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Moore C, Fernandes RJ, Manrique J, Polissar NL, Miljacic L, Hippe DS, Vaux J, Thompson MJ. Cytotoxic Effects of Common Irrigation Solutions on Chondrosarcoma and Giant Cell Tumors of Bone. J Bone Joint Surg Am 2022; 104:2153-2159. [PMID: 36367764 PMCID: PMC10168128 DOI: 10.2106/jbjs.22.00404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Irrigation is commonly used as an adjuvant treatment during the intralesional curettage of bone tumors. The goal of the present study was to analyze the in vitro cytotoxicity of commonly used irrigation solutions on chondrosarcoma and giant cell tumor (GCT) cells as there is no consensus on which solution leads to the greatest amount of cell death. METHODS An in vitro evaluation was performed by exposing human GCT and human chondrosarcoma cell lines to 0.9% saline solution, sterile water, 70% ethanol, 3% hydrogen peroxide, 0.05% chlorhexidine gluconate (CHG), and 0.3% povidone iodine solutions independently for 2 and 5 minutes. A low-cytotoxicity control (LCC) and a high-cytotoxicity control (HCC) were established to determine the mean cytotoxicity of each solution and each solution's superiority to LCC and non-inferiority to HCC. RESULTS The present study demonstrated that 0.05% CHG was non-inferior to the HCC when chondrosarcoma was exposed for 5 minutes and when GCT was exposed for 2 and 5 minutes (mean cytotoxicity, 99% to 102%) (p < 0.003 for all). Sterile water was superior to the LCC when chondrosarcoma was exposed for 5 minutes and when GCT was exposed for 2 minutes (mean, 28% to 37%) (p < 0.05). Sterile water (mean, 18% to 38%) (p < 0.012) and 3% hydrogen peroxide (mean, 7% to 16%) (p < 0.001) were both inferior to the HCC. The 3 other solutions were non-superior to the LCC (mean, -24% to -5%) (p < 0.023). CONCLUSIONS In vitro irrigation in 0.05% CHG provided high cytotoxicity, comparable with the HCC. Therefore, the use of a 0.05% CHG solution clinically could serve as a potential chemical adjuvant during intralesional curettage of chondrosarcoma and GCT. CLINICAL RELEVANCE In an effort to reduce the burden of residual tumor cells, irrigation solutions are often utilized as adjuvant local therapy. Use of a 0.05% CHG solution clinically could serve as a potential chemical adjuvant to intralesional curettage of chondrosarcoma and GCT. Further in vivo studies may be indicated to assess clinical outcomes and safety associated with the use of 0.05% CHG in the treatment of chondrosarcoma and GCT.
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Affiliation(s)
- Chris Moore
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Russell J Fernandes
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Jorge Manrique
- Department of Orthopaedic Surgery, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Weston, Florida
| | - Nayak L Polissar
- The Mountain-Whisper-Light: Statistics & Data Science, Seattle, Washington
| | - Ljubomir Miljacic
- The Mountain-Whisper-Light: Statistics & Data Science, Seattle, Washington
| | - Daniel S Hippe
- The Mountain-Whisper-Light: Statistics & Data Science, Seattle, Washington
| | - Jonathon Vaux
- Gundarson Building Orthopedics, The Everett Clinic, Everett, Washington
| | - Matthew J Thompson
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
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Siddiqi A, Mahmoud Y, Manrique J, Molloy RM, Krebs VE, Piuzzi NS. The Use of Megaprostheses in Nononcologic Lower-Extremity Total Joint Arthroplasty: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202202000-00010. [PMID: 35180180 DOI: 10.2106/jbjs.rvw.21.00185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» As the number of primary total joint arthroplasty (TJA) procedures continues to rise, megaprostheses have found an emerging role in more complex revision arthroplasty cases that require additional reconstruction, stability, and restoration of function. » Megaprosthesis options have evolved: in addition to cemented prostheses, cementless and even hybrid fixation designs optimize longevity. Proximal femoral replacement (PFR), distal femoral replacement (DFR), proximal tibial replacement (PTR), and total femoral replacement (TFR) are all limb salvage options in the setting of substantial bone loss, poor bone quality, and soft-tissue compromise. » Dislocation is one of the most common complications after PFR, likely due to the loss of soft-tissue integrity, most notably the hip abductor musculature from the greater trochanter. The utilization of dual-mobility constructs, larger femoral heads, elevated acetabular liners, and constrained acetabular liners may reduce the risk of instability and improve overall hip function. » Patients with megaprostheses may be more prone to periprosthetic joint infection and surgical site infection given multiple variables, such as the lengthy nature of the surgical procedure, prolonged wound exposure, extensive soft-tissue dissection and resection, poor soft-tissue coverage, and poorer host status. » Despite advances in technology, complication and revision rates remain high after megaprosthesis reconstruction. Therefore, thorough attention to patient-specific factors must be considered for appropriate use of these constructs.
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Affiliation(s)
- Ahmed Siddiqi
- Orthopaedic Institute Brielle Orthopaedics, Manasquan, New Jersey.,JFK University Medical Center, Hackensack Meridian Health, Edison, New Jersey.,Department of Orthopedic Surgery, Hackensack Meridian School of Medicine, Nutely, New Jersey
| | - Yusuf Mahmoud
- Department of Orthopedic Surgery, Hackensack Meridian School of Medicine, Nutely, New Jersey
| | - Jorge Manrique
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Ameri BJ, O'Keefe S, Lima D, Higuera-Rueda C, Manrique J. Robotic-Assisted Pelvic Reconstruction After Metastatic Renal Cell Carcinoma Resection: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00052. [PMID: 34762604 DOI: 10.2106/jbjs.cc.20.00908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CASE A 76-year-old man presented with metastatic renal cell carcinoma (RCC) in the right acetabulum with pelvic compromise. The patient had right hip pain and difficulty with ambulation, as such he elected to undergo tumor resection with subsequent reconstruction of pelvic defect. Given the size and location of the anticipated pelvic defect, robotic-assisted hip arthroplasty was used to execute prosthetic component placement and anatomic pelvic reconstruction. CONCLUSION Advances in technology, such as robotics and 3D navigation, have application in orthopaedic oncology surgery, especially for reconstructions after pelvic resections. The goal of this case report is to describe the utility of this technology in a case of metastatic RCC.
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Affiliation(s)
- Bijan Joseph Ameri
- Broward Health Orthopaedic Department, Broward Health Medical Center, Fort Lauderdale, Florida
| | - Shawn O'Keefe
- Broward Health Orthopaedic Department, Broward Health Medical Center, Fort Lauderdale, Florida
| | - Diego Lima
- Orthopaedic Surgery and Rheumatology Center, Cleveland Clinic, Weston, Florida
| | | | - Jorge Manrique
- Orthopaedic Surgery and Rheumatology Center, Cleveland Clinic, Weston, Florida
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Komnos GA, Manrique J, Foltz C, Klement MR, Restrepo C, Parvizi J. Transfusion Rates in Total Hip Arthroplasty Are lower in Patients with Direct Anterior Approach. Arch Bone Jt Surg 2021; 9:659-664. [PMID: 35106331 PMCID: PMC8765200 DOI: 10.22038/abjs.2021.50237.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/08/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Blood conservation and reduction in the need for allogeneic blood transfusion (ABT) has been a subject of importance in total hip arthroplasty. There are a number of well-recognized parameters that influence blood loss during total hip arthroplasty (THA). The role of surgical approach on blood loss and the rate of ABT during THA is not well studied. The hypothesis of this study was that blood loss and the need for ABT is lower with direct anterior (DA) approach. METHODS In a case-control retrospective cohort study, we analyzed 1,524 primary THAs performed at a single institution by seven fellowship-trained surgeons between January 2015 to March 2017. All patients received THA using either the modified direct lateral (DL) or direct anterior (DA) approach using a standard operating table. The overall ABT rate was 10.2% (155/1,524) in the cohort. Demographic, surgical, and postoperative data were extracted and analyzed. Logistic regression was used to identify independent risk factors for transfusion. RESULTS Higher preoperative hemoglobin (p<0.001), use of DA approach (p<0.016) and administration of tranexamic acid TXA, (p=0.024) were identified as independent factors which reduced the odds of ABT. Operative time (p<0.001) was associated with an increased odd of ABT, while age, BMI and type of anesthesia were not statistically significant. CONCLUSION Based on the findings of this study, direct anterior approach for THA appears to be protective against blood loss and reduced ABT rate, when controlling for confounding variables.
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Affiliation(s)
- George A. Komnos
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jorge Manrique
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA, Cleveland Clinic Florida, Weston, FL, USA
| | - Carol Foltz
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mitchell R. Klement
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Camilo Restrepo
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Rezaie AA, Blevins K, Kuo FC, Manrique J, Restrepo C, Parvizi J. Response to Letter to the Editor on "Total Hip Arthroplasty After Prior Acetabular Fracture: Infection Is a Real Concern". J Arthroplasty 2021; 36:e17. [PMID: 33199097 DOI: 10.1016/j.arth.2020.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Arash Aali Rezaie
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Kier Blevins
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Feng-Chih Kuo
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jorge Manrique
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Camilo Restrepo
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Aali Rezaie A, Blevins K, Kuo FC, Manrique J, Restrepo C, Parvizi J. Total Hip Arthroplasty After Prior Acetabular Fracture: Infection Is a Real Concern. J Arthroplasty 2020; 35:2619-2623. [PMID: 32564969 DOI: 10.1016/j.arth.2020.04.085] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Acetabular fractures often require surgical intervention for fracture fixation and can result in premature osteoarthritis of the hip joint. This study hypothesized that total hip arthroplasty (THA) in patients with a prior acetabular fracture who had undergone open reduction and internal fixation (ORIF) is associated with a higher rate of subsequent periprosthetic joint infection (PJI). METHODS About 72 patients with a history of acetabular fracture that required ORIF, undergoing conversion THA between 2000 and 2017 at our institution, were matched based on age, gender, body mass index, Charlson comorbidity index, and date of surgery in a 1:3 ratio with 215 patients receiving primary THA. The mean follow-up for the conversion THA cohort was 2.9 years (range, 1-12.15) and 3.06 years (range, 1-12.96) for the primary THA. RESULTS Patients with a previous acetabular fracture, compared with the primary THA patients, had longer operative times, greater operative blood loss, and an increased need for allogeneic blood transfusion (26.4% vs 4.7%). Most notably, PJI rate was significantly higher in acetabular fracture group at 6.9% compared with 0.5% in the control group. Complications, such as aseptic revision, venous thromboembolism, and mortality, were similar between both groups. CONCLUSION The present study demonstrates that conversion THA in patients with prior ORIF of acetabular fractures is associated with higher complication rate, in particular PJI, and less optimal outcome compared with patients undergoing primary THA. The latter findings compel us to seek and implement specific strategies that aim to reduce the risk of subsequent PJI in these patients.
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Affiliation(s)
- Arash Aali Rezaie
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Kier Blevins
- Duke University Medical Center, Department of Orthopaedic Surgery, Durham, NC
| | - Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jorge Manrique
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Camilo Restrepo
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Manrique J, Schiffman CJ, Chan AD, Olsen D, Thompson MJ. Extra-Articular Hip Resection and Reconstruction with Custom Acetabular Resection Guide and Implants in a Case of High-Grade Spindle Cell Sarcoma of the Proximal Femur: A Case Report. JBJS Case Connect 2020; 10:e1900529. [PMID: 32910595 DOI: 10.2106/jbjs.cc.19.00529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 29-year-old man was admitted with acute atraumatic left hip pain and inability to bear weight. Subsequent workup revealed an intracapsular pathologic fracture of the femoral neck secondary to a high-grade spindle cell sarcoma. A unique method of extra-articular resection and reconstruction using a 3-dimensional (3D)-printed custom cutting jig and a custom acetabular component was pursued. Wide margins were achieved without violating the joint capsule but preserving pelvic integrity, allowing a return to an active lifestyle. CONCLUSION Three-dimensional-printed custom resection guides and implants can help achieve adequate resection margins while preserving pelvic integrity and function.
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Affiliation(s)
- Jorge Manrique
- 1Orthopaedic Surgery & Rheumatology Center, Cleveland Clinic Florida, Weston, Florida 2Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington 3Orthopaedic Oncology, University of Washington Medical Center, Seattle, Washington 4University of Washington School of Medicine, Seattle, Washington
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Komnos GA, Manrique J, Goswami K, Tan TL, Restrepo C, Sherman MB, Parvizi J. Periprosthetic Joint Infection in Patients Who Have Multiple Prostheses in Place: What Should Be Done with the Silent Prosthetic Joints. J Bone Joint Surg Am 2020; 102:1160-1168. [PMID: 32618923 DOI: 10.2106/jbjs.18.01500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although periprosthetic joint infection (PJI) can affect multiple joints concurrently, the majority of patients with multiple prosthetic joints present with PJI of a single joint. Data regarding the optimal management of these patients are limited. We aimed to identify the prevalence, risk factors for a subsequent PJI, and clinical circumstances of PJI in patients with multiple prosthetic joints. METHODS We retrospectively reviewed the clinical records of 197 patients with ≥2 total joint prostheses in place who presented with PJI from 2000 to 2017. The average follow-up was 3.6 years (range, 0.5 to 17 years). Demographic data and risk factors for synchronous or metachronous PJI were identified. The time from the initial to the second PJI and organism profile data were collected as well. The workup for other joints with a prosthesis in place at the time of the initial PJI was noted. RESULTS Among the 197 patients with PJI and multiple joint prostheses in situ, 37 (19%) developed PJI in another joint; 11 had a synchronous PJI and 26 had a metachronous PJI. The average time between the first and the second infection in the metachronous cases was 848 days (range, 20 to 3,656 days). Females and patients with an initial PJI with methicillin-resistant Staphylococcus aureus (MRSA) were more likely to have a metachronous PJI, and patients with rheumatoid arthritis had an increased risk of a second (metachronous or synchronous) PJI. Three of 11 patients in the synchronous group and 19% (5) of the 26 in the metachronous group had bacteremia at the time of the initial PJI compared with 12% (19) of the 160 with a single PJI. The percentage of negative cultures increased from 10% for the initial PJIs to 38% for the metachronous PJIs. CONCLUSIONS Patients who have multiple prosthetic joints in place and present with PJI of a single joint are at risk of developing PJI in another joint. Female sex, rheumatoid arthritis, bacteremia at presentation, and infection with MRSA appear to be risk factors for PJI of another joint. Clinical evaluation of the other prosthetic joint(s) should be carried out in all patients and aspiration of those joint(s) should be considered for patients with any of the above risk factors. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- George A Komnos
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jorge Manrique
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Karan Goswami
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Timothy L Tan
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Camilo Restrepo
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew B Sherman
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Palmer JR, Pannu TS, Villa JM, Manrique J, Riesgo AM, Higuera CA. The treatment of periprosthetic joint infection: safety and efficacy of two stage versus one stage exchange arthroplasty. Expert Rev Med Devices 2020; 17:245-252. [DOI: 10.1080/17434440.2020.1733971] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Joseph R. Palmer
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Tejbir S. Pannu
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Jesus M. Villa
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Jorge Manrique
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Aldo M. Riesgo
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Carlos A. Higuera
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Orera A, Lacarra S, Fernández L, Gómez N, Slon MF, Manrique J. [Secondary glomerulonephritis in neurofibromatosis type 1. Two case reports]. An Sist Sanit Navar 2019; 42:345-349. [PMID: 31859277 DOI: 10.23938/assn.0720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Neurofibromatosis type 1 (NF-1) is an autosomal dominant neurocutaneous disorder with systemic clinical manifestations. There are few publications about the renal effects of this disease, with renal vascular disease and adrenal tumors being the most frequent forms of renal involvement, while cases describing glomerular effects are exceptional. Despite the lack of published information, common molecular mechanisms in both NF-1 and nephrotic syndrome, involving the mTOR pathway, were suggested to explain a possible association between both pathologies. We present two cases of renal involvement in the form of nephrotic syndrome in patients diagnosed with NF1. A 41-year-old female was diagnosed of NF-1 in the context of a nephrotic syndrome with resistance to steroid treatment; the renal biopsy revealed a diagnosis of minimal changes disease. The second case is other 71-year-old woman with a history of NF-1, who presented a nephrotic syndrome and secondary renal amyloidosis.
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Affiliation(s)
- A Orera
- Servicio de Medicina Intensiva. Complejo Hospitalario de Navarra. Pamplona..
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Goswami K, Cho J, Foltz C, Manrique J, Tan TL, Fillingham Y, Higuera C, Della Valle C, Parvizi J. Polymyxin and Bacitracin in the Irrigation Solution Provide No Benefit for Bacterial Killing in Vitro. J Bone Joint Surg Am 2019; 101:1689-1697. [PMID: 31567806 DOI: 10.2106/jbjs.18.01362] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many surgeons add topical antibiotics to irrigation solutions assuming that this has a local effect and eliminates bacteria. However, prior studies have suggested that the addition of antibiotics to irrigation solution confers little benefit, adds cost, may potentiate anaphylactic reactions, and may contribute to antimicrobial resistance. We sought to compare the antimicrobial efficacy and cytotoxicity of an irrigation solution containing polymyxin-bacitracin with other commonly used irrigation solutions. METHODS Staphylococcus aureus and Escherichia coli were exposed to irrigation solutions containing topical antibiotics (500,000-U/L polymyxin and 50,000-U/L bacitracin; 1-g/L vancomycin; or 80-mg/L gentamicin), as well as commonly used irrigation solutions (saline solution 0.9%; povidone-iodine 0.3%; chlorhexidine 0.05%; Castile soap 0.45%; and sodium hypochlorite 0.125%). Following 1 and 3 minutes of exposure, surviving bacteria were manually counted. Failure to eradicate all bacteria in any of the 3 replicates was considered not effective for that respective solution. Cytotoxicity analysis in human fibroblasts, osteoblasts, and chondrocytes exposed to the irrigation solutions was performed by visualization of cell structure and was quantified by lactate dehydrogenase (LDH) activity. Efficacy and cytotoxicity were assessed in triplicate experiments, with generalized linear mixed models. RESULTS Polymyxin-bacitracin, saline solution, and Castile soap at both exposure times were not effective at eradicating S. aureus or E. coli. In contrast, povidone-iodine, chlorhexidine, and sodium hypochlorite irrigation were effective against both S. aureus and E. coli (p < 0.001). Vancomycin irrigation was effective against S. aureus but not against E. coli, whereas gentamicin irrigation showed partial efficacy against E. coli but none against S. aureus. Within fibroblasts, the greatest cytotoxicity was seen with chlorhexidine (mean [and standard error], 49.38% ± 0.80%; p < 0.0001), followed by Castile soap (33.57% ± 2.17%; p < 0.0001) and polymyxin-bacitracin (8.90% ± 1.40%). Povidone-iodine showed the least cytotoxicity of the efficacious solutions (5.00% ± 0.86%). Similar trends were seen at both exposure times and across fibroblasts, osteoblasts, and chondrocytes. CONCLUSIONS Irrigation with polymyxin-bacitracin was ineffective at bacterial eradication, and statistically inferior to povidone-iodine. Chlorhexidine lavage conferred the greatest in vitro cytotoxicity. CLINICAL RELEVANCE These data suggest that the addition of polymyxin-bacitracin to saline solution irrigation has little value. Given the cost and antimicrobial resistance implications, our findings, combined with prior clinical literature, provide adequate reason to avoid widespread use of antibiotics in irrigation solutions. Povidone-iodine may be a more effective and safer option.
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Affiliation(s)
- Karan Goswami
- Parvizi Surgical Innovation, Philadelphia, Pennsylvania
| | - Jeongeun Cho
- Parvizi Surgical Innovation, Philadelphia, Pennsylvania
| | - Carol Foltz
- Parvizi Surgical Innovation, Philadelphia, Pennsylvania
| | | | - Timothy L Tan
- Parvizi Surgical Innovation, Philadelphia, Pennsylvania
| | | | | | | | - Javad Parvizi
- Parvizi Surgical Innovation, Philadelphia, Pennsylvania
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Manrique J, Paskey T, Tarabichi M, Restrepo C, Foltz C, Hozack WJ. Total Hip Arthroplasty Through the Direct Anterior Approach Using a Bikini Incision Can Be Safely Performed in Obese Patients. J Arthroplasty 2019; 34:1723-1730. [PMID: 31003782 DOI: 10.1016/j.arth.2019.03.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/16/2019] [Accepted: 03/25/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Direct anterior approach (DAA) total hip arthroplasty can be performed through a traditional vertical incision or a horizontal (bikini) incision. The purpose of this study is to compare the 2 approaches, performed by a single surgeon past the learning curve, in terms of (1) overall wound complications and (2) patient-reported esthetics at the 6-month follow-up. METHODS A case-control retrospective study was conducted. Eighty-six bikini DAA patients were matched 3:1 to 230 conventional DAA patients for gender, age, body mass index (BMI), and American Society of Anesthesiologists score. Outcomes evaluated included wound complications, acute periprosthetic joint infection, transfusion, length of surgery, and dysesthesia. A subgroup analysis was also performed on obese patients, BMI greater than 30 kg/m2. Furthermore, the patients rated cosmesis of the incision at 6 months using a Patient Scar Assessment Scale and the Vancouver Scar Assessment Scale. RESULTS Bikini patients had lower rates of delayed wound healing compared to conventional incision (2.3% vs 6.1%, P = .087). This difference was statistically significant (0% vs 16.6%, P < .05) in obese patients. There was no difference in terms of incision cosmesis between the 2 incision types. CONCLUSION Our study demonstrates that the DAA total hip arthroplasty can be performed safely through an alternative horizontal bikini incision with complication rates equivalent to conventional incision DAA and to those in other approaches when performed by surgeons in a high volume, efficient hip replacement institution. In patients whose BMI is >30, a potential benefit of the horizontal incision may be lower wound complications. This study design should be performed at other institutions and ideally at a multi-institution level to evaluate if results can be corroborated. Our opinion is that the horizontal bikini incision should be utilized but only after mastery of the DAA approach using the conventional vertical incision.
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Affiliation(s)
- Jorge Manrique
- Rothman Orthopaedic Institute, Philadelphia, PA; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA
| | | | | | | | - Carol Foltz
- Rothman Orthopaedic Institute, Philadelphia, PA
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Abdel MP, Akgün D, George A, Akinola B, Alencar P, Amanatullah DF, Babazadeh S, Borens O, Vicente Cabral RM, Cichos KH, Deirmengian C, de Steiger R, Ghanem E, Radtke Gonçalves JR, Goodman S, Hamlin B, Hwang K, Klatt BA, Lee GC, Manrique J, Moon AS, Ogedegbe F, Salib CG, Tian S, Winkler T. Erratum to "Hip and Knee Section, Diagnosis, Pathogen Isolation, Culture: Proceedings of International Consensus on Orthopedic Infections" [The Journal of Arthroplasty 34 (2019) S361-S367]. J Arthroplasty 2019; 34:1863. [PMID: 31155458 DOI: 10.1016/j.arth.2019.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Abstract
Total knee arthroplasty (TKA) is a highly successful operation that improves patients' quality of life and functionality. Yet, up to 20% of TKA patients remain unsatisfied with their clinical result. Robotic TKA has gained increased attention and popularity as a means of improving patient satisfaction. The promise of robotic-assisted TKA is that it provides a surgeon with a tool that accurately executes bone cuts according to presurgical planning, as well as provides the surgeon with intraoperative feedback helpful for restoring knee kinematics and soft tissue balance. Several systems are now available, each with their own advantages and disadvantages. Evidence that the use of robotics will lead to improved implant survival, function, and patient-reported outcomes is slowly being accumulated, but this has not been clearly proven to date. Recent literature does show that the use of robotics during TKA is not associated with increased surgical time or complications. The goal of this review is to provide an objective assessment of the evidence surrounding robotic technology for TKA.
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Affiliation(s)
- Maria Bautista
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, School of Medicine, Universidad del Rosario, Bogota, Colombia
| | - Jorge Manrique
- Rothman Institute, Department of Orthopedic surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - William J Hozack
- Rothman Institute, Department of Orthopedic surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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Abouljoud MM, Backstein D, Battenberg A, Dietz M, Erice A, Freiberg AA, Granger J, Katchky A, Khlopas A, Kim TK, Kjaersgaard-Andersen P, Koo KH, Kosashvili Y, Lazarovski P, Leighton J, Lombardi A, Malizos K, Manrique J, Mont MA, Papanagiotoy M, Sierra RJ, Sodhi N, Stammers J, Stiehler M, Tan TL, Uchiyama K, Ward D, Ziogkou A. Erratum to 'Hip and Knee Section, Treatment, Surgical Technique: Proceedings of International Consensus on Orthopedic Infections' [The Journal of Arthroplasty 34 (2019) S445-S451]. J Arthroplasty 2019; 34:1300. [PMID: 30930160 PMCID: PMC6800225 DOI: 10.1016/j.arth.2019.02.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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16
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Abdel MP, Barreira P, Battenberg A, Berry DJ, Blevins K, Font-Vizcarra L, Frommelt L, Goswami K, Greiner J, Janz V, Kendoff DO, Limberg AK, Manrique J, Moretti B, Murylev V, O'Byrne J, Petrie MJ, Porteous A, Saleri S, Sandiford NA, Sharma V, Shubnyakov I, Sporer S, Squire MW, Stockley I, Tibbo ME, Turgeon T, Varshneya A, Wellman S, Zahar A. Hip and Knee Section, Treatment, Two-Stage Exchange Spacer-Related: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S427-S438. [PMID: 30348562 DOI: 10.1016/j.arth.2018.09.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Aalirezaie A, Arumugam SS, Austin M, Bozinovski Z, Cichos KH, Fillingham Y, Ghanem E, Greenky M, Huang W, Jenny JY, Lazarovski P, Lee GC, Manrique J, Manzary M, Oshkukov S, Patel NK, Reyes F, Spangehl M, Vahedi H, Voloshin V. Hip and Knee Section, Prevention, Risk Mitigation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S271-S278. [PMID: 30348568 DOI: 10.1016/j.arth.2018.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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18
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Abouljoud MM, Backstein D, Battenberg A, Dietz M, Erice A, Freiberg AA, Granger J, Katchky A, Khlopas A, Kim TK, Kjaersgaard-Andersen P, Koo KH, Kosashvili Y, Lazarovski P, Leighton J, Lombardi A, Malizos K, Manrique J, Mont MA, Papanagiotoy M, Sierra RJ, Sodhi N, Stammers J, Stiehler M, Tan TL, Uchiyama K, Ward D, Ziogkou A. Hip and Knee Section, Treatment, Surgical Technique: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S445-S451. [PMID: 30348548 PMCID: PMC6607902 DOI: 10.1016/j.arth.2018.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abouljoud MM, Alvand A, Boscainos P, Chen AF, Garcia GA, Gehrke T, Granger J, Kheir M, Kinov P, Malo M, Manrique J, Meek D, Meheux C, Middleton R, Montilla F, Reed M, Reisener MJ, van der Rijt A, Rossmann M, Spangehl M, Stocks G, Young P, Young S, Zahar A, Zhang X. Hip and Knee Section, Prevention, Operating Room Environment: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S293-S300. [PMID: 30343970 DOI: 10.1016/j.arth.2018.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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20
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Akonjom M, Battenberg A, Beverland D, Choi JH, Fillingham Y, Gallagher N, Han SB, Jang WY, Jiranek W, Manrique J, Mihov K, Molloy R, Mont MA, Nandi S, Parvizi J, Peel T, Pulido L, Sarungi M, Sodhi N, Alberdi MT, Olivan RT, Wallace D, Weng X, Wynn-Jones H, Yeo SJ. General Assembly, Prevention, Blood Conservation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S147-S155. [PMID: 30348569 DOI: 10.1016/j.arth.2018.09.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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21
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Zainul-Abidin S, Amanatullah DF, Anderson MB, Austin M, Barretto JM, Battenberg A, Bedard NA, Bell K, Blevins K, Callaghan JJ, Cao L, Certain L, Chang Y, Chen JP, Cizmic Z, Coward J, DeMik DE, Diaz-Borjon E, Enayatollahi MA, Feng JE, Fernando N, Gililland JM, Goodman S, Goodman S, Greenky M, Hwang K, Iorio R, Karas V, Khan R, Kheir M, Klement MR, Kunutsor SK, Limas R, Morales Maldonado RA, Manrique J, Matar WY, Mokete L, Nung N, Pelt CE, Pietrzak JRT, Premkumar A, Rondon A, Sanchez M, Novaes de Santana C, Sheth N, Singh J, Springer BD, Tay KS, Varin D, Wellman S, Wu L, Xu C, Yates AJ. General Assembly, Prevention, Host Related General: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S13-S35. [PMID: 30360983 DOI: 10.1016/j.arth.2018.09.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Tian S, Goswami K, Manrique J, Blevins K, Azboy I, Hozack WJ. Direct Anterior Approach Total Hip Arthroplasty Using a Morphometrically Optimized Femoral Stem, a Conventional Operating Table, Without Fluoroscopy. J Arthroplasty 2019; 34:327-332. [PMID: 30448326 DOI: 10.1016/j.arth.2018.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Our experience with direct anterior approach total hip arthroplasty (THA) suggests that it can be performed successfully with a morphometrically optimized metaphyseal-diaphyseal engaging femoral stem (NOT a short stem), a regular operating room table (NOT a special custom table), and WITHOUT intraoperative fluoroscopy. We report our minimum 2-year results. METHODS A retrospective review of a single-surgeon series of primary direct anterior approach THAs was performed. All procedures were performed on a regular table, without fluoroscopy, using a cementless tapered femoral stem. Clinical, functional, and radiographic outcomes were evaluated at a minimum of 2 years. RESULTS In total, 1017 primary THAs were performed. The preoperative Harris Hip Score was 40.7 ± 5.1 and improved to 95.3 ± 4.2 at minimum 2-year follow-up. There were 3 dislocations (0.3%) and 15 revisions (1.5%): 7 for infection (0.7%), 4 for periprosthetic fractures (0.4%), 2 for instability (0.2%), 1 for loosening (0.1%), and 1 for pain (0.1%). Five patients (0.5%) required blood transfusion. One patient developed deep vein thrombosis and pulmonary embolism. No intraoperative fractures, perforation, or THA-related mortality occurred. Neutral stem alignment was confirmed in 98.3%. Mean cup inclination was 38.8° ± 5.1° and anteversion was 16.2° ± 3.5°. The mean leg-length discrepancy was corrected from 1.2 ± 0.2 cm preoperatively to 0.2 ± 0.1 cm postoperatively. CONCLUSION Using a morphometrically optimized metaphyseal-diaphyseal engaging tapered femoral stem instead of a short stem reduces component malposition and minimizes risk of loosening. Combining the use of this implant design and the technique and elements described in our cohort demonstrated to have excellent results at 2 years. The patients will need continued follow-up to demonstrate further durability of this device and technique compared to others performing direct anterior THA.
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Affiliation(s)
- Shaoqi Tian
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA; Affiliated Hospital of Qingdao University, Qingdao, China
| | - Karan Goswami
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jorge Manrique
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA
| | - Kier Blevins
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ibrahim Azboy
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - William J Hozack
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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23
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Abdel MP, Akgün D, Akin G, Akinola B, Alencar P, Amanatullah DF, Babazadeh S, Borens O, Vicente Cabral RM, Cichos KH, Deirmengian C, de Steiger R, Ghanem E, Radtke Gonçalves JR, Goodman S, Hamlin B, Hwang K, Klatt BA, Lee GC, Manrique J, Moon AS, Ogedegbe F, Salib CG, Tian S, Winkler T. Hip and Knee Section, Diagnosis, Pathogen Isolation, Culture: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S361-S367. [PMID: 30343972 DOI: 10.1016/j.arth.2018.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Manrique J, Alijanipour P, Heller S, Dove M, Parvizi J. Increased Risk of Heterotopic Ossification Following Revision Hip Arthroplasty for Periprosthetic Joint Infection. Arch Bone Jt Surg 2018; 6:486-491. [PMID: 30637303 PMCID: PMC6310194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/23/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND To investigate whether surgery for Periprosthetic Joint Infection (PJI) of the hip, the number of procedures and their duration contribute to risk of Heterotopic Ossification formation. METHODS 56 patients with hip PJI undergoing one-stage (10) or two-stage (46) exchange arthroplasty were matched to 112 patients undergoing revision arthroplasty for aseptic failure based on age, gender, body mass index (BMI), surgical approach (all direct lateral) and date of surgery (2006-2013). Patients with Paget's disease and ankylosing spondylitis, or preoperative HO were excluded. Perioperative pain management included use of the anti-inflammatory medications in all patients without prophylactic radiotherapy. Six-month postoperative radiographs were reviewed based on Brooker classification. RESULTS The incidence of overall HO in PJI and aseptic groups was 84% (47/56) and 11% (12/112), respectively. High grade HO (grades 3 and 4) in PJI and aseptic groups were 25% (24/56) and 4% (4/112), respectively. PJI was an independent risk factor for HO in the multivariate analysis (odds ratio of 9.3, 95% CI: 2.9-29.9, P<0.001). CONCLUSION Patients undergoing surgical treatment of hip PJI seem to be at increased risk of developing HO compared to aseptic failure. HO prophylaxis regimens may be recommendable in eligible patients undergoing surgical intervention for PJI of the hip. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jorge Manrique
- Research performed at The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Pouya Alijanipour
- Research performed at The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Snir Heller
- Research performed at The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Dove
- Research performed at The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- Research performed at The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Serrano-Alonso M, Guillen-Grima F, Martin-Moreno P, Rabago G, Manrique J, Garcia-del-Barrio M, Reina G, Torre-Cisneros J, Fernandez-Alonso M, Herrero J. Reduction in mortality associated with secondary cytomegalovirus prophylaxis after solid organ transplantation. Transpl Infect Dis 2018; 20:e12873. [DOI: 10.1111/tid.12873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/02/2018] [Accepted: 01/14/2018] [Indexed: 01/06/2023]
Affiliation(s)
| | - F. Guillen-Grima
- Preventive Medicine Department; Clínica Universidad de Navarra; Pamplona Spain
- Department of Health Sciences; Public University of Navarra; Pamplona Spain
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
| | - P. Martin-Moreno
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Nephrology Department; Clínica Universidad de Navarra; Pamplona Spain
| | - G. Rabago
- Cardiac Surgery Department; Clínica Universidad de Navarra; Pamplona Spain
| | - J. Manrique
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Nephrology Department; Complejo Hospitalario de Navarra; Pamplona Spain
| | | | - G. Reina
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Microbiology Department; Clínica Universidad de Navarra; Pamplona Spain
| | - J. Torre-Cisneros
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC); Reina Sofía University Hospital; University of Cordoba; Cordoba Spain
| | - M. Fernandez-Alonso
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Microbiology Department; Clínica Universidad de Navarra; Pamplona Spain
| | - J.I. Herrero
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Liver Unit; Clínica Universidad de Navarra; Pamplona Spain
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd); Madrid Spain
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Manrique J, Rasouli MR, Restrepo C, Maltenfort MG, Beri J, Oliver J, Patel R, Parvizi J. Total Knee Arthroplasty in Patients with Retention of Prior Hardware Material: What is the Outcome? Arch Bone Jt Surg 2018; 6:23-26. [PMID: 29430491 PMCID: PMC5799595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 05/13/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND There is an information gap in literature regarding postoperative outcome of total knee arthroplasty (TKA) in patients with hardware in-situ from the previous knee surgery. The present study aims to evaluate impact of retained hardware on short-term outcome of TKA patients. METHODS Perioperative radiographs of patients who had undergone TKA between 2007 and 2012 were reviewed and patients in whom partial or complete retention of hardware was evident after TKA were included. These patients were matched in 1 to 2 ratio based on age (+/- 2 years), gender, surgeon and year of surgery to a group of patients that underwent primary TKA without hardware in the affected knee. The average follow up of these patients was 43.45 (range 12-155.2) months. Complication rates were compared between the two groups using statistical tests that took into account the matched data structure. RESULTS We included a total of 55 cases and 110 controls. The incidence of complications was higher, although not all statistically significant, in the case group. Only mechanical complications were significantly different in the cases group (5.5% versus 0%, P=0.01). Time to event analysis using the mixed-effects Cox model didn't show a statistically significant difference between two groups for various outcomes. CONCLUSION Presence of retained hardware around the knee may predispose the patient to a higher rate of complications particularly mechanical complications of the implant after TKA. Further studies are required to investigate impact of retained hardware around the knee in patients undergoing TKA.Level of evidence: III.
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Affiliation(s)
- Jorge Manrique
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad R Rasouli
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Camilo Restrepo
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitchell G Maltenfort
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jonathan Beri
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jeffrey Oliver
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Raj Patel
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Parvizi
- Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Zmistowski BM, Manrique J, Patel R, Chen AF. Recurrent Periprosthetic Joint Infection After Irrigation and Debridement With Component Retention Is Most Often Due to Identical Organisms. J Arthroplasty 2016; 31:148-51. [PMID: 27378647 DOI: 10.1016/j.arth.2016.05.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Irrigation and debridement with prosthetic retention (I&D) is an oft-utilized treatment option for PJI, despite its known limited success. While it is known that nearly half of all patients treated with I&D have recurrent infection, the organism persistence between infection events remains unreported. In addition, identifying those cases in which I&D routinely failed to eradicate the infection (not simply prevent recurrent infection) may allow improved patient selection for this less morbid procedure-a difficult task to date. METHODS Using an institutional database, 146 patients (153 joints) undergoing I&D between April 2000 and July 2013 were identified. There were 60 hips (40%). The overall success rate of I&D in this group was 52% (80/153). The failure group was limited to those patients with growth on culture at both initial failure and recurrent failure (46 cases). Analyses were performed to identify potential predictors of failed I&D and organism persistence in those cases. RESULTS In the study group, 83.7% (36/43) of cases failed with the same organism. Knees with failed I&D had an organism persistence of 92.3% (24/26) compared with 70.5% (12/17; P = .09) for the hip. Patients initially infected with Staphylococcus aureus (specifically methicillin-resistant [13/13]) had a higher risk of persistent PJI (96%; 24/25) compared to other organisms (66.7%; 12/18; P = .01). CONCLUSION I&D had a success rate of approximately 50% and typically failed due to organism persistence rather than a new infection. Given that persistent infection was most common in knees and S aureus, I&D should have a limited role in treating PJI, especially in these cases.
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Affiliation(s)
- Benjamin M Zmistowski
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jorge Manrique
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ripal Patel
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Antonia F Chen
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Tan TL, Gomez MM, Manrique J, Parvizi J, Chen AF. Positive Culture During Reimplantation Increases the Risk of Subsequent Failure in Two-Stage Exchange Arthroplasty. J Bone Joint Surg Am 2016; 98:1313-9. [PMID: 27489323 DOI: 10.2106/jbjs.15.01469] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is strongly recommended that tissue and synovial fluid culture samples be obtained during reimplantation performed as part of a 2-stage exchange arthroplasty. The rate of positive cultures during reimplantation and the influence of positive cultures on subsequent outcomes, to our knowledge, are unknown. This study was designed to determine the rate of positive cultures during reimplantation and to investigate the association between positive cultures at reimplantation and subsequent outcomes. METHODS We retrospectively reviewed the data of 259 patients who met the Musculoskeletal Infection Society criteria for periprosthetic joint infection (PJI) and who underwent both stages of 2-stage exchange arthroplasty at our institution from 1999 to 2013. Among these patients were 267 PJIs (186 knees and 81 hips); 33 (12.4%) had ≥1 positive culture result at reimplantation. Treatment failure was assessed according to the Delphi-based consensus definition. Logistic regression analysis was performed to assess the predictors of positive culture and risk factors for failure of 2-stage exchange arthroplasty. RESULTS Of the 33 cases with PJI, 15 (45.5%) had a subsequent failure of the 2-stage exchange arthroplasty compared with 49 (20.9%) of the cases that were culture-negative at reimplantation. When controlling for other variables using multivariate analyses, the risk of treatment failure was higher (odds ratio = 2.53; 95% confidence interval [CI] = 1.13 to 5.64) and reinfection occurred earlier (hazard ratio = 2.00; 95% CI = 1.05 to 3.82) for the cases with a positive culture during reimplantation. The treatment failure rate did not differ (p = 0.73) between cases with ≥2 positive cultures (36.4%) and 1 positive culture (50%). CONCLUSIONS Positive intraoperative culture at the time of reimplantation, regardless of the number of positive samples, was independently associated with >2 times the risk of subsequent treatment failure and earlier reinfection. Surgeons should be aware that a positive culture at the time of reimplantation independently increases the risk of subsequent failure. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Duarte C, Bastidas F, de los Reyes A, Martínez MC, Hurtado G, Gómez MC, Sánchez R, Manrique J. Randomized controlled clinical trial comparing radioguided occult lesion localization with wire-guided lesion localization to evaluate their efficacy and accuracy in the localization of nonpalpable breast lesions. Surgery 2015; 159:1140-5. [PMID: 26549819 DOI: 10.1016/j.surg.2015.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/21/2015] [Accepted: 09/24/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to compare the radioguided occult lesion localization (ROLL) technique with the wire-guided lesion localization (WGLL) technique to assess their efficacy and accuracy in the localization of nonpalpable breast lesions in patients at a unique reference medical center. These patients' reports were negative for malignancy but included highly suspicious imaging findings. METHODS A controlled clinical trial was designed to compare the WGLL and ROLL techniques in women presenting with breast lesions diagnosed by mammography or ultrasonography at the Instituto Nacional de Cancerología in Bogotá, Colombia, from March 2006 to June 2011. RESULTS This study examined 129 patients; 64 (49.6%) patients were treated with ROLL, and 65 (51.4%) were treated with WGLL. The ROLL technique achieved better median lesion centricity (ROLL = 11.7 and WGLL = 15.4; P = .038). No significant differences were found regarding demographic variables, operative specimen characteristics, the need to extend margins, operative complications, the degree of difficulty, or patient or surgeon satisfaction. CONCLUSION The ROLL technique is as effective as WGLL for the localization of nonpalpable breast lesions. In our study, ROLL achieved better lesion centricity. Therefore, we propose that this technique could be used as a standard procedure in the detection of nonpalpable breast lesions at experienced centers.
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Affiliation(s)
- Carlos Duarte
- Grupo de Cirugía de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá D.C., Colombia.
| | - Faustino Bastidas
- Grupo de Cirugía de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
| | - Amelia de los Reyes
- Grupo de Medicina Nuclear, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
| | | | - Gloria Hurtado
- Grupo de Imágenes Diagnósticas, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
| | | | - Ricardo Sánchez
- Grupo de Investigación Clínica, Instituto Nacional de Cancerología, Bogotá D.C., Colombia; Facultad de Medicina Universidad Nacional de Colombia, Bogotá D.C., Colombia
| | - Jorge Manrique
- Grupo de Cirugía de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
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Abstract
BACKGROUND Two-stage exchange arthroplasty remains the preferred method to treat periprosthetic joint infection. The aim of this study was to investigate the clinical course of periprosthetic joint infection following resection arthroplasty and insertion of a spacer. METHODS Our institutional database was used to identify 504 cases of periprosthetic joint infection (326 knees and 178 hips) treated with resection arthroplasty and spacer insertion as part of a two-stage exchange arthroplasty. A review of the patient charts was performed to extract information relevant to the objectives of this study that included the details of the clinical course following resection arthroplasty. RESULTS The mean follow-up duration after initial spacer implantation was 56.2 months. Reimplantation occurred in the joints of 417 (82.7%) of 504 cases. Of these 417 cases, 329 (78.9%) had a minimum one-year follow-up, and 81.4% of these had successful treatment. The mean duration from resection arthroplasty to reimplantation was 4.2 months (range, 0.7 to 131.7 months). Sixty (11.9%) of the 504 joints required interim spacer exchange(s). Of the eighty-seven cases that did not undergo reimplantation, six (6.9%) required amputation, five (5.7%) underwent a Girdlestone procedure, four (4.6%) underwent arthrodesis, and seventy-two (82.8%) underwent spacer retention. Thirty-six patients died in the interstage period. CONCLUSIONS The commonly held belief that two-stage exchange arthroplasty carries a high success rate for the eradication of periprosthetic joint infection may need to be reexamined. A considerable number of patients undergoing the first stage of a two-stage procedure do not undergo a subsequent reimplantation for a variety of reasons or require an additional spacer exchange in the interim. Reports on the success of two-stage exchange should account for the mortality of these patients and for patients who never undergo reimplantation.
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Affiliation(s)
- Miguel M Gomez
- Rothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107. E-mail address for J. Parvizi:
| | - Timothy L Tan
- Rothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107. E-mail address for J. Parvizi:
| | - Jorge Manrique
- Rothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107. E-mail address for J. Parvizi:
| | - Gregory K Deirmengian
- Rothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107. E-mail address for J. Parvizi:
| | - Javad Parvizi
- Rothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107. E-mail address for J. Parvizi:
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Shahi A, Chen AF, McKenna PB, Roberts AL, Manrique J, Belden KA, Austin MS. Bacterial Contamination in Tips of Electrocautery Devices During Total Hip Arthroplasty. J Arthroplasty 2015; 30:1410-3. [PMID: 25817186 DOI: 10.1016/j.arth.2015.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 03/10/2015] [Accepted: 03/11/2015] [Indexed: 02/01/2023] Open
Abstract
Surgical equipment can become contaminated during surgery. It is unknown if electrocautery tips can become contaminated in clean orthopedic procedures despite the produced heat. Therefore, we conducted a prospective study to address this concern. The tips from 25 primary and 25 aseptic revision THAs were collected and an additional 5 sterile tips served as negative controls. Aerobic and anaerobic cultures were incubated for a minimum of 3 days. There were 3 positive cultures (6%); one in primary THA (4%) with Lactobacillus and Enterococcus faecalis; two among revisions (8%), one with E. faecalis and another one with alpha hemolytic streptococci and coagulase negative Staphylococcus. The mean exposure time of the contaminated tips was 132.3 minutes. Patients were followed for 90 days postoperatively and none of them developed surgical site infection. This is the first study to demonstrate that electrosurgical devices can become contaminated during THA in laminar flow equipped operating rooms.
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Affiliation(s)
- Alisina Shahi
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Antonia F Chen
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Paul B McKenna
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amity L Roberts
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jorge Manrique
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine A Belden
- Division of Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Matthew S Austin
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Abstract
Stiffness after total knee arthroplasty (TKA) adversely affects outcome and impacts patient function. Various risk factors for stiffness after TKA have been identified, including reduced preoperative knee range of motion, history of prior knee surgery, etiology of arthritis, incorrect positioning or oversizing of components, and incorrect gap balancing. Mechanical and associated causes, such as infection, arthrofibrosis, complex regional pain syndrome, and heterotopic ossification, secondary gain issues have also been identified. Management of stiffness following TKA can be challenging. The condition needs to be assessed and treated in a staged manner. A nonsurgical approach is the first step. Manipulation under anesthesia may be considered within the first 3 months after the index TKA, if physical therapy fails to improve the range of motion. Beyond this point, consideration should be given to surgical intervention such as lysis of adhesions, either arthroscopically or by open arthrotomy. If the cause of stiffness is deemed to be surgical error, such as component malpositioning, revision arthroplasty is indicated. The purpose of this article is to evaluate the various aspects of management of stiffness after TKA.
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Affiliation(s)
- Jorge Manrique
- Research Department, Rothman Institute, Philadelphia, Pennsylvania
| | - Miguel M Gomez
- Research Department, Rothman Institute, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Research Department, Rothman Institute, Philadelphia, Pennsylvania
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Manrique J, Chen AF, Heller S, Hozack WJ. Direct anterior approach for revision total hip arthroplasty. Ann Transl Med 2014; 2:100. [PMID: 25405154 DOI: 10.3978/j.issn.2305-5839.2014.09.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/26/2014] [Indexed: 02/06/2023]
Abstract
Revision total hip arthroplasty (THA) can be successfully performed through the direct anterior (DA) approach. Patient positioning, the surgical approach and specific instruments are important for obtaining adequate exposure. Acetabular exposure can be facilitated by capsular release and correct placement of retractors. Distal and proximal extension of the incision, as well as a femoral extended trochanteric osteotomy (ETO) can be performed to increase femoral exposure. The purposes of this article are to describe the DA approach, provide surgical techniques for revision THA through this approach, and describe the indications, contraindications and complications of this approach.
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Affiliation(s)
- Jorge Manrique
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Antonia F Chen
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Snir Heller
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - William J Hozack
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Duarte C, Manrique J, Lehmann C. 2506 POSTER Isolated Limb Perfusion in Cancer Patients: a Primary National Experience Report in a Developing Country. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sotelo R, Astigueta J, Carmona O, De Andrade R, Cuomo B, Manrique J, Canes D, Gill I, Desai M. VID-02.05: Single Port Laparoscopic Augmentation Enterocystoplasty. Urology 2009. [DOI: 10.1016/j.urology.2009.07.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rodriguez E, Vera V, Perez-Puigbo A, Capriles-Hulett A, Ferro S, Manrique J, Abate J. Equivalence of a single saline nebulised dose of formoterol powder vs three doses of nebulised Albuterol every twenty minutes in acute asthma in children: a suitable cost effective approach for developing nations. Allergol Immunopathol (Madr) 2008. [DOI: 10.1016/s0301-0546(08)72549-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rodriguez E, Vera V, Perez-Puigbo A, Capriles-Hulett A, Ferro S, Manrique J, Abate J. Equivalence of a single saline nebulised dose of formoterol powder vs three doses of nebulised Albuterol every twenty minutes in acute asthma in children: a suitable cost effective approach for developing nations. Allergol Immunopathol (Madr) 2008; 36:196-200. [PMID: 18928685 DOI: 10.1157/13127042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND An increase in asthma prevalence is reported from developed as well as developing nations, with rising costs from acute asthma and great expenditures to health care systems. Venezuela's Ministry of Health ambulatory facilities care for 80 % or more of a mostly urban and impoverished population of 26 million inhabitants, registering close to a million acute asthma visits per year; a nebulised fixed fenoterol-ipratropium bromide combination (Bero-dual, Boehringer-Ingelheim) in repeated dosing is the standard treatment. OBJECTIVES to simplify acute asthma care and management in a cost effective manner employing Formoterol Fumarate powder, a long acting beta agonist with immediate bronchodilator effects. METHODOLOGY Fifty acute asthmatic children (5-12 years old) were randomly assigned (25 patients in each group) to receive either a nebulised single dose (US $1.35) of two 12 microg Formoterol Fumarate capsules (Foradil 12 microg/cap, Novartis Pharma AG, Basel, Switzerland) diluted in 2.5 ml of sterile saline solution; or 3 doses of Albuterol (US $ 6.73) every twenty minutes for one hour (Glaxo Smith Kline Albuterol ampoules, 2.5 mg/2.5 ml, at a dose of 0.15 mg/kg/dose, maximum dose 2.5 mg). Symptoms score, oxygen saturation and lung function testing were recorded before and one hour after commencing treatments. RESULTS Both groups improved significantly on all parameters, except for FEV(1) in the Albuterol group. CONCLUSIONS Single dose nebulised Formoterol Fumarate (dry powder) in sterile saline solution, as depicted in this trial, is equivalent to three doses of Albuterol every twenty minutes for one hour in acute asthma in children, simplifying acute care management and at one fifth of medication costs. A pursuit of simpler and more cost effective approaches is found wanting in developing nations with depressed economies and unique cultural and socio-medical contexts; also, in countries where pharmaco-economics orients quality of health policies, novel approaches like this are worth exploring.
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Affiliation(s)
- E Rodriguez
- Hospital Pediátrico "Elías Toro". Caracas. Venezuela
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Manrique J, Errasti P, Orbe J, Páramo JA, Rodríguez JA. Folic acid and B vitamins improve hyperhomocysteinemia-induced cardiovascular risk profile in renal transplant recipients. J Thromb Haemost 2007; 5:1072-6. [PMID: 17461937 DOI: 10.1111/j.1538-7836.2007.02506.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Manrique J, Diáz A, Gavira JJ, Hernández A, Pujante D, Errasti P. Preliminary Results of the Effect of Treatment of Hyperhomocysteinemia and Its Relationship With Inflammation, Coagulation Status, and Endothelial Function After Renal Transplantation. Transplant Proc 2005; 37:3782-4. [PMID: 16386537 DOI: 10.1016/j.transproceed.2005.08.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to assess the relationship between total plasma homocysteine (tHC) and several markers of endothelial function, coagulation, and pro-inflammatory status in renal transplant recipients. Our own previous study demonstrated the efficacy of folic acid (FA) and vitamin B(12) (B(12)) treatment to reduce tHC. Using 70 stable recipients, 56 of whom showed hyperhomocisteinemia (HHC) (tHC > or = 14 micromol/L) and a control group (n = 14, tHC < 14 micromol/L), we treated 29 patients in the HHC group (10 mg FA and 500 mg B(12) daily) and determined their endothelial function, inflammatory activity, and coagulation status. We assessed plasma levels of von Willebrand Factor and fibrinogen as the prothrombotic profile and C-reactive protein and plasma albumin as inflammation markers. We performed Doppler sonography of the brachial artery to assess endothelial function. The mean value of plasma tHC of 19.05 +/- 3.70 micromol/L before treatment decreased to 13.45 +/- 3.25 micromol/L after 3 months of treatment (P < .001). The vWF was significantly correlated with tHC (P < .05) and was higher in the HHC patients (P < .05). The fibrinogen mean level was also significantly higher in HHC patients (P < .05). The C-reactive protein level was significantly higher and the albumin level was lower among patients with HHC. The endothelium-dependent dilation (EDD) correlated with baseline tHC (P < .05). In preliminary data we observed that homocysteine-lowering therapy may provide cardiovascular protection by enhancing endothelial function, limiting oxidative stress, and reducing procoagulation status.
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Affiliation(s)
- J Manrique
- Renal and Cardiology Unit, Clinica Universitaria de Navarra, Pamplona, Spain
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40
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Calvo EJ, Danilowicz C, Lagier CM, Manrique J, Otero M. Characterization of self-assembled redox polymer and antibody molecules on thiolated gold electrodes. Biosens Bioelectron 2004; 19:1219-28. [PMID: 15046753 DOI: 10.1016/j.bios.2003.11.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2003] [Revised: 11/14/2003] [Accepted: 11/14/2003] [Indexed: 11/29/2022]
Abstract
Multilayer immobilization of antibody and redox polymer molecules on a gold electrode was achieved, as a strategy for the potential development of an amperometric immunosensor. The step-by-step assembly of antibiotin IgG on Os(bpy)(2)ClPyCH(2)NH poly(allylamine) redox polymer (PAH-Os) adsorbed on thiolated gold electrodes was proved by quartz crystal microbalance (QCM) and atomic force microscopy (AFM) experiments, confirming the electrochemical evidence. The increase of redox charge during the layer-by-layer deposition demonstrated that charge propagation within the layers is feasible. The multilayer structure proved to be effective for the molecular recognition of horseradish peroxidase-biotin conjugate (HRP-biotin), as confirmed by the QCM measurements and the electrocatalytic reduction current obtained upon H(2)O(2) addition. The catalytic current resulting from PAH-Os mediation was shown to increase with the number of assembled layers. Furthermore, the inventory of IgG molecules on the supramolecular self-assembled structure and the specific and non-specific binding of HRP-biotin conjugate were confirmed by the QCM transient studies, giving information on the kinetics of IgG deposition and HRP-biotin conjugate binding to the IgG.
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Affiliation(s)
- E J Calvo
- INQUIMAE, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Pabellón 2, Ciudad Universitaria AR-1428, Buenos Aires, Argentina.
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Manrique J, Rossich E, Hernández Sierra A. [Multiple complications after renal transplantation]. Nefrologia 2004; 24 Suppl 3:26-9. [PMID: 15219064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
This is the case of a 32-year-old male patient, diagnosed with end stage renal disease secondary to a focal and segmental glomerulonephritis. After four years of haemodialysis, he received a renal graft from a cadaveric donor. During the following sixteen years, he developped many different complications. In the early post-transplant period, he developed a severe acute tubular necrosis and two episodes of acute rejection took place, both of them with later recovery. Among the outstanding infectious complications were a virus herpes zoster dorsal infection and a Pseudomonas aeruginosa nosocomial pneumonia. Twelve months later, a series of severe digestive complications took place: cholecystitis that required cholecystectomy, pancreatic pseudocyst which required laparotomy because of an abdominal complication, two separate episodes of upper digestive bleeding that finally required gastric surgery, and an hemorrhagic subphrenic abscess that required a second laparotomy. Currently he has developed a calcified chronic pancreatitis. Moreover, metabolic complications must be mentioned carbohydrate intolerance, cataracts and an avascular bone necrosis, all of them closely related to the immunosuppressive therapy. In spite of these multiple complications, he mantains a good renal function and his quality of life is acceptable.
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Affiliation(s)
- J Manrique
- Servicio de Nefrología, Clínica Universitaria de Navarra, Pamplona.
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Errasti P, Manrique J, Lavilla J, Rossich E, Hernandez A, Pujante D, Ndarabu A, García N, Purroy A. Autosomal-dominant polycystic kidney disease: high prevalence of graft loss for death-related malignancies and cardiovascular risk factors. Transplant Proc 2003; 35:1717-9. [PMID: 12962769 DOI: 10.1016/s0041-1345(03)00619-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Autosomal-dominant polycystic kidney disease (ADPKD) is a systemic disease with multiple extrarenal manifestations. It accounts for 7% to 11% of patients receiving dialysis or renal transplantation (RT) for end-stage renal disease (ESRD) in Europe. We analyzed retrospectively the causes of death, the prevalence of cardiovascular risk factors (CVRF) and the patient and graft survivals in 62 consecutive ADPKD patients who received 63 cadaveric grafts (29 men and 34 women), of the 600 RTs performed between 1980-2001. The diagnosis of ADPKD was established by family history and ultrasound techniques. At present, 50 patients (79.4%) have functioning grafts, with a mean follow-up of 84.7 months (range, 12-255), and 13 patients have lost their grafts. The main cause of failure was patient death with a functioning graft (9 cases). Malignancies occurred in 5 patients, including 2 lymphomas, 1 renal carcinoma, 1 pancreas sarcoma, and 1 lung cancer associated with infection. Three patients died of cardiocerebrovascular events, and 1 patient of pneumonia. One patient lost the graft after decreasing the immunosuppression for an obstructing colon cancer. Three additional patients now on dialysis lost their grafts due to chronic rejection in 2 cases and primary nonfunction in 1 case. The prevalence of cardiovascular risk factors among the 50 patients with functional grafts were: hypertension, 70%; hypercholesterolemia, 62%; hyperhomocysteinemia, 30%; hyperfibrinogenemia, 68%; increased lipoprotein (a), 18%; microalbuminuria, 22%; hyperuricemia, 48%; hyperparathyroidism, 24%; overweight status, 24%; and nonlethal myocardial infarction, 10%. We conclude that ADPKD patients have good graft and patient survivals, and that the presence of malignancy is the main cause of death and graft failure at our center.
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Affiliation(s)
- P Errasti
- Renal Unit, University Clinic, University of Navarra, Pamplona, Navarra, Spain.
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Manrique J, Errasti P, Lavilla J, Rossich E, Hernandez A, Pujante D, Garcia-Fernández N, Purroy A. Treatment of hyperhomocysteinemia after renal transplantation. Transplant Proc 2003; 35:1742-4. [PMID: 12962778 DOI: 10.1016/s0041-1345(03)00628-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Several epidemiologic prospective studies have provided strong evidence that hyperhomocysteinemia (HHC) is a risk factor for cardiovascular disease (CVD) due to its role in producing endothelial damage due to oxidation stress. Several studies show that combined folic acid (FA) and vitamin B12 (B12) treatment decreases fasting total homocysteine (HC) levels in renal transplant recipients (RTR). The aim of the study was to determine the efficacy and safety during one year of combined FA and B12 treatment in 89 RTR, as well as the relationship between HHC with other known risk factors for CVD and the intrinsic characteristics of the transplantation. METHODS Among 193 RTR in whom we determined the baseline levels of HC, FA, B12, creatinine, and CV risk factors, 81 had normal (HC < 14 micromol/L) and 112 elevated (HC > or = 14 micromol/L) HC levels, 89 of whom were included in a treatment group (23 nontreated). Analytic measures were performed at baseline and 1, 3, and 12 months. RESULTS We observed a decrease in HC levels among the treatment group (P<.05) after 12 months without differences in the other groups. There were no differences in age, hypertension, hypercholesterolemia, smoking, presence of diabetes, or type of immunosuppression between the groups. There was a significant correlation between basal creatinine and HC level (P<.05). A higher prevalence of CVD was observed in the HHC group (P<.05). CONCLUSION HHC is associated with worse renal function and a higher prevalence of CVD. FA and B12 treatment normalize HC levels, representing a safe treatment that could improve the long-term vascular prognosis of RTR.
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Affiliation(s)
- J Manrique
- Renal Unit, Clinica Universitaria de Navarra, Pamplona, Spain
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Garcia I, Errasti P, Lavilla FJ, Ballester B, Manrique J, Rossich E, Purroy A. Effects of cerivastatin in dyslipemia and other cardiovascular risk factors after renal transplantation. Transplant Proc 2002; 34:401-2. [PMID: 11959344 DOI: 10.1016/s0041-1345(01)02817-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- I Garcia
- Renal Unit, University Clinic, University of Navarra, Pamplona, Spain
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Errasti P, García I, Lavilla J, Ballester B, Manrique J, Purroy A. Reduction in blood cyclosporine concentration by orlistat in two renal transplant patients. Transplant Proc 2002; 34:137-9. [PMID: 11959223 DOI: 10.1016/s0041-1345(01)02829-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- P Errasti
- Renal Unit, University Clinic, University of Navarra, Pamplona, Spain.
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González L, Vañó E, Oliete S, Manrique J, Hernáez JM, Lahuerta J, Ruiz J. Report of an image quality and dose audit according to directive 97/43/Euratom at Spanish private radiodiagnostics facilities. Br J Radiol 1999; 72:186-92. [PMID: 10365071 DOI: 10.1259/bjr.72.854.10365071] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An audit of Spanish private medicine radiodiagnostics facilities has been carried out, based partly on Spanish legislation relating to European Directives on health protection against ionizing radiation risks in medical exposure. The study included an appraisal of infrastructure and equipment, and aspects of quality assurance and radiation protection, by means of data collected through surveys. Of the 51 centres audited, a sample of 24 X-ray rooms was chosen, then an external evaluation with regard to image quality and patient dose was performed, by an advisory board of radiologists and medical physicists. The methodology used was similar to that of the group of European Union experts in European dose evaluation and image quality trials. Chest, abdomen, lumbar spine and breast examinations were monitored. Doses were measured with thermoluminescent dosimeters. A third of the X-ray rooms evaluated reached or exceeded dose reference values, and in a third of the cases the image quality left considerable room for improvement. Breast and chest examinations showed themselves to be the hardest to perform, not only as a result of exceeding the reference doses, but also due to failure to meet good image quality standards.
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Affiliation(s)
- L González
- Radiology Department, Complutense University, Madrid, Spain
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Berríos J, Sedano O, Calle E, Montero F, Manrique J, Hinostroza E. [Upper digestive hemorrhage in the inhabitants of high altitudes in Peru]. Rev Gastroenterol Peru 1996; 16:13-8. [PMID: 8664481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
One hundred cases of upper gastrointestinal hemorrhage in peruvian highlanders were studied at a hospital in La Oroya (3850 meters above the sea level). On admission in all of them an esophagogastroduodenal fiberscope was performed to establish the diagnosis. Most of them were males (98%), between 30-39 years of age (38%) and presented at the same time hematemesis and melena (64%). After bleeding in 72% the hemoglobin was over 14 g%. As a whole the most frequent diagnosis were: gastric ulcer (33%). duodenal ulcer (23%) and erosive gastritis (23%). In those living between 3000-3500 m.a.s.l. duodenal ulcer had the highest incidence. At 3500 m.a.s.l. was gastric ulcer more frequent, followed by erosive gastritis. In 11% surgery was required and only in 27% it was necessary a blood transfusion. After bleeding 10% had an hemoglobin level over 20 g% and because of this they were considered as having Chronic Mountain Sickness, 4 of them with severe cardiorespiratory and consciousness disturbances required after the gastrointestinal hemorrhage, an immediate bleeding in order to compensate the patient, a completely unusual occurrence in general pathology but a peculiar treatment in these patients living at high altitudes of the peruvian Andes.
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Affiliation(s)
- J Berríos
- Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Perú
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Manrique J, Maseda J, Juffe A, Avello F. [Rare respiratory obstruction during pneumonectomy]. Rev Esp Anestesiol Reanim 1987; 34:67-8. [PMID: 3563006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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49
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Criado A, Manrique J, Carmona J, Maseda J, Reig E. [Analgesia with epidural morphine and intramuscular meperidine in the postoperative period of thoracic surgery]. Rev Esp Anestesiol Reanim 1986; 33:242-6. [PMID: 3764021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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50
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Manrique J, Carmona J, Escarpa A, Vaquero M. [Total spinal anesthesia: a rare complication of retrobulbar block]. Rev Esp Anestesiol Reanim 1986; 33:199. [PMID: 3738097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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