Triple Threat Ttrauma: A Rare Case Report of Avulsion Fracture of the Posterior Cruciate Ligament, Lateral Collateral Ligament, and diaphyseal Tibia Fracture.

We present the case of a 24-year-old male who sustained a fall from a motorcycle resulting in a rare combination of injuries, including avulsion fractures of the posterior cruciate ligament (PCL) and femoral lateral collateral ligament (LCL), along with an ipsilateral diaphyseal tibia fracture. This case report aims to highlight the importance of early diagnosis, appropriate management, and comprehensive rehabilitation for such complex knee injuries. We discuss the patient's presentation, radiographic findings, surgical intervention, postoperative care and long-term outcomes. To our knowledge this kind of injury has never been documented in the literature.

Bilateral clavicle fracture: A case report.

Clavicle fractures are among the most common fractures in adults. Nevertheless, bilateral fractures are rarely reported in the literature. We present the case of a 35-year-old male patient who was admitted with a bilateral clavicle fracture following a motorcycle accident. The patient underwent open reduction and bilateral intramedullary fixation with Kirschner wires. After six months of follow-up, the functional result was satisfactory; the patient achieved full range of motion in both shoulders and was free from pain. X-rays showed a complete fusion of the fracture on both sides.

Aspirin withdrawal: A risk factor for ischemic stroke severity.

INTRODUCTION: Acetylsalicylic acid (ASA) cessation, is suggestive of a rebound phenomenon laying the ground for ischemic stroke (IS) re-occurrence but nothing is known about its implication for IS severity (ISS). Thus, the aim of our study is to examine whether or not aspirin withdrawal is a risk factor for ISS. PATIENTS AND METHODS: This study, recruited patients having presented an IS in the following 2 weeks of ASA withdrawal, matched with treatment free cases. ISS was evaluated in all patients at admission using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRS) at 3 months' follow-up. FINDINGS: Fifty cases were included in this study and fifty, manually matched, controls. ISS analysis found that the case group had a more severe stroke at admission (mean NIHSS: 12.76 (±7.319) in cases vs 10.04 (±5.562) in controls, P=0.039), with ASA discontinuation judged as a risk factor directly related to ISS regardless of the underlying cardiovascular risk factors (using the multivariate analysis). CONCLUSION: Our study's findings suggest that aspirin interruption over a 15-days period could result in a more severe IS in the acute phase. To our knowledge, no study has ever discussed this outcome, shedding the light on the pressing need for larger studies with various withdrawal periods to support these data.

Isolated dorsal dislocation of the distal radioulnar joint: A case report.

Isolated distal radioulnar joint (DRUJ) dislocation is a rare injury. Reports of isolated DRUJ luxations, volar or dorsal, are often case reports and rarely a series of cases. We present a case of an isolated acute dorsal dislocation of the distal radioulnar joint in a 25-year-old man. The patient underwent closed reduction and a transcutaneous radioulnar pinning was done followed by cast immobilization in neutral rotation during 6 weeks. After six months follow -up, the functional result was satisfactory, patient experienced no pain and had no restrictions in work or sports-related activities.

Influence of the container on the consumption of cosmetic products.

The container, also known as primary package or inner package, could be defined as the packaging designed to come into direct contact with the cosmetic product. To author's knowledge, no study was available regarding the effect of the primary package on the consumption of cosmetic products. The aim of the study was to assess the impact of the container on the consumption of three cosmetic products widely used, i.e. shampoo, shower gel and emollient cream. The three products were contained in a tube with a flip top cap and in a bottle with a pump. The study was conducted on 221 French adults: 108 women and 113 men. Results showed that the consumption of each cosmetic product was slightly higher when the product was packaged in tube with a flip top cap than in bottle with a pump. The difference of consumption could vary from 5 % to 23 % when calculated with mean values. This information could be interesting for safety evaluators, safety agencies and commercial services of cosmetic manufacturers.

Probabilistic exposure assessment of sun care products.

The aim of this study has been to assess the consumption and the exposure to 6 types of sun care products: sunscreen cream, sunscreen milk, sunscreen spray, sunscreen stick, moisturizing cream with SPF and after-sun milk. Consumption data were obtained from 75 clinical safety studies conducted on 3001 subjects: 371 children aged 3-9, 149 children aged 10-14 and 2481 adults aged more than 15. Exposure was assessed using a probabilistic method. Strength of the study include stratification of consumption and exposure data according to sex and age, as well as other important points such as the galenic form, the site of application and the value of the sun protection factor.

Exposure assessment of family cosmetic products dedicated to babies, children and adults.

Very few consumption and exposure data is available for family cosmetic products. The aim of the present study was to assess the consumption and the exposure to family cosmetic products used by babies, children and adults. 10 categories of products were studied: shampoo, shower gel, solid soap, cleansing lotion, emollient foam, emollient bath, cream, milk, balm and lip balm. Consumption data were obtained from 2994 participants (789 babies aged 0-3 years, 837 children aged 4-12 years and 1368 adults aged more than 18 years) included in 87 clinical safety studies. Exposure was performed using a probabilistic method. The implementation of consumption and exposure assessment by age has strengthened this work, as consumption and mainly exposure differences were shown. In fact, babies were always the most exposed to family products, followed by children and adults. These original data will be useful for safety assessors and safety agencies in order to protect consumers.

Bilateral anterior shoulder dislocation with bilateral fractures of the greater tuberosity: A case report.

Bilateral anterior dislocation of the shoulders with fractures of both greater tuberosities is very rare. A 76-year-old woman sustained a bilateral anterior dislocation of her shoulders with fractures of the greater tuberosity on both sides after a fall on stairs. Her arms were abducted and externally rotated. Radiological examination revealed the bilateral anterior dislocation and also the bilateral fractures of the greater tuberosity. Prompt closed reduction followed by a 3 weeks immobilization and subsequent rehabilitation allows a good outcome. Results at one-year follow-up were satisfactory with normal range of motion and no redislocations occurring. To our knowledge, this is the first reported case of bilateral anterior shoulder dislocation associated with fractures of both greater tuberosities in elderly woman.

Multifocal bone tuberculosis: a case report.

Multifocal long bones tuberculosis without articular involvement is very rare. Pain and swelling are the common presenting symptoms. Difficulties in diagnosis often lead to delayed treatment, sometimes with devastating consequences for patients. Radiographs may mimic other diseases. Histopathological study is necessary to establish the diagnosis. The antibacillary chemotherapy produces excellent results. We report a case of a 60-year-old woman afflicted with multifocal tibial tuberculosis.

Open medial ankle dislocation without associated fracture: a case report.

Tibiotalar dislocation without associated fracture is a rare injury. We report a case of an unusual open medial ankle dislocation without any associated bony injury. After reduction and debridement under general anaesthesia, capsule suture and ligaments repair were performed. An external fixator was applied for ankle immobilization. After 3 years follow-up, functional results were excellent without signs of instability or degenerative arthritis.

[Tuberculosis of the hand and wrist: different aspects of 30 cases]. / La tuberculose de la main et du poignet : différents aspects à propos de 30 cas.

Tuberculosis of the hand and wrist is a rare entity. We report 30 cases of tuberculosis of the hand and wrist, including ten cases of wrist osteoarthritis, ten cases of tenosynovitis, four cases of metacarpophalangeal and interphalangeal osteoarthritis and six cases of metacarpal and phalangeal osteitis. The histological study after surgical biopsy revealed caseating giant cell granulomas with epitheloid cells confirming the diagnosis. Antibacillary chemotherapy promoted healing and good outcome in our patients. The aim of our work is to analyze the epidemiological, diagnostic, therapeutic and evolutionary aspects of this disease through a series of 30 cases.

El papel de la escapulectomía en el tratamiento de los tumores de la escápula: a propósito de 6 casos / The role of scapulectomy in the care of the scapular tumors: a report of 6 cases

Este estudio retrospectivo tiene como objetivo mostrar el papel de la escapulectomía en el tratamiento de tumores escapulares analizando los resultados en 6 pacientes tratados en el Servicio de Cirugía Ortopédica del Hospital IBN SINA en Rabat por distintos tumores en la escápula entre los años 1996 y 2009. La evaluación de estos pacientes mediante el sistema de Enneking mostró en el plano funcional, excelentes resultados para 4 pacientes y buenos en los otros dos casos. En el aspecto oncológico, sólo un caso requirió la ampliación de la escapulectomía por recidiva tumoral, teniendo este paciente una buena evolución posterior. Ya que la escapulectomía ampliada es una intervención que lleva a un déficit funcional importante, actualmente el tratamiento de los tumores malignos de la escápula se realiza con una cirugía conservadora de miembro, realizándose una escapulectomía simple. Ésta debe llevarse a cabo tras una buena estadificación del paciente, para lo que es necesario un estudio de imagen completo y buen conocimiento de la anatomía para una correcta indicación quirúrgica (AU)

This retrospective study aims to demonstrate the role of scapulectomy in the treatment of scapular tumours by assessing the results of 6 patients treated for various scapular tumours in the Orthopaedic Department of IBN SINA hospital in Rabat between 1996 and 2009. The evaluation of these patients by the Enneking system showed, on a functional scale, an excellent score for 4 patients and good one for 2 patients; on the oncology scale, a single case required a total scapulectomy after recurrence with a good evolution. Since an enlarged scapulectomy leads to functional deficit, the majority of malignant tumours of the shoulder are currently treated conservatively, by performing a simple scapulectomy. Patient selection must be made after appropriate staging, a complete imaging study and a good knowledge of anatomy for a correct surgical indication (AU)

Well-circumscribed deep-seated lipomas of the upper extremity. A report of 13 cases.

BACKGROUND: The purpose of this study is to determine if giant size is of bad prognosis in deep lipomas of the upper extremity. PATIENTS AND METHODS: We report a retrospective study of 13 patients with deep-seated lipomas of the upper extremity treated during the period from April 1997 to April 2008. We evaluated the clinical and radiological characteristics, treatment and evolution profile of these patients. RESULTS: There were 10 women and three men, with an average age of 53 years (range 30-79 years). Seven of these lipomas were in the arm, one in the shoulder, and five in the forearm. Six lipomas were intramuscular, six intermuscular (three of them being attached to bone and labelled parosteal lipoma) and one epivaginal lipoma of the flexor tendon sheath. All patients presented a progressive slow-growing mass that was associated with radial paralysis in one case and carpal tunnel syndrome in one case. Plain radiographs showed a radiolucent soft-tissue image in all cases and an associated osteochondroma in one parosteal lipoma. Computer tomography (CT) or magnetic resonance imaging (MRI) suggested the lipomatous nature and benign characteristics of these deep lipomas that were giant in all cases (mean size: 7 cm). Lipoma marginal excision was performed and histopathological examination demonstrated features consistent with a benign lipoma. There was good function and no clinical recurrence was observed after a mean follow-up of three years. DISCUSSION: Giant deep-seated lipomas of the upper extremity are uncommon and can be intermuscular or intramuscular. A painless soft-tissue mass is the most frequent chief complaint. MRI with fat suppression suggests the diagnosis and studies the extension of deep lipoma. Marginal excision is the treatment of choice and histopathology eliminates diagnosis of well-differentiated liposarcoma. CONCLUSION: Appropriate evaluation of deep lipoma is to rule out malignancy by systematically performing MRI and biopsy. In contrast to deep-seated lipomas of the lower extremity or the retroperitoneal space, the prognosis of deep-seated lipomas of the upper extremity is good irrelevant of their size. Recurrence and the degeneration are very rare. LEVEL OF EVIDENCE: Level 4.

Upward tibiotalar dislocation without fracture: A case report.

Pure tibiotalar dislocations without associated fracture are rare. The authors report a case of an unusual closed tibiotalar dislocation without fracture involving proximal ascension of the talus. Immediate closed reduction was performed. Repair of the disrupted medial ligament was performed and one syndesmosis screw inserted, followed by 6 weeks of immobilization. After 1 year of follow-up, functional results were excellent.

Antituberculous treatment and total hip arthroplasty in ald tuberculous hip. A case report

We report a case of Total Hip Arthroplasty using cemented Charnley prothesis. This was done in an old tuberculous hip without using antituberculous chemoprophylaxis. The patient developed periprosthetic bacterial infection not related to tuberculous site reactivation. We report our experience with this case and review of relevant literatures

A novel non-toxic camptothecin formulation for cancer chemotherapy.

The use of a novel injectable biocompatible and biodegradable camptothecin-polymer implant for sustained intra-tumoral release of high concentrations of camptothecin is described. The drug delivery vehicle is an in situ thermogelling formulation, which is based on the natural biopolymer chitosan. This formulation, containing homogeneously dispersed camptothecin, was implanted intra-tumorally into a sub-cutaneous mouse tumor model (RIF-l). The effectiveness of treatment was measured in terms of tumor growth delay (TGD). Animals treated with the polymer implants containing camptothecin had significantly longer TGDs compared to untreated animals as well as to animals treated systemically with camptothecin by intra-peritoneal injection with no evidence of toxicity in terms of loss of body weight. The results indicate that this novel biodegradable polymer implant is an effective vehicle for the sustained intra-tumoral delivery of camptothecin which might also be suitable to deliver other insoluble anti-cancer drugs such as taxol.

Spectrophotometric determination of metronidazole and secnidazole in pharmaceutical preparations.

A rapid and sensitive spectrophotometric method is proposed for determination of metronidazole and secnidazole. The method depends on the reduction of metronidazole and secnidazole molecule with zinc dust and hydrochloric acid flowed by diazotization and coupling with 8-quinolinol to give red colored chromogens easily measured spectrophotometrically which has lambda(max) = 500 nm. The experimental conditions were optimized and Berr's law was obeyed over the applicable concentration ranges both techniques were applied successfully to a wide variety of pharmaceutical preparations.

Cystic echinococcosis in the Berber of the Mid Atlas mountains, Morocco: new insights into the natural history of the disease in humans.

Precise knowledge of the natural history of cystic echinococcosis (CE) in humans remains somewhat arcane. The aim of the present study was to determine whether aspects of the natural history of established human infection with Echinococcus granulosus could be investigated by using a cross-sectional approach, in a community where CE was endemic. A mass ultrasound-screening survey, coupled with a questionnaire to record all previous surgical histories related to CE, was carried out amongst the primarily transhumant Berber people of the Mid Atlas mountains in Morocco. During two periods of intensive screening, of 10 days in May 2000 and 11 days in May 2001, 11,612 people, representing > 98% of the local population, were checked. One hundred and twenty six (1.1%) of the subjects--75 (59.5%) of the 6864 females investigated and 51 (40.5%) of the 4748 males--were found ultrasound-positive for CE. Overall, 14.1% of the CE cases detected were children aged 1-15 years (who made up 44% of the study population). Most (77.4%) of the ultrasound-positive subjects investigated were also found seropositive for CE. The frequency of a past history of surgery for CE increased with subject age (P = 0.024), 125 (1.1%) of the subjects being recorded as having had such surgery. The frequency of surgery for pulmonary CE was relatively constant in all age-groups, indicating that infection can occur at any time. The frequency of abdominal CE increased with age (R2 = 0.8102). Assuming that the incidence of infection remains fairly constant over time and that the longer a person spends in this endemic area the more likely it is that he or she will develop CE, then a progression from active through transitional to inactive CE should occur. The cysts observed by ultrasound in the present study were categorized, as type 1, 2, 3, 4 or 5, according to the new, standardized, ultrasound classification of CE developed by the World Health Organization (WHO). There was a clear exponential decline in the frequency of the various cyst types, from type 1 (the most frequent) to type 5 (the rarest). This decline validates the assumptions made, about the natural history of established CE, by those who developed the WHO's classification. The classification should therefore be invaluable to surgeons and clinicians, when they have to consider treatment options for patients with the various types of CE, and to policy makers trying to establish the economic costs of treating CE in endemic settings.