Combination-type periprosthetic tibial fracture: Felix type (II+IV)A.

Tibial periprosthetic fractures are rare but present a complicated problem for orthopaedic surgeons. Literature in relation to combination-type periprosthetic fractures is extremely scarce, and there is limited guidance available on its treatment. We report the case of a woman in her 60s, whose radiographs revealed a periprosthetic fracture of the tibia, which was a Felix type (II+IV)A fracture. The tibial tuberosity fragment was fixed with a cannulated cancellous screw. The fracture adjacent to the stem was managed conservatively as the prosthesis was stable. Follow-up radiographs revealed both fractures to have healed completely by 12 weeks. The patient returned to preinjury functional levels by 4 months. Our demonstrated treatment of a Felix type II+IV periprosthetic fracture could be a viable treatment option for such fractures.

Osteoid Osteoma of Talus - A Rare Occurrence Mimicking Ankle Arthritis: A Case Report.

Introduction: Osteoid osteoma is a benign, bone forming tumor which accounts for nearly 10% of all benign bone tumors. The foot is very rarely involved, with only around 2% of osteoid osteomas being reported to occur in bones of the foot. Osteoid osteoma of the talus could present as symptoms mimicking monoarticular arthritis of the ankle. We present a case of osteoid osteoma occurring in the neck of talus, presenting such a diagnostic dilemma. Case Report: A 13-year-old male child had complaints of pain and swelling in his right ankle since 1 year. The pain was predominantly aggravated at night and partially relieved by non-steroidal anti-inflammatory drugs. On examination, we found a diffuse, ill-defined, and soft swelling over the anteromedial aspect of the right ankle, which was anterior and inferior to the medial malleolus. The movements at the ankle joint were restricted and painful. Lateral radiograph of ankle revealed a solitary, osteolytic, and circular lesion involving the neck of the talus. Computed tomography (CT) scan showed a well-defined, lucent, and intramedullary lesion with a sclerotic rim in the neck of talus. The child was diagnosed to have osteoid osteoma of the neck of talus. We performed percutaneous CT-guided radiofrequency ablation (RFA) of the lesion. The child had complete relief of pain after the procedure. The child was followed up for 3 years and had no complaints of pain. Conclusion: Osteoid osteoma very rarely occurs in the talus. It can present as monoarticular arthritis involving the ankle joint and requires a high degree of suspicion to be identified. A CT scan remains the most accurate investigation to confirm the diagnosis. We found percutaneous CT-guided RFA to have yielded good outcome without recurrence.

Total knee arthroplasty with long tibial stem for tibial stress fractures with knee osteoarthritis: Two birds with one stone.

PURPOSE: The treatment and outcome of tibial stress fractures concomitant with knee osteoarthritis (OA) are complicated. The aim of this study was to evaluate the functional and radiological outcome of total knee arthroplasty with long tibial stem as a treatment for patients having knee OA and tibial stress fracture. METHODS: Patients who were diagnosed to have proximal tibia stress fracture along with knee OA at our institution between June 2013 and November 2018 were included in our study. All patients underwent total knee arthroplasty with long tibial stem. Preoperative and postoperative functional assessments were done according to range of movement of the knee joint, knee society score and knee injury and OA outcome score. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables. RESULTS: Twelve patients were included in the study. All patients were found to have stress fractures in the proximal half of tibia and extra-arthrosis. Four patients had non-union/delayed union, and 8 patients had acute fractures. The average preoperative range of movement was 88.1°, which improved to 116.3° at 3 months following surgery. It was found that the fracture has healed in all cases. Mean knee society score improved from 32.9 preoperatively to 89.3 at 1 year follow-up. Knee injury and OA outcome score improved from a mean score of 28.3 preoperatively to 81.1 at 1 year follow-up. CONCLUSION: Stress fractures can occur in the proximal tibia in patients with knee OA. Total knee arthroplasty with tibial stem provides a suitable solution for both conditions. Additional plating or bone graft is unlikely to be required.

Giant synovial chondromatosis of hip.

Synovial chondromatosis is a rare, benign condition occurring due to metaplasia of synovium. A 65-year-old woman presented with pain in her right hip for 6 years. On examination, a swelling was palpable at the base of scarpa's triangle and her right hip movements were restricted. Imaging modalities showed ossified nodules in the antero-inferior aspect of the hip joint, joint effusion and arthritic changes. We diagnosed the patient to have synovial chondromatosis with secondary arthritis of the hip joint. We performed a total hip arthroplasty with simultaneous synovectomy and extraction of the osteochondral loose bodies, 5 of which were about 2×2 cm in size. We found that excessive acetabular reaming was required due to craters, the osteochondral masses formed on the acetabular surface. Histopathological analysis confirmed the diagnosis. The patient had an excellent functional outcome and no recurrence 5 years following the surgery.

LncRNA as a Therapeutic Target for Angiogenesis.

BACKGROUND: Out of 3 billion base pairs in human genome only ~2% code for proteins; and out of 180,000 transcripts in human cells, about 20,000 code for protein, remaining 160,000 are non-coding transcripts. Most of these transcripts are more than 200 base pairs and constitute a group of long non-coding RNA (lncRNA). Many of the lncRNA have its own promoter, and are well conserved in mammals. Accumulating evidence indicates that lncRNAs act as molecular switches in cellular differentiation, movement, apoptosis, and in the reprogramming of cell states by altering gene expression patterns. However, the role of this important group of molecules in angiogenesis is not well understood. Angiogenesis is a complex process and depends on precise regulation of gene expression. CONCLUSION: Dysregulation of transcription during this process may lead to several diseases including various cancers. As angiogenesis is an important process in cancer pathogenesis and treatment, lncRNA may be playing an important role in angiogenesis. In support of this, lncRNA microvascular invasion in hepatocellular carcinoma (MVIH) has been shown to activate angiogenesis. Furthermore, lncRNA-Meg3-knockout mouse showed increased expression of vascular endothelial growth factor pathway genes and increased cortical microvessel density. Overall, there is strong evidence that lncRNA is an important class of regulatory molecule, and a number of studies have demonstrated that these can be targeted to change cellular physiology and functions. In this review, we have attempted to summarize these studies and elucidate the potential of this novel regulatory molecule as a therapeutic target.

Thyroid-gonad relationship in bronchial asthma

Serum concentrations of thyroxine (T4), triodothyronine (T3), thyrotropin (TSH), T3 uptake (T3U), free thyroxine (FT4I) and free triodothyronine (FT3I) indices and testosterone (T) were studied by radioimmunoassays to elucidiate thyroid-gonad relationships in 30 men of African origin with bronchial asthma. In asthmatic subjects, (i) there were decreases (p<0.001) in both serum T3, FT3I and T levels;(ii) significant increases (p<0.001) in T3U were not associated with changes in serum T4 and FT4I, indicating an abnormality in thyroid-binding globulins (TBG); and is concluded that the hypophyseal-thyroid-gonadal axis may be set at a lower level in asthmatic patients (AU)

Socio-economic status and lung function in Jamaican children

A study was carried out in Afro-Jamaican children of both sexes, 6 to 15 years of age, to examine the role of socio-economic status on various pneometric tests such as forced vital capacity (FVC), mid-expiratory flow rate (MEFR 0.2-1.2), mean transit time (MTT), peak expiratory flow rate (PEFR), forced expiratory volume (FEV 1.0) and FEV 1.0 percent. Based on the annual income of the parents, the children were subdivided into 3 groups (I,II,III). Statistical analysis of the data revealed significant differences in all pulmonary function tests in children >10 years of age in both sexes and in all the groups, except PEFR in girls and MEFR 0.2-1.2 in boys <10 years of age in group II. The girls belonging to the same groups had higher values for all lung functions except significantly lower values of MTT. The study suggests differences in both central and peripheral airway function, with poorer function in the lower income group children who may be more susceptible to subclinical infections, probably due to malnutrition. The lower lung function in boys was attributed inter alia to lower mean values of height and weight than in girls (AU)

Pulmonary function in cement industry workers

Pulmonary function studies, including one second forced expiratory volume (FEV 1.0 percent) and mean transit time, were carried out in 217 persons employed in the cement manufacturing industry. The results showed that abnormal pulmonary functions were positively correlated with the length of employment and dust concentration. The highest incidence of low FEV 1.0 percent, peak expiratory flow rate and mid-expiratory flow rate were found in the high dust areas where the dust concentration exceeded the threshold limit value (TLV) by 2620 per cent. Most of the abnormalities were of the restrictive type. It is suggested that the quartz content of the raw and finished product may be a causative factor in the disease entity (AU)

Thyroid-gonad relationship in marijuana smokers: a field study in Jamaica

Serum concentrations of thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH), T3 uptake (T3U), free thyroxine index (FTI) and testosterone were studied by radioimmunoassays to elucidate thyroid-gonad relationship in 26 male marijuana smokers in Jamaica. Serum T3 levels were significantly lower (p<0.05) in smokers compared with non-smokers, whereas serum T4, TSH, T3U, FTI and testosterone levels were found to be within normal limits. Decrease in serum T3 levels has been attributed to ingestion of tetrahydrocannabinol in addition to other factors associated with marijuana smoking. Such a profile of thyroid hormones, with no change in TSH, is suggestive of euthyroidism in smokers. The study also did not indicate any alteration in the pituitary-thyroid-gonad axis in chronic marijuana smokers (AU)

Chronic effects of marihuana extract on thyroid-gonad relationship in rats

Studies were carried out to elucidate the effects of Crude Aqueous Marihauna Extract free of tetrahydrocannabinol and other cannabinoids (CAME) on thyroid-gonad relationship in male rats. Oral indigestion of CAME for 52 days increased (p<0.01) the plasma levels of total circulating thyroxine and triiodothyronine, increased the weight of the adrenal gland (p<0.05), slightly decreased the plasma thyrotrophin level and the weight of the thyroid gland. These changes suggest the presence of hyperthyroidism in rats receiving CAME. Increased plasma thyroxine levels in CAME-treated rats correlated with the total plasma testosterone (r=0.526), indicating a possibility of thyroid-gonad relationship in such rats (AU)

Altered thyroid status in marihuana-exposed male rats

The effects of marihuana exposure, particularly of THC-free crude aqueous marihuana extract (CAME) on liver gycogen, total plasma cholesterol, BMR, Raw and growth rate were studied in male Wistar rats. Liver glycogen decreased following administration of CAME and T4 (P<0.01), and increased with methimazole (P<0.01). However, marihuana smoking did not affect liver glycogen. Both marihuana smoking and CAME administration decreased the levels of plasma cholesterol (P<0.01), and methimazole increased them (P,0.01). Airway resistance decreased in rats treated with CAME, T4 and marihuana smoking and decreased with methimazole. The growth rate with marihuana exposure improved slightly (AU)

Response to the central and peripheral airways to cigarette smoking in humans and rats

The effect of tobacco smoke on the central and peripheral airways were assessed in humans and rats by direct and indirect methods. In both species tobacco smoke affected the central and peripheral airways. In humans there were apparent decreases in the 1-second forced expiratory volume, peak expiratory flow rate and significant increases in closing volume and closing capacity (P less than 0.001). In rats significant changes were seen in specific airway resistance from the 6th week of exposure onwards. Similarly, airway luminal diameter decreased markedly in tobacco-exposed animals to subthreshold concentrations of acetylcholine (10(-8) M). This decrease was also exposure time dependent. The increased responsiveness of the respiratory system has been attributed to inter alia: (1) increased vagal activity; (2) increased mucus production leading to decreased airway lumen; (3) mucosal swelling due to changed ionic constellation; (4) disturbance of the lungs' defense mechanism; (5) imbalance in and easy accessibility to the adrenoceptors. (AU)

Maternal respiratory function during pregnancy

Maternal respiratory function in the second (26) and third (76) trimesters of pregnancy was measured in 102 women and showed that: (i) Thirty-eight per cent and 36 percent of the women in second and third trimesters respectively had FEV1.0 percent<75 percent. MTT 0.7 sec. (ii) Nineteen per cent and 29 percent of the women in the second and third trimesters respectively had MTT>0.7 sec. (iii) Pregnancy superimposed on previous respiratory disorders such as bronchial asthma potentiated the compromisation of both central and peripheral airway function in the third trimester in that 41 percent had FEV<75 percent and 34 percent MTT>0.7 sec. It is concluded that normal pregnancy does not significantly affect central and peripheral airway function. However, pregnancy in the presence of upper or lower respiratory tract disease may influence respiratory function negatively. (AU)

Pulmonary function in Afro-Jamaicans: implications in screening

Pneometric parameters and closing volume were measured in 950 Afro-Jamaicans of both sexes. Prediction formulae relating each measurement to age and height were constructed. Based on these formulae it is concluded that differences in compartments of the lung exist in Afro-Jamaicans. Closing volume measurements yielded higher values for Afro-Jamaicans than is observed in white populations. It is suggested that in the absence of baseline values an erroneous diagnosis of small airway disease could result. The possibility that the observed differences may have been due to environmental rather than genetic factors is discussed. (AU)