scholarly journals Classification of osteonecrosis of the femoral head

2019 ◽  
Vol 8 (10) ◽  
pp. 451-458 ◽  
Author(s):  
Yutaka Kuroda ◽  
Takeyuki Tanaka ◽  
Takaki Miyagawa ◽  
Toshiyuki Kawai ◽  
Koji Goto ◽  
...  
Keyword(s):  
Femoral Head ◽  
Treatment Guidelines ◽  
Type A ◽  
Type B ◽  
Kaplan Meier ◽  
Joint Preserving Surgery ◽  
Asymptomatic Patients ◽  
Study Results ◽  
Collapse Rate

Objectives Using a simple classification method, we aimed to estimate the collapse rate due to osteonecrosis of the femoral head (ONFH) in order to develop treatment guidelines for joint-preserving surgeries. Methods We retrospectively analyzed 505 hips from 310 patients (141 men, 169 women; mean age 45.5 years (sd 14.9; 15 to 86)) diagnosed with ONFH and classified them using the Japanese Investigation Committee (JIC) classification. The JIC system includes four visualized types based on the location and size of osteonecrotic lesions on weightbearing surfaces (types A, B, C1, and C2) and the stage of ONFH. The collapse rate due to ONFH was calculated using Kaplan–Meier survival analysis, with radiological collapse/arthroplasty as endpoints. Results Bilateral cases accounted for 390 hips, while unilateral cases accounted for 115. According to the JIC types, 21 hips were type A, 34 were type B, 173 were type C1, and 277 were type C2. At initial diagnosis, 238/505 hips (47.0%) had already collapsed. Further, the cumulative survival rate was analyzed in 212 precollapsed hips, and the two-year and five-year collapse rates were found to be 0% and 0%, 7.9% and 7.9%, 23.2% and 36.6%, and 57.8% and 84.8% for types A, B, C1, and C2, respectively. Conclusion Type A ONFH needs no further treatment, but precollapse type C2 ONFH warrants immediate treatment with joint-preserving surgery. Considering the high collapse rate, our study results justify the importance of early diagnosis and intervention in asymptomatic patients with type C2 ONFH. Cite this article: Y. Kuroda, T. Tanaka, T. Miyagawa, T. Kawai, K. Goto, S. Tanaka, S. Matsuda, H. Akiyama. Classification of osteonecrosis of the femoral head: Who should have surgery?. Bone Joint Res 2019;8:451–458. DOI: 10.1302/2046-3758.810.BJR-2019-0022.R1.

scholarly journals Anterolateral Necrotic Lesion Serves as an Early Warning Sign of Developing Collapse in Osteonecrosis of the Femoral Head

2021 ◽  
Author(s):  
Qiu-Shi Wei ◽  
Min-Cong He ◽  
Xiao-Ming He ◽  
Tian-Ye Lin ◽  
Peng Yang ◽  
...  
Keyword(s):  
Femoral Head ◽  
Bone Structure ◽  
Weight Bearing ◽  
Type A ◽  
Necrotic Lesion ◽  
Initial Time ◽  
Type B ◽  
Joint Preserving Surgery ◽  
Collapse Rate

Abstract Objective: Load bearing capacity of the bone structure of anterolateral weight-bearing area plays an important role in the progressive collapse in osteonecrosis of the femoral head (ONFH). The purpose of this study is to assess the efficacy of combined evaluation of anteroposterior (AP) and frog-leg lateral (FLL) view to diagnose collapse.Methods: Between December 2016 to August 2018, a total of 478 hips from 372 patients with ONFH (268 men, 104 women; mean age 37.9±11.4 years) were retrospectively evaluated. All patients received standard AP and FLL views of hip joints. Japanese Investigation Committee (JIC) classification system was used to classified necrotic lesion in AP view. Anterior necrotic lesion was evaluated by FLL view. All patients with precollapse ONFH underwent non-operative hip preserving therapy. The collapse rate was calculated and compared with Kaplan–Meier survival analysis with radiological collapse as endpoints.Results: Forty-four (44/478, 9.2%) hips were classified as type A, 65 (65/478, 13.6%) as type B, 232 (232/478, 48.5%) as type C1, and 137 (137/478, 28.7%) as type C2. Three hundred cases (300/478, 62.5%) were collapsed at the initial time point. Two hundred and twenty six (226/300, 75.3%) hips and 298 (298/300, 99.3%) hips collapse were identified with AP view and FLL view, respectively. An average follow-up of 37.0±32.0 months was conducted to evaluate the occurence of collapse in 178 precollapse hips. During follow-up period, collapse occurred in 89 hips (50.0%). Seventy-seven (77/89, 86.5%) hips was determined with AP view alone and 85 (85/89, 95.5%) hips were determined with combination of AP and FLL views. The collapse rate at five years were reported as 0% and 0%, 16.2% and 24.3%, 58.3% and 68.1%, and 100% and 100% according to combination of AP and FLL views or AP view alone for types A, B, C1, and C2, respectively.Conclusion: The collapse can be diagnosed more accurately by combination of AP and FLL views. Besides, JIC type A and type B ONFH can be treated with conservative hip preservation, but precollapse type C2 ONFH should be treated with joint-preserving surgery. Type C1 needs further study to determine which subtype has potential risk of collapse.

scholarly journals The survival of non-traumatic osteonecrosis of femoral head at ARCO II with ring-shaped sclerotic zone: a mid-term follow-up retrospective study

2021 ◽  
Author(s):  
Zhong-Shu Wu ◽  
Guoju Hong ◽  
Peng Yang ◽  
Fan Yang ◽  
Zhen-Qiu Chen ◽  
...  
Keyword(s):  
Femoral Head ◽  
Survival Curve ◽  
Type A ◽  
Type B ◽  
Chi Square ◽  
Radiographic Images ◽  
Osteonecrosis Of Femoral Head ◽  
Kaplan Meier ◽  
Chi Square Test

Abstract The sclerotic zone in the osteonecrosis of femoral head (ONFH), containing condensed trabecular bone and abundant neovascularization, is the transition area between osteonecrosis and normal tissue. Due to the prominent feature in ONFH, the characteristics of the sclerotic zone might indicate the femoral head survival of the disease. Thirty ONFH patients (41 hips) with ring-shaped sclerotic zone at Association Research Circulation Osseous-II were recruited during 1996 to 2019, and the corresponding radiographic images in their follow-up are reviewed retrospectively. Two subtypes (type A and B) are defined to discriminate different locations of ring-shaped sclerotic zone in the femoral head (center or subchondral bone plate) in accordance with the radiographic images. The natural history of the enrolled subjects was followed up for average 9 years to record and compare their collapse incidences as well as the progress of hip symptoms. Chi-square test shows that the occurrence rates of symptomatic hip of type A are significantly lower than that of type B and differences between these two groups were significant (P < 0.05). Kaplan Meier survival curve analysis shows that the mean survival time of type A is 247.600 M (95% CI: 203.072 ∼ 292.128 M) and type B is 88.795 M (95% CI: 72.607 ∼ 104.984 M). The survival rate of femoral head of type A is significantly higher than that of type B (P < 0.005). This study demonstrates that type A shows a more satisfactory clinical outcomes and lower femoral head collapse rate in a mid-term follow-up.

scholarly journals Femoral head collapse rate among Japanese patients with pre-collapse osteonecrosis of the femoral head

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110233
Author(s):  
Ryuta Asada ◽  
Hiroyasu Abe ◽  
Hidetoshi Hamada ◽  
Yusuke Fujimoto ◽  
Hyonmin Choe ◽  
...  
Keyword(s):  
Femoral Head ◽  
Weight Bearing ◽  
Type A ◽  
Japanese Patients ◽  
Femoral Head Collapse ◽  
Kaplan Meier ◽  
Direct Association ◽  
Type C ◽  
The Relationship ◽  
Collapse Rate

Objective In this study, we aimed to elucidate the relationship between the duration from diagnosis to femoral head collapse and the collapse rate among patients with pre-collapse osteonecrosis of the femoral head (ONFH). Methods In this retrospective, observational, multicenter study, we analyzed 268 patients diagnosed with ONFH and classified them using the Japanese Investigation Committee classification. The primary endpoint was duration from the time of diagnosis to femoral head collapse for each type of ONFH. Results The 12-, 24-, and 36-month collapse rates among participants were 0%, 0%, and 0% for type A, respectively; 0%, 2.0%, and 10.8% for type B, respectively; 25.5%, 40.8%, and 48.5% for type C-1, respectively; and 57.4%, 70.3%, and 76.7% for type C-2 ONFH, respectively. A comparison of unilateral and bilateral ONFH, using Kaplan–Meier survival curves demonstrated similar collapse rates. Conclusions The lowest collapse rate was observed for ONFH type A, followed by types B, C-1, and C-2. Additionally, a direct association was observed between the collapse rate and location of the osteonecrotic lesion on the weight-bearing surface.

A New Classification of Cochleovestibular Malformations and Implications for Predicting Speech Perception Ability after Cochlear Implantation

2015 ◽  
Vol 20 (2) ◽  
pp. 90-101 ◽  
Author(s):  
Sung-Wook Jeong ◽  
Lee-Suk Kim
Keyword(s):  
Speech Perception ◽  
Cochlear Implantation ◽  
Test Scores ◽  
Type A ◽  
Cochlear Nerve ◽  
Type B ◽  
New Classification ◽  
Type D ◽  
Type C

Objectives: The aims of this study were to introduce a new classification of cochleovestibular malformation (CVM) and to investigate how well this classification can predict speech perception ability after cochlear implantation in children with CVM. Methods: Fifty-nine children with CVM who had used a cochlear implant for more than 3 years were included. CVM was classified into 4 subtypes based on the morphology of the cochlea and the modiolus on temporal bone computed tomography (TBCT): normal cochlea and normal modiolus (type A, n = 16), malformed cochlea and partial modiolus (type B, n = 31), malformed cochlea and no modiolus (type C, n = 6), and no cochlea and no modiolus (type D, n = 6). Speech perception test scores were compared between the subtypes of CVM using analysis of covariance with post hoc Bonferroni test. Univariate and multivariate regression analyses were used to identify the significant predictors of the speech perception test scores. Results: The speech perception test scores after implantation were significantly better in children with CVM type A or type B than in children with CVM type C or type D. The test scores did not differ significantly between the implanted children with CVM type A or type B and those without CVM. In univariate regression analysis, the type of CVM was a significant predictor of the speech perception test scores in implanted children with CVM. Multivariate regression analysis revealed that the age at cochlear implantation, cochlear nerve size and preimplantation speech perception test scores were significant predictors of the postimplantation speech perception test scores. The chance of cochlear nerve deficiency increased progressively from CVM type A to type D. Conclusion: The new classification of CVM based on the morphology of the cochlea and the modiolus is simple and easy to use, and correlated well with postimplantation speech perception ability and cochlear nerve status. This simple classification of CVM using TBCT with cochlear nerve assessment by magnetic resonance imaging is helpful in the preoperative evaluation of children with CVM.

scholarly journals Cost Estimates of COVID-19 Clinical Management in Myanmar

2021 ◽  
Author(s):  
Phyu Win Thant ◽  
Khin Thu Htet ◽  
Wit Ye Win ◽  
Ye Min Htwe ◽  
Thant Sin Htoo
Keyword(s):  
Health Care ◽  
Health System ◽  
Critically Ill ◽  
Clinical Management ◽  
Treatment Guidelines ◽  
Unit Cost ◽  
Economic Evaluations ◽  
First Case ◽  
Asymptomatic Patients ◽  
Study Results

Abstract Objective: This study aims to estimate the cost of clinical management of COVID-19 infected patients based on their severity by exploring the resources used in care provision in Myanmar. Methods: A multicenter retrospective cost analysis of COVID-19 patients treated was performed using the micro-costing approach from the perspective of the health system. It covered two cost components, namely Direct and Indirect cost of treating a patient. Input data and their quantities were obtained from COVID-19 Standard Treatment Guidelines of Ministry of Health and Sports, and administrative and financial record of resource utilization of three designated health facilities in Yangon Region. Valuation of these resources was based on the price list from the Procurement Section of the Ministry. Results: The analysis estimated the unit cost of clinical management of COVID-19 infected patients with no symptom to be 953,552 MMK(717 USD), with Mild-Moderate Symptoms to be 1,155,222 MMK(869 USD) and with Severe-Critically Ill conditions to be 5,705,052 MMK(4290 USD). Average cost for a patient par day was 86,687 MMK(65 USD) for asymptomatic patients, 105,020 MMK(79 USD) for Mild-Moderate patients and 283,252 MMK(214 USD) for severe-critically ill patients. Since the first case detected till December 31, 2020, COVID-19 clinical management cost was accounted for 139 Billion MMK (104 million USD) for total 124630 confirmed cases. Conclusions: The result of this study indicates that the COVID-19 Pandemic leads Myanmar Health System to incur the significant health care expenses. Timely implementation of the sustainable, affordable and efficient policy for COVID-19 responses is of utmost important for every nation especially in this situation of Pandemic. Specifically, the study results should be of value for strategic planning, for future economic evaluations of different policy interventions, and to contribute healthcare policy recommendations by analyzing the current cost of health care system and preparing for the potential state of COVID-19 infection.

Drug Allergies

2018 ◽  
Author(s):  
James L Baldwin ◽  
Aimee L. Speck
Keyword(s):  
Adverse Drug Reactions ◽  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Type A ◽  
World Health ◽  
Hypersensitivity Reactions ◽  
Type B ◽  
Drug Reactions ◽  
Drug Hypersensitivity Reactions

Adverse drug reactions (ADRs) are an important public health problem. An ADR is defined by the World Health Organization as an unintended, noxious response to a drug that occurs at a dose usually tolerated by normal subjects. The classification of ADRs by Rawlins and Thompson divides ADRs into two major subtypes: (1) type A reactions, which are dose dependent and predictable, and (2) type B reactions, which are uncommon and unpredictable. The majority of ADRs are type A reactions, which include four subtypes: overdosage or toxicity, side effects, secondary effects, and interactions. Type B reactions constitute approximately 10 to 15% of all ADRs and include four subtypes: drug intolerance, idiosyncratic reactions, pseudoallergic reactions, and drug hypersensitivity reactions. This chapter reviews the epidemiology of ADRs, risk factors for drug hypersensitivity reactions, the classification of drug reactions, diagnostic tests, reactions to specific drugs, and management of the patient with drug allergy. Figures illustrate drugs as haptens and prohaptens, the Gell and Coombs system, the four basic immunologic mechanisms for drug reactions, the chemical structure of different β-lactam antibiotics, penicillin skin testing, sulfonamide metabolism and haptenation, nonsteroidal antiinflammatory drug effects, and patient management. Tables outline the classification of ADRs, drugs frequently implicated in allergic drug reactions, and reagents and concentrations recommended for prick and intradermal skin testing. This review contains 8 figures, 7 tables, and 60 references. Key Words: Adverse drug reactions, drug hypersensitivity reactions, overdosage, toxicity, Type A reactions, Type B reactions, human leukocyte antigen, pruritus, angioedema, urticarial, bronchospasm, laryngeal edema, rhinoconjunctivitis

Drug Allergies

2018 ◽  
Author(s):  
James L Baldwin ◽  
Aimee L. Speck
Keyword(s):  
Adverse Drug Reactions ◽  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Type A ◽  
World Health ◽  
Hypersensitivity Reactions ◽  
Type B ◽  
Drug Reactions ◽  
Drug Hypersensitivity Reactions

Adverse drug reactions (ADRs) are an important public health problem. An ADR is defined by the World Health Organization as an unintended, noxious response to a drug that occurs at a dose usually tolerated by normal subjects. The classification of ADRs by Rawlins and Thompson divides ADRs into two major subtypes: (1) type A reactions, which are dose dependent and predictable, and (2) type B reactions, which are uncommon and unpredictable. The majority of ADRs are type A reactions, which include four subtypes: overdosage or toxicity, side effects, secondary effects, and interactions. Type B reactions constitute approximately 10 to 15% of all ADRs and include four subtypes: drug intolerance, idiosyncratic reactions, pseudoallergic reactions, and drug hypersensitivity reactions. This chapter reviews the epidemiology of ADRs, risk factors for drug hypersensitivity reactions, the classification of drug reactions, diagnostic tests, reactions to specific drugs, and management of the patient with drug allergy. Figures illustrate drugs as haptens and prohaptens, the Gell and Coombs system, the four basic immunologic mechanisms for drug reactions, the chemical structure of different β-lactam antibiotics, penicillin skin testing, sulfonamide metabolism and haptenation, nonsteroidal antiinflammatory drug effects, and patient management. Tables outline the classification of ADRs, drugs frequently implicated in allergic drug reactions, and reagents and concentrations recommended for prick and intradermal skin testing. This review contains 8 figures, 7 tables, and 60 references. Key Words: Adverse drug reactions, drug hypersensitivity reactions, overdosage, toxicity, Type A reactions, Type B reactions, human leukocyte antigen, pruritus, angioedema, urticarial, bronchospasm, laryngeal edema, rhinoconjunctivitis

scholarly journals Preliminary proposal: a classification system for reconstruction with autologous femoral head after periacetabular tumors resection

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Chunzhi Yi ◽  
Jiaqian Zheng ◽  
Ruoyu Li ◽  
Yun Lan ◽  
Mincong He ◽  
...  
Keyword(s):  
Femoral Head ◽  
Classification System ◽  
Malignant Tumors ◽  
Type A ◽  
Clinical Results ◽  
Type B ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Total Incidence ◽  
And Function

Abstract Background Although researchers have adopted various methods for the resection and reconstruction of periacetabular tumors, the total incidence rate of complications remains high. Aiming for preserving the acetabulum and reducing the risk of complications, we applied a surgery method using tumor-free autologous femoral head to reconstruct the defective acetabulum after resection of periacetabular tumors followed by performing a conventional total hip arthroplasty (THA). Moreover, we proposed a preliminary classification system for these surgery methods. Methods We retrospectively reviewed 6 patients treated with acetabulum reconstruction combined with autologous femoral head following peri-acetabulum resection between April 2010 and May 2018. All patients were diagnosed as periacetabular tumors including chondrosarcoma (n = 5) and chondroblastoma (n = 1). Clinical data such as age, diagnosis, complications, local recurrence or metastasis, and function (Musculoskeletal Tumor Society 1993, MSTS93) were documented. The average time of follow-up was 62.5 months (range, 17 to 106 months). Results A total of 5 patients survive with average MSTS93 score of 27.8 points (range, 26–30). One patient, suffering from multiple bone metastasis prior treatment, ended up dying. One who had received radiotherapy before surgery had poor incision healing. Further, a classification system was preliminary proposed in 2 patients involving the pubis (type A) and 4 patients involving ischium (type B). Conclusions Based on the results, we preliminary proposed a classification system for reconstruction with autologous femoral head after periacetabular low malignant tumors resection. The clinical results suggested that surgery methods involving pubis (type A) and ischium (Type B) are safe and feasible. However, further researches should be conducted to verify our classification system.

scholarly journals A BIOLOGICAL CLASSIFICATION OF ENCAPSULATUS PNEUMONIÆ (FRIEDLÄNDER'S BACILLUS)

1926 ◽  
Vol 44 (1) ◽  
pp. 113-128 ◽  
Author(s):  
Louis A. Julianelle
Keyword(s):  
Serological Test ◽  
Type A ◽  
Heterogeneous Group ◽  
Type B ◽  
Biological Classification ◽  
Type C ◽  
Working Out

A biological classification has been made of thirty strains of Friedländer's bacillus. This study reveals that there exist among these strains three sharply defined and specific types and one heterogeneous group. The three types are Type A, fifteen strains; Type B, six strains; Type C, three strains; and Group X, six strains. The agglutination, agglutinin adsorption, protection, thread, and precipitin reactions have been employed in the working out of this classification, and the types have been proved highly specific by means of each serological test.

Comparison between type A and type B early adiposity rebound in predicting overweight and obesity in children: a longitudinal study

2020 ◽  
Vol 124 (5) ◽  
pp. 501-512
Author(s):  
Johanna Roche ◽  
Sylvain Quinart ◽  
David Thivel ◽  
Stéphanie Pasteur ◽  
Frédéric Mauny ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Type A ◽  
Overweight And Obesity ◽  
Type B ◽  
Health Records ◽  
Adiposity Rebound ◽  
Starting Point ◽  
Bmi Trajectory ◽  
Postnatal Factors

AbstractEarly adiposity rebound (EAR) predicts paediatric overweight/obesity, but current approaches do not consider both the starting point of EAR and the BMI trajectory. We compared the clinical characteristics at birth, age 3–5 and 6–8 years of children, according to the EAR and to its type (type A/type B-EAR). We assessed the childrenʼs odds of being classified as overweight/obese at age 6–8 years, according to the type of EAR as defined at age 3–5 years. As part of this two-wave observational study, 1055 children were recruited and examined at age 3–5 years. Antenatal and postnatal information was collected through interviews with parents, and weight and height from the health records. Type A and type B-EAR were defined in wave 1 according to the BMI nadir and the variation of BMI z-score between the starting point of the adiposity rebound and the last point on the curve. At 6–8 years (wave 2), 867 children were followed up; 426 (40·4 %) children demonstrated EAR. Among them, 172 had type A-EAR, higher rates of parental obesity (P < 0·05) and greater birth weight compared with other children (P < 0·001). Odds for overweight/obesity at 6–8 years, when adjusting for antenatal and postnatal factors, was 21·35 (95 % CI 10·94, 41·66) in type A-EAR children and not significant in type B-EAR children (OR 1·76; 95 % CI 0·84, 3·68) compared with children without EAR. Classification of EAR into two subtypes provides physicians with a reliable approach to identify children at risk for overweight/obesity before the age of 5 years.

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