We report five cases of intertrochanteric fractures that needed open reduction after failed closed reduction techniques. In all cases the shaft fragment included the lesser trochanter, and there was a long spike on the head—neck fragment. This was evident clinically as the proximal shaft, pulled by the iliopsoas tendon, produced a swelling in front of the hip joint. Radiographically, the fracture was minimally comminuted. The anteroposterior view revealed upward riding of the shaft fragment, while lateral view showed the femoral shaft in front of the head and neck. We describe a three-step technique, which was applied for open reduction in these unusual cases. With the patient supine on a standard operating table, the fracture site was exposed. The limb was placed in full adduction and external rotation to slacken the iliopsoas tendon. A Hohmann retractor was then passed medial to the shaft and behind the fractured surface of the sunken femoral neck, levering it anteriorly. Traction in abduction and internal rotation was applied to complete the reduction. Additional iliopsoas tenotomy was performed in two patients. All cases were fixed with a dynamic hip screw and all fractures united uneventfully. # 2005 Elsevier Ltd. All rights reserved.

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Background Pulmonary hypertension (PH) is a common complication of idiopathic pulmonary fibrosis (IPF) that is associated with poor prognosis. Noninvasive screening for PH in IPF patients is challenging and a combination of several noninvasive determinations can improve discrimination. Methods We included 235 IPF patients who underwent right heart catheterization (RHC) as part of the lung transplant evaluation. We measured electrocardiographic (ECG) and echocardiographic variables as well as the pulmonary artery (PA) and ascending aorta (AA) diameters on chest CT. We recorded results of arterial blood gases (ABG), pulmonary function (PFT) and 6-min walk tests (6MWT). Results Several variables were predictors of PH in IPF patients in univariable models including a lower arterial oxygenation and 6MWT distance; worse right ventricular (RV) function, rightward deviation of the QRS axis and a higher FVC/DLCOc ratio, PA/AA diameter ratio, and estimated RV systolic pressure. In multivariable analysis, a worse RV function and higher PA/AA ratio remained predictors of PH (c-index 0.75 (0.65–0.84)). Similarly, a worse RV function, a higher PA/AA ratio and a rightward QRS axis deviation were independent predictors of precapillary PH (c-index 0.86 (0.76–0.92)). A combination of PA/AA diameter ratio 1.1, a QRS axis 90° and normal RV function showed a negative predictive value of 85% for precapillary PH. Conclusions There are significant differences in ECG, echocardiographic, chest CT, PFT and ABG parameters between IPF patients with and without PH. However, these noninvasive tests alone or combination have limited discrimination ability for PH screening in IPF.

The incidental finding of high systolic pulmonary artery pressure on echocardiography is common. What we should do about it varies according to clinical presentation, comorbidities, and results of other tests, including assessment of the right ventricle. Thus, the optimal approach ranges from no further investigation to right heart catheterization and, in some cases, referral to a pulmonary hypertension center.

Firearm injuries collected fro medico legal files ministry of Justice in Assiut

Firearm injuries collected fro medico legal files ministry of Justice in Assiut

Firearm injuries collected fro medico legal files ministry of Justice in Assiut

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