Primary synovial chondromatosis: a reassessment of malignant potential in 155 cases

OBJECTIVE

Primary synovial chondromatosis (PSC) is a rare disorder characterised by cartilage formation in synovium-lined joints, tendon sheaths and bursae. It is thought that PSC cartilage arises from the proliferation of mesenchymal cells, which exhibit cartilaginous metaplasia in subintimal connective tissue. There are reports of transformation of PSC to chondrosarcoma, although the precise incidence and nature of this complication is uncertain. In this study we carried out a retrospective review PSC to determine the incidence of sarcomatous change in this condition, in addition to the clinical, radiological and pathological features that characterise this complication

MATERIALS AND METHODS

We reviewed 155 cases of PSC and identified 4 cases (3 in the hip joint; 1 in the elbow joint) of aggressive behaviour and chondrosarcoma-like histology.

RESULTS

Radiologically, these cases were all reported as showing features consistent with PSC and aggressive extra-articular soft tissue/bone involvement. Histologically, in addition to typical features of PSC, there was morphological evidence of peri-articular soft tissue and, in 2 cases, bone involvement by an infiltrating cartilaginous tumour. These tumours all behaved as locally aggressive neoplasms and did not give rise to metastasis.

CONCLUSION

Our findings show that chondrosarcoma arises infrequently in PSC (approximately 2.5 %), and that this complication occurs most commonly in the hip joint (approximately 11 % of cases of hip PSC). These tumours behaved mainly as low-grade, locally aggressive tumours analogous to atypical cartilaginous tumour of bone/grade 1 chondrosarcoma of bone.

An apparatus to measure frictional, anelastic, and viscous behavior in ice at temperate and planetary conditions

In this paper, we describe a cryogenic, servo-controlled biaxial friction apparatus designed to measure the deformational behaviors of ice. The apparatus is specifically designed to accurately achieve and measure the low differential stresses applicable to deforming ice on earth and on icy satellites. We can apply loads in the range ∼2-1800 kPa and velocities up to 4 mm/s, with resolution of 39 Pa and 0.7 μm, respectively. Precise temperature control, measurement, and insulation allow testing at constant temperature (from -2 to -30 °C) for prolonged periods of time. The apparatus is tested with various plastics as well as with polycrystalline ice samples and the results are consistent with previously published values. Critical components of the instrument are described along with examples of data collection schemes and preliminary results. The flexibility of the design allows for both glaciological and planetary applications over a range of deformational behaviors including friction, anelastic, and viscous.

Novel antibody associations in immune-mediated necrotising myopathy without inflammation

INTRODUCTION

The patient presenting with proximal muscle weakness, elevated serum creatinine kinase and myopathic electromyography and biopsy findings has a wide differential diagnosis that includes toxic, autoimmune, paraneoplastic and congenital myopathies. Autoimmune myopathies are important to identify because they may respond to immunosuppressive therapies.

METHODS

We describe two cases of immune-mediated necrotizing myopathy each associated with a novel antibody.

RESULTS

Case 1 describes a progressive myopathy in a statin user. Antibodies to 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase were identified and the patient responded to steroid therapy. Case 2 describes an aggressive myopathy associated with antibodies to signal recognition particle. There was no response to steroids. Clinical improvement followed treatment with rituximab and cyclophosphamide.

CONCLUSION

The identification of myositis-specific antibodies is important because they are associated with distinct clinical phenotypes and may guide the physician in terms of treatment strategies.

12 weeks of simulated barefoot running changes foot-strike patterns in female runners

To investigate the effect of a transition program of simulated barefoot running (SBR) on running kinematics and foot-strike patterns, female recreational athletes (n=9, age 29 ± 3 yrs) without SBR experience gradually increased running distance in Vibram FiveFingers SBR footwear over 12 weeks. Matched controls (n=10, age 30 ± 4 yrs) continued running in standard footwear. A 3-D motion analysis of treadmill running at 12 km/h(-1) was performed by both groups, barefoot and shod, pre- and post-intervention. Post-intervention data indicated a more-forefoot strike pattern in the SBR group compared to controls; both running barefoot (P>0.05), and shod (P<0.001). When assessed barefoot, there were significant kinematic differences across time in the SBR group for ankle flexion angle at toe-off (P<0.01). When assessed shod, significant kinematic changes occurred across time, for ankle flexion angles at foot-strike (P<0.001) and toe-off (P<0.01), and for range of motion (ROM) in the absorptive phase of stance (P<0.01). A knee effect was recorded in the SBR group for flexion ROM in the absorptive phase of stance (P<0.05). No significant changes occurred in controls. Therefore, a 12-week transition program in SBR could assist athletes seeking a more-forefoot strike pattern and "barefoot" kinematics, regardless of preferred footwear.

Life threatening sepsis while on high dose steroids requiring extra-corporeal membrane oxygenation

We present a case of life-threatening streptococcal sepsis in a young man with a history of Behçet's disease within two weeks of commencing high dose corticosteroid therapy for an exacerbation of Behçet's disease.

A national survey of clubs medical personnel, facilities and protocols in Irish Rugby Union

BACKGROUND

Rugby Union is one of the most popular sports in Ireland. Participation in all sports carries risk, and there is an onus on governing bodies and those involved in sport to minimise this risk using injury prevention and management programmes.

AIMS

The aim of this study was to evaluate the current status of medical personnel, facilities and equipment in Rugby Union clubs in Ireland.

METHODS

A nationwide cross sectional survey of affiliated clubs in Ireland was undertaken at the beginning of the 2011-2012. Clubs were surveyed on a range of variables including their medical personnel, facilities, equipment, policies and concussion.

RESULTS

47.7 % of those surveyed responded. The majority reported involvement of appropriate medically qualified personnel, having a dedicated medical area/room, a first aid kit and defibrillator, and a demand for first aid courses.

CONCLUSIONS

This survey provided key information on the current medical status of clubs in Ireland to the governing body. Many clubs have adequate medical resources in place, however a large number do not have medical professionals working with them or own basic medical equipment. The results of this study have lead to the development and implementation of a rugby specific injury prevention and management programme for medical and non-medical personnel at all levels of the game in Ireland.

Are we justified in doing blood tests 'routinely' for all neurosurgical patients?

To ensure continuing patient care in a cost effective and efficient manner and to determine the importance of routine pre-op bloods in patients undergoing spine surgery, a retrospective audit of 170 patients was carried out in the Neurosurgery Department at Cork University Hospital. There were 94 males and 76 females. No test had less than 87.4% normal results. There were 17 (10.7%) abnormal haemoglobin levels, 13 (8.2%) abnormal white cell count levels, 14 (8.9%) abnormal creatinine levels and of sodium and potassium levels, 5 (3.2%) and 3 (2%) were abnormal respectively. Of the abnormal results, the majority fell close to reference range. 95% of the total cost incurred in performing the procedure was attributed to normal blood results. Abnormal blood results in this cohort of patients did not alter management. We conclude that routine blood tests, including coagulation screen, may not be necessary in healthy individuals undergoing elective spine surgery.