Pappas M. Efthymios, Mpournaka Spiridoula, Katopodis Periklis, Chardalias Andreas, Tsakas Sotiris, Eleftheriadis Theodoros, Papachristou Evangelos, Katopodis P. Konstantinos and Goumenos S. Dimitrios
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Viktor Kamnar, Anastasika Poposka, Nenad Atanasov and Milena Bogojevska
Background: The aim of this study is to affirm the importance of operative treatment of severe dysplastic coxarthrosis through analysis of the results of implantation of total cementless endo-prothesis in patients with DDH Crowe types III and IV.
Patients and methods: This retrospective study involved 28 patients (30 hips) with dysplastic coxart-hrosis, in whom an implantation of cementless total hip endoprothesis was performed at the University Clinic for Orthopaedic Surgery in Skopje. In 26 of the patients the involvement was unilateral and in two patients it was bilateral. The inclusion criterion was radiographically proved severe hip dysplasia Crowe types III and IV. Twenty-one of the patients were female and 7 male, and age distribution was in an interval from 30 to 65 years. The ingrowth of the implant was evaluated using the clinical method, native radiographs and radioisotopic examination with Tc99m. The follow-up period lasted 5 years, and the results were evaluated using the Harris hip score system.
Results: 19 of the patients presented an excellent result of the operative treatment, there were 8 good results with persistent local pain 6 months postoperatively, in one case a surgical revision and reimplantation of the acetabular cup was performed, while one patient underwent a surgical revision and reimplantation of the femoral stem and in another patient there was nonunion at the place of the subtrochanteric osteotomy. Full weight-bearing without the use of crutches was achieved 3 months postoperatively, and no serious early postoperative complications were registered in our patients.
Discussion and conclusions: In the majority of cases in whom a total hip replacement with cemen-tless endoprothesis is performed because of dysplastic coxarthrosis, a sufficient primary fixation both of the acetabular and the femoral component is achieved, unless one-third of the acetabular cup is left uncovered with bone stock. The problems of decreased muscle strength and limping are usually solved by means of physical therapy in a time period of 45 months.
Irina Panovska-Stavridis, Martin Ivanovski, Sanja Trajkova, Aleksandra Pivkova-Veljanovska, Marija Popova-Labaceska, Nadica Matevska-Geshovska, Predrag Noveski, Dijana Plaseska-Karanfilska, Lidija Cevreska and Aleksandar J. Dimovski
Myelodysplastic syndrome (MDS) is a diverse group of clonal hematologic neoplasms. The only curative treatment for MDS is allogeneic stem cell transplantation (SCT). Epigenetic changes play an important role in the pathogenesis of MDS and treatment with DNA methyl transferase inhibitors, Azacitidine, significantly prolong the survival of high-risk MDS patients. Here we report a case of a 58-year-old male presented with pancytopenia, macrocytosis, and hyperplastic bone marrow with 3-lineage dysplasia with ~14% of myeloid blasts. Cytogenetic studies with G banding showed normal karyotype. Multiplex ligation-dependent probe amplification (MLPA) screening for most predictive cytogenetic abnormalities of MDS showed loss of the Y chromosome. Those findings later were confirmed with Quantitative Fluorescent (QF)-PCR and specific MLPA for Y chromosome, showing loss of the Y chromosome in >80% of cells. He was diagnosed with MDS-RAEB2 according to 2008 WHO classification and stratified into high risk group (IPSS score 5). Unrelated allogeneic SCT was planed and bridging treatment with Azacitidine at a dose of 75mg/m2/daily subcutaneously for 7 days every 28 days was initiated. Hematologic improvements, according to the International Working Group 2006 criteria, were observed after 4 cycles of Azacitidine treatment. After 6 cycles, complete hematological remission was achieved. Interestingly, molecular analysis performed after the 8th cycle showed normal presence of Y chromosome indicating a cytogenetic remission, molecularly confirmed. Maintenance treatment with Azacitidine was assigned, and the scheduled SCT was postponed. Experience from our case showed that the loss of the Y chromosome was related to the disease onset, and indicated that Azacitidine might be consider as effective treatment for MDS cases associated with good cytogenetic
Vaso Antunović, Aleksandar Mirčić, Slobodan Marinković, Luciano Brigante, Miloš Mališ, Biljana Georgievski and Miljana Aksić
There is scarce data in the contemporary literature regarding the correlation of the microanatomy of the perforating arteries, their atherosclerosis, and the ischemia in their territory. In order to examine, at least partially, those parameters, the perforating arteries of 12 brains were microdissected or their vascular casts were obtained. In addition, 30 specimens of the perforators were used for a histological and immunohistochemical study. Finally, radiological images of 14 patients with deep cerebral infarcts were examined following a selection among 62 subjects. It was found out that certain groups of the perforators ranged in number between 0 to 11 (1.1-8.4 on average). In addition to the origin from the parent vessels, some of the perforators also arose from the leptomeningeal branches. Occlusion of such a branch may result in both a superficial and a deep ischemic lesion. Besides, the common stems of certain perforators supplied both right and left portions of the corresponding brain regions. Occlusion of such a common trunk leads to bilateral infarction. The atherosclerosis of the perforating vessels, which was found in one third of the specimens, is the basis for the ischemic lesions development on their territory. Among the 62 patients with ischemic lesions, 14 had a deep cerebral infarcts, most often within the thalamus, as well as on the territory of the middle cerebral and the anterior choroidal artery perforators of the hemispheres. Our study showed that a strong correlation exists between certain microanatomical features, atherosclerosis, and region of supply of the perforating arteries, on the one hand, and location of the ischemic lesions on the other hand.
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Vasso Apostolopoulos, Juliana Antonipillai, Kathy Tangalakis, John F Ashton and Lily Stojanovska
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