ABSTRACT
Background: Plasma cell leukemia (PCL) is a rare, yet aggressive plasma cell (PC) neoplasm, variant of multiple myeloma (MM), characterized by high levels of PCs circulating in the peripheral blood. PCL can either originate de novo (primary PCL) or as a secondary leukemic transformation of MM (secondary PCL) and is characterized by circulating PCs >2×109/L in peripheral blood and a peripheral blood plasmacytosis >20%. Aims & Objective: Present study was undertaken to analyze the main clinical & pathological features of PCL. For diagnostic purpose the morphological appearances and confirmation by immunophenotyping are emphasized rather than more sophisticated testing methods that may not be widely available. Material and Methods: A descriptive study was carried out in the department of Pathology, in a tertiary care teaching hospital, Ahmedabad, India during year 2009-2013. We investigated the important clinical characteristics, pathological, biochemical & radiological features, immunophenotype, & prognostic factors of 7 patients of PCL. Results: Common clinical features at diagnosis were anaemia, renal insufficiency, bone pain, splenomegaly or hepatomegaly. Anaemia, leucocytosis, thrombocytopenia & plasmacytosis were seen in peripheral blood. Plasma cell marker - CD 38 & CD 138 were expressed in all cases. Serum β2-microglobulin, serum LDH were increased & serum albumin was decreased in all 7 cases & were associated with poor prognosis. The median survival time from diagnosis was 9 months. Conclusion: Plasma cells have characteristic morphological features which can be easily identified on peripheral blood & bone marrow examination.CD 38 & CD 138 are excellent plasma cell markers. Increased serum β2-microglobulin & serum LDH & decreased serum albumin are potent poor prognosis factors. PCL is aggressive neoplasm with poor response to chemotherapy & low median survival time from diagnosis.
ABSTRACT
Background: Proximal humerus fractures are very common fractures occurring in the skeleton. They account for approximately 4 – 5% of the fracture attendance at the hospital. It is the most common fracture of shoulder girdle. It is the 3rd most common fracture in elderly. Till date various methods are used including percutaneous and open reduction & fixation according to fracture type. Aims & Objective: To study the occurrence, mechanism of injury and displacement of various types of fractures and different modalities of the fixations in proximal humerus fractures. Come to conclusion about preferred modality of treatment of proximal humerus fractures according to the pattern of fracture. Material and Methods: In present study 44 patients of complex fracture of proximal humerus treated with either open reduction internal fixation or percutaneous fixation from 2009 to 2012. Follow up assessment was done by Constant score. Results: Radiological union occur at about 8 to 12 weeks. Closed reduction and percutaneous k wire or cancellous screws fixation showed excellent results in majority cases of 3 -part fracture. All 4 part fractures are treated with ORIF. Open reduction and internal fixation with locking compression plates showed good results among all implants used. Conclusion: Principle of fixation is reconstruction of the articular surface, including the restoration of the anatomy, stable fixation, with minimal injury to the soft tissues preserving the vascular supply, should be applied. Majority of poor results are due to poor surgical techniques and lack early physiotherapy.
ABSTRACT
Background: Proximal third femur fractures are common fractures seen in community. Till date large numbers of intramedullary and extramedullary implant were used in the treatment of these fractures. These fractures differ significantly from femoral shaft fractures and more proximal femoral fractures in mechanisms, treatment and complications. In 1996 AO group has introduced proximal femoral nail (PFN) for treatment of these fractures. The use of PFN in both these fractures resulted in rotational stability along with union in more anatomic position. Aims & Objective: To prove the advantages of PFN like (1) close reduction of fracture which decreases the blood loss and chance of infection; (2) controlled impaction of the fracture; (3) rotational stability; and (4) load bearing capacity of the implant. Material and Methods: We have done a retrospective study of proximal femur fractures operated with proximal femoral nailing at our institute with follow up of 5 – 36 months. Our study included 30 patients with 8 patients having intertrochanteric fracture and 22 patients having subtrochanteric fracture. Patient was asked to come for follow up on 1, 2, 3 and 6 months from the date of surgery. At each follow up patient was assessed clinically as per Harris Hip score12 and x ray AP/LAT view of hip with femur is taken. Results: It concludes that according to Boyd and Griffith classification type II is the most common variety. In our study excellent to good results noted in 74% patients. All of them performing their routine normal activity well. 5 patients had poor results. Complication rate in our study was much lower. There was only one infection which was known case of diabetes mellitus. Conclusion: The procedure takes less time and the patient can be mobilized fast postoperatively as well after fixation with PFN. PFN should always be considered for management of subtrochanteric fractures in young as well as elderly patients who have multiple pre-existing illnesses. PFN is a closed nailing procedure which achieves a Biological Fracture fixation with minimal blood loss, preserving the fracture hematoma and helping easy healing of the unstable subtrochanteric femoral fracture as well as intertrochanteric fracture.
ABSTRACT
Background: Intertrochanteric fracture of femur is one of the most common fractures seen in general population. Till date various fixation devices are used for fixation of this fracture that includes both extra medullary and intramedullary implants. Ender and Simon Weidner popularised the condylocephelic intramedullary nailing for this fracture. But it is seen that fracture treated by ender nailing alone resulted in varus malunion. Aims & Objective: Along with ender nail we added the cannulated cancellous screw which results in controlled collapse of the fracture with union in anatomic position. Material and Methods: We studied 50 patients of intertrochanteric fracture treated by ender nail and cannulated cancellous screw between year 2009 to 2011. Follow up assessment was done by Harris hip score. Results: The union achieved in mean time of 7 weeks. In study of 50 patients we obtained 86% excellent to good results. 14% patient had fair to poor results. Conclusion: We found that use of Ender nail and cannulated cancellous screw results in fracture union in more anatomical position with better patient compliance and early mobilization.