Showing papers by "British Hospital published in 2014"

Anterior Cruciate Ligament Injury: Is the decreased mobility of the hip a predisposing factor?

Abstract: Objectives:The objective of this study was to analyze whether it is more frequent the presence of a decreased range of motion in the hips of recreational athletes with primary injury of the anterio...

A biomechanical study on proximal plate fixation techniques in periprosthetic femur fractures

Abstract: Introduction Proximal plate fixation is a crucial factor in osteosynthesis of periprosthetic femur fractures. Stability and strength of different fixation concepts for proximal plate fixation were compared. Materials and methods Twelve fresh frozen, bone mineral density matched human femora, instrumented with cemented hip endoprosthesis were osteotomized simulating a Vancouver B1 fracture. Specimens were instrumented with locking compression plates, fixed proximally with either locking attachment plate (LAP), monocortical screws, cerclage plus monocortical screws (1cerclage) or cerclages only (4cerclages). Cyclic testing was performed with monotonically increasing load until failure. Relative movements at the proximal plate–femur interface were registered by motion tracking. Results The LAP construct exhibited a significantly longer cumulative survival (failure criterion 1 mm separation at the proximal plate fixation) compared to the monocortical ( p = 0.048) and 4cerclages constructs ( p = 0.012) but not to 1cerclage constructs. Conclusion Bicortical screw anchorage improves proximal plate fixation in periprosthetic fractures. The cerclage–screw combination is a valuable alternative especially in osteoporotic bone.

Recommendations for adjunctive basic skin care in patients with psoriasis

Abstract: Background: Psoriasis is a multifactorial disease involving both genetic predisposition and external triggers, resulting in epidermal and immune dysfunctions. Regardless of the severity of the disease, patients require additional basic topical treatment with emollients. Basic skin care products are well known for their role in moisture retention and symptom control in psoriasis, yet patients underuse them. Dry skin and cutaneous inflammation are associated with an impaired epidermal barrier function. This breakdown of the skin barrier causes the release of pro-inflammatory mediators that exaggerate inflammation. Objectives: to provide recommendations for the use of emollients (including ceramides, urea, keratolytic agents, zinc salts, niacinamide), thermal water and skin care products in psoriasis. Methods: A review of the current literature from 2000 to 2012 using Medline and Ovid was performed by a working group of five European Dermatologists with clinical and research experience in psoriasis. Results: Either alone or used adjunctively, basic topical therapy can restore and protect skin barrier function, increase remission times between flare-ups and enhance the effects of pharmaceutical therapy. Conclusion: We provide physicians with a tool to assist them in implementing basic skin care in an integrated disease management approach.

Screening of major depression in epilepsy: The Neurologic Depression Disorders Inventory in Epilepsy-Spanish version (Argentina)

Abstract: Summary Objectives To validate and translate the English version of the Neurologic Depression Disorders Inventory in Epilepsy (NDDI-E) into Spanish as a screening instrument for major depressive episodes (MDE) for patients with epilepsy from Argentina and Uruguay. Methods One hundred fifty-five consecutive outpatients with epilepsy participated in this study. The module of MDE of the MINI International Neuropsychiatric Instrument (MINI Plus version) was used as the gold standard against which the translated version of the NDDI-E was validated. Results Among the 155 patients, 25 (16%) met Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) criteria for MDE according to the MINI. With a total score of >15, The NDDI-E identified MDE with an 80% sensitivity, 90% specificity, 60% positive predictive value, and 95.5% negative predictive value. Significance These data indicate that the Spanish version of the NDDI-E can reliably identify MDE in patients with epilepsy from Argentina and Uruguay.

Germinoma with involvement of midline and off-midline intracranial structures.

Abstract: Germinomas are malignant intracranial germ tumors, usually found in suprasellar regions. Less than 10% are localized in off-middle structures, and synchronous involvement of both structures has only exceptionally been published. A case of an 18-year-old male patient with progressive right-sided hemiparesis and panhypopituitarism was reviewed. Brain MRI showed a solid mass involving pituitary and hypothalamus with thickening of pituitary stalk, high intensity lesions on T2-weighted imaging in left internal capsule, caudate nucleus, globus pallidus, and mild atrophy of the left internal capsule and cerebral peduncle. Nonadenomatous lesions were considered in the differential diagnosis. Alfa-fetoprotein (AFP) levels were negative in both serum and cerebrospinal fluid (CSF), while β-human chorionic gonadotrophin (β-HCG) levels were slightly increased in CSF. A transsphenoidal biopsy identified a germinoma. Four cycles of chemotherapy with bleomicine, etoposide, and cysplatin were given, followed by radiotherapy, but patients died due to a recidiva. Conclusion. Germinoma must be considered in patients with insipidus diabetes with a sellar mass with thickening of pituitary stalk; and ectopic germinoma must be suspected in patients with slowly progressive hemiparesis with cerebral hemiatrophy. Even with a rare condition, colocalization of midline and off-midline germinoma must be suspected in the presence of these typical signs of both localizations.

Jak-2 Positive Myeloproliferative Neoplasms

Abstract: Originally described by Dameshek in 1951, myeloproliferative disorders are today classified as myeloproliferative Neoplasms (MPNs) in WHO’s Classification of Tumors of Hematopoietic and Lymphoid Tissues. The term includes a range of conditions, [ie, BCR-ABL-positive chronic myelogenous leukemia (CML), chronic neutrophilic leukemia (CNL), polycythemia vera (PV), primary myelofibrosis (PMF), essential thromobocythemia (ET), chronic eosinophilic leukemia not otherwise specified (CEL-NOS), mastocytosis, and unclassifiable myeloproliferative neoplasm]. In the specific case of CML, a better understanding of the pathogenesis and pathophysiology of the disease has led to a targeted therapy. The presence of chromosome Philadelphia, t(9;22)(q34;11) results in the oncogene BCR-ABL, which characterizes the disease; this molecular rearrangement gives rise to a tyrosine-kinase, which in turn triggers the proliferation of the myeloid line through the activation of the signaling pathways downstream. Tyrosine-kinase inhibitors (TKIs) have altered the therapy and monitoring of CML patients and improved both their prognosis and quality of life. In 2005, various groups of investigators described a new point mutation of the gene JAK2 associated to MPNs. Although the presence of this mutation has led to a modification in the diagnostic criteria of these conditions, the impact of the use of JAK2 inhibitors on the prognosis and course of the disease continues to be controversial.

Reflecting on the World Report on Disability: a short report from Argentina.

Abstract: In 2003, the National Survey of Persons with Disabilities identified 2,176,123 persons (7.1% of the total population of the country) with an impairment that affects some of the most important aspects of everyday life (walking, standing up, sitting down, seeing, hearing, learning, or general behavior). In Argentina, several laws support the rights of persons with disabilities. However, inappropriate implementation of these legislations, particularly in the inland provinces, results in shortage of services, low labor force participation, and poor housing conditions. The number of rehabilitation professionals is not sufficient to satisfy the demand for rehabilitation.

Commentary: The Ideal Carotid Stent? Time Will Tell:

Abstract: In this issue of the JEVT, Schönholz et al. describe the first implantation of a stent that has been eagerly awaited by interventionists for a long time. We were all aware that we needed an adaptable, flexible closed-cell stent for our carotid cases. This new stent from W. L. Gore is applicable in tortuous anatomy and overall in patients with soft plaques, which produce more particles and also potentially protrude through the interstices of stents. I believe that this is a big step forward for carotid stent users. I have no question that I would select this stent for many of my patients. Currently, I am using the carotid Wallstent, which has the smallest interstices of all the stents on the market. My results are remarkably good, and I do not see transient ischemic attacks or stroke after the procedure. Using transcranial Doppler (TCD) monitoring, particles detected in the middle cerebral artery after the procedure are almost nonexistent. The problem with the Wallstent is its rigidity. When applied in internal carotid arteries with tortuosity, it translates the curves cephalad to the distal end of the stent, potentially producing kinks. It is obvious that we need to follow these patients with Gore’s new design for a long time to see tissue reaction and the incidence of restenosis. What surprises me is that Gore & Associates elected to use filters instead their superb flow reversal device. It is common knowledge that filters produce more strokes, more high-intensity transient signals (HITS), and more new lesions seen on diffusion-weighted magnetic resonance imaging than flow reversal. The presence of mural thrombus in the lumen of a carotid stenosis was 24% in our study of .300 endarterectomy specimens (Figure), and in the study done in Stanford, the figure was almost to 50%. According to our experience using TCD, routinely crossing lesions with filters is not desirable. We have enough information about these findings and even the CREST II trial decided to include flow reversal as a subgroup of carotid artery stenting (CAS).

Examining patients' preferences for participation in clinical decision-making: the experience in a Latin American chronic obstructive pulmonary disease and cancer outpatient population

Abstract: Background and Aims It is generally accepted that patients prefer to be told the truth by their physicians; however, the practice of partial truth-telling is frequent with an existing ‘norm of nondisclosure.’ Our primary objective was to determine what patients wanted to be told about their illness, and whether there might be differences between patients with either cancer or advanced chronic obstructive pulmonary disease (COPD). A second objective was to determine how these patients envisioned their participation, or lack thereof, in the treatment decision-making process. Methods Subjects were eligible for this prospective study if they were attending the oncology or pulmonary outpatient consultation services at the British Hospital or the Sanatorio Guemes Private Hospital in Buenos Aires, Argentina between June 2009 and May 2010. Results Ninety-nine patients were recruited. Forty-four had a diagnosis of COPD, and 55 patients had cancer. Seventeen of the patients expected their health to improve in the future, but a significantly higher proportion of patients with malignant disorders expected to get better in the near future as compared with those with COPD (98.2% vs 62.8%, P < 0.001). Most study participants expressed a desire to receive all the information available about their condition. A majority of the participants expressed a preference for making treatment decisions in collaboration with their physician (40.4%) Conclusions While they considered the role of their families relevant and wanted information to be shared so that family members might participate in decision-making, they did not want their families to have a right to withhold information, make final decisions.

What the radiologist needs to know about restaging of rectal carcinoma after chemoradiation therapy

Abstract: Aim The purpose of this exhibit is to describe and compare the high-resolution MRI features of rectal carcinoma after chemoradiation treatment (CRT) and to correlate with the histologic findings after total mesorectal excision (TME). Method High resolution T2-W MR imaging (HRMRI) was performed in a 1.5 T unit between January 2013 and February 2014 before and immediately after CRT in the care of 25 patients with locally advanced adenocarcinoma of the rectum. After total mesorectal excision (TME) the piece was cut by the pathologist under the supervision of the radiologist, who indicated areas of residual tumour after neoadjuvant therapy or changes such as fibrosis, oedema, cellular and acellular mucin, desmoplastic reaction and pseudotumour appearance. Thus, initially we did a correlation between the macroscopic and MR imaging. Subsequently, we performed the same correlation but in this case between microscopy and MR imaging. Changes in morphologic and signal intensity features were evaluated with respect to primary tumour and nodal downstaging. Summary Emerging evidence has shown the prognostic importance of reassessing rectal cancer using HRMRI after completion of CRT. A systematic cooperation between radiologist and pathologist is essential for optimal treatment planning and patient care.

Mortality in Patients on Renal Replacement Therapy and Permanent Cardiac Pacemakers

Abstract: End stage renal disease is a relatively frequent disease with high mortality due to cardiac causes. Permanent pacemaker (PM) implantation rates are also very common; thus combination of both conditions is not unusual. We hypothesized that patients with chronic kidney disease with a PM would have significantly higher mortality rates compared with end stage renal disease patients without PM. Our objectives were to analyze mortality of patients on renal replacement therapy with PM. 2778 patients were on renal replacement therapy (RRT) and 110 had a PM implanted during the study period. To reduce the confounding effects of covariates, a propensity-matched score was performed. 52 PM patients and 208 non-PM matched patients were compared. 41% of the PM were implanted before entering the RRT program and 59% while on RRT. Mortality was higher in the PM group. Cardiovascular disease and infections were the most frequent causes of death. Propensity analysis showed no differences in long-term mortality between groups. We concluded that in patients on RRT and PM mortality rates are higher. Survival curves did not differ from a RRT propensity-matched group. We concluded that the presence of a PM is not an independent mortality risk factor in RRT patients.

In response to comments on "screening of major depression in epilepsy: the Neurologic Depression Disorders Inventory in Epilepsy-Spanish version (Argentina).

Abstract: To the Editors: In 2006, Gilliam et al. introduced the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) to be used as a screening tool in the outpatient neurology clinic setting. The NDDI-E is a self-administered instrument that includes six items rated on a Likert scale from “never” to “always or often.” We read with great interest the work of Thomson et al., who translated and validated the NDDI-E into Spanish for patients in Argentina and Uruguay. Despite the already validated version of NDDI-E in Spanish for patients in Spain, Thomson et al. acknowledged the significant differences in the vocabulary, idioms, and local expressions between the Spanish-speaking countries, and consequently made a second version of the Spanish NDDI-E. We strongly believe that it is important to study the diagnostic value of the NDDI-E in different languages and different dialects, as it has been shown that in different languages the cutoff points might differ slightly. Therefore, we congratulate the authors for undertaking this project. We would like, however, to highlight that the NDDI-E not only has been translated and validated in Portuguese, Japanese, Italian, and Spanish from Spain, as Thomson et al. mention in their introduction, but also has been translated and validated in German, Korean, Greek, and more recently in Arabic. We encourage clinicians to proceed to the translation and validation of the NDDI-E in other languages, as it is an excellent tool for screening for depression in epilepsy. Because it is brief and simple, it could also be used in primary care settings by clinicians who take care of patients with epilepsy once the epilepsy specialists adjust the treatment.

Neuroendoscopy in Spinal Pathology: Our Experience, New Trends, and Developments

Abstract: In the last decade the neuroendoscope has been used increasingly in the surgical management of spinal diseases, both intradural and extradural.