Functional and Radiologic Results of Posteromedial Limited Surgery in Developmental Dysplasia of the Hip

PURPOSE OF THE STUDY In treatment algorithm of developmental dysplasia of the hip, posteromedial limited surgery is placed between closed reduction and medial open articular reduction. The aim of the present study was to assess the functional and radiologic results of this method. MATERIAL AND METHODS This retrospective study was performed in 37 Tönnis grade II and III dysplastic hips of 30 patients. The mean age of the patients at operation was 12.4 months. The mean follow-up time was 24.5 months. Posteromedial limited surgery was applied when sufficient stable concentric reduction was not achieved by closed technique. No pre-operative traction was applied. Postoperatively, human position hip spica cast was applied for 3 months. Outcomes were evaluated regarding modified McKay functional results, acetabular index and presences of residual acetabular dysplasia or avascular necrosis. RESULTS Thirty-six hips had satisfactory and one hip had poor functional result. The mean pre-operative acetabular index was 34.5 degrees. It improved to 27.7 and 23.1 degrees at the postoperative 6th month and the last control X-Rays. The change in acetabular index was statistically significant (p<0.05). At the last control, 3 hips had findings of residual acetabular dysplasia and 2 hips had avascular necrosis. CONCLUSIONS Posteromedial limited surgery for developmental dysplasia of the hip is indicated when closed reduction remains insufficient and medial open articular reduction remains unnecessarily invasive. This study, in line with the literature, provides evidences that this method might decrease the incidences of residual acetabular dysplasia and avascular necrosis of the femoral head. Key words: developmental dysplasia of the hip, posteromedial limited surgery, closed reduction, medial open reduction.

Dioxins (PCDD/Fs) and PCBs in offal: occurrence and dietary exposure

Offals are widely consumed in different cuisines, but information on the occurrence of dibenzo-p-dioxins, dibenzofurans (PCDD/Fs) and polychlorinated biphenyls (PCBs) in these foods is sparse. In the first structured investigation of its kind, this study reports levels of these contaminants in commonly consumed offals (n=173) such as lamb, ox, deer and pig's liver, kidneys, tongue and heart, and offal products such as pâté, haggis, tripe and black pudding. The results support literature observations on the preferential accumulation of contaminants in liver tissue, as the highest concentrations of PCDD/Fs were observed in liver, relative to the other organs (e.g. 8.4 ng WHO-TEQ kg(-1) lamb liver compared to 1.1 ng WHO-TEQ kg(-1) lamb kidney and 1.27 ng WHO-TEQ kg(-1) lamb heart). Offal products generally showed lower contaminant levels which may be a result of processing or dilution. For most samples, the main contribution to WHO-TEQ arose from PCDD/Fs rather than PCBs. Just under half of the lamb liver samples showed PCDD/F concentrations that exceeded the EU maximum limit of 6 ng kg(-1) fat weight (although deer liver which is not subject to the regulation, generally showed higher levels). Dietary exposure estimates indicate that the weekly consumption of up to two 100g portions of lamb, ox, calf or pig liver or one portion of deer liver would not breach the tolerable daily intake (TDI) level even when the rest of the diet was included. However, the consumption of more than one portion of deer liver per week may lead to the TDI being exceeded.

Polychlorinated naphthalenes (PCNs): congener specific analysis, occurrence in food, and dietary exposure in the UK

Information on the occurrence of toxicologically significant polychlorinated naphthalenes (PCNs) in food, or on human exposure, is sparse. In this work, PCN congeners (PCNs 52, 53, 66/67, 68, 69, 71/72, 73, 74, and 75) were selected for analysis, based on the available literature on current occurrence and toxicology, and limited by the commercial availability of reference standards. The analytical methodology used cold solvent extraction of prehydrolyzed samples fortified with internal standards ((13)C(10) labeled PCNs), activated carbon and basic alumina purification, and measurement by HRGC-HRMS. The investigation showed PCN occurrence in all studied foods: meat, milk, fish, dairy and meat products, eggs, poultry, vegetables, fruits, etc. The most frequently detected congeners were PCN 52, PCNs 66/67, and PCN 73. The highest concentrations were observed in fish (maximum value of 37 ng/kg w.w. for the sum of the measured congeners). The dioxin-like toxicity (PCN TEQ) associated with these concentrations is 1-2 orders of magnitude lower than those reported for chlorinated dioxins or PCBs in food and, on the basis of dietary intakes estimated using very conservative assumptions regarding concentrations of these contaminants in the UK, the levels of PCNs alone in food do not suggest any toxicological concerns.

Dioxins and polychlorinated biphenyls (PCBs) in fish oil dietary supplements: occurrence and human exposure in the UK

Commercially available fish oil supplements sourced from retail outlets in the UK, as well as by mail order, were surveyed in 2000-02 for dioxin (PCDD/Fs) and polychlorinated biphenyl (PCB) content. Sampled products were representative of market share. The WHO-TEQ values for these products ranged from 0.18 to 8.4 ng kg-1 for SigmaPCDD/F and from 1.1 to 41 ng kg-1 for Sigma dioxin-like PCBs. The results suggest a downward trend in the levels of dioxins in fish oil supplements over the last decade, since levels for similar products ranged from 0.3 to 10 ng kg-1 for SigmaPCDD/F WHO-TEQ in 1996. Levels of ICES (International Council for the Exploration of the Seas) 7 PCBs in the current study ranged from 8.3 to 267 microg kg-1. Subsequent to this survey, European Union legislation has been introduced that includes a maximum limit of 2 ng kg-1 WHO-TEQ for dioxins in fish oil products for human consumption. Twelve of the 33 products reported here would have exceeded this limit. Negotiations are in progress to incorporate dioxin-like PCBs into the European Union regulations. When manufacturer-recommended doses were applied to the observed levels, the estimated upper bound human exposure to dioxins and dioxin-like PCBs from dietary intake of these products ranged from 0.02 to 7.1 pg WHO-TEQ kg-1 body weight day-1 for adults and from 0.02 to 10 pg WHO-TEQ kg-1 body weight day-1 for schoolchildren. This level rises to 1.8-8.9 pg WHO-TEQ kg-1 body weight day-1 for adults and 1.4-14 pg WHO-TEQ kg-1 body weight day-1 for schoolchildren when combined with the average exposure from the whole diet in 1997. Again, subsequent to this survey, the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) revised the UK tolerable daily intake (TDI) for mixtures of dioxins and dioxin-like PCBs from 10 to 2 pg WHO-TEQ kg-1 body weight day-1. This is in line with the tolerable weekly intake (TWI) of 14 pg WHO-TEQ kg-1 body weight set by the Scientific Committee on Food (SCF).

Dioxins and polychlorinated biphenyls (PCDD/Fs and PCBs) in food from farms close to foot and mouth disease animal pyres

To control the outbreak of foot and mouth disease, which occurred in the UK in early 2001, a large number of farm animals were slaughtered. Where it was not possible to render or landfill the carcasses, they were destroyed by burning on open pyres, with wood, coal and other materials. Uncontrolled combustion such as this is known to produce small quantities of dioxins and an investigation was made into whether, as a result of the burning, there was an elevation in the concentrations of these compounds in food produced in the areas close to the pyres. With few exceptions, concentrations of PCDD/Fs and PCBs were within the expected ranges as predicted by reference data. No accumulation over time was evident from a repeat milk sampling exercise. Where elevated concentrations of PCDD/Fs and PCBs were found in chickens and eggs, they were in samples not destined for the food chain. Elevated levels in some samples of milk from Dumfries and Galloway were not found in earlier or later samples and may have been found as a result of a temporary feeding regime. Elevated concentrations in lamb from Carmarthenshire were from very young animals which would not have entered the food chain. There was no evidence of any significant increase in dietary exposure to PCDD/Fs and PCBs as a result of the FMD pyres.