Pancreatitis, panniculitis and polyarthritis syndrome: A case report

BACKGROUND

Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a rare form of pancreatic disease. It is characterized by bullous erythematous skin lesions and arthritis, and both are triggered by pancreatic malfunction. Few cases have been described in the literature thus far. Due to the inconsistency in its clinical presentation, its diagnosis can be a challenge. Early therapy initiation is essential to reduce mortality; however, there is currently no gold standard for treatment.

CASE SUMMARY

A 66-year-old polymorbid male patient presented with several superficial abscesses on both lower legs and painful swelling in the knee. Treatment for septic arthritis and septic skin infection over several weeks failed. His general condition deteriorated gradually and worsened with sudden onset of abdominal pain. A diagnosis of necrotizing pancreatitis was made. He subsequently underwent a laparotomy and drainage of the pancreas. Eventually, our patient improved, and his abdominal complaints, knee pain, and dermal lesions resolved.

CONCLUSION

PPP syndrome is rare and easily misdiagnosed, as abdominal symptoms may be delayed or absent. Clinicians should consider PPP syndrome if they encounter refractory panniculitis in combination with joint infection.

Learning Curve for Short-Stem Total HIP Arthroplasty through an Anterolateral Approach

Background and Objectives: Short-stem total hip arthroplasty has become increasingly popular in recent years. While many studies have shown excellent clinical and radiological results, very little is known about the learning curve for short-stem total hip arthroplasty through an anterolateral approach. Therefore, the aim of this study was to determine the learning curve for short-stem total hip arthroplasty among five residents in training. Materials and Methods: We performed retrospective data analysis of the first 30 cases of five randomly selected residents (n = 150 cases) with no experience before the index surgery. All patients were comparable, and several surgical parameters and radiological outcomes were analyzed. Results: The only surgical parameter with a significant improvement was the surgical time (p = 0.025). The changes in other surgical parameters and radiological outcomes showed no significant changes; only trends can be derived. As a result, the correlation between surgical time, blood loss, length of stay, and incision/suture time can also be seen. Only two of the five residents showed significant improvements in all examined surgical parameters. Conclusions: There are individual differences among the first 30 cases of the five residents. Some improved their surgical skills faster than others. It could be assumed that they assimilated their surgical skills after more surgeries. A further study with more than 30 cases of the five surgeons could provide more information on that assumption.

Periprosthetic knee joint infection caused by Brucella melitensis which was first -osteoarticular brucellosis or osteoarthrosis: A case report

BACKGROUND

Brucellosis is the most common zoonosis worldwide and is endemic in the Middle East, Africa, Asia, and Latin America. However, it is uncommon in Central Europe, and periprosthetic infections caused by Brucella are therefore rare. Due to the low prevalence and nonspecific clinical presentation of the disease, accurate diagnosis can be challenging; no gold standard currently exists for treating brucellosis.

CASE SUMMARY

Here, we present a 68-year-old Afghan woman living in Austria with a periprosthetic knee infection caused by Brucella melitensis. The interval from total knee arthroplasty to septic loosening was five years. A profound medical history and examinations suggested that the patient had been suffering from unrecognized chronic osteoarticular brucellosis prior to total knee arthroplasty. She was successfully treated by two-stage revision surgery and combined antibiotic therapy over three months.

CONCLUSION

Clinicians should consider brucellosis as a possible cause of chronic arthralgia and periprosthetic infection in patients originating from countries with a high brucellosis burden.

Haemodynamic response at double lumen bronchial tube placement - Airtraq vs. MacIntosh laryngoscope, a randomised controlled trial

INTRODUCTION

Tracheal intubation causes a haemodynamic response that might be harmful for patients. The Airtraq® laryngoscope has been shown to decrease the haemodynamic response to single-lumen tube intubation. We hypothesised that double-lumen bronchial tube placement with the Double-lumen Airtraq® laryngoscope would cause a reduced haemodynamic response and decreased catecholamine release compared with the MacIntosh laryngoscope.

METHODS

Forty adult patients were randomly assigned to the Airtraq® group or to the MacIntosh group. Intubation with either the Airtraq® or the MacIntosh laryngoscope was performed two minutes after standardised induction of anaesthesia. Arterial blood pressure, heart rate, catecholamine levels, bispectral index and duration of the intubation procedure were measured.

RESULTS

Mean (standard deviation [95% confidence interval]) systolic arterial blood pressure at laryngoscopy with the Airtraq® laryngoscope was 124 (34 [106 to 141]) mmHg and, with the MacIntosh laryngoscope, it was 110 (25 [99 to 122]) mmHg (p=1.0). Heart rate at laryngoscopy with the Airtraq® laryngoscope was 75 beats·min-1 (16 [67 to 83]) and, with the MacIntosh laryngoscope, it was 64 beats·min-1 (14 [58 to 71]) (p=0.71). Adrenaline levels post-intubation were 54.3 ng·l-1 (41.5) [29.3 to 79.4] in the Airtraq® group and 30.5 ng·l-1 (25.6) [15.1 to 46.0] in the MacIntosh group (p=0.016). The duration of intubation with the Airtraq® laryngoscope was 88 s (31 [72-104]) while, with the MacIntosh laryngoscope, the duration was 75 s (35 [59-92]) (p=0.26).

CONCLUSIONS

The use of the Double-lumen Airtraq® laryngoscope provides no benefit regarding stress response compared to the MacIntosh laryngoscope.