Clinical Outcomes and Infection Rates Following Revision Total Knee Arthroplasty: Aseptic Failure versus Septic Failure

Background@#It is controversial whether revision total knee arthroplasty (TKA) due to septic failure shows inferior clinical outcomes compared with TKA due to aseptic failure. Moreover, few studies have compared the infection rates after revision TKA between aseptic and septic failure. We aimed to compare the clinical outcomes and infection rates after aseptic and septic revision TKA. @*Methods@#Between April 2006 and May 2019, 68 and 26 patients underwent revision TKA due to aseptic failure (aseptic group) and septic failure (septic group), respectively. The postoperative range of motion (ROM), Western Ontario and McMaster Universities Osteoarthritis index, Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and infection rates were compared between the two groups. @*Results@#The mean follow-up durations in the aseptic and septic groups were 44.4 and 54.8 months, respectively. The septic group showed inferior postoperative ROM (124.1° and 109.4°, p = 0.004), KSKS (88.9 and 78.8, p = 0.001), and KSFS (72.8 and 59.0, p = 0.001). Three patients of aseptic group had infection. Three patients of septic group had recurred infection (same pathogen with the first infection) and 1 patient had a new infection (different pathogen). The septic group showed slightly higher but not significantly different infection rates (4.4% and 15.4%, p = 0.089). @*Conclusions@#Revision TKA with septic failure showed inferior postoperative clinical outcomes compared with aseptic revision surgery. A slightly higher infection rate was observed in the septic group but it was not significantly different.

Radiographic Factors of Proximal Junctional Failure According to Age Groups in Adult Spinal Deformity

Background@#Patient age has been associated with the development of proximal junctional failure (PJF). The characteristics of adult spinal deformity (ASD) are considered different between younger and older age groups. We hypothesized that the radiographic risk factors of PJF would be different according to age groups. This study aimed to evaluate different radiographic risk factors of PJF between two age groups undergoing thoracolumbar fusion for ASD. @*Methods@#ASD patients aged ≥ 60 years who underwent thoracolumbar fusion from the low thoracic level (T9–T12) to the sacrum were included. The minimum follow-up duration was 2 years. PJF was defined as proximal junctional angle (PJA) ≥ 20°, fixation failure, fracture, myelopathy, or necessity of revision surgery. Using various radiographic risk factors including age-adjusted ideal pelvic incidence (PI)-lumbar lordosis (LL), univariate and multivariate analyses were performed separately in two age groups: < 70 years and ≥ 70 years. @*Results@#A total of 186 patients (90.3% women) with a mean age of 69 years were enrolled. The mean follow-up duration was 67.4 months. PJF developed in 97 patients (52.2%). There were fractures in 53 patients, PJA ≥ 20° in 26, fixation failure in 12, and myelopathy in 6. PJF developed more frequently in patients 70 years or older than in those younger than 70 years. In patients aged less than 70 years, preoperative LL, PI-LL, and a change in LL were significant risk factors in univariate analysis. Multivariate analysis showed only a change in LL was significant for PJF development (odds ratio [OR], 1.025; p = 0.021). On the other hand, in patients 70 years or older, postoperative LL, postoperative PI-LL, and overcorrection relative to the conventional PI-LL target (within ± 10°) and age-adjusted ideal PI-LL target were significant risk factors. On multivariate analysis, only overcorrection of PI-LL relative to the age-adjusted ideal target was a single significant risk factor of PJF (OR, 5.250; p = 0.024). @*Conclusions@#In patients younger than 70 years, a greater change in LL was associated with PJF development regardless of PIrelated values. However, in older patients, overcorrection of PI-LL relative to the age-adjusted PI-LL target was a significant risk factor of PJF.

Complications of reverse shoulder arthroplasty: a concise review

Reverse shoulder arthroplasty is an ideal treatment for glenohumeral dysfunction due to cuff tear arthropathy. As the number of patients treated with reverse shoulder arthroplasty is increasing, the incidence of complications after this procedure also is increasing. The rate of complications in reverse shoulder arthroplasty was reported to be 15%–24%. Recently, the following complications have been reported in order of frequency: periprosthetic infection, dislocation, periprosthetic fracture, neurologic injury, scapular notching, acromion or scapular spine fracture, and aseptic loosening of prosthesis. However, the overall complication rate has varied across studies because of different prosthesis used, improvement of implant and surgical skills, and different definitions of complications. Some authors included complications that affect the clinical outcomes of the surgery, while others reported minor complications that do not affect the clinical outcomes such as minor reversible neurologic deficit or minimal scapular notching. This review article summarizes the processes related to diagnosis and treatment of complications after reverse shoulder arthroplasty with the aim of helping clinicians reduce complications and perform appropriate procedures if/when complications occur.

Knot-Tying versus Knotless Suture Anchors for Arthroscopic Bankart Repair: A Comparative Study

Purpose@#This study aimed to compare the results of using knotless and knot-tying suture anchors in arthroscopic Bankart repair. @*Materials and Methods@#The patients who underwent arthroscopic Bankart repair between 2011 and 2017 using knot-tying and knotless suture anchors were retrospectively reviewed. We collected demographic data, clinical scores (pain visual analogue scale), functional visual analogue scale, American Shoulder and Elbow Society scores, and Rowe score), and range of motion (ROM). Re-dislocation and subjective anterior apprehension test rates between the two techniques were also analyzed. @*Results@#Of the 154 patients who underwent arthroscopic Bankart repair, 115 patients (knot-tying group: n=61 and knotless group: n=54) were included in this study. Of the 115 patients, 102 were male and 13 were female. The mean patient age was 27 years (range: 17–60), and the mean follow-up period was 43 months (range: 24–99). There were no significant differences in the final clinical scores and ROM between the two groups. Re-dislocation was observed in 6 (9.8%) and 4 (7.3%) patients in the knot-tying and knotless groups, respectively. Apprehension was observed in 11 (18.0%) and 12 (22.2%) patients in the knot-tying and knotless groups, respectively. There were no significant differences between the two groups in regards to re-dislocation and anterior apprehension. @*Conclusion@#Re-dislocation rates and clinical scores were similar with the use of knotless and knot-tying suture anchors in arthroscopic Bankart repair after a minimal 2 year follow-up.

Complications of reverse shoulder arthroplasty: a concise review

Reverse shoulder arthroplasty is an ideal treatment for glenohumeral dysfunction due to cuff tear arthropathy. As the number of patients treated with reverse shoulder arthroplasty is increasing, the incidence of complications after this procedure also is increasing. The rate of complications in reverse shoulder arthroplasty was reported to be 15%–24%. Recently, the following complications have been reported in order of frequency: periprosthetic infection, dislocation, periprosthetic fracture, neurologic injury, scapular notching, acromion or scapular spine fracture, and aseptic loosening of prosthesis. However, the overall complication rate has varied across studies because of different prosthesis used, improvement of implant and surgical skills, and different definitions of complications. Some authors included complications that affect the clinical outcomes of the surgery, while others reported minor complications that do not affect the clinical outcomes such as minor reversible neurologic deficit or minimal scapular notching. This review article summarizes the processes related to diagnosis and treatment of complications after reverse shoulder arthroplasty with the aim of helping clinicians reduce complications and perform appropriate procedures if/when complications occur.

Knot-Tying versus Knotless Suture Anchors for Arthroscopic Bankart Repair: A Comparative Study

Purpose@#This study aimed to compare the results of using knotless and knot-tying suture anchors in arthroscopic Bankart repair. @*Materials and Methods@#The patients who underwent arthroscopic Bankart repair between 2011 and 2017 using knot-tying and knotless suture anchors were retrospectively reviewed. We collected demographic data, clinical scores (pain visual analogue scale), functional visual analogue scale, American Shoulder and Elbow Society scores, and Rowe score), and range of motion (ROM). Re-dislocation and subjective anterior apprehension test rates between the two techniques were also analyzed. @*Results@#Of the 154 patients who underwent arthroscopic Bankart repair, 115 patients (knot-tying group: n=61 and knotless group: n=54) were included in this study. Of the 115 patients, 102 were male and 13 were female. The mean patient age was 27 years (range: 17–60), and the mean follow-up period was 43 months (range: 24–99). There were no significant differences in the final clinical scores and ROM between the two groups. Re-dislocation was observed in 6 (9.8%) and 4 (7.3%) patients in the knot-tying and knotless groups, respectively. Apprehension was observed in 11 (18.0%) and 12 (22.2%) patients in the knot-tying and knotless groups, respectively. There were no significant differences between the two groups in regards to re-dislocation and anterior apprehension. @*Conclusion@#Re-dislocation rates and clinical scores were similar with the use of knotless and knot-tying suture anchors in arthroscopic Bankart repair after a minimal 2 year follow-up.

A Case of Gastric Neuroendocrine Carcinoma Presenting as Early Gastric Cancer Diagnosed by Endoscopic Submucosal Dissection

Gastric neuroendocrine carcinomas are very rare, when compared with gastric adenocarinomas. In addition, it is difficult to distinguish between gastric adenocarcinoma and gastric neuroendocrine carcinoma histol-ogically without immunohistochemical staining. In most of the reported cases, neuroendocrine carcinomas were diagnosed at an advanced stage, confirmed postoperatively by histological examinations using immunohistochemical staining and associated with a poor prognosis. A 55-year-old woman was diagnosed as cellular atypia by screening endoscopy for her health check-up at a local clinic. Histological examination from the endoscopic specimen revealed suspicious early gastric cancer. Endoscopic submucosal dissection was performed for therapeutic and diagnostic purposes and the pathologic findings revealed neuroendocrine carcinoma. Herein, we report a case of gastric neuroendocrine carcinoma presenting as early gastric cancer that was diagnosed by endoscopic submucosal dissection.

A Case of Gastric Neuroendocrine Carcinoma Presenting as Early Gastric Cancer Diagnosed by Endoscopic Submucosal Dissection

Gastric neuroendocrine carcinomas are very rare, when compared with gastric adenocarinomas. In addition, it is difficult to distinguish between gastric adenocarcinoma and gastric neuroendocrine carcinoma histol-ogically without immunohistochemical staining. In most of the reported cases, neuroendocrine carcinomas were diagnosed at an advanced stage, confirmed postoperatively by histological examinations using immunohistochemical staining and associated with a poor prognosis. A 55-year-old woman was diagnosed as cellular atypia by screening endoscopy for her health check-up at a local clinic. Histological examination from the endoscopic specimen revealed suspicious early gastric cancer. Endoscopic submucosal dissection was performed for therapeutic and diagnostic purposes and the pathologic findings revealed neuroendocrine carcinoma. Herein, we report a case of gastric neuroendocrine carcinoma presenting as early gastric cancer that was diagnosed by endoscopic submucosal dissection.

Acute Motor Axonal Neuropathy Associated with Anti-GM1 Antibody: A case report

Guillain-Barre syndrme (GBS) has several subtypes that are divided by clinical, electro- physiological, and pathological findings. A novel form of GBS, that is termed acute motor axonal neuropathy (AMAN), is characterized by the selective involvement of motor fibers, and is associated with anti-GM1 antibodies. A 8-year-old male patient were developed ascending, symmetrical paralysis, and areflexia, but no sensory disturbance. Elevated titers of serum IgG anti-GM1 antibodies were detected. His thoracolumbar spine magnetic resonance imaging (MRI) revealed thickening of cauda equina and enhancement of anterior nerve roots of T12-L1 spinal level after Gd-DTPA infusion. Electrophysiological diagnosis was acute motor axonal neuropathy (AMAN). We report this case with review of the literature.

Rapid Identification of Mycoplasma Pneumoniae, Mycobacterium Tuberculosis and Staphylococcus Aureus in Pleural Fluid by PCR

PURPOSE: Pleural effusions may develop during the course of bacterial pneumonia. The aim of this study was to evaluate the significance of the polymerase chain reaction (PCR) method for detection of Mycoplasma pneumoniae, Mycobaterium tuberculosis and Staphylococcus aureus from pleural fluid. METHODS: Total 12 samples were obtained from pleural fluid; 2 samples from children with Mycoplasma pneumonia, 5 samples from adults with tuberculous pleurisy, and 5 samples from sterile pleural fluid seeded artificially with staphylococcus aureus. The primers used for our PCR were prepared to amplify M. pneumonia-specific MP5 gene, M. tuberculosis-specific IS6110 gene, and S. aurus-specific femA and mecA gene. The amplified PCR products were detected by ethidium bromide-stained agarose gel electrophoresis. RESULTS: A total of 12 pleural fluid samples were tested by nested PCR using the specific primer set. We could amplify MP5 gene in 2 samples, IS6110 gene in 5 samples, mecA gene in 3 samples, and femA gene in 5 samples. These PCR data were correlated with serolological data, microbiological data and methicillin-sensitivity test result. There were no false-positive results due to cross-contaminating DNA between these 3 organisms. CONCLUSIONS: We conclude that enzymatic amplification of specific gene from pleural fluid might be useful to diagnose the infectious pleural effusion by Mycoplasma pneumoniae, Mycobacterum tuberculosis or Staphylococcus aureus.

Effect of pH on the ATP-sensitive K+ channel in aortic smooth muscle cells from rats

The effects of pH on K+ currents were investigated in single smooth muscle cells isolated from the thoracic aorta of Wistar-Kyoto rats. Whole-cell K+ currents were recorded in the conventional configuration of the voltage-clamp technique. Pinacidil (10muM) activated the whole-cell current and the pinacidil-activated current was completely inhibited by glibenclamide (10muM), an inhibitor of ATP-sensitive K+ channel (KATP channel). Pinacidil-activated current was reversed at near the K+ equilibrium potential. This current was time- and voltage-independent and reduced by elevating intracellular ATP. Pinacidil-activated current was reduced by lowering the external pH. However, alteration of internal pH has controversial effects on pinacidil-activated current. When the single cell was dialyzed with 0.1 mM ATP, alteration of internal pH had no effect on pinacidil-activated K+ current. In the contrast, when the single cell was dialyzed with 3 mM ATP, pinacidil-activated current was increased by lowering internal pH. Our results suggest that K+ channel activated by pinacidil may be KATP channel and internal H+ may reduce the inhibitory effect of ATP on KATP channel.

A case of seronegative enthesopathy and arthropathy syndrome (SEA syndrome)

No abstract available.