Evaluation of femoral condyle volumes in patients with trochlear dysplasia: a pilot study.

AIM: To examine the volumes of the medial and lateral femoral condyles and the trochlear groove, and to determine their relationship with trochlear dysplasia. MATERIALS AND METHODS: Computed tomography images of the knees of 21 patients with trochlear dysplasia and 18 healthy individuals were analysed retrospectively. According to the modified Dejour classification, the degree of trochlear dysplasia was recorded, such as type A trochlea being low-grade dysplasia and types B, C, and D trochlea being high-grade dysplasia. Volume of the trochlear groove and medial and lateral femoral condyles were calculated using the three-dimensional (3D) volume-rendering method. RESULTS: The volumes of lateral condyle, medial condyle, and trochlear groove were statistically significantly lower in patients with trochlear dysplasia when compared to healthy participants. When compared according to Dejour types, all parameters were statistically significantly lower in both high- and low-grade dysplasia patients (p<0.05). The correlation between femoral condyle volumes and trochlear groove volume was low in the control group, but there was a moderate positive correlation in the patient group (r=0.50-0.75, p<0.05). CONCLUSION: In trochlear dysplasia, the volume of the trochlear groove decreases and hypoplasia may occur in both lateral femoral and medial femoral condyles. Therefore, hypoplasia of only one condyle should not be interpreted as trochlear dysplasia. A holistic approach to patients is required.

Outpatient Follow Up and Reconstructive Surgery Rates in Massive Burn Survivors: Investigating the Social Determinants.

Burn care continues to improve and larger total body surface area (TBSA) burn survival is increasing. These survivors require more extensive care than smaller burns and are at higher risk for wound/scar related complications. Prior work has shown low rates of follow up for burn survivors linked to socioeconomic factors such as housing insecurity and substance use. There are limited studies that evaluate socioeconomic factors that contribute to follow up and reconstructive surgery rates in massively burned patients. Patients that survived to discharge with >50% TBSA burns and planned return to treating institution were included in the study. Univariate and multivariate analyses were performed on the data collected. Sixty-Five patients were included with an average TBSA of 63.1%. Fifty-three patients (81.5%) attended at least one follow up appointment with median of four follow-up appointments. Younger patients (33±9 vs 44±11; p=0.0006), patients with larger TBSA burns (65±13 vs 55±5%; p=0.02), those with private insurance and those without housing insecurity (1.8% vs 45.4%; p=0.003) were more likely to follow up. On multivariate regression analysis, patients with housing insecurity were independently associated with lack of follow up (OR: 0.009 CI: 0.00001-0.57). Thirty-five patients had at least one reconstructive surgery and 31 patients had reconstructive surgery after discharge. No patients with housing insecurity underwent reconstructive surgery. Follow up rates in massive burns were higher than reported for smaller TBSA burns and more than half received reconstructive surgery. Housing insecure patients should be targeted for improved follow up and access to reconstructive surgery.

Association of TYRP1 with hypoxia and its correlation with patient outcome in uveal melanoma

Purpose Molecular mechanisms of uveal melanoma development in association with high pigmentation are unclear. Tyrosinase Related Protein (TYRP1) is not only one of the important melanogenesis marker that contributes to melanin synthesis, but can also prevents the melanocyte death. The induction of melanogenesis leads to induction of HIF-1α which can affect the behavior of melanoma cells and its surrounding environment. The aim of our study was to determine the expression of TYRP1 and HIF-1α at the protein and RNA level and determine its prognostic significance. Methods In the present study, the expression of TYRP1 and HIF-1α was investigated on 61 formalin-fixed paraffin-embedded choroidal melanoma samples by immunohistochemistry. Fresh 50 samples were validated by real-time PCR. Results were correlated with clinicopathological parameters and Kaplan–Meier was performed to determine the prognostic significance. Results High immunoexpression of TYRP1 and HIF-1α was present in 61 and 54% of patients, respectively. Both TYRP1 and HIF-1α correlated well with high pigmentation and BAP1 (BRCA1 Associated Protein-1) loss (p < 0.05) at IHC level as well as transcriptional level. There was reduced metastatic free survival in patients with necrosis and this was statistically significant (p = 0.010). Conclusion Our findings indicate that TYRP1 can be used as a potential biomarker in the development of targeted therapy in UM. Further studies on melanogenesis markers associated with TYRP1 could provide us a better understanding in this field (AU)

Does NEMO/IKKgamma protein have a role in determining prognostic significance in uveal melanoma?

Purpose: Uveal melanoma, although a rare form of cancer, is the most common primary malignancy of the eye in adults. Nuclear factor-kapaB (NF-kapaB) is a transcription factor that transactivates genes involved in the regulation of cell growth, apoptosis, angiogenesis, and metastasis, but the molecular mechanisms that negatively regulate NF-kapaB activation are not fully understood. NF-kapaB can also be activated by DNA damage pathway through NEMO protein. Therefore, the objective of this study is to elucidate the role of NEMO/IKKgamma protein in uveal melanoma patients. Methods: Seventy-five formalin-fixed paraffin-embedded prospective tissues of uveal melanoma were included in the present study. These cases were reviewed and investigated for the expression of NEMO/IKKgamma protein by immunohistochemistry and validated by western blotting along with the qRT-PCR for mRNA expression. Expression levels were correlated with the clinicopathological parameters and patients’ outcome. Results: Immunohistochemistry showed cytoplasmic expression of NEMO/IKKgamma expression in only 22 out of 75 (29.33%) cases. This result was confirmed by western blotting, and correlated well with the immunohistochemical expression of NEMO/IKKgamma protein (48 kDa). In addition, downregulation of this gene was found in 87.93% of the cases when compared with the normal tissues. On statistical analysis, loss of NEMO/IKKgamma protein was correlated with neovascularization, high mitotic count, and presence of vascular loop (p < 0.05). There was less overall survival rate with low expression of NEMO/IKKgamma protein in patients with uveal melanoma. Conclusion: This was the first study suggesting the relevant role of NEMO/IKKgamma protein, and highlights the prognostic significance with outcome in uveal melanoma patients. This protein might be used as a screening biomarker in these patients after large-scale validation and translational studies

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Fratura do hâmulo do hamato: a propósito de uma observaçäo e revisäo da literatura / Fracture of the hook of the hamate: apropos of an observation and review of the literature

Os autores relatam um caso de fratura do hâmulo do hamato, conseqüente a acidente em via pública, fazendo uma revisäo da literatura para este raro tipo de patologia. Utilizam, além de radiografias convencionais, o recurso da tomografia computadorizada

Zigomicose - relato de um caso / Zygomycosis - a case report

Os autores relatam um caso de zigomicose granulotomatosa visceral em uma paciente indígena xerente de quatro anos de idade, examinada por meio de ultra-sonografia e exames radiográficos. A confirmação diagnóstica foi feita pelo anatomopatológico. A literatura é brevemente revista e são discutidas a classificação, a fisiopatogenia e a evolução dessa enfermidade.