Mohamed Hegazy

Correction of relapsed or neglected clubfoot using a simple Ilizarov frame.

We present the results of using a simple Ilizarov fixator frame in treatment of 66 feet in 52 patients (mean age 8.5 years) of 58 relapsed and eight neglected clubfeet with grade III or IV severity with a mean follow-up of 40 (26–58) months. Our frame, in spite of being simple and easy for surgeons and patients to handle, achieved satisfactory correction comparable to the literature.RésuméNous présentons les résultats de l’utilisation d’un cadre simple de fixateur Ilizarov dans le traitement de 66 pieds bots chez 52 malades (âge moyen 8,5 années) avec un suivi moyen de 40 mois (26–58). Il s’agissait de pieds bots de niveau de sévérité III ou IV, 8 négligés et 58 récidives. Notre cadre, bien que simple et de maniement facile pour les chirurgiens et les malades, a conduit à une correction comparable aux résultats de la littérature.

Radiographic Parameters to Predict Union After Volar Percutaneous Fixation of Herbert Type B1 and B2 Scaphoid Fractures

PURPOSE To study the angle of screw placement in relation to the scaphoid fracture plane and its effect on union after percutaneous fixation of scaphoid waist fractures. METHODS Twenty-four consecutive scaphoid waist fractures were retrospectively evaluated for the orientation of screws in relation to the fracture plane using a method in which the sum-of-smaller angles (SSA) in 3 different radiographs were used to correlate with time to fracture union. RESULTS All but one patient achieved union after percutaneous fixation of the scaphoid. Another patient required revision surgery within the study period for inadequate fixation. A shortened time to union was significantly correlated to larger SSA. CONCLUSIONS SSA may be a reasonable predictor of union after percutaneous fixation of scaphoid waist fracture. It can be reliably calculated using plain radiographs. An SSA of 190° or more correlated with union by 8 weeks postoperatively.

Long-Term Efficacy of Interferon-Free Antiviral Treatment Regimens in Patients With Hepatitis C Virus–Associated Cryoglobulinemia Vasculitis

Background & Aims In small‐size and short‐term studies of hepatitis C virus–associated cryoglobulinemia vasculitis (HCV‐CryoVas), patients had a higher rate of response and tolerance to direct‐acting antiviral (DAA) agents than interferon‐containing regimens. We collected follow‐up data from a clinical trial to determine the long‐term effectiveness and tolerance of all‐oral, interferon‐free DAA regimens in patients with CryoVas. Methods We collected follow‐up data from a prospective international multicenter cohort study of 148 patients with symptomatic HCV‐CryoVas (53.7% with cirrhosis and 49.3% naive to treatment with DAAs). All patients received DAA (sofosbuvir plus daclatasvir, n = 53; sofosbuvir plus ribavirin, n = 51; sofosbuvir plus ledipasvir, n = 23; or sofosbuvir plus simeprevir, n = 18), for 12 or 24 weeks, from 2014 through 2017; the median follow‐up time was 15.3 months. A complete clinical response was defined as improvement of all organs involved at baseline and the absence of clinical relapse; a partial response was defined as improvement in some but not all organs involved at baseline. The primary end point was clinical response of CryoVas symptoms at week 12 after stopping DAA therapy. Results A complete response was reported for 106 patients (72.6%), a partial response for 33 patients (22.6%), and no response for 7 patients (4.8%). Cryoglobulins were no longer detected in blood samples from 53.1% of patients, and 97.2% of the patients had a sustained virologic response to therapy. Premature DAA withdrawal was reported for 4.1% of patients. Factors associated with no or partial response to therapy included a severe form of CryoVas (odds ratio, 0.33; 95% CI, 0.12–0.91; P = .03) and peripheral neuropathy (odds ratio, 0.31; 95% CI, 0.11–0.84; P = .02). After a median follow‐up time of 15.3 months, 4 patients (2.8%) died. The CryoVas manifestation of purpura was cleared from 97.2% of patients, renal involvement from 91.5% of patients, arthralgia from 85.7% of patients, neuropathy from 77.1% of patients, and cryoglobulinemia from 52.2%. Conclusions In a long‐term follow‐up analysis of data from a clinical trial, we found that more than 95% of patients with HCV‐CryoVas have a full or partial response of symptoms to different DAA treatment regimens. Fewer than 5% of patients stop therapy prematurely and less than 3% die. A severe form of CryoVas and peripheral neuropathy were associated with a lack of response of HCV‐CryoVas to DAA therapy.

Increased genomic instability following treatment with direct acting anti-hepatitis C virus drugs

Mixed Cryoglobulinemic Vasculitis (MCV) is a prominent extra-hepatic manifestation of Hepatitis C virus (HCV) infection. HCV has been reported to cause B-cell disorders and genomic instability. Here, we investigated B-cell activation and genome stability in HCV-MCV patients receiving the direct antiviral agent, Sofosbuvir, at multiple centers in Egypt. Clinical manifestations in HCV-MCV patients were improved at the end of treatment (EOT), such as purpura (100%), articular manifestations (75%) and neuropathy (68%). Eighteen patients (56%) showed vasculitis relapse after EOT. BAFF and APRIL were higher at EOT and continued to increase one year following treatment onset. Chromosomal breaks were elevated at EOT compared to baseline levels and were sustained at 3 and 6 months post treatment. We report increased expression of DNA genome stability transcripts such as topoisomerase 1 and TDP1 in HCV-MCV patients after treatment, which continued to increase at 12 months from treatment onset. This data suggest that B-cell activation and DNA damage are important determinants of HCV-MCV treatment outcomes.

A novel subsartorial approach in open reduction of developmental dysplasia of the hip: a preliminary 2-year follow-up report of 20 hips

Background: The anterior (Smith-Peterson) and medial (Ludloff) procedures are the most common approaches used for subluxation or dislocation in developmental dysplasia of the hip that cannot be treated conservatively. If conservative treatment has failed, additional procedures on the pelvic or femoral side may become necessary. Methods: In this prospective study we used a new subsartorial approach in the surgical treatment of 20 hips (17 patients of whom three had bilateral hip dysplasia) with a mean follow-up of 23.9 mo (range 22-26 mo). There were 16 hips in 13 girls and four unilateral hips in four boys. At surgery, the ages ranged from 9 to 24 mo, with a mean of 16.5 mo. The degree of initial hip subluxation was graded according to the Tönnis classification, with two hips (10%) type II, eight hips (40%) type III, and 10 hips (50%) type IV. We evaluated the clinical and radiographic outcomes of the patient cohort with the McKay and Severin classifications, respectively. Results: Clinically there were 15 hips (75%) with an excellent results and five hips with good results. According to the radiographic Severin classification, nine hips had an excellent result (type I), 10 had a good result (type II), and one hip had a fair result (type III). One hip (5%) developed avascular necrosis according to the Kalmachi and MacEwan classification but eventually had good clinical outcome precluding any surgical intervention. Two girls (10%) developed left lateral subluxation 3 mo postoperatively. Femoral derotation osteotomy was done 6 mo postoperatively. Conclusions: The subsartorial approach was a safe, reliable, and reproducible approach in the pediatric hip in patients younger than 2 yr of age who had not had a previous operation or a history of paralytic hip dislocation. We recommend this approach for surgeons who are familiar with the pediatric hip.