Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion

@#Introduction: Restoration of a functional hand is the ultimate goal following a distal radius tumour resection. The early outcomes of mobile wrist reconstruction are satisfactory; however, long-term results are unpredictable due to late wrist instability and degenerative arthritis. Our aim is to compare mobile wrist reconstruction with wrist fusion (pan-carpal fusion) in our cohort of patients. Materials and Methods: A retrospective cohort study was performed for functional outcomes of all patients who underwent resection for distal radius tumour and treated with either fusion or reconstruction of the wrist in a single institution from years 2000-2013 with a minimum of three years follow-up. Results: Eleven patients were included in the study, six of whom had wrist reconstruction with proximal fibula graft and the remaining five wrist fusion, with a mean follow-up of 6.3 years. The mean Musculoskeletal Tumour Society (MSTS) score was 82.78%, ranging from 70% to 93.3%. Average grip strength compared to the normal contralateral hand was 60.0% for total wrist fusion, which was better than wrist reconstruction with 58.07%. There was no difference in the functional outcome between fusion and mobile reconstruction in our study. Osteoarthritis changes and subluxation of the wrist joint were the most common findings in the long-term follow-up for this group. Conclusion: There was no difference in the functional outcome of the long-term follow-up between the two groups.

Detection of acute cerebral hemorrhage in rabbits by magnetic induction

Acute cerebral hemorrhage (ACH) is an important clinical problem that is often monitored and studied with expensive devices such as computed tomography, magnetic resonance imaging, and positron emission tomography. These devices are not readily available in economically underdeveloped regions of the world, emergency departments, and emergency zones. We have developed a less expensive tool for non-contact monitoring of ACH. The system measures the magnetic induction phase shift (MIPS) between the electromagnetic signals on two coils. ACH was induced in 6 experimental rabbits and edema was induced in 4 control rabbits by stereotactic methods, and their intracranial pressure and heart rate were monitored for 1 h. Signals were continuously monitored for up to 1 h at an exciting frequency of 10.7 MHz. Autologous blood was administered to the experimental group, and saline to the control group (1 to 3 mL) by injection of 1-mL every 5 min. The results showed a significant increase in MIPS as a function of the injection volume, but the heart rate was stable. In the experimental (ACH) group, there was a statistically significant positive correlation of the intracranial pressure and MIPS. The change of MIPS was greater in the ACH group than in the control group. This high-sensitivity system could detect a 1-mL change in blood volume. The MIPS was significantly related to the intracranial pressure. This observation suggests that the method could be valuable for detecting early warning signs in emergency medicine and critical care units.

Augmentation index is a better marker for cardiovascular risk in young Malaysian males. A comparison of involvement of pulse wave velocity, augmentation index, and C-reactive protein

To determine the association between carotid femoral pulse wave velocity PWV[CF] and augmentation index [AI] with future cardiovascular disease [CVD] risk, and to assess whether high sensitivity C-reactive protein [hs-CRP] is an important mediator towards these vascular changes, among young men. This cross-sectional study was conducted at Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia from July 2011 to December 2012. Two hundred and eleven young men were recruited. The PWV[CF] and AI were measured using Vicorder. High sensitivity C-reactive protein was measured by using immunological methods. The future CVD risk was assessed by Framingham risk score [FRS] and age adjusted FRS [A-FRS]. Data for analysis was conducted using the Statistical Package for Social Sciences Version 15 [SPSS Inc., Chicago, IL, USA]. The mean age of the subjects was 27.09 [95% confidence intervals [CI] 26.39-27.79] years old. Those with >/-2 risk factors had significantly higher AI [10.09 [95% CI: 9.06-11.12] versus 6.56 [95% CI: 5.54-7.57] [p=0.001], but not PWV[CF] 7.45 [95% CI: 7.29-7.61] m/s versus 7.29 [95% CI: 7.06-7.51] m/s, [p=0.90] when compared to the healthy subjects. High sensitivity C-reactive protein was not an independent determinant for PWVCF and AI. Only AI was significantly associated with FRS and A-FRS [p=0.0001]. To assess the impact of risk factors on vascular damage and for future assessment of CVD risk among the young men, AI may be a better marker than PWVCF. The increase in AI among these subjects was not related to hs-CRP

High C reactive protein associated with increased pulse wave velocity among urban men with metabolic syndrome in Malaysia

To determine the association between carotid femoral pulse wave velocity [PWV[CF]]; augmentation index [AI]; and high-sensitivity C reactive protein [hs-CRP] with metabolic syndrome [MetS], and to determine the influence of ethnicity on PWV[CF] and AI, and the association between high hs-CRP and increased PWV, and AI in MetS. A cross-sectional study was conducted at Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia from September 2009 to September 2011. Three hundred and eighty men [Chinese and Malays] were recruited from the study. The PWV[CF] and AI were measured by Vicorder [SMT Medical, Wuerzburg, Germany]. The hs-CRP level was also determined. We defined MetS using the International Diabetes Federation [IDF] and harmonized criteria. Malays had higher AI compared to the Malaysian Chinese. Patients with MetS had higher PWV[CF] [IDF criteria: 8.5 [8.3-8.7] versus 8.2 [8.0-8.4] m/s, p=0.03; harmonized criteria: 8.5 [8.4-8.7] versus 8.2 [8.0-8.4] m/s, p=0.007] and hs-CRP [IDF criteria: 0.9 +/- 2.0 versus 0.4 +/- 1.1 mg/L, p=0.0007; harmonized criteria: 0.8 +/- 1.9 versus 0.4 +/- 1.1 mg/L, p=0.002] compared to non-MetS. In subjects with MetS, those with high hs-CRP [>3mg/L] had higher PWV[CF]. Augmentation index values were significantly higher in Malays compared with Malaysian Chinese. Metabolic syndrome was associated with increased PWV[CF] and hs-CRP. Patients with MetS and high hs-CRP were associated with higher PWV[CF]. The measurement of hs-CRP reflects the degree of subclinical vascular damage in MetS

Non-ulcerative soft tissue mycosis of long duration mimicking soft tissue sarcoma--a case report.

Soft tissue mycosis usually presents with a triad of tumefaction, suppuration and ulceration. We report an unusual case of soft tissue mycosis in a 42-year-old male teacher who presented with painless swelling over the anterolateral aspect of the right shin for 4 years duration.