Orhideja Stomnaroska-Damcevski, Elizabeta Petkovska, Snezana Jancevska and Dragan Danilovski
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Marijan Bosevski, Irena Mitevska, Marica Pavkovic, Milka Klincheva, Emilija Trajkovska Lazarova, Emilija Velkova, Zlate Stojanoski, Nela Kostova, Savetka Paljoskovska Jordanova, Danica Petkoska, Mimi Mancheva, Aleksandra Gulevska, Marjan Baloski, Vasko Hadjiev, Gorjan Krstevski, Viktorija Kralevska, Ivica Bojovski, Mario Jovanovski, Vesna Nedelkovska and Atanas Gjorgievski
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Porous metal augments have been used successfully for management of large acetabular defects during revision hip arthroplasty. This study analyzes and compares the clinical and radiographic outcomes of porous metal augments in cemented and uncemented acetabular revisions, all performed at the same institution. In the period 2015-2017, 36 patients with 37 large acetabular defects were treated with porous metal augments in cemented and uncemented acetabular revisions. Postoperatively, patients were monitored for two years on average period of 24-36 months.
Acetabular augments were used when preoperative and intraoperative findings indicated the presence of large acetabular defects that can hinder the stability of the revision implants. We used lateral approach, 36 mm femoral head, and cementless or cemented acetabular cup depending on local bone quality. Postoperatively, all patients followed total hip arthroplasty precautions, with weight bearing as tolerated regimen with use of crutches during 6 weeks after surgery. The follow-up was radiological and clinical. We used HHS. At a mean follow-up of two years (range 24-36 months) one patient had reinfection and one patient had infection. None of the patients shown signs of aseptic augment or acetabular cup loosening. Porous metal augments show comparable excellent radiographic and clinical short-term outcomes, when combined with cemented or uncemented cups in revision hip arthroplasty. They allow good bone ingrowth, adequate implant contact and good stability. Complications were related to infection and not related to the augments itself.
Sasko Kedev, Biljana Zafirovska, Elizabeta Srbinovska-Kostovska, Slobodan Antov, Aleksandar Nikolic, Omer Dzemali and Matjaz Bunc
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Krsto Grozdanovski, Zvonko Milenkovikj, Ilir Demiri, Katerina Spasovska, Marija Cvetanovska, Goran Rangelov, Velimir Saveski and Biljana Grozdanovska
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Irena Peovska Mitevska, Jelka Davceva Pavlovska, Elizabeta Srbinovska, Marijan Bosevski, Maja Zdravkovska, Daniela Pop Gorceva and Marina Zdravevska
Background: We wanted to evaluate the presense of myocardial ischaemia in asymptomatic patients with high cardiovascular risk, the influencing clinical and laboratory factors and the impact of ischaemia on final management decision.
Material and methods: We evaluated 60 asymptomatic patients with high CV risk, who underwent SPECT myo-cardial perfusion imaging (MPI) for detection of suspected CAD. We used the 17 segment model for quantitative and semiquantitative scan perfusion and function analysis using perfusion scores. All patients had full blood laboratory analyses including lipid values, presence of albuminuria, rest and stress ECG. Logistic regression analysis was used to assess the impact of clinical and laboratory parameters on myocardial ischaemia prevalence.
Results: Stress-inducible ischaemia was found in 19 pts (33%), fixed defects were found in 13% and mixed defects in 9% of cases. The average ischaemia amount was 10%. Mild ischaemia was found in 12 patients (64%) - summed stress score (SDS) < 4, moderate ischaemia in 5 patients (26%) - SDS 5-7 and severely abnormal scans in 2 patients (10%) - SDS > 7. Severe ischaemia was only related to the duration of diabetes. Six pts with severe ischaemia had ST depression > 2 mm on stress study, and a higher wall motion index and LVEF fall > 5% during stress study (p < 0.01). Stepwise logistic regression analysis for prediction of stress-induced ischaemia showed OR 2.4 (95% CI 1.7?3.6) for stress-induced ECG changes and OR 3.9 for presence of DM over 10y (95% CI 2.3?6.6). Seven patients with ischaemia > 10%, were referred for coronary angiography.
Conclusions: MPI is a valuable method for preclinical assessment of myocardial ischaemia in patients with high CV risk, which can improve prognosis and guide treatment decision.