The clinical and radiological evaluation of the use of an allograft-prosthesis composite in the treatment of proximal femoral giant cell tumours

Giant cell tumour is the most common aggressive benign tumour of the musculoskeletal system and has a high rate of local recurrence. When it occurs in proximity to the hip, reconstruction of the joint is a challenge. Options for reconstruction after wide resection include the use of a megaprosthesis or an allograft-prosthesis composite. We performed a clinical and radiological study to evaluate the functional results of a proximal femoral allograft-prosthesis composite in the treatment of proximal femoral giant cell tumour after wide resection. This was an observational study, between 2006 and 2012, of 18 patients with a mean age of 32 years (28 to 42) and a mean follow-up of 54 months (18 to 79). We achieved excellent outcomes using Harris Hip Score in 13 patients and a good outcome in five. All allografts united. There were no complications such as infection, failure, fracture or resorption of the graft, or recurrent tumour. Resection and reconstruction of giant cell tumours with proximal femoral allograft-prosthesis composite is a better option than using a prosthesis considering preservation of bone stock and excellent restoration of function. A good result requires demanding bone banking techniques, effective measures to prevent infection and stability at the allograft-host junction.

An erupted compound odontoma

Odontomas are familiar entities but their eruption into the oral cavity is an extraordinary occurrence, which may be associated with pain, infection, malocclusion, etc. Not many cases of erupted odontomas have been reported in the literature. This paper puts forth a case of erupting odontoma in an attempt to add to the list of reported cases of this unique pathology.

Ocular disability--WHO grade 2 in persons affected with leprosy

Leprosy remains to be a leading cause of peripheral neuropathy and disability. In recent years under Leprosy control programme more stress is being laid on disability assessment. This study was aimed to find prevalence of grade of Ocular disability among persons affected with leprosy (PAL) according to WHO disability grading scale and to find Ocular contributors to grade 2 disability in PAL. A cross sectional study was carried out in tertiary care hospital in Lucknow, Uttar Pradesh. About 302 PAL were interviewed and their eyes clinically examined during 2 years. Data was analysed in percentages, x2 test, Anova. Ocular disability was found in 39.40% persons affected with leprosy (PAL). Of 604 eyes, 13.07% had grade 1 disability and 19.86% had grade 2 disabilities. Bilateral disability was more common than unilateral disability. Ocular disability was more common in PAL with more than one year of leprosy and even higher in those staying in leprasoria (p = 0.012). The most common cause of ocular grade 2 disabilities was corneal involvement (14.23% PAL). Cataract was found to be the most common cause of visual disability (although it is not caused by leprosy). Screening for ocular disability should be incorporated as a routine protocol in PAL to reduce the severity of Ocular disability. Early diagnosis and prompt preventive measure is essential to reduce the burden of visual impairment and blindness in PALthus bringing down the load of grade 2 disability due to leprosy in the society which in itself is an indicator of leprosy control.

Quality of operation notes in orthopaedic hip arthroplasty surgery: are we complying with British Orthopaedic Association's guide to good practice?

This retrospective audit evaluates the compliance of our operation notes with the British Orthopaedic Society Primary Hip Arthroplasty 'A guide to good practice' using a 24-data point question (BOA 2006). Ninety-nine notes reviewed, of which 94% had patient identifiers, the surgical team was documented in 92.5%, post-operative instruction in 97%, and prosthesis stability in 97% of cases. Despite high standards, we did not achieve the 100% gold standard. We suggest that increased awareness of the 24-point BOA guideline via education and proformas would help to ensure better practice

Lack of activity of 15-epi-lipoxin A₄ on FPR2/ALX and CysLT1 receptors in interleukin-8-driven human neutrophil function

Neutrophil recruitment and survival are important control points in the development and resolution of inflammatory processes. 15-epi-lipoxin (LX)A interaction with formyl peptide receptor 2 (FPR2)/ALX receptor is suggested to enhance anti-inflammatory neutrophil functions and mediate resolution of airway inflammation. However, it has been reported that 15-epi-LXA₄ analogues can also bind to cysteinyl leukotriene receptor 1 (CysLT1) and that the CysLT1 antagonist MK-571 binds to FPR2/ALX, so cross-reactivity between FPR2/ALX and CysLT1 ligands cannot be discarded. It is not well established whether the resolution properties reported for 15-epi-LXA4 are mediated through FPR2/ALX, or if other receptors such as CysLT1 may also be involved. Evaluation of specific FPR2/ALX ligands and CysLT1 antagonists in functional biochemical and cellular assays were performed to establish a role for both receptors in 15-epi-LXA₄-mediated signalling and function. In our study, a FPR2/ALX synthetic peptide (WKYMVm) and a small molecule FPR2/ALX agonist (compound 43) induced FPR2/ALX-mediated signalling, enhancing guanosine triphosphate-gamma (GTPγ) binding and decreasing cyclic adenosine monophosphate (cAMP) levels, whereas 15-epi-LXA₄ was inactive. Furthermore, 15-epi-LXA4 showed neither binding affinity nor signalling towards CysLT1. In neutrophils, 15-epi-LXA₄ showed a moderate reduction of interleukin (IL)-8-mediated neutrophil chemotaxis but no effect on neutrophil survival was observed. In addition, CysLT1 antagonists were inactive in FPR2/ALX signalling or neutrophil assays. In conclusion, 15-epi-LXA₄ is not a functional agonist or an antagonist of FPR2/ALX or CysLT1, shows no effect on IL-8-induced neutrophil survival and produces only moderate inhibition in IL-8-mediated neutrophil migration. Our data do not support an anti-inflammatory role of 15-epi-LXA₄- FPR2/ALX interaction in IL-8-induced neutrophil inflammation.

Acquired lacrimal sac fistula mimicking basal cell carcinoma

BACKGROUND

Lacrimal sac fistulae can arise after an episode of dacryocystitis, usually forming below the medial canthus. Preceding symptoms of a watery eye with mucous discharge and a history or signs of inflammation are typical.

OBJECTIVES

To highlight the features of lacrimal sac fistulae and encourage readers to consider this in the differential diagnosis of apparently ulcerative medial canthal skin lesions.

METHODS

We describe three patients with inferior-medial canthal ulcerative skin lesions, all referred to ophthalmic plastic surgeons either by dermatologists or plastic surgeons, presumed clinically to have basal cell carcinoma (BCC).

RESULTS

All three were in fact due to acquired lacrimal sac fistulae, and syringing of the nasolacrimal system confirmed the presence of a fistula.

CONCLUSIONS

These cases illustrate the importance of questioning patients about their previous ocular symptoms when dealing with less familiar periocular lesions.

A comparison of facial muscle squeezing versus non-facial muscle squeezing on the efficacy of botulinumtoxin-A injections for the treatment of facial dystonia

BACKGROUND

This study was performed to address whether voluntary muscle squeezing post botulinum toxin-A treatment with increased neuronal activity translates into noticeable patient benefit in practice.

METHODS

This was a prospective, consecutive, double crossover interventional study. Participants were receiving regular (3 monthly) botulinum toxin-A treatment for aberrant facial nerve regeneration (AFNR), benign essential blepharospasm (BEB) or hemifacial spasm (HFS). Twenty-six participants were recruited and these were randomised into two groups (A and B). Group A performed a program of intensive facial exercises for 5 minutes after their first and third treatment whereas after their second treatment, they were asked to rest in a seated position for 5 minutes, and instructed not to talk or perform any voluntary movements of their face. Conversely group B were only asked to perform squeezing exercises after their second treatment. Outcomes were evaluated objectively using video-recordings and subjectively by questionnaire and telephone interview of participants.

RESULTS

Video-recording data was complete for 21 participants. There was a mean 40% reduction in the frequency of facial muscle spasms and a 33% lower severity score (video-recordings graded by 1 masked investigator) where intensive facial exercises were performed post-treatment. These findings did not reach statistical significance (Mann- Whitney two-tailed test; p = 0.367).

CONCLUSION

Although statistical significance was not achievable, this study suggested a possible trend towards an increased efficacy of botulinum toxin-A, with facial muscle squeezing post BTX treatment. Future studies with a larger number and a better defined subset of subjects may lead to statistical significance.

A comparative analysis between fixed bearing total knee arthroplasty (PFC Sigma) and rotating platform total knee arthroplasty (PFC-RP) with minimum 3-year follow-up

BACKGROUND

Since the introduction of mobile bearing total knee designs nearly 30 years back, many studies have been done to evaluate its long-term result. Comparison with fixed bearing designs has been done in the past, but the studies were confounded by variables such as disease, surgeon, bone quality, pain tolerance, etc. We attempt to eliminate these variables in this study.

METHODS

A total of 50 patients who had bilateral arthritis of the knee with similar deformity and pre-operative range of motion on both sides agreed to have one knee replaced with mobile bearing total knee design (PFC-RP) and the other with a fixed bearing design (PFC Sigma) were prospectively evaluated. Comparative analysis of both the designs was done at a mean follow-up of 40 months, minimizing patient, surgeon and observer related bias. Clinical and radiographic outcome, survival and complication rates were compared.

RESULTS

At a mean follow-up of 40 months (range 36-47 months), no benefit of mobile bearing (PFC-RP) over fixed bearing design (PFC Sigma) could be demonstrated with respect to Knee Society scores, pain scores, range of flexion, subject preference or patello-femoral complication rates. Radiographs showed no difference in prosthetic alignment. No patient required a revision surgery till last follow-up.

CONCLUSIONS

Our study demonstrated no advantage of the mobile-bearing arthroplasty over fixed bearing arthroplasty with regard to clinical results at short-term follow-up. However, longer follow-up is necessary to confirm whether these results are sustained.

Dry eyes can be exacerbated by systemic antihypertensive medication

Dry eye disease (DED) is a frequent problem in ophthalmology, causing considerable morbidity. DED is a multifactorial disease and requires a comprehensive approach in identifying the potential contributing factors. Often, clinicians overlook the fact that systemic medications are a cause of dry eye. We report two patients who developed symptoms and signs of DED secondary to systemic antihypertensive medication that improved following cessation of systemic medication.

MicroRNA let-7: an emerging next-generation cancer therapeutic

In recent years, various RNA-based technologies have been under evaluation as potential next-generation cancer therapeutics. Micrornas (miRNAS), known to regulate the cell cycle and development, are deregulated in various cancers. Thus, they might serve as good targets or candidates in an exploration of anticancer therapeutics. One attractive candidate for this purpose is let-7 ("lethal-7"). Let-7 is underexpressed in various cancers, and restoration of its normal expression is found to inhibit cancer growth by targeting various oncogenes and inhibiting key regulators of several mitogenic pathways. In vivo, let-7 administration was found effective against mouse-model lung and breast cancers, and our computational prediction supports the possible effectiveness of let-7 in estrogen receptor (ER)-positive metastatic breast cancer. Data also suggest that let-7 regulates apoptosis and cancer stem cell (CSC) differentiation and can therefore be tested as a potential therapeutic in cancer treatment. However, the exact role of let-7 in cancer is not yet fully understood. There is a need to understand the causative molecular basis of let-7 alterations in cancer and to develop proper delivery systems before proceeding to therapeutic applications. This article attempts to highlight certain critical aspects of let-7's therapeutic potential in cancer.

Lattice-Type Polymers from an Adduct of C60 and 2-Methylaziridine

A one to ten adduct of C60 and 2-methylaziridine was prepared and copolymerized with Novolac, Epon and Bisphenol A to obtain three dimensional polymers containing C60 with low coefficients of friction and good wear properties, which bode well for their potential use as solid lubricants.