The fate of ARCO stage-II femur head necrosis with ring-shaped hardening zone: forty-one hips followed for average of nine years

Abstract Purpose The goal of this retrospective study is to report the lower collapse risk and good prognosis of the ARCO stage-II femur head necrosis with ring-shaped hardening zone. Methods We retrospectively recruited 30 patients (41 hips) with ring-shaped hardening zone from the ARCO stage II femur head necrosis. In these 41 hips with ring-shaped hardened bands, we found two subtypes which named type A and type B by us respectively. These hips were followed for a minimum of 5 years after the diagnosis. (average 9 years). Results 20 (48.8%) of the 41 hips suffered from hip pain, 18 (43.9%) of the them were painlessness, and 3 (7.3%) of the them were discomfort. Without special treatment, 9 (22.0%) of the 41 hips collapsed, 8 of them were type B and one was type A. At the last follow-up, the collapse of the nine hips were without apparent progress. At the most recent follow-up, the thirty patients had good daily hip function, 39 (95.1%) of the 41 hips were asymptomatic and only 2 (4.9%) of them were discomfort. ConclusionsThis study demonstrates that the ARCO stage II femur head necrosis with ring-shaped hardening zone at the middle of femoral head (stay away from the weight-bearing area) which called type A by our team have a low frequency of collapse. Surprisingly, we found that regardless of type A or type B, whether or not collapse occurred, the stage-II femur head necrosis with ring-shaped hardening zone has a good prognosis without special treatment.

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

10.21203/rs.3.rs-676727/v1 ◽

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.

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Natural History and Clinical Outcomes of Paravertebral Arteriovenous Shunts

Stroke ◽

10.1161/strokeaha.120.033963 ◽

2021 ◽

Author(s):

Yueshan Feng ◽

Jiaxing Yu ◽

Jiankun Xu ◽

Chuan He ◽

Lisong Bian ◽

...

Keyword(s):

Natural History ◽

Clinical Outcomes ◽

Clinical Intervention ◽

Type A ◽

Neurological Deficits ◽

Type B ◽

Deterioration Rate ◽

Arteriovenous Shunts ◽

Spinal Segments

Background and Purpose: Paravertebral arteriovenous shunts (PVAVSs) are rare. Whether the intradural venous system is involved in drainage may lead to differences in clinical characteristics through specific pathophysiological mechanisms. This study aims to comprehensively evaluate the natural history and clinical outcomes of PVAVSs with or without intradural drainage. Methods: Sixty-four consecutive patients with PVAVSs from 2 institutes were retrospectively reviewed. Lesions were classified as type A (n=28) if the intradural veins were involved in drainage; otherwise, they were classified as type B (n=36). The clinical course from initial presentation to the last follow-up was analyzed. Results: The patients with type A shunts were older at presentation (52.5 versus 35.5 years, P <0.0001) and more likely to have lower spinal segments affected than patients with type B PVAVSs (67.8% versus 13.9%, P =0.00006). After presentation, the deterioration rates related to gait and sphincter dysfunction were significantly higher in patients with type A than type B shunts (gait dysfunction: 71.8%/y versus 17.0%/y, P =0.0006; sphincter dysfunction: 63.7%/y versus 11.3%/y, P =0.0002). According to the angiogram at the end of the latest treatment, 79% of type A and 75% of type B PVAVSs were completely obliterated. If the lesions were partially obliterated, a significantly higher clinical deterioration rate was observed in patients with type A shunts than those with type B shunts (69.9%/y versus 3.2%/y, P =0.0253). Conclusions: Type A PVAVSs feature rapid progressive neurological deficits; therefore, early clinical intervention is necessary. For complex lesions that cannot be completely obliterated, surgical disconnection of all refluxed radicular veins is suggested.

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Midterm results of consecutive periprosthetic femoral fractures Vancouver type A and B

Clinics and Practice ◽

10.4081/cp.2016.871 ◽

2016 ◽

Vol 6 (3) ◽

Cited By ~ 4

Author(s):

Klemens Trieb ◽

Rainer Fiala ◽

Christian Briglauer

Keyword(s):

Femoral Fractures ◽

Type A ◽

Periprosthetic Femoral Fracture ◽

Type B ◽

Single Center ◽

Midterm Results ◽

Periprosthetic Femoral Fractures ◽

Multimorbid Patients ◽

Lost To Follow Up

Surgical treatment of periprosthetic femoral fractures has a high complication and mortality rate of more than 10%. The aim of this study is to report the outcome of a consecutive single center patient group. Thirty-four consecutive patients (mean age 81.2+/-8.5 years, 14 male, 20 female) with a periprosthetic femoral fracture Vancouver type A (n=5) or type B (n=29) were followed-up after 43.2 months, none of the patients were lost to follow- up. Nineteen of the patients were treated through change of the stem and cerclage fixation, five by plates and ten by cerclage cables. One successfully treated infection was observed. No further complications have been reported peri- or postoperatively, therefore resulting in 2.9% overall complication rate. These results demonstrate that precisely selected revision surgery protocol following periprosthetic femoral fractures within elderly multimorbid patients may lead to beneficial outcomes at a low risk of complications.

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On assessing the efficiency of single-room provision in hospital wards

Epidemiology and Infection ◽

10.1017/s0022172400066766 ◽

1951 ◽

Vol 49 (4) ◽

pp. 452-457 ◽

Cited By ~ 1

Author(s):

Norman T. J. Bailey

Keyword(s):

Current Practice ◽

Type A ◽

Theory And Practice ◽

Special Treatment ◽

Clear Understanding ◽

Type B ◽

Present Practice ◽

Single Room ◽

Close Observation ◽

Hospital Wards

In many hospital wards it is usual to have a certain proportion of the beds separately accommodated in single-bed rooms. Current practice shows a great variety not only in the availability of separate accommodation but also in the use made of such a facility. A clear understanding of both the demand and the way in which it can be met is of great importance in the theory and practice of ward design. This problem has been discussed in a recent paper by J. W. D. Goodall (1951), who, using purely medical criteria for the need for separate accommodation, considered that present practice was on the whole largely inadequate. He found it convenient to divide patients into two groups. First, those who have to be kept under close observation, such as dying cases, infants under 2 years, cases of posttraumatic psychosis, patients requiring special treatment, and so on. These are called type A patients, and their beds must be situated for easy observation and attention. Secondly, there are those who need to be separated but who do not require constant nursing supervision, such as patients who are liable to infect others or who are peculiarly susceptible to infection, burns cases and physically unpleasant patients, etc. These are of type B and need not be placed in such immediately accessible parts of the ward. Goodall obtained data from many different hospital wards showing the day-to-day demand for single rooms over, in most cases, at least a month.

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The Role of Type A Behaviour Pattern in Chronic Headache

Behaviour Change ◽

10.1017/s0813483900008172 ◽

1988 ◽

Vol 5 (1) ◽

pp. 3-8 ◽

Cited By ~ 1

Author(s):

Joel J. Hillhouse ◽

Edward B. Blanchard ◽

Kenneth A. Appelbaum ◽

Cynthia Kirsch

Keyword(s):

Chronic Headache ◽

Type A ◽

Behaviour Pattern ◽

Type B ◽

Daily Diaries ◽

Dependent Variables ◽

Headache Type ◽

Activity Survey

Chronic headache sufferers (N = 133) were assessed for Type A behaviour pattern using the Jenkins Activity Survey (JAS). The Type A score frequency distribution for all headache subjects combined, and each headache type separately were examined. Median scores of the all subjects combined group fell into the indeterminate range of Type A scores, that is, neither Type A or Type B. This was also the case for migraine and tension sufferers. Mixed subject's scores fell into the range of scores usually classified as Type A. Forty-five percent of the mixed subjects fit the criteria for Type A behaviour pattern. Follow-up bivariate and multivariate analysis using J AS subscale scores as independent predictors and headache activity scores, from daily diaries, as dependent variables revealed only three correlations which approached significance. These results argue against a clear linear relationship between chronic headache and Type A behaviour pattern. There may be some utility in this construct when differentiated by headache type.

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Associations of ABO blood type and galactose-deficient immunoglobulin A1 with adverse outcomes in patients with IgA nephropathy

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz171 ◽

2019 ◽

Cited By ~ 1

Author(s):

Manliu Wang ◽

Jicheng Lv ◽

Pei Chen ◽

Guizhen Yu ◽

Sufang Shi ◽

...

Keyword(s):

Iga Nephropathy ◽

Cox Regression ◽

Type A ◽

Adverse Outcomes ◽

Blood Type ◽

Blood Group Antigens ◽

Type B ◽

Progression Of Kidney Disease ◽

Abo Blood Type

Abstract Background Both ABO blood group antigens and pathogenic immunoglobulin A1 (IgA1) in patients with IgA nephropathy (IgAN) are influenced by modifications of N-acetylgalactosamine and galactose. The purpose of this study was to assess whether ABO blood type is associated with galactose-deficient IgA1 (Gd-IgA1) in the progression of kidney disease in patients with IgAN. Methods We enrolled 1313 IgAN patients with a median of 44 months follow-up and measured the plasma Gd-IgA1 levels. Multivariate Cox regression models were used to estimate the association between all variables and adverse outcomes. Using the propensity score matching method, 718 IgAN patients with blood type either A or B were selected, and their data were used to assess the association of blood type and Gd-IgA1/serum complement 3 (sC3) with outcomes. Results We found that the risk of adverse outcomes was significantly higher in patients with blood type A than in those with type B (hazard ratio = 1.82, 95% confidence interval 1.23–2.71; P = 0.003) after multivariate adjustment. The Gd-IgA1 levels showed trends similar to the multivariate-adjusted event-free curves for the blood types. However, this higher risk of adverse outcomes in type A than in type B patients was no longer significant after the addition of Gd-IgA1/sC3 to the model. Conclusions IgAN patients with blood type A had a higher risk of adverse outcomes than those with type B, and this risk was associated with Gd-IgA1/sC3. Thus, the ABO blood type may provide a reference for the prognostic factors for individuals with IgAN.

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Sunrise effect on 40 kHz signal amplitude and its characteristic variation with respect to geomagnetic storms

Canadian Journal of Physics ◽

10.1139/cjp-2014-0319 ◽

2015 ◽

Vol 93 (12) ◽

pp. 1574-1582 ◽

Cited By ~ 3

Author(s):

Apurba Saha ◽

Anirban Guha ◽

Barin Kumar De

Keyword(s):

Geomagnetic Storms ◽

Low Frequency ◽

Signal Amplitude ◽

Type A ◽

Radio Waves ◽

Type B ◽

Type D ◽

Characteristic Variation ◽

Sunrise Effect ◽

Type C

The sunrise effect is a characteristic feature of very low frequency and low frequency radio waves propagated over a large distance. The 40 kHz signal level, transmitted from Miyakoji station (37.4° N, 140.9° E), Japan, and received at Tripura University (23° N, 91.4° E), is found to be attenuated during sunrise with an enhancement before the decrease in the signal level. On the basis of the nature of attenuation of the observed records from 2005 to 2006, those are classified into four different types, namely, type A (three step attenuation), type B (two step attenuation), type C (one step attenuation), and type D (no attenuation). During geomagnetically active days, 84% of type D cases and 31% of type C cases are observed, whereas only 0.9% of type A cases and 7% of type B cases are observed during geomagnetically active days. The fade amplitude of type C fade is also found to maintain a good negative correlation of 77.3% with the geomagnetic Ap indices over the period of 2 years. From the model calculation it is found that in the altitude range from 65 to 80 km, on average the electron density increases by a factor of 5.22 times during geomagnetically active days versus normal days.

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

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab013 ◽

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.

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Transcatheter Closure of Perimembranous Ventricular Septal Defect with Aneurysm: Radiologic Characteristic and Interventional Strategy

Journal of Interventional Cardiology ◽

10.1155/2020/6646482 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Weibing Guo ◽

Yifan Li ◽

Jinjin Yu ◽

Junjie Li ◽

Ling Sun ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Transcatheter Closure ◽

Type A ◽

Left Ventricular ◽

Type B ◽

Residual Shunt ◽

Perimembranous Ventricular Septal Defect ◽

Type C

Objectives. We aimed to explore the radiologic characteristics and interventional strategies for perimembranous ventricular septal defect (pmVSD) with aneurysm. Methods. 257 patients who underwent transcatheter closure of pmVSD with aneurysm were included in our study. We retrospectively reviewed the left ventricular opening of the aneurysm (a), diameter of the midsegment of the aneurysm (b), and diameter of the right ventricular opening of the aneurysm (c). If there were multiple defects within the aneurysm, the largest defect was denoted as c1 and so forth. We developed a novel VSD classification method in which pmVSD with aneurysm was classified into three types (A, B, and C). When a >b ≥ c, it was classified as type A, when b > a ≥ c, it was type B, and when c > a ≥ b, it was type C; c/c1 described the relationship among defects. Results. All of the 257 cases of pmVSD with aneurysm were defined using left ventriculography: type A, 60, type B, 58, and type C, 139. Transcatheter closure was attempted in 244 patients and succeeded in 227 cases (success rate was 93.0%; 227/244). Forty symmetric VSD occluders and 13 asymmetric VSD occluders were used for type A aneurysm occlusion; 31 symmetric VSD occluders, 19 asymmetric VSD occluders, and one Amplatzer duct occluder II (ADOII) were used for type B; 59 VSD symmetric occluders, 59 asymmetric VSD occluders, three eccentric VSD occluders, and two ADOII were used for type C. Within 24 hours after procedure, 2.2% patients had postprocedural residual shunt, and 2.2% experienced malignant arrhythmia (including type II second-degree AVB, cAVB, and CLBBB). Two hundred and twelve patients completed follow-up (93%, 212/227). No new severe complications were reported during follow-up, except in one patient who underwent surgery (removal of the device, VSD repair, and tricuspid valvuloplasty) due to severe postprocedural tricuspid regurgitation. Conclusions. It is safe and effective to apply this method for the classification of pmVSD with aneurysm and its interventional strategy.

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P1778Changes in size of ascending aorta in patients with bicuspid aortic valves

European Heart Journal ◽

10.1093/eurheartj/ehz748.0530 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M V Garcia-Ruiz ◽

V M Becerra Munoz ◽

J Robledo-Carmona ◽

I Rodriguez-Bailon ◽

E De Teresa Galvan

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Coarctation ◽

Severe Aortic Stenosis ◽

Adult Congenital Heart Disease ◽

Type A ◽

Ascending Aorta ◽

P Value ◽

Type B

Abstract Introduction It is well known that bicuspid aortic valve (BAV) is associated with premature valve dysfunction and ascending aorta dilation. However, limited data still exists regarding the rate of growth of the ascending aorta and the risk factors associated with it in these patients. Methods We analyzed prospectively baseline characteristics and echocardiographic data from 192 adult patients with BAV followed in an Adult Congenital Heart Disease Unit from 2007 until 2018. The exclusion criteria were: patient's without at least 2 echocardiographic examinations >6 months apart, and patients with aortic valve and/or ascending aorta surgery at baseline o at follow up (except aortic coarctation). Following the ASE guidelines two cardiologists experts in echocardiography made all the studies at baseline and follow-up where they measured the aortic root and ascending aortic diameters, as well as typified the aortic valve and analyzed the degree of stenosis (AS) and regurgitation (AR). Statistical analysis was performed using Stata 13.1, and a p value of ≤0.05 was considered significant. Results 97 patients were finally included (70 male, mean age 37.56±18.9 years). 66 patients had type A BAV (68.04%), 21 type B (21.7%), 2 type C (2.06%) and 7 unicuspid (7.22%). 19 patients had hypertension (19.59%) and 9 had a corrected aortic coarctation. In baseline echocardiogram, 20 had aortic stenosis ≥ moderate (20.6%) and 38 regurgitation ≥ grade II (39.18%). Mean diameter of ascending aorta was 35.78mm ± 6.73. With a mean follow-up time of 50.53±27.05 months, mean rate of diameter progression was 0.76 mm/year at the proximal ascending aorta (95% CI 0.6 to 1.2). Progression was significantly higher in patients with moderate or severe aortic stenosis (0.65 vs. 1.17 mm/year, p=0.021). Age, sex, hypertension, AR and high baseline diameters (≥40mm or ≥45mm) were not associated with progression. In a direct comparison between the two more frequent forms of BAV, Type A and Type B, rate of diameter progression was significantly higher in Type B (0.61 vs. 1.05 mm/year, p=0.044). In a multivariate analysis, none of the variables statistically associated to major progression were found to be predictors of growth of the ascending aorta. Conclussions In our population of BAV patients, mean rate of diameter progression at the proximal ascending aorta was 0.76 mm/year. Moderate-severe AS, and having type B BAV were associated, but not predictors, of higher growth rates.

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