developments are fully accommodated in the new guidelines.

Treatment of femoral nonunions by using cyclic compression and distraction.

UNLABELLED: Eleven patients with femoral diaphyseal nonunions after intramedullary nailing were treated with cyclic compression and distraction with an external fixator over the nail. We evaluated the limitations of this technique and whether patients having this closed procedure could achieve union without additional operative procedures. Patients with hypertrophic nonunions (n = 4) were treated with gradual compression of the nonunion site. Cyclic compression and distraction was done in patients with oligotrophic (n = 2) or atrophic nonunions (n = 5) to stimulate consolidation. The average age of the patients was 32.9 years (range, 21-48 years), and the average followup was 40.5 months (range, 24-64 months). Union was achieved in an average of 5.8 months in all patients after one operation and without additional surgical intervention. However, pain necessitating strong analgesic agents and pin-related complications consisting of osteomyelitis, septic arthritis, and pin breakage in the atrophic nonunion group were a major limitation of this technique. Based on our study, the cyclic compression and distraction technique can be used in hypertrophic and oligotrophic nonunions that have failed one or more prior exchange nailings. However, it might not be an option for treatment of patients with atrophic nonunions unless pin-site problems are resolved. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

The effect of melatonin on plasma oxidant-antioxidant skeletal muscle reperfusion injury in rats.

We investigated the effects of melatonin administration on skeletal muscle ischaemia-reperfusion injury (IRI) by assessing plasma malondialdehyde (MDA), superoxide dismutase (SOD), total glutathione (GSSH), glutathione peroxidase (GPX) and myeloperoxidase (MPO) concentrations. Male Sprague-Dawley rats (n = 32) were randomized into four groups: group 1 served as time controls; group 2 were the test animals; group 3 received melatonin (30 mg/kg) intraperitoneally prior to the induction of ischaemia; and group 4 received melatonin (30 mg/kg) intraperitoneally prior to the reperfusion period. Administration of melatonin prior to reperfusion significantly decreased the elevated MDA concentration caused by IRI, and significantly elevated GSSH concentrations, which had been reduced by IRI. Ischaemia-reperfusion injury significantly increased activities of GPX, SOD and MPO, and melatonin administration reversed this effect. In conclusion, a pharmacological dose of melatonin showed significant protective effects against IRI by decreasing lipid peroxidation, MPO, SOD and GPX enzyme activities and regulating glutathione content.

Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study.

OBJECTIVE: Traumatic dislocation and fracture-dislocation of the hip is an absolute orthopedic emergency that is steadily increasing in incidence. Early recognition and prompt, stable reduction is the essence of successful management. A delay in recognition and reduction leads to preventable complications and morbidity. The purpose of this retrospective study is to identify prognostic factors that predict long-term outcome after hip dislocation. METHODS: Between 1980 and 1994, 107 patients with traumatic dislocation of the hips were treated, and 62 are reviewed in this study. There were 57 posterior fracture-dislocations and 5 anterior-obturator dislocations. All of the patients' charts were reviewed. The physical examinations and radiologic controls of the patients who were called for last follow-up examination were performed by the first two authors (V.S. and E.K.). Anterior and posterior fracture-dislocations were classified according to the classification system developed by Steward and Milford and femoral head fractures were classified according to the Pipkin classification. All of the hips were classified as very good, good, medium, fair, and poor according to the functional evaluation system described by Merle d'Aubigne. Statistical analysis of the results was performed. RESULTS: There were 47 male patients and 15 female patients, with ages ranging from 14 to 72 years (mean, 34.5 years). Traffic accidents constituted the leading cause of traumatic dislocation in this series (52 cases [83.9%]). Associated injuries were found in 44 cases (71%). Fifty patients were treated with closed reduction, and 12 patients were treated with open reduction. Thirty-five hips (56.5%) were reduced within 12 hours. Full weight-bearing was resumed between 2 and 10 weeks (average, 8 weeks) after injury. In follow-up periods ranging from 3.6 years to 18.4 years (mean, 9.6 years), 44 patients (71%) had very good or good to medium results. Ten patients (16.1%) developed late posttraumatic osteoarthritis of the hip, and 5 patients (9.6%) developed osteonecrosis of the femoral head. In this study, it is found that the time between injury and reduction and the associated injuries are the most important factors in long-term prognosis. CONCLUSION: We believe that good results were obtained in patients with early, stable, and accurate reductions by either closed or open methods. Concentric reduction absolutely should be confirmed by radiographs of the pelvis and, if necessary, by computed tomographic scan. The routine use of seat belts could have prevented many of these injuries.