The treatment of old unreduced traumatic dislocations of the hip

Old unreduced traumatic dislocations of the hip present great difficulties in management, especially in countries where implants for reconstructive surgery are not readily available. Eleven patients were initially treated with continuous skeletal traction of 10–30 kg for a period of 3 weeks. All of five type I dislocations, were reduced by this method even though there had been 3 weeks–6 months delay before treatment. By contrast, traction was not successful in three Type II and three Type III dislocations even after extensive surgical mobilization of the head and neck of femur because they were so much more serious injuries. Acceptable results were achieved in these cases after arthrodesis or excision arthroplasty and excellent results comparable to those achieved by implants followed by temporary transfixion of the hip joint. From our experience of these results, we believe that the traditional pessimism about the effects of old, unreduced traumatic dislocation of the hip is not justified.     

The salivatory nuclei in the brainstem of the monkey (Macaca mulatta)

By inducing retrograde degeneration the salivatory nuclei were localized in the brainstem of the Macaca mulatta. It was observed that the neurons sending efferent fibres to the three salivary glands lie in two discrete groups, the lateral and medial salivatory nuclei situated under the floor of the fourth ventricle at the level of the pontomedullary junction. The lateral nucleus was in close relation to the medial and lateral vestibular nuclei, was about 0.3 mm long and consisted of mediumsized neurons. The medial nucleus was situated close to the median raphe, was about 0.5 mm long and consisted of smaller-sized neurons. The caudal parts of the nuclei showed evidence of sending fibres to the ipsilateral glands, the cranial parts to the contralateral glands, and that the intermediate zones sent fibres bilaterally.     

The congenital diaphragmatic hernia composite prognostic index correlates with survival in left-sided congenital diaphragmatic hernia

PurposeWe developed the congenital diaphragmatic hernia congenital prognostic index (CDH-CPI) to incorporate all known prognostic variables into a single composite index to improve prognostic accuracy. The purpose of this study is to examine the ability of the CDH-CPI to predict survival in patients with left-sided congenital diaphragmatic hernia and to determine if the index has a stronger correlation with survival than each of the individual components.MethodsA retrospective review of patients with left-sided congenital diaphragmatic hernia between 2004 and 2010 was conducted. Ten prenatal parameters of the CDH-CPI were collected, total score was tabulated, and patients stratified according to total score and survival.ResultsSixty-four patients with a prenatal diagnosis of left-sided congenital diaphragmatic hernia were identified. Patients with a CDH-CPI score of 8 or higher had a significantly higher survival than patients with a CDH-CPI score of lower than 8. The CDH-CPI has the strongest correlation with survival compared with the individual parameters measured. The CDH-CPI correlates with extracorporeal membrane oxygenation use, and 75% of patients with a score of 5 or lower were placed on extracorporeal membrane oxygenation.ConclusionsThe CDH-CPI accurately stratifies survival in left-sided congenital diaphragmatic hernia. The amalgamation of 10 prenatal parameters of the CDH-CPI may be a better prenatal predictor than any single prognostic variable currently used.     

Fine needle aspiration of an intrathyroidal parathyroid carcinoma mimicking a primary thyroid anaplastic carcinoma: A case report with review of the literature

Intrathyroidal parathyroid carcinoma is an uncommon malignancy. A 46‐year‐old male presented with a left neck mass. Computed tomography (CT) scan revealed a hypodense mass in the left thyroid lobe along with evidence of metastatic lymphadenopathy. Aspiration of the left thyroid nodule was performed, and a diagnosis of malignancy was rendered, favoring a primary anaplastic carcinoma. Based on the cytologic diagnosis, the patient underwent a total thyroidectomy. Before the surgery, intact parathyroid hormone (PTH) and calcium level (PTH = 78 pg/mL; Calcium = 10.6 mg/dL) were found to be minimally elevated. On gross examination, a 3.2 cm mass within the left inferior thyroid lobe was seen. Histopathologic examination and ancillary studies supported the diagnosis of a parathyroid carcinoma. We, hereby present, an exceedingly rare presentation of an intrathyroidal parathyroid carcinoma with only minimal elevation of PTH and calcium, mimicking a primary anaplastic thyroid carcinoma on cytologic examination.     

Delaying Cholecystectomy for Complicated Gallstone Disease in Pregnancy is Associated with Recurrent Postpartum Symptoms

Introduction

Pregnancy is a risk factor for gallstone disease; in some patients, cholecystectomy may be delayed to the postpartum period. Our aim was to examine the effect of antepartum interventions on postpartum outcomes in complicated gallstone disease (CGD) during pregnancy.

Material and Methods

Retrospective analysis of patients seeking medical care for CGD (cholecystitis, choledocholithiasis, or gallstone pancreatitis) during pregnancy at a single tertiary care institution over a 10-year period (2002–2012). Patients were contacted via standardized telephone survey to account for outside hospitalizations.

Results and Discussion

We identified 56 patients with CGD during pregnancy, 42.9 % initially presenting during the second trimester. Choledocholithiasis was the most common diagnosis (n?=?30). Antepartum cholecystectomy was performed in 17.9 %. Seventeen patients did not follow up postpartum and did not complete telephone survey. Of the remaining 29 patients, 58.6 % had recurrent postpartum symptoms, 35.3 % recurred within 1 month, and 82.4 % within 3 months of delivery. Antepartum ERCP with biliary sphincterotomy decreased postpartum symptom recurrence (38.5 vs. 75.0 %, p?=?0.07).

Conclusions

The majority of patients with CGD who do not undergo antepartum cholecystectomy have recurrent postpartum symptoms often within 3 months postpartum. When appropriate, physicians should advocate for antepartum or early postpartum cholecystectomy to minimize symptom recurrence and unplanned hospitalizations.