ABSTRACT
Introduction: Osteochondritis dissecans of the talus is a rarecondition that can create challenges for both the patient andthe treating surgeon. Arthroscopic bone marrow stimulation(i.e. microfracture, drilling) is a well-accepted and proventechnique to allow fibrocartilage differentiation and therebyprovide infill at the site of a cartilage defect in several joints,including the ankle. The aim of our study was to examine therole of arthroscopic bone marrow stimulation techniques as ameans of treatment for osteochondral lesions of the talus.Material and methods: Thirty two ankles were identifiedbetween January 2012 and January 2020 with talus OCD thatunderwent arthroscopic bone marrow stimulation. Each lesionwas classified according to the Berndt and Harty classification.Study patients were evaluated at 6 weeks, 3 months, 6 months,12 months, and annually after surgery. Assessments via avisual analogue scale (VAS) for pain during daily activitiesand sport activity and the American Orthopaedic Foot & AnkleSociety (AOFAS) scoring system were obtained at each visit.Result: There were 25 men and 4 women of average age 35years (range 17–50) and mean body mass index (BMI) 22 kg/m2 (range 20–34) at the time of surgery. Quantitative MRImeasurements on 3D FSPGR Sequence showed that meanarea of the lesions were 0.801 ± 0.505 cm2. Mean AOFASscores improved from 66 points (range 53–77) preoperativelyto 90 points (range 83–100) at final follow-up (p<0.05) andmean Visual Analogue Scale (VAS) scores from 6 points(range 5–8) to 2 points (range 0–5) with p value <0.05 whichis statistically significant.Conclusion: Arthroscopic management of osteochondrallesions of the talus has the advantages of better cosmeticresults, less pain, and less surgical trauma. This techniqueis technically demanding and should be reserved for theexperienced foot and ankle arthroscopist.
ABSTRACT
Introduction: A lack of bone stock, deficient medial cupsupport and medial & proximal migration of the joint centerare the main challenges in treating cases of protrusio acetabuliwith end stage arthritis. The purpose of this prospective studywas to assess the functional outcome, radilogical parameters& complications related to uncemented total hip arthroplastyin these patients.Material and methods: From November2017 to December2019, 20 patients (33 hips) with secondary acetabularprotrusions (25 grade II & 8 grade I) with end stage arthritisunderwent uncemented total hip arthroplasties with or withoutautologous bone grafting. The Harris hip scoring systemwas used to evaluate hip function during follow-up. X-rayswere taken to assess the prosthesis loosening, bone grafthealing, cup inclination angle & comparing various pre andpostoperative radiological parameters.Results: The operation time ranged from 60 to 120 min (mean=77.12 ± 14 min). The blood loss was 200 to 400 mL (mean= 252 ± 49.5 mL). The average follow-up duration was 1.5years (range 6m-2yrs). Postoperative X-rays revealed bonegraft union at 6 months post-surgery. The Harris hip scoresincreased from 34.07 ± 11.43 to 86.22 ± 6.85 postoperativelythat was statistically significant (P < 0.01). The distance fromthe center of the femoral head to Kohler’s line increasedfrom 18.76 ± 3.7 mm to 20.4 ± 3.3 mm after the operation(P < 0.01). During follow-up, no hip acetabular prosthesisloosening & progression of protrusio was evident.There wasno dislocation but one case of infection and one case of sciaticnerve injury as postoperative complication.Conclusion: The use of impacted or unimpacted morselizedautograft in conjunction with porous-coated cementlessacetabular components was a technically straight forwardsolution through which the hip bio mechanics were restoredand strong fixation was achieved, thereby preventingrecurrence of protrusio in grade II or III. For grade I protrusiowith end stage arthritis only uncement THR without bonegraft was adequate.
ABSTRACT
Introduction: Cancer chemotherapy induced diarrhea(CCID) is a frequent problem during anticancer treatment.Patho-physiology of CCID differs between chemotherapeuticagents. Neither there is specific treatment for CCID noradequate experimental models. The objective of this study wasto develop a relevant experimental animal model of CCID,which can help in development of specific therapy for CCID.Material and methods: In this study thirty six albino rats ofeither sex were divided into 6 groups of 6 animals each. GroupI rats received distilled water and served as control. GroupII,III,IV, V, VI received 5-Fluorouracil(5-FU) once intraperitoneal(IP) at doses 10,20,30,40 and 50 mg/kg respectivelyand served as test groups for experimental model of CID.Standard parameters like stool samples for quality& quantity,incidence of diarrhea, histopathology of intestine and fataloutcome in rats were recorded.Results: Out of test groups, rats treated with 5-FU 30mg/kg IP single dose developed diarrhea in 50% rats,mean timefor onset of diarrhea was 84±16.7 hours and duration was62±9.16 hours, diarrhea subsided within 7 days with mildchanges of intestinal histopathology and 16.7% mortality.Occurrence of diarrhea, change in intestinal histopathologywas not remarkable with dosage less than 30mg/kg. In 5 FU40 mg/kg & 50mg/kg group incidence of diarrhea increased to66.6% but death rate were further increased to 33.3% in5 FU40 mg/kg& 83.3% with 50mg/kg.Conclusion: The results suggest 5-FU 30mg/kg single doseIP to albino rats can be used as a suitable experimental modelfor CCID for evaluation of novel potential candidate drugs fortreatment of CCID.
ABSTRACT
Spinal tuberculosis is the most frequently encountered & destructive form of skeletal tuberculosis. We wanted to evaluate the advantages of transmanubrial transclavicular approach in the surgical management of the pathologies (mainly tuberculosis) at the cervicothoracic junction (C7,T1-2).METHODSFrom June 2013 to August 2019, thirty patients with tuberculosis of CTJ presented to SCBMC & H and were operated with transmanubrial transclavicular approach. Debridement with corpectomy of tuberculosis of C7-T1 and T1 vertebral bodies were followed by fusion of C6-T2 and C7-T2 vertebra respectively with the help of titanium mesh cage and anterior cervical plating. Advantages & limitations of this surgical approach were evaluated retrospectively. Visual analogue scoring & Frankel scoring were used for assessing postoperative clinical outcome.RESULTSAll 30 cases were of tuberculosis of CTJ involving either C7-T1 or T1-T2. They presented with a permutation combination of upper thoracic pain, paraparesis, and collapse of vertebra & cord compression. All patients were followed up for 12.37 ± 5.38 months on average (range 4 -24 m). The mean postoperative visual analogue scale score was 7.86 ± 1.02 (range 6-10) preoperatively, which improved to 3.27 ± 0.88 (range 0-5) postoperatively at final evaluation (p<0.005). There was also postoperative increase in Frankel score in seventeen cases (56%). Three patients developed temporary hoarseness postoperatively, two cases got infected (one superficial & one deep) & one patient died. There was no non-union or persistent pain at manubrium or clavicle end.CONCLUSIONSThe transmanubrial transclavicular approach for tuberculosis of CTJ lesions can achieve favourable clinical outcomes by providing wide exposure, direct decompression of lesions, fusions and less complications as compared to standard approaches.