Evaluation of different Rheumatoid factors in patients with rheumatoid arthritis: correlation with disease activity and response to therapy

Antibodies to citrullinated proteins have been described in patients with rheumatoid arthritis [RA] and these appear to be the most specific markers of the disease. Our objective was to determine the frequency of antibodies to cyclic citrullinated [CCPs] in patients with RA and investigate that. Comparison of available serologic rheumatoid markers in patient with rheumatoid arthritis [anti-CCP and rheumatoid factor]and correlation of the relevance of these markers to disease activity and their sensitivity to anti rheumatoid drugs. Patients divide into two groups 1[st] group contain 30 patients with RA [Newly diagnosed], 2[nd] group contain 30 patients with RA [Receiving different therapies] and 10 consider as healthy control group, median age of patient 25 years, range [10-35 years]. This study was conducted in the outpatient rheumatology unit of Damanhour Medical Institute. There was no significant difference between the anti-CCP positive and negative patients with RA. There was also no significant correlation between anti-CCP antibody and ESR, CRP. A small but significant correlation was found between RF and anti-CCP antibody. Anti-CCP antibodies had a better diagnostic value than RF for RA. However the moderate sensitivity and high specificity of anti CCP antibodies for RA, along with the appearance of anti-CCP antibodies before disease onset, suggest that anti-CCP antibodies be included in the classification criteria for RA

Rule of the ilizarov method in treatment of congenital pseudoarthrosis of the tibia

Congenital pseudoarthrosis tibia is relatively a rare condition, occurring in 1 in 190.000 to 1 in 250.000 live births but it is one of the most perplexing problems in pediatric orthopedics. After the fracture has occurred, it is refractory for union. A great number of different surgical procedures have been used to treat it. However, these methods had not been uniformly successful in obtaining and maintaining union. Recently, Ilizarov method had been introduced to treat such cases where it demonstrated by many authors satisfactory results. Nine cases of congenital pseudoarthrosis of the tibia were treated by Ilizarov method since January 2003 till December 2005. The mean follow-up after Ilizarov-device removal was 2.9 years [range 2-4, SD 0.7]. Consolidation was obtained in the all patients operated. The leg length discrepancy was corrected in all patients. Ilizarov technique is a successful method of treatment for congenital pseudoarthrosis of the tibia that tackles all problems of the disease

Management of traumatic tibial non-union using the Ilizarov method

Traumatic nonunion of the tibia is the most frequently observed long bone nonunion. Usually Infection, bone loss, deformity, disuse osteopaentia, soft tissue atrophy together with neurovascular damage may compound the problem. Twenty patients of difficult traumatic tibial nonunion cases were treated by Ilizarov method. Five modalities of Ilizarov techniques were used. The suitable [method] modality for treating each individual case was chosen. These methods are: external lengthening technique, bone transport - internal lengthening- technique, a combination of the above 2 techniques either in succession or simultaneously, compression distraction technique, and gradual correction with compression technique. The obtained results compare favorably with that of the similar international works. We have not had any significant complications with the ilizarov method. There were no incidents of neurovascular injury, no pin fractures, no pin tract osteomyelitis, and no incidents of compartmental syndrome. The most common complication was a superficial pin tract infection, which respond to oral antibiotics and proper pin care. Pain especially during the distraction phase and patient acceptance of the apparatus were two important subjective problems encountered in our experience. Ilizarov method is a comprehensive approach to manage all aspects of these complicated aspects of chronic tibial nonunion

Long-term results of non-union scaphoid fracture treated by volar bone peg autograft

The aim of this work was to determine the results of long-term follow up of surgical treatment of non-united fracture of the scaphoid using volar cortical bone peg autograft, harvested from the ipsilateral lower fourth radius. Material of this work included 57 cases. Fracture of the waist of scaphoid was encountered in 45 cases [78.95%]. Fracture of the proximal pole was present in 3 cases [5.26%]. Non-united scahoid with fragmentation of proximal pole and excessive arthritic changes were excluded from this study. Cases were evaluated for an average of 21 months after operation then follow up every year for long term study. The final end results according to Cooney score were 19 excellent [33.34%], 17 good, [29.82%], 13 fair [22.80%], and 8 poor, [14.04%]. Radiologically 46 cases showed complete bone union, while signs of non union were still present in 11 cases [19.30%], 6 cases [10.53%] of which the fracture was present in the proximal pole. Objectively, range of movement and grip strength were improved with union at the fracture site. This technique is a simple, cost effective and good option for management of non-united scaphoid fracture especially for waist fracture. All cases persistent with non-union developed arthritic changes of the wrist