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  • ISSN: 2373-9290
    Volume 5, Issue 1
    Case Report
    Cornelius Wimmer, ElsayedShaheen, Thomas Pfandlsteiner, and Ahmed Ezzat Siam
    Purpose: Reporting preliminary results of MCGR.
    Study design: A prospective uncontrolled, single-center, single-surgeon, clinical and radiological study
    Patient sample: Between November 2012 and March 2015, 14 children with EOS were treated using MCGR
    Outcome measures: Preoperative, postoperative and final follow-up (FFU) whole spine radiographs were reviewed to determine the degree of spinal deformity and correction, measured using Cobb angle. T1-S1 length was calculated. Clinical notes to determine number of rod lengthening procedures using remote control device and to record any complications during surgery or FU period.
    Methods: Mean age was 12.1 years, 2 boys and 12 girls, nine children had primary correction by MCGR; five of them had neuromuscular, three infantile and one congenital scoliosis. All had a dual MCGR implanted. The remaining five patients had previously undergone other growing rod operation before converting to MCGR implant.
    Results: Mean pre-operative Cobb angle of the primary group was 73.4°, postoperative 34.8° (51.3% correction), FFU 28.8°. Mean initial percentage of the lengthening was 18.4%. Thoracic kyphosis changed significantly from preoperative mean of 48.7° to 31.2° postoperatively (p=0.008). Of the revision group, mean pre-operative Cobb angle was 49.6°, postoperative 41.1° (16.5% correction) and 40.3° at FFU. Mean initial percentage lengthening was 6.9%. One patient had wound infection, two had pull-out of proximal screws, one sustained a breakage of a single-rod construct 6 months after surgery and was replaced by a double magnetic-rod construct.
    Conclusions: In our consecutive series of patients treated with MCGR we found that scoliosis was well controlled. Cobb angle was significantly reduced following surgery in patients who had MCGR performed as a primary procedure. Generally, the correction was maintained at FFU. Comparing our results for MCGR and other growing rod techniques, they are comparable, without need to repeated surgery.
    Imane Ben Slama*, F Allali, S El kabbaj, T Lakhdar, L Medrare, A Ngeuleu, R Abouqal, H Rkain, and N Hajjaj Hassouni
    Background: Disease Activity Score-28 joints (DAS-28) is nowadays the gold standard for measuring the disease activity in patients with RA. The original DAS-28 was based on erythrocyte sedimentation (ESR), but an alternative formula incorporating C-reative protein (CRP) [DAS-28(CRP)] has been developed.
    Objectives: To compare the disease activity score DAS28-ESR versus DAS28–CRP, and to determine the factors that might influence their difference. To estimate the disease activity score DAS28-CRP threshold values that correspond to DAS28- ESR values in Moroccan patients with rheumatoid arthritis.
    Patients and methods: Patients with RA were included in a cross-sectional study. We have collected the demographic characteristics and the characteristics of the RA: duration of evolution, global disease activity on a 100 mm visual analogue scale assessed both by the patient (GDAP), morning stiffness in minutes, functional impact of the disease assessed by the HAQ (Health Assessment Questionnaire), and current corticosteroid dose. The disease activity was assessed by the DAS28-ESR and DAS28-CRP. A concordance correlation between DAS28-ESR and DAS28 -CRP was performed. We defined a new variable DIFDAS=DAS28-ESR – DAS28-CRP (differences between the two indexes). Factors influencing this difference were tested by univariate then multivariate logistic regression. Using DAS28-ESR as gold standard, the passing Bablok and Bland- Altman methods were used to assess the agreement between DAS28-ESR and DAS28-CRP.
    Results: 103 patients were included with a female predominance (87.4 %). Mean age was 49.7 ± 11.4 years. Median disease duration was 8 years [3-14]. There was a strong positive concordance between the two indexes of 0.93 with CI 95% [0.91-0.95], although the DAS28-ESR value obtained was higher than that of DAS28-CRP at approximately 90% of the visits (n= 93). Significantly, the difference between both indexes was higher than 0.6 in 42.7% of the visits studied (n=44). In multivariate analysis, factors significantly associated with this difference were high dose of steroids and significant functional impairment (p< 0.05). There was a difference between DAS28-ESR and DAS28-CRP values (p< 0.05). Using bland and Altman method, we found that DAS28-CRP under-estimate threshold values of DAS28-ESR by 0.49 with CI 95% [-1.96, +1.96].
    Conclusion: Our study showed a positive concordance between the DAS28-ESR and DAS28 -CRP. But DAS28-ESR would be higher than DAS28-CRP in patients with high dose of corticosteroids and significant functional impairment.
    Zhang Hongwei, Wang Chaoyang, Sun Jianhua, DU Xinhui, Fang Qinzheng, and Moris Topaz*
    Currently, open fracture in lower extremity is a common trauma, which can easily form the skin defect. If the skin defect become an ulcer or ulcer like wound, the treatments will encounter a sticky situation that is hard to heal. Although skin flap grafting, tissue stretching and expansion can be available in this situation, however, they all have disadvantages, such as time consuming, costly, and difficult to operate, etc.. In this case, we reviewed one novel treatment, RNPT (regulated negative pressure-assisted wound therapy) combined with Topclosure (skin stretching and wound closure-secure system) , for an skin defect patient with lower extremity open fracture, which achieved sound outcome.
    Ali Zein AA Alkhooly* and Ahmed A Zein AA Alkhooly
    Restoration of elbow flexion is of great importance for a good clinical and functional outcome. Depending on the level of injury and the degree of reinnervation there are different types of surgical procedure. The surgical goal is to restore good muscle strength through a range of elbow motion (30 to 130 degrees).
    We introduced modification of flexor- plasty descriped by Steindler (1918) to restore elbow flexion after brachial plexus injury and paralysis of elbow flexor and the result was good after short period of follow.
    Review Article
    Cesar Salcedo Canovas*
    The use of external fixation is the most common technique for bone elongation. While this technique is very versatile, its use is not free of difficulties, and some surgeons have used it to perform elongations over an intramedullary nail to minimize the time the patient has the fixator implanted.
    Theoretically, the reduction of the external fixation time would imply fewer problems of infection of the screws, more comfort for the patient, and less joint stiffness. In addition, having an internal support would reduce angular deviations and decrease the fracture rate of the regenerated bone.
    To compare the two techniques, two groups of 15 femurs (N=30), homogeneous in terms of age, the amount of elongation, the elongation difficulty (according to Paley’s criteria), and the etiology of the shortening, were paired. From these groups, the external fixation time, external fixation rate (fixation time per centimeter of elongation), consolidation index (months per centimeter of elongation), complication rate (classified according to Paley’s criteria), and range of motion of the knee were analyzed.
    After analyzing the data, statistically significant differences were found in favor of elongation over a nail in the external fixation time, in the external fixation index, in the rate of complications, and in the range of articular motion. No differences were found in the bone consolidation index or the clinical results obtained.
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