Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Long-term efficacy of total versus posterior partial fundoplication in patients with gastro-oesophageal reflux disease: a systematic review and meta-analysis

INTRODUCTION

Laparoscopic fundoplication remains the standard treatment for patients with severe gastro-oesophageal reflux disease (GORD). Multiple randomised controlled trials (RCTs) have compared the two most commonly performed surgical techniques, total and posterior partial fundoplication (Nissen [NF] and Toupet [TF]), in terms of symptom control and treatment failure in patients without subsequent dysmotility disorders. We aimed to conduct a systematic review and meta-analysis of these two techniques with regard to the long-term effect on reflux control and associated dysphagia.

METHODS

The MEDLINE®, Embase®, PubMed® and Cochrane Library databases were searched, and all the relevant published RCTs were shortlisted according to the inclusion criteria. The summated outcomes of long-term results relating to the recurrence of GORD and dysphagia were evaluated in a meta-analysis using RevMan software.

RESULTS

Eight studies (all RCTs) on 1,545 patients undergoing NF or TF were eligible for inclusion in this meta-analysis. There were 799 patients in the NF group and 746 in the TF group. In the random effects model analysis, the incidence of long-term recurrence of GORD was not statistically different between the NF and TF cohorts (odds ratio [OR]: 0.69, 95% confidence interval [CI]: 0.34-1.41, z=1.01, p=0.31). However, the incidence of long-term dysphagia was statistically lower in the TF group (OR: 2.92, 95% CI: 1.49-5.72, z=3.13, p=0.002) with low between-study heterogeneity (I2=0%).

CONCLUSIONS

The findings of this systematic review and meta-analysis on symptomatic GORD appear to be in favour of partial posterior fundoplication (TF) as the optimal treatment. It provides equivalent outcomes in reflux symptom control with a lower risk of postoperative dysphagia compared with total fundoplication (NF).

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

499 Upper GI Surgical Clinic Referrals, Can We Improve Patient Experience?

Introduction

With increasing pressure on NHS to deal with long waiting lists, solutions to reduce waiting times are imperative. In the era of the COVID-19 pandemic, we need to reshape the way we look into Outpatient clinic appointments.

Aim

To review all clinic referrals to UGI surgical clinic and highlight any potential pathways that can improve waiting times and patient experience.

Method

Patients referred to UGI clinic over 2 months were collected from Iclip, EPR and EDM. Post-discharge appointments and DNA’s were excluded. Data collected included time from referral to clinic, type of referral, symptoms, investigations, potential pathway, first clinic outcome, and appropriateness of referral.

Results

Total of 147 referrals analyzed. Time from referral to clinic appointment is 51 days. GP referrals represented 73% while the rest from consultant colleagues. The most common symptoms were biliary colic and GORD. OGD and PH manometry were the most common investigations requested. The most common first outcome was pre investigate and clinic follow up. Two potential pathways identified are Biliary colic and GORD pathway. 90% of referrals were appropriate.

Conclusions

Biliary colic pathway and GORD pathway are 2 potential pathways that can cut off waiting times for clinic appointments and improve patient experience in outpatient clinics.

Abstract P3-08-13: Exploring the role of ctDNA in triple negative breast cancer

BACKGROUND: Previously published work shows that triple negative (TNBC) is a heterogeneous disease with varying levels of genomic instability, where higher genomic instability is associated with poorer prognosis. Subgroups of TNBC patients with distinct patterns of genome aberrations may indicate pathologies in specific genome maintenance/repair processes. Circulating tumor DNA (ctDNA) as assessed by next generation sequencing (NGS) is a relatively non-invasive test that may provide prognostic and predictive information.

AIM OF STUDY: To analyze genomic alterations with serial plasma samples using NGS methods of ctDNA analysis and determine the utility for actionability and disease burden monitoring. We shall also determine whether TNBC subgroups differ in their ctDNA profiles. Shallow whole genome sequencing vs targeted capture at depth will be contrasted to determine sensitivity for relapse detection.

METHODS: Enrollment of a planned cohort of TNBC patients (N=300) with any stage, at diagnosis (dx) or within 2 years of dx, or at relapse of disease with ongoing plasma sampling every 3 -6 months. Patient age, stage, grade, type of chemotherapy, date of relapse and date of last followup are collected. Tumor tissue (FFPE), saliva for germline mutations and serial blood draws for ctDNA are analyzed with two NGS sequencing methods: (i) a high sensitivity small hotspot gene panel (33 genes, 170 hotspots), directed purely at actionable findings (ii) capture sequencing directed at multiple regions of the genome or shallow whole genome sequencing.

RESULTS: Preliminary analysis in 20 patient cases using the targeted hotspot panel. . Median followup 151 days. Two cases had plasma drawn at time of relapsed disease and 1 at the time of de novo metastatic disease; 12 had plasma samples drawn prior to neoadjuvant chemotherapy (clinical T1/T2N1, T3/T4Nany), and 5 had plasma draws after primary surgery (pathologic T1N0, T2N0). Of the neoadjuvant cases, 5 (42%) had a pathologic complete response (pCR); 4 with ctDNA mutations and 1 without. Six (58%) neoadjuvant cases did not achieve a pCR; 3 with ctDNA mutations, 3 without. One patient is awaiting surgery. Twelve (60%) cases had mutations in TP53, one case had 2 different TP53 mutations (no pCR) and one case had 3 mutations: TP53, PIK3CA, KRAS (achieved pCR). Of the cases treated with curative intent, with short followup (FU), there have been no relapses including the case of the sample containing 3 mutations.

CONCLUSION: TP53 mutations may be a marker of higher genomic alteration burden and may have prognostic value in patients with newly diagnosed, non-metastatic TNBC with longer FU. Ongoing analysis of serial plasma samples and FFPE analysis may provide further insight into the prognostic value of ctDNA. Full genome sequencing may be needed identify other mutations that have prognostic and/or predictive value. We have accrued over 200 patients with samples being analyzed and plan to present an interim analysis of the cohort at SABCS 2018.

Citation Format: den Brok WD, Kong E, Bates C, Aguirre-Hernandez R, Miller RR, Lum A, Wan A, Shah S, Aparicio S, Gelmon KA. Exploring the role of ctDNA in triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-08-13.

An unusual diaphragmatic hernia with gastric perforation and sub-acute presentation

Gastric perforation into the thoracic cavity through a diaphragmatic hernia is rare but, when it occurs, patients present in severe distress, with mortality approaching 50%. We present a unique case in which a fibrotic reaction between the stomach and the parietal pleura led to a subacute presentation upon perforation. The extra time that this afforded led to more effective multidisciplinary team management and ultimately an excellent outcome for the patient.

Demonstration of High Performance in Layered Deuterium-Tritium Capsule Implosions in Uranium Hohlraums at the National Ignition Facility

We report on the first layered deuterium-tritium (DT) capsule implosions indirectly driven by a "high-foot" laser pulse that were fielded in depleted uranium hohlraums at the National Ignition Facility. Recently, high-foot implosions have demonstrated improved resistance to ablation-front Rayleigh-Taylor instability induced mixing of ablator material into the DT hot spot [Hurricane et al., Nature (London) 506, 343 (2014)]. Uranium hohlraums provide a higher albedo and thus an increased drive equivalent to an additional 25 TW laser power at the peak of the drive compared to standard gold hohlraums leading to higher implosion velocity. Additionally, we observe an improved hot-spot shape closer to round which indicates enhanced drive from the waist. In contrast to findings in the National Ignition Campaign, now all of our highest performing experiments have been done in uranium hohlraums and achieved total yields approaching 10^{16} neutrons where more than 50% of the yield was due to additional heating of alpha particles stopping in the DT fuel.

Thin shell, high velocity inertial confinement fusion implosions on the national ignition facility

Experiments have recently been conducted at the National Ignition Facility utilizing inertial confinement fusion capsule ablators that are 175 and 165  μm in thickness, 10% and 15% thinner, respectively, than the nominal thickness capsule used throughout the high foot and most of the National Ignition Campaign. These three-shock, high-adiabat, high-foot implosions have demonstrated good performance, with higher velocity and better symmetry control at lower laser powers and energies than their nominal thickness ablator counterparts. Little to no hydrodynamic mix into the DT hot spot has been observed despite the higher velocities and reduced depth for possible instability feedthrough. Early results have shown good repeatability, with up to 1/2 the neutron yield coming from α-particle self-heating.

Introgression of leaf rust and stripe rust resistance from Sharon goatgrass (Aegilops sharonensis Eig) into bread wheat (Triticum aestivum L.)

Leaf rust and stripe rust are devastating wheat diseases, causing significant yield losses in many regions of the world. The use of resistant varieties is the most efficient way to protect wheat crops from these diseases. Sharon goatgrass (Aegilops sharonensis or AES), which is a diploid wild relative of wheat, exhibits a high frequency of leaf and stripe rust resistance. We used the resistant AES accession TH548 and induced homoeologous recombination by the ph1b allele to obtain resistant wheat recombinant lines carrying AES chromosome segments in the genetic background of the spring wheat cultivar Galil. The gametocidal effect from AES was overcome by using an "anti-gametocidal" wheat mutant. These recombinant lines were found resistant to highly virulent races of the leaf and stripe rust pathogens in Israel and the United States. Molecular DArT analysis of the different recombinant lines revealed different lengths of AES segments on wheat chromosome 6B, which indicates the location of both resistance genes.

Observation of turbulent intermittency scaling with magnetic helicity in an MHD plasma wind tunnel

The intermittency in turbulent magnetic field fluctuations has been observed to scale with the amount of magnetic helicity injected into a laboratory plasma. An unstable spheromak injected into the MHD wind tunnel of the Swarthmore Spheromak Experiment displays turbulent magnetic and plasma fluctuations as it relaxes into a Taylor state. The level of intermittency of this turbulence is determined by finding the flatness of the probability distribution function of increments for magnetic pickup coil fluctuations B˙(t). The intermittency increases with the injected helicity, but spectral indices are unaffected by this variation. While evidence is provided which supports the hypothesis that current sheets and reconnection sites are related to the generation of this intermittent signal, the true nature of the observed intermittency remains unknown.

Cancer-associated somatic DICER1 hotspot mutations cause defective miRNA processing and reverse-strand expression bias to predominantly mature 3p strands through loss of 5p strand cleavage

Our group recently described recurrent somatic mutations of the miRNA processing gene DICER1 in non-epithelial ovarian cancer. Mutations appeared to be clustered around each of four critical metal-binding residues in the RNase IIIB domain of DICER1. This domain is responsible for cleavage of the 3' end of the 5p miRNA strand of a pre-mRNA hairpin. To investigate the effects of these cancer-associated 'hotspot' mutations, we engineered mouse DICER1-deficient ES cells to express wild-type and an allelic series of the mutant DICER1 variants. Global miRNA and mRNA profiles from cells carrying the metal-binding site mutations were compared to each other and to wild-type DICER1. The miRNA and mRNA profiles generated through the expression of the hotspot mutations were virtually identical, and the DICER1 hotspot mutation-carrying cells were distinct from both wild-type and DICER1-deficient cells. Further, miRNA profiles showed that mutant DICER1 results in a dramatic loss in processing of mature 5p miRNA strands but were still able to create 3p strand miRNAs. Messenger RNA (mRNA) profile changes were consistent with the loss of 5p strand miRNAs and showed enriched expression for predicted targets of the lost 5p-derived miRNAs. We therefore conclude that cancer-associated somatic hotspot mutations of DICER1, affecting any one of four metal-binding residues in the RNase IIIB domain, are functionally equivalent with respect to miRNA processing and are hypomorphic alleles, yielding a global loss in processing of mature 5p strand miRNA. We further propose that this resulting 3p strand bias in mature miRNA expression likely underpins the oncogenic potential of these hotspot mutations.

Novel quantum dots-carboxymethyl chitosan nanocomposite nitric oxide donors capable of detecting release of nitric oxide in situ

Nitric oxide (NO) donor compounds are primarily monofunctional in that they release NO under the requisite conditions. To detect the amount and duration of NO released, subsequent analysis methods are required. It would be advantageous if a NO donor compound could both release and detect NO at the same time. This would eliminate potential errors in the analysis. In this paper, novel cadmium telluride quantum dots (CdTe QD)-carboxymethyl chitosan (CMCS) nanocomposite NO donors, including both diazeniumdiolates and fluorescence probes, were fabricated by first synthesizing CdTe QD in CMCS aqueous solution and then reacting NO as well as ethyl bromide with the resultant CdTe QD-CMCS nanocomposites. Transmission electron microscopy, scanning electron microscopy and particle size analysis were used to examine the morphology and size distribution of the CdTe QD-CMCS nanocomposite NO donors. The donors are nanospheres with CdTe QD encapsulated and have dimensions of ~300 nm. Fourier transform infrared spectroscopy, X-ray diffraction, X-ray photoelectron spectroscopy and contact angle tests were employed to characterize the chemical structure of the donors, and the results also show that CdTe QD are well incorporated into CMCS, and many of them are close to the surface of the donors. The precursors of the donors exhibit a fluorescent effect, and the fluorescence can be quenched by NO. The donors can release NO spontaneously in a phosphate-buffered saline solution similar to a physiological environment, and can quantitatively detect the release of NO in situ based on fluorescence quenching of the donors by the NO.

Mesenteric paraganglioma with gallbladder paraganglion nest

We report on an original case of a 64 year old lady diagnosed with an extraadrenal mesenteric paraganglioma associated with an incidental histological finding of a gallbladder paraganglion. Paragangliomas are rare neuroendocrine, neural crest-derived tumours, found in diverse locations and display variable catecholamine secreting behaviour. Malignant potential can be difficult to predict on histology. We review the current literature on these multifarious tumours.

A changing pattern of injuries to horse riders

OBJECTIVES

To describe the demographics and nature of injuries occurring on or around horses, to examine the nature of protective clothing in relation to these injuries, and to compare our data with previously published work in this area.

METHODS

Patients were identified using the term "sports injury-horse riding" from the departmental database for one calendar year from February 2000. Data were collected regarding demographics, injuries, protective clothing, and outcome. The data were then analysed and compared with the previously published literature.

RESULTS

260 patients' records were analysed. The patients were mostly young (median age 26) and female (84.6%). The majority of patients had a single injury (88.8%). Seventeen per cent had an isolated head injury, all of which proved to be minor. Multiple injuries including the head accounted for 8.5% of all injuries. These again proved minor, bar one fatality where the helmet came off before impact. Upper limb injuries accounted for 29.2% of all injuries of which 61.8% sustained a fracture of which 36.2% were to the wrist. When compared with previous work the incidence and severity of head injury continues to decline while the relative number and severity of upper limb injuries increases.

CONCLUSIONS

The majority of head injured riders are wearing approved helmets and sustaining only minor injury. There is currently no protective gear recommended for the upper limb and more specifically the wrist. This paper identifies the potential need for research and development of such protection.

A technique for safe placement of a biliary endoprosthesis after laparoscopic choledochotomy

BACKGROUND

Biliary endoprosthesis has been proposed as an alternative to T-tube placement after laparoscopic choledochotomy in an attempt to eliminate the complications associated with T-tubes. Biliary endoprostheses have been, until now, placed under fluoroscopic guidance. We present a modification of Gersin's method for endoprosthesis placement under direct vision.

PATIENTS AND METHODS

As of July 2001, seven patients who fulfilled the criteria for common bile duct (CBD) exploration through a choledochotomy, a biliary endoprosthesis was inserted under direct vision at the end of the procedure with primary closure of the CBD above it. In all cases, plastic biliary stents 10F in diameter were used ranging from 5 to 10 cm in length. We describe in detail the technique of CBD stent placement using the choledochoscope as the advancing device. We also propose the use of intraoperative cholangiography instead of on-table endoscopy to check the final correct position of the stent.

RESULTS

The median postoperative hospital stay was 2 days. Two patients developed transient hyperamylasemia in the immediate postoperative period. None of the patients developed short-term complications (<30 days), namely bile leak, CBD erosion, stent occlusion, or stent migration. The long-term results revealed early return to full daily activities and normal liver function tests. Stents were removed endoscopically 4 weeks after the initial procedure except in two patients who spontaneously passed them.

CONCLUSION

We propose a 10F 10-cm biliary endoprosthesis placed under direct vision as a safe, effective, time-sparing, and cost-effective adjunct to CBD exploration through a choledochotomy. Placement of the endoprosthesis is associated with low morbidity and eliminates the complications related to T-tubes.

Investigation of colonic disease

Bowel cancer awareness among the general public has heightened in recent years. The promotion of prompt referral and the pressure on early diagnosis will alter our previous strategies on colonic evaluation. This article gives an overview of the colonic investigations currently available.

A controlled study of the morphometric changes in the primary dentition of pre-term, very-low-birthweight children

The aim of the present investigation was to compare the dimensions of the primary incisors from pre-term children and full-term controls. One hundred and eleven pre-term children, consisting of 86 very-low-birthweight (< 1,500 g), 25 low-birthweight (from 1,500 to 2,500 g), and 169 full-term, normal-birthweight (> 2,500 g) children, donated a total of 572 maxillary and mandibular primary central and lateral incisors for study. The teeth were measured by means of a digital micrometer. The results showed that there was a dose-response effect of birthweight on tooth size. The very-low-birthweight teeth showed the smallest dimensions, the normal-birthweight controls the largest, and the low-birthweight teeth intermediate dimensions (p < 0.001). In the maxillary primary central and lateral incisors, and the mandibular primary central incisors, very-low-birthweight teeth were from 6 to 11% smaller in both mesiodistal and faciolingual dimensions compared with normal-birthweight teeth (p < 0.001). The largest differences were observed in the maxillary lateral incisors, where mean decreases of 0.58 +/- 0.45 mm in mesiodistal and 0.50 +/- 0.40 mm in faciolingual dimensions (11% reduction in both measurements) were observed. In addition, in the mandibular and maxillary lateral incisors of very-low-birthweight children, the left-sided teeth were significantly smaller than those on the right side in both mesiodistal and faciolingual dimensions (p < 0.03).

Early experience and validation work with Procedicus VA--the Prosolvia virtual reality shoulder arthroscopy trainer

Shoulder arthroscopy is a difficult procedure, commonly used for both diagnostic and therapeutic purposes. Until now, the majority of training has been done in theatre, assisting and practising under supervision. Few good simulations exist. Procedicus VA, from Prosolvia Clarus, is a virtual reality simulation of shoulder arthroscopy, with interactive graphics and haptic feedback. The simulator has various modes including anatomy manipulation pathology subacromial decompression. We describe our experience with the simulator, attempting to validate some of the scoring mechanisms, and highlighting some of the pitfalls discovered as the simulator is first trialled by surgeons. This early experience has highlighted both successful aspects of the simulator, and some of the initial pitfalls. Our initial experience confirms the need for close collaboration between virtual programmers and surgical trainers. We are revising the assessment criteria over the coming months.

Prevalence of caries in urban Australian aborigines aged 1-3.5 years

PURPOSE

This study investigated the prevalence and etiological factors associated with caries in a group of young Australian aboriginal children from 1 to 3.5 years of age.

METHODS

One hundred and forty-seven healthy infants, aged from 1 to 3.5 years, attending a community health center in Brisbane, a nonfluoridated state capital city, were randomly selected for the study.

RESULTS

The caries prevalence was 39% by subjects and 32% by the total number of teeth present. The mean number of decayed, filled teeth (dtf) was 2.5 +/- 0.4, which is more than twice the figure for 3-year-old children in Australia. Furthermore, the filled (f) component represented only 1% of the total dft, suggesting very low treatment levels. Increased caries experience of the infants was strongly associated with high dental plaque scores, high levels of Streptococcus mutans infection, and sleep-time consumption of milk containing added sugar.

CONCLUSION

The results suggest that urban Australian aboriginal infants are at high risk for caries, and that preventive strategies are urgently required.

The prevalence of pre-eruptive dentin radiolucencies in the permanent dentition

PURPOSE

Although intracoronal radiolucencies in radiographs of unerupted teeth have been reported for several decades, the prevalence of this condition remains unknown. This study determined the prevalence and associated dental conditions of permanent teeth showing pre-eruptive dentin radiolucencies in bite-wing radiographs of school children attending two school dental therapy training centers.

METHODS

There were 1959 subjects (934 males and 1025 females), each providing a set of bite-wing radiographs which showed the crowns of unerupted permanent teeth. The mean age of the children at radiographic exposure was 7.8 +/- 1.79 years of age.

RESULTS

126 (6%) of subjects had radiolucencies in the crowns of pre-eruptive permanent teeth. Of the 9919 teeth viewed on the radiographs, 163 (2%) were affected. There were no significant racial and gender differences in the prevalence of the defects. Of the 126 subjects with dentin radiolucencies, 93 (74%) had only 1 affected tooth compared with 31 (25%) who had two teeth affected, and 2 (2%) who had 3 affected teeth.

CONCLUSIONS

Within each tooth type, the highest tooth prevalence was found in the mandibular first molar (4%), followed by the mandibular first premolar (2%), the mandibular second molar (1%), mandibular second premolar (1%), maxillary first molar (1%), maxillary first premolar (1%), and maxillary second premolar (0.2%). In addition, the group with dentin radiolucencies had a high prevalence of ectopically-positioned teeth of 14% compared with only 2% in the group without the defect, suggesting that ectopic position may predispose a tooth to pre-eruptive radiolucent defects. Other common developmental and acquired dental conditions were also examined, but no significant differences were noted between groups with and without the pre-eruptive dentin radiolucencies.

Prevalence of G6PD deficiency among recruits in the Singapore Armed Forces

Between 1986 and 1990, 107,397 National Servicemen between the ages of 17 to 18 years were screened on enlistment for Glucose-6-Phosphate Dehydrogenase (G6PD) enzyme activity by fluorescent spot test. The overall prevalence rate was 1.6% with ethnic differences as follows: 1.62% for Chinese, 1.80% for Malay, 0.76% for Indian and 0.68% for other races. The majority had no prior knowledge of their G6PD deficiency status (89.9%), or of any significant haemolytic episode (93.3%). The rest gave a history of neonatal jaundice, non-neonatal jaundice, anaemia and haemoglobinuria. Maloprim, fava beans, sulphur drugs and aspirin were cited as triggering factors.

Interscalene brachial plexus blocks in the management of shoulder dislocations

Interscalene brachial plexus block is a simple and effective alternative to intravenous benzodiazepines or general anaesthesia for manipulation of the dislocated shoulder. Thirty interscalene brachial plexus blocks were performed on 29 patients with dislocations of the shoulder to provide regional anaesthesia for reduction. Pain was abolished by 14 out of the 30 blocks performed, improved by 13 and unchanged by three. Muscle relaxation (MRC grade 3 or less) occurred in 21 patients. In 26 cases the block allowed reduction of the dislocation without additional analgesia or sedative. Reduction was not possible in four cases. There were no significant complications.

Locking of the distal radio-ulnar joint due to loose bodies

A patient is described in whom loose bodies in the distal radio-ulnar joint caused intermittent locking of rotation of the forearm.

Locking of the Distal Radio-Ulnar Joint Due to Loose Bodies

A patient is described in whom loose bodies in the distal radio-ulnar joint caused intermittent locking of rotation of the forearm.