Biomarkers for the prognosis of pulmonary arterial hypertension: Holy Grail or flying circus?

Despite recent and major progresses in the field of pulmonary vascular diseases pulmonary arterial hypertension (PAH) outcome still needs improvement. In parallel, several changes are observed in a disease that is no longer described as typically affecting young women. This is outlined in the most recent reports from PAH registries, where increasing age at the time of diagnosis is constantly described.

Updated clinical classification of pulmonary hypertension.

In 1998, a clinical classification of pulmonary hypertension (PH) was established, categorizing PH into groups which share similar pathological and hemodynamic characteristics and therapeutic approaches. During the 5th World Symposium held in Nice, France, in 2013, the consensus was reached to maintain the general scheme of previous clinical classifications. However, modifications and updates especially for Group 1 patients (pulmonary arterial hypertension [PAH]) were proposed.

Pulmonary hypertension due to left heart diseases.

Pulmonary hypertension (PH), a common complication of left heart diseases (LHD), negatively impacts symptoms, exercise capacity, and outcome. Although the true prevalence of PH-LHD is unknown, a subset of patients might present significant PH that cannot be explained by a passive increase in left-sided filling pressures. The term "out-of-proportion" PH has been used to identify that population without a clear definition, which has been found less than ideal and created confusion.

The need to move from 6-minute walk distance to outcome trials in pulmonary arterial hypertension.

Assessment of change in exercise capacity using the 6-min walk distance (6MWD) test has been the primary end-point in the majority of pulmonary arterial hypertension (PAH) clinical trials. The 6MWD has some advantages as an end-point in such studies. It is simple and inexpensive to perform, reproducible and validated.

Acute bilateral posterior dislocation of the shoulder: one-stage reconstruction of both humeral heads with cancellous autograft and cartilage preservation.

We present a case of bilateral posterior shoulder dislocation after an epileptic seizure. The anterior humeral-head impression fracture was 60% of the articular surface on the right shoulder and 30% on the left shoulder. We performed an early one-stage reconstruction of both humeral heads.

Intraoperative ultrasonography during percutaneous Achilles tendon repair.

Background: The purpose of the study was to determine whether real-time intraoperative ultrasonography improved implant positioning and stump approximation in patients with acute Achilles tendon rupture managed percutaneously.

Materials And Methods: The needles were introduced percutaneously without ultrasonography and their position was checked relative to cutaneous landmarks and by palpation. Then, intraoperative ultrasonography was performed to assess needle position at the proximal tendon segment, tendon tear, and distal tendon segment.

Preoperative imaging study of the spinal cord vascularization: interest and limits in spine resection for primary tumors.

The necessicity to localize the anterior spinal arteries before anterior approach of the spine stays controversial by orthopaedic surgeons. On the other hand the surgical treatment of thoracoabdominal aneurisms routinely sacrifices many segmental arteries pairs without spinal arteries localization. This, associated with spinal cord protection, results to few neurological complication.

Severe open ankle sprain (SOAS): a lesion presenting as a penetrating soft tissue injury.

The objective of this retrospective case study was to describe the incidence and clinical features of severe open ankle sprain (SOAS), defined as a tear of the lateral or medial collateral ligaments with an associated transverse tear of the skin over the corresponding malleolus. To this end, we reviewed the medical records of patients with SOAS managed between January 2005 and January 2009, using the databases of 3 different orthopedic trauma centers. Our review revealed 9 patients with SOAS, 7 (77.

Percutaneous retrograde screw fixation of non-displaced fractures of the scaphoid waist: an antirotation wire may not be necessary.

Some authors recommend using an antirotation wire when performing percutaneous screw fixation of acute non-displaced scaphoid waist fractures. The aim of this study of 21 cadaveric wrists was to assess the usefulness of such a wire in Herbert's B2-type fractures. A B2-type fracture was created experimentally on each scaphoid.

Comparison of percutaneous dorsal versus volar fixation of scaphoid waist fractures using a computer model in cadavers.

Purpose: Percutaneous screw fixation (PSF) is widely used to treat acute nondisplaced scaphoid waist fractures. PSF can be performed through a volar or dorsal approach. The aim of our study was to compare a dorsal versus volar surgical approach for PSF according to the sagittal orientation of the waist fracture (B1 or B2 in Herbert and Fisher's classification scheme, in which B1 and B2 designate, respectively, oblique and transverse nondisplaced scaphoid waist fractures) on computer modeling of cadaver wrists.

Cadaveric assessment of a new guidewire insertion device for volar percutaneous fixation of nondisplaced scaphoid fracture.

Purpose: Volar percutaneous screw fixation (PSF) of acute nondisplaced scaphoid waist fractures allows early mobilisation of the wrist and a faster return to work than prolonged cast immobilisation. Usually, placement of the wire which guides the definitive canulated screw is performed by hand. Nevertheless, correct placement of this wire is technically difficult.

Original portals for arthroscopic decompression of the suprascapular nerve: an anatomic study.

Operative treatment of suprascapular nerve entrapment consists of decompression of the nerve, either at the suprascapular notch or the spinoglenoid notch. The aim of this study was to describe new arthroscopic portals to approach these 2 notches at the same time. Twenty shoulders in 10 fresh frozen cadavers were investigated.

[New trends in progressive multifocal leukoencephalopathy].

Infection by Polyomavirus JC is a model of chronic active viral infection, closely controlled by the immune system. Progressive multifocal leucoencephalopathy (PML) is a deadly demyelinating disease of the central nervous system, consecutive to the lytic infection of oligodendrocytes by JC virus. Reactivation of JC virus occurs only in the setting of severe cellular immune deficiency.

Quantitation of ligament laxity in anterior shoulder instability: an experimental cadaver model.

Three groups of cadaver specimens were studied. In group 1 (20 shoulders) glenohumeral ligaments were detached from the humerus until a permanent dislocation of the humeral head occurred in abduction plus external rotation. On the dislocated joint the ligament was reconstructed using a fascia lata lengthening plasty.

The effect of static in vivo bending on the murine intervertebral disc.

Background Context: Intervertebral disc cell function in vitro has been linked to features of the local environment that can be related to deformation of the extracellular matrix. Epidemiologic data suggest that certain regimens of spinal loading accelerate disc degeneration in vivo. Yet, the direct association between disc cell function, spinal loading and ultimately tissue degeneration is poorly characterized.

[Contribution of systematic culture of drainage fluids in Altemeier class 1 and 2 procedures].

Purpose Of The Study: We conducted a prospective study to determine the therapeutic impact of systematic culture of suction drainage collections in Altemeier class I and II procedures.

Materials And Methods: We examined the following questions: how many microbiologically positive samples and infections of the operative site were present in the included patients? for positive cases, what was the antibiotic prescription (excluding antibiotic prophylaxy protocols planned before surgery for cleaning)? if the sample was positive in a patient with no clinical infection, what antibiotics were prescribed?

Results: A total of 1039 samples were collected in 470 patients undergoing Altemeier class I and II procedures. One hundred five cultures were positive in 34 patients who had undergone major surgery.

[Revision arthroplasty of the shoulder for painful glenoid loosening: a series of 14 cases with acromial prostheses reviewed at four year follow up].

Purpose Of The Study: We present the results of a continuous series of 14 patients who underwent revision arthroplasty of the shoulder for painful major loosening of the glenoid component.

Material And Methods: Mean follow-up was four years after revision. Loosening was diagnosed seven and a half years after the primary arthroplasty.

Progressive multifocal leukoencephalopathy in human immunodeficiency virus type 1-infected patients: absence of correlation between JC virus neurovirulence and polymorphisms in the transcriptional control region and the major capsid protein loci.

Progressive multifocal leukoencephalopathy (PML) is a rapidly fatal demyelinating disease of the central nervous system related to JC polyomavirus (JCV) replication in oligodendrocytes. PML usually occurs in immunocompromised individuals, especially in the setting of AIDS. Administration of highly active anti-retroviral therapy (HAART) may improve survival prognosis in some, but not all, patients with AIDS-related PML.

Prolonged survival without neurological improvement in patients with AIDS-related progressive multifocal leukoencephalopathy on potent combined antiretroviral therapy.

To evaluate the benefit of combined antiretroviral therapy including protease inhibitors (CART) on survival time and neurological progression in patients with AIDS-related progressive multifocal leukoencephalopathy (PML), 81 consecutive PML cases, collected between January 1990 and June 1998, were reviewed. Fifteen patients were neuropathologically proven. JC virus detection in CSF was positive in 59 patients.

Ureteroureteral anastomosis in the treatment of reflux associated with ureteral duplication.

Purpose: Reflux is the most common pathological condition associated with ureteral duplication. Based on 18 cases of reflux associated with ureteral duplication that were managed by ipsilateral ureteroureteral anastomosis, we analyzed this method of treatment and its advantages.

Materials And Methods: Between 1978 and 1991, 19 ipsilateral ureteroureterostomies were performed in 18 children.

Tendon of the normal supraspinatus muscle: correlations between MR imaging and histology.

The aim of this study was to attempt to specify the nature of the signal modifications observed in MRI in the supraspinatus tendon apart from any pathology of the shoulder, and due, according to certain authors, to an artefact associated with MRI. Five macroscopically normal supraspinatus tendons were removed from 4 young subjects (14-28 years), 30 min after cardiac arrest, with the authorization of the ethical committee. These tendons were examined by MRI in the frontal oblique plane along the axis of the muscle with a surface coil of 4 cm diameter, using a T2-weighted spin-echo sequence, and then studied histologically using the same plane of section.