Showing papers by "London Bridge Hospital published in 2008"

Posterior approach vertebrectomy in the thoracolumbar spine with expandable cage reconstruction: indications and techniques based on eight cases.

Abstract: We present a series of eight patients undergoing circumferential neural decompression and stabilization of the thoracolumbar spine via a single midline posterior approach, with complete vertebrectomy for a variety of indications. Four had primary tumours, two secondary tumours, one patient had tuberculosis and one had delayed deformity due to trauma. This single posterior approach is made possible via the use of an expandable cage that may be expanded in situ to offer anterior and middle column reconstruction. There were no major neurological complications and all patients with deficits improved postoperatively. Extensive posterior fixation was avoided with five patients undergoing a one above/one below fixation and three undergoing a two above/two below fixation. When combined with pedicle screw and rod fixation this anterior reconstruction makes a sound construct. The flexibility of this approach in the thoracolumbar spine, some of the biomechanical advantages and pitfalls are considered.

Hughes syndrome (the antiphospholipid syndrome): 25 years old

Abstract: The antiphospholipid (Hughes) syndrome (APS) is a unique thrombotic disorder, causing both arterial and venous thrombosis, linked to the presence of antibodies directed against phospholipid–protein complexes. The first papers describing the syndrome were published in 1983 and, over the next two years, a series of publications described in detail the various clinical manifestations of the syndrome. Laboratory standardisation workshops were also set up and, in 1984, the first “world” symposium on APS was held. The international APS conferences have continued to grow in numbers and in stature. The APS has already had an impact in obstetrics, in medicine, in psychiatry, and in surgery. The approximate figure of 1 in 5 is a useful guide—1 in 5 of all young strokes, 1 in 5 recurrent miscarriages, 1 in 5 DVTs. More precise data will become available in the worlds of epilepsy, migraine, Alzheimer’s, and MS. The advent of newer “biologic” immunosuppressives such as rituximab may offer help in selected cases. Intravenous immunoglobulin has proved successful, especially in the emergency setting.

Results of resection of medial patellar plica through a supero-lateral portal as a main arthroscopic procedure.

Abstract: PURPOSE OF THE STUDY The aim of this study was to evaluate the results of resection of Medial Patellar Plica of the knee. The criteria for inclusion was that resection of the Medial Patellar Plica was the main arthroscopic intervention performed. MATERIAL From 1st January 2002 to 31st December 2006, 1408 arthroscopies of the knee were carried out at the London Knee Clinic, London Bridge Hospital without the use of a tourniquet. In all cases of Medial Patellar Plica the Plica was observed through a supero-lateral portal as well as the standard portals. 53 knees fulfilled the criteria, of which 35 knees were traced and included in the study with an average follow-up period of 23.7 months. Typically patients were between the ages of 20-30 and engaged in sporting activities. METHODS Age, sex, symptoms (onset and duration), VAS (Visual Analogue pain Scale from 1 to 10) before and after operation, return to sporting activity and patient's subjective evaluation of the result were recorded in 31 patients (35 knees). RESULTS The average period of symptom duration prior to the operation was 18.6 months (minimum 2 months). The mean follow- up period was 23.7 months from operation (8-67 months), average VAS score was 6 points before surgery, and 2 points after surgery (0- no pain, 10 excruciating pain). Mean improvement was 4 points. 34 % of patients were totally pain free after arthroscopic resection (0 point on VAS). 65.8% returned to the same level of sporting activity as occurred before the onset of knee problems. When asked whether they would undergo the same procedure on the other knee 72 % replied positively. DISCUSSION Despite numerous publications about knee Plicae describing their anatomical and patho-physiological characteristics, there are still some arthroscopists who do not believe in their significance as a pathological entity and the diagnosis of Plica Syndrome remains controversial. The success of arthroscopic resection of one or more Plicae in most previous studies is rated on the scale excellent, good, poor, and very poor. The present study focuses on the type of Plica which is most frequently pathological, that is the Medial Patellar Plica and evaluates the outcome of surgery in terms of VAS score, return to sporting activity and the patient's satisfaction with treatment. CONCLUSION Plicae are common anatomical structures, which sometimes become symptomatic. When pathological, they can give rise to quite disabling patello-femoral symptoms as well as participating in the acceleration of arthritic changes. In order to evaluate the Medial Patellar Plica properly including its involvement in patello-femur disorders, it is essential to examine the knee through a supra-patellar portal and to undertake dynamic examination of the knee in various degrees of flexion and extension. Resection of pathological Medial Patellar Plica is a successful procedure giving good results in a majority of patients with return to sporting activities. In some cases however, symptoms persist at a lower intensity even after their resection so that the sporting activity has to be reduced in the long term.

Cardiovascular effects of testosterone

Abstract: Several studies have evaluated the relationship between cardiovascular disease (CVD) and low testosterone level. Long-term follow-up data suggest that low testosterone level may increase CVD mortality and be a risk factor for CVD development. Low testosterone level is associated with visceral obesity, increased inflammatory markers, insulin resistance, the metabolic syndrome, hyperlipidemia, and impaired endothelial function. Testosterone replacement as a means of modifying CVD risk and reducing CVD morbidity and mortality is an attractive concept; however, evidence of benefit is not yet available. With the particularly strong association between the potential beneficial impact of testosterone therapy and obesity, the metabolic syndrome, and CVD, clinical end-point studies are clearly needed to elucidate the role of testosterone replacement in CVD prevention.