Aseptic bone necrosis (ABN), also known as avascular necrosis (AVN), is a serious and often overlooked complication of systemic lupus erythematosus (SLE), a chronic autoimmune disease with diverse symptoms. AVN in SLE is caused by multiple factors, including blood supply disruption due to clotting disorders, chronic inflammation, and especially prolonged use of moderate to high- dose corticosteroids. This review analyzes 17 out of 62 peer-reviewed European studies (2015–2024) from the PubMed database, focusing on osteonecrosis in lupus. ABN affects between 0.8% and 33% of SLE patients, with a mean symptomatic rate of 9%, while up to 29% may be asymptomatic. The femoral head is most commonly involved. Besides corticosteroid use, other risk factors include antiphospholipid antibodies (especially anticardiolipin IgM), endogenous hypercortisolemia, hypercoagulability, dyslipidemia, and active disease. In Romania, where no national registry exists, a representative case of a 27-year-old woman with undiagnosed SLE and bilateral femoral head necrosis without steroid exposure highlights the role of autoimmune coagulopathy. Misdiagnosis of her facial rash as rosacea delayed proper identification, emphasizing the importance of clinical awareness in atypical cases.
Background: Infection and sepsis represent major complications after abdominal surgery for secondary peritonitis. Finding new tools that can help identify patients at risk for developing postoperative complications is of the utmost importance for clinicians. We tried to evaluate the use of different biomarkers in evaluating the postoperative prognosis of patients with secondary peritonitis. Methods: We searched the available literature on the usefulness of serum biomarkers in evaluating prognosis in patients with secondary peritonitis. Results: Elevated postoperative lactate levels and high procalcitonin (PCT) levels were associated with negative outcomes. C-reactive protein values increase rapidly in response to the surgical insult but have no value in assessing the overall prognosis. Conclusion: Procalcitonin (PCT) is superior to other biomarkers in predicting severe septic complications and overall mortality in patients with secondary peritonitis.
In the context in which life expectancy increases and the population becomes more active, the number of people who are affected by gonarthrosis symptoms increases proportionally. By the year 2030, in the United States of America, one in three adults is expected to suffer from gonarthrosis, this prediction will be the beginning of an epidemic. Total knee arthroplasty has been shown to relieve pain and improve joint function; however, studies have shown that active young patients still have limitations in performing high-level activities such as dancing, golfing, skiing, and gardening. Currently, modern TKA implants are designed to reproduce the normal biomechanics of the knee joint, mimicking the physiological “medial pivot” pattern with greater compliance on the medial compartment between the tibial insert and femoral condyle and less congruence on the lateral side.
One of the most controversial topics in total knee arthroplasty is rotation of the femoral component. The current gold-standard in total knee arthroplasty consists in positioning the femoral component in 3 degrees of external rotation to the epicondylar axis, having as reference the tangent to the posterior condyles. Achieving the correct rotation of the femoral components is one of the main goals during total knee arthroplasty. Multiple complications can result from internal femoral rotation, such as lateral patellar tilt, patellar subluxation or dislocation, mobilization with movement on pain, and low survival rates of the femoral components. Postoperative rotational assessment of protective components can only be performed correctly using computed tomography. The known evaluation methods are related to anteversion of the femoral neck, femoral trans-epicondylar line, insertion of the posterior cruciate ligament from the tibia and tibial tuberosity. The purpose of this study was to evaluate the rotation of the prosthetic components in the group of patients with the methods validated by studies and to find alternatives to evaluate the rotation of the femoral component. Thirty-four patients diagnosted with gonarthrosis, proposed for total knee arthroplasty, were included in the study. This is a prospective cohort study in which applied statistics consisted of analyzing data using frequency and percentage for qualitative and mean variables and standard deviation for quantitative variables.
Diabetes and increased body mass index are two of the most associated comorbidities in patients undergoing total knee arthroplasty. With the number of patients undergoing knee arthroplasty increasing and with the incidence of diabetes and increased BMI, we can expect that in the coming decades the association of the two comorbidities will be frequent. An ethical issue arises when the patients who are refused for total knee arthroplasty are instructed to change the risk factors, and they fail either because of a mental problem or because of a physical problem. This study analyzes the effects of controlled, uncontrolled, uncomplicated and complicated diabetes on the rates of post- knee arthroplasty complications. The study proposes to evaluate obese patients in terms of functional outcomes and postoperative complications after total knee arthroplasty.
The applications of negative-pressure wound therapy (NPWT) have achieved remarkable diversification. Initially used in the therapy of soft tissue wounds related to open fractures, this technique led to the understanding of the complex mechanisms underlying it. This paper aims to analyze the evolutionary scenarios of a group of patients with heterogeneous lesions under negative pressure aspiration treatment. We aimed to identify and analyze various associated pathologies that have the potential to negatively influence the healing process under negative pressure treatment and implicitly analyze the particularities of representative cases for the group whose evolution under treatment proved to be unfavorable. Retrospective, observational study, type series of cases focused on a group of 17 hospitalized patients, who received treatment by negative aspiration, between 2015-2019 in the Surgery Department of the University Emergency Hospital Bucharest. Regarding the obtained results, diabetes mellitus, obliterating arteriopathy, and anemia had a prevalent distribution in the group with unfavorable evolution. The glycemic value can predict 17% of the evolutionary scenario of a patient (favorable/unfavorable) being necessary an integrative therapeutic conduct. Concluding, although an extremely promising therapeutic option, NPWT can prove to be disappointing given its impact in the background of suboptimally managed comorbidities.
Background: Although locoregional anesthesia techniques in total knee arthroplasty (TKA) have progressed steadily, the emergence of the adductor canal block representing a step forward for postoperative evolution in preservation of the quadriceps muscle strength, analgesia of the posterior territory of the knee still remains a challenge. The emergence of IPACK, in association with earlier techniques, offers promising preliminary results in terms of its contribution to a favourable evolution and to the satisfaction of TKA patients. Materials and methods: Prospective trial performed on a group of 28 patients undergoing a total knee arthroplasty intervention; analgesia control in the postoperative period was performed either with opioid and nonopioid systemic analgesics, or by associating the continuous adductor canal block with IPACK and systemic analgesics. The primary objective is pain control at rest/on mobilization, while the secondary purpose is analysis of opioid use, their side effects and recovery of joint mobility. Results: There is a significantly better pain control in the group of patients with locoregional anesthesia, both at rest and on mobilization (p<0.005), accompanied by a decrease in opioid use (p<0.00001) and the related adverse reactions; at the same time, there is an improvement in the functional recovery of the knee joint, quantified by the flexion degree at 24 and 48 hours after surgery ( 61.5/71.12 degrees for continuous adductor canal block with IPACK versus 45.14/55.42 degrees for general anaesthesia) Conclusions: The introduction of peripheral nerve blocks in the multimodal analgesia regimen after TKA results in better control of postoperative pain, both at rest and on mobilization, in a decrease in opioid use and their related adverse reactions and in an improved recovery of joint range of motion, as well.
Bladder trauma is caused by a direct blow to the distended bladder, severe injury fracturing the pelvis, iatrogenic, or penetrating wounds. Early detection and diagnosis are key to successful management of cases, but omission or late reveal of bladder damage increase mortality and create long-term problems. A bladder injury may not always present with immediate obvious signs and symptoms, especially in a multi-trauma patient, who is also more difficult to investigate. Moreover, during the COVID-19 pandemic, delayed patients’ access to tertiary, multidisciplinary hospitals, increases the risk for delayed diagnosis and also increases the need for more specialists from different surgical and non-surgical areas to raise their awareness of less common manifestations of bladder trauma. We present a review of literature and cases of less common bladder damage from the perspective of a multi-disciplinary team in the University Emergency Hospital in Bucharest.
In an attempt to standardize the X-ray analysis and to create relevant correlations between it and the functional results, we present a pilot model of an artificial neural network based on a Bayesian belief network (BNN) designed for the automatic analysis of anteroposterior X-ray of the knee following total knee arthroplasty and more precisely the analysis of the tibial component. A prospective analysis was conducted in which 30 patients were analyzed and two groups resulted: the first was made up of 12 cases considered “normal” by the examiners (optimal positioning and cementation) and the second one, which was considered “pathological” (incorrect positioning or cementation) and included 16 cases. Based on 22 points established on the tibial component several geometric sizes (calculated parameters) were computed. Several parameters were compared and the results were up to 75% accuracy, 81.25% sensitivity, and 66.7% specificity. BBNs can be a solution for X-ray evaluation of total knee arthroplasty and can improve the understanding of its evolution. It needs confirmation in time, its accuracy rising with the number of patients introduced in the analysis algorithm.
Metformin was a revelation in the treatment of patients with type 2 diabetes, being widely used, with remarkable outcomes. Lately, research has greatly expanded the indications of metformin treatment, which can be used not only in diabetes but also in many other conditions. Although still debatable, several studies have shown the beneficial effects of metformin treatment in patients with psoriasis. This article is a review of the latest data of scientific literature about the effects of metformin administration in patients with diabetes and psoriasis, but also in nondiabetic patients with psoriasis
Rotational malalignment complication following TKA, is common but can be avoided with proper surgical technique. This paper reviews the literature regarding rotational alignment during TKA, femoral and tibial rotation, and highlights the techniques prior in obtaining proper rotational positioning, nevertheless correct positioning in all three planes is important. Proper femoral component positioning in the axial plane is done using as landmarks the posterior condylar line (PCL), surgical transepicondylar axis (sTEA), anatomical transepicondylar axis and the trochlear anteroposterior (AP) axis. The paper describes the angular relationships between these landmarks and the distal femur. Axial tibial positioning is done when using intraarticular landmarks, the combination of more than one landmark could be a solution for solving this problem. The consensus is that femoral component should be positioned according to TEA but the interobserver variability of this land mark is very high. The rotation of the tibial component remains an open subject, most studies suggesting a point between half of the distance of patellar ligament and 1/3 of the internal tuberosity as optimal landmark.
Single ventricle heart (SVH) is a very rare congenital heart disease. However, since the introduction of Fontan's intervention, the survival rate of patients with SVH has been significantly improved, increasing the number of women who may become pregnant in this condition. It has been already reported, in isolated case presentations or in some series of patients, that the pregnacy in the context of SVH and Fontan circulation carries a very high risk for first trimester miscarriage, maternal cardiovascular or obstetric complications and for an increased rate of pre-term birth. Therefore, it is an open field of debate weather or not to allow pregnancy in this category of patients. We are presenting the case of a 22 years old patient who underwent two surgeries for SVH: a Glenn procedure when she was 2 years old and the implantation of a Fontan circuit at the age of 16 years. Since the last surgery she was under permanent internal cardiac stimulation. During the pregnancy the patient was hemodynamically stable, with a normal resting oxygen saturation and a good ejection fraction of the single ventricle. However, the evolution of this patient has become even more challenging due to an aberrant praevia placental lobe. This condition brought her to hospital for several episodes of metrorrhagia and uterine contractions. She delivered at 33 weeks of gestation by emergency Caesarian section with a good evolution until discharge, for mother and the newborn. This case is supporting the opinion that pregnancy can be tolerated without important cardiovascular events in patients with SVH and Fontan circulation, unless heart failure or cardiac arrythmia are associated. Nevertheless, the obstetrical complications remain an important problem in pregnancy overcome of patients with Fontan circulation for SVH that can be superimposed with other unfavorable conditions, like aberrant praevia placental lobe in this case. During the management of such particular clinical settings difficult decisions must be taken, including those addressing the antithrombotic therapy that will be covered in the presentation of this case.
