Biomedical subjects
Publications and source records attributed to Marinis Pirpiris.
Here we report the first documented case of rice body formation within the biceps tenosynovium in a patient with juvenile rheumatoid arthritis. We discuss the pathophysiology and the clinical and radiographic findings and correlate these to prior case studies. Lastly, we suggest that limited awareness is a barrier in achieving a timely diagnosis and appropriate management.
Few areas in orthopaedics have evolved so dramatically over the past few decades as our knowledge of knee physiology, knee kinematics, and knee replacement surgery. This article addresses major breakthroughs in knee replacement surgery, the thought process behind these concepts, and their impact on clinical practice. It focuses on compartmental arthroplasty, use of minimally invasive surgery, advances in biomaterials, and biological solutions for treating arthritis. Compartmental knee replacements are gaining popularity, especially for medial compartment arthritis. Minimally invasive surgery (i.e., quadriceps sparing arthroplasty) has become very popular in the last few years and is being used routinely for unicompartmental knee replacement and increasingly used for total knee replacement. Computer-assisted surgery has the ability to help the surgeon place the components in the desired position, thereby avoiding component malpositioning, which can cause pain, instability, limited range of movement, excessive polyethylene wear, and subsequent implant loosening. Recent advances in the metallurgy have led to the introduction of tantalum trabecular metal which offers several advantages over other current conventional materials used for implants. Expanding knowledge regarding cartilage biochemistry and the pathogenesis of osteoarthritis has focused the research on slowing the progression of osteoarthritis and promoting cartilage matrix synthesis. Perichondrial transplantation as well as periosteal transplantation have been tried by a few investigators but they have limited and temporary success. Autologous chondrocyte implantation is another technique that is gaining popularity. The chondrocytes harvested from the patient are cultured and reimplanted after 3-4 weeks of culturing. In the future, we are likely to see advances in diagnosis as well as management of osteoarthritis. The treatment modalities will probably evolve at the cellular level and it will not be long before a patient-specific medication can be given to a asymptomatic patient in order to prevent development of osteoarthritis. Patients with end-stage osteoarthritis will be offered a combination of treatments (e.g., partial replacement of one compartment or localized cartilage repair if there is localized cartilage defect in the other compartment).
Pyomyositis is relatively rare in temperate climates. This is the first report of a case of calf pyomyositis associated with septic arthritis of the knee. This case illustrates that pyomyositis should be included in the differential diagnosis of a swollen, tender calf in an emergency setting. The other notable feature of this case is that the infective organism was not the usual Staphylococcus aureus but rather the relatively rarely involved Streptococcus pyogenes.
INTRODUCTION: Wound blisters are formed in the epidermis adjacent to surgical incisions and are a significant cause of morbidity following hip surgery. This study was designed to compare two commonly used primary dressings, namely a nonadherent absorbable (NAA) dressing and paraffin tulle gras (PTG). Monitoring for the subsequent development of wound blisters in the epidermis adjacent to the surgical incision was then undertaken. METHODS: The present study was performed in the setting of a prospective, randomised trial of 50 consecutive patients undergoing hip surgery. It was assumed there would be no difference in the development of blisters between the dressing groups. The alternative hypothesis was that PTG would, because of its properties, provide less friction in the epidermis and contribute to fewer wound blisters. RESULTS: A statistically significant difference (P = 0.0028) between the two dressing groups was observed with the NAA group developing blisters in 17 (64%) patients and the PTG group in only two (8%) of the patients. CONCLUSION: The present study would suggest that PTG produces fewer wound blisters following hip surgery when compared to the NAA type as a primary dressing.
We devised a new Functional Mobility Scale (FMS) to describe functional mobility in children with cerebral palsy, as an aid to communication between orthopaedic surgeons and health professionals. The unique feature of the FMS is the freedom to score functional mobility over three distinct distances, chosen to represent mobility in the home, at school and in the wider community. We examined the construct, content, and concurrent validity of the FMS in a cohort of 310 children with cerebral palsy by comparing the FMS to existing scales and to instrumented measures of physical function. We demonstrated the scale to be both valid and reliable in a consecutive population sample of 310 children with cerebral palsy seen in our tertiary referral center. The FMS was useful for discriminating between large groups of children with varying levels of disabilities and functional mobility and sensitive to detect change after operative intervention.
Quantitative evaluation of function, in children with physical disabilities, has to date been mainly focused on laboratory-based measures. However, the measurement of activity in the community may have a more direct relationship with physical function, health, and well-being. We assessed the utility of a remote activity monitor, the Uptimer (National Aging Research Institute of Melbourne, Melbourne, Australia), to measure one aspect of physical function, time spent in the upright position, in a consecutive cohort of 300 children with cerebral palsy who attended an orthopedic outpatient department. The Uptimer was found to be a valid and reliable tool to measure the amount of time children spent on their feet each day. Uptime was closely related to the severity of cerebral palsy and had excellent correlations with validated instruments including the Pediatric Orthopaedic Data Collection Instrument (PODCI), the Child Health Questionnaire (CHQ), and the Functional Mobility Scale (FMS). Uptime complements any quantitative functional assessment of impairments in children with cerebral palsy.
The aim of management of the child with a severe, rigid equinovarus foot is to provide a foot that is plantigrade and painless and can be placed within standard footwear. The authors identified a retrospective cohort of 17 children with a mean age at surgery of 5.6 years (range 2.3-9.6 years) who underwent 31 talectomy procedures for the management of their rigid, equinovarus foot deformities (14 isolated talectomies, 17 combined talectomy and calcaneocuboid fusions). The underlying diagnosis was predominantly arthrogryposis. The average follow-up was 9.7 years (range 2.3-9.5 years) and 3.8 years (range 2.8-9.6 years) respectively. The addition of calcaneocuboid fusion prevented the development of postoperative equinus, varus, adductus, and supination deformities as determined by clinical examination at medium-term follow-up (P = 0.01, P < 0.001, P < 0.001, P < 0.001, P < 0.01, respectively). This was associated with a decreased incidence of recurrent foot pain with weightbearing (P < 0.001) and a reduced need for revision surgery for pain or deformity (P < 0.001). This study determined that the addition of a concomitant calcaneocuboid fusion in the setting of talectomy may improve the medium-term surgical outcome.
The purpose of this study was to determine whether there is a significant association between function and well-being in children with cerebral palsy. To determine this, the authors used validated measures of function (Gillette Functional Assessment Questionnaire, Gross Motor Function Classification System, Gross Motor Function Measure, and walking speed) and correlated them to health-related quality of life (HRQOL) measures (Pediatric Outcomes Data Collection Instrument, Pediatric Quality of Life instrument). In a cross-sectional study of ambulatory children with mild to moderate cerebral palsy aged 10.2 +/- 3.2 years, mild to moderate decreases in function were found when compared with normative data. As the assessment of HRQOL comprises both functional well-being and psychosocial well-being, the authors decided to specify the aspect of well-being to which they were referring. It was found that the child's function was not correlated to psychosocial well-being. The children with mild cerebral palsy had greater effects on their psychosocial well-being than would be predicted by their functional disability. Functional measures were good at predicting the functional well-being but were weak at predicting the psychosocial arm of well-being.
This is a series of 7 children (14 hips) with a mean age of 7.3 years (range, 3.3-10.5 years) and an underlying diagnosis of developmental dysplasia of the hips and no previous open-hip surgery who underwent plain radiographic and magnetic resonance imaging (MRI) measures of bony acetabular index. There was a significant correlation between the measurement of acetabular index using plain radiography and MRI, with a Spearman correlation coefficient of 0.88 (95% confidence interval, 0.61-0.96; P<0.001) and a mean difference between the 2 measures of 0.36+/-6.5 degrees. Furthermore, the bony and cartilaginous acetabular indexes as measured by MRI had a significant correlation with a Spearman correlation coefficient of 0.88 (95% confidence interval, 0.80-0.98; P<0.001). We suggest that plain radiography is still an appropriate tool for follow-up for the nonoperated hip with developmental dysplasia and may be a good indicator of hip cartilaginous development.
Approximately 20% of children with idiopathic slipped capital femoral epiphysis (SCFE) have bilateral disease. Predicting which patients will develop problems with both hips remains difficult. This is the first study to evaluate the relationship between body mass index (BMI) and unilateral and bilateral SCFEs. Height and weight measurements of patients presenting with SCFE to our institution were obtained and used to calculate the BMI. Of the 54 patients enrolled in the study, 16 ultimately had bilateral disease. The mean BMI of patients with bilateral disease was significantly greater than that of patients with unilateral disease. In addition, patients presenting with unilateral involvement who progressed to bilateral disease had a significantly greater average BMI than patients who did not progress. Elevated BMI is associated with SCFE, especially bilateral SCFE.
As the increasing prevalence of overweight and obese children is approaching epidemic proportions in North America, this study was designed to investigate whether Body Mass Index (BMI) and age- and gender-specific percentile Body Mass Index (BMI %) are associated with the likelihood of being listed for surgery for Blount disease after initial presentation to a tertiary referral centre. In a restrospective consecutive sample of 102 children with an average age of 5.9 +/- 4.3 years, it was determined that there was a significant association between BMI and BMI% and being listed for surgery, after adjusting for the effects of the child's age and gender, with mean odds ratios of 1.30 (95% confidence interval 1.02-1.60) and 1.05 (95% confidence interval 1.01-1.09) respectively. When the sample was subgrouped into infantile (less than 3 years of age) and late-onset (greater than 3 years of age), BMI and BMI% were still significantly associated with the children being listed for surgery in the late-onset group with mean odds ratios 2.75 (95% confidence interval 1.03-7.33) and 1.09 (95% confidence interval 1.01-1.18) respectively. However, of the two measures only the BMI was significant in the infantile group with an odds ratio of 1.27 (95% confidence interval 1.01-1.60). Should these associations be real then measures aimed at decreasing weight in children may have some effect on the number of children undergoing surgery for the treatment of Blount disease.