Ankle and Hindfoot Alignment Changes in Advanced OA Varus Knees After Cruciate Retaining Total Knee Arthroplasty: A Prospective Cohort Study.

Background: Correct alignment of the knee is considered to be one of the most influential factors in determining the long-term outcomes after Total Knee Arthroplasty (TKA), and is believed to decrease both the mechanical and shear stresses placed on the bearing surfaces, as well as the bone/prosthesis interfaces. Compensatory malalignment of ankle and hindfoot is a recognized cause for ankle disability and deformity in long-standing osteoarthritic patients with varus deformity. This study aims to assess changes in ipsilateral ankle and hindfoot if any, pre- and post-operative TKA. Methods: 65 knees of 54 patients of osteoarthritis knee were evaluated for alignment in knee, ankle and hindfoot pre- and post-TKA. Pre- and post-operative scanogram were evaluated for knee and ankle alignment. Hindfoot alignment view was used to calculate hindfoot alignment angle. All parameters were compared before TKA and after 10 weeks TKA and Wilcoxon signed rank test was used to test the significance of the values. Results: Mean age of the patients was 62.9 years (49-80 years). Mean varus before surgery was 14.49 which changed to 4.01 and mean hindfoot angle valgus reduced from 9.23 to 6.62, both of which was found significant. Significant changes were also observed between pre- and post-op measurements of knee society scores, AOFAS, with improved functional outcomes both in knee and ankle. Conclusion: This study reveals the radiological and functional changes occurring in the ankle and hindfoot after acute correction of long-standing varus deformity of the knee using total knee arthroplasty. Hindfoot valgus alignment in varus knees decreased significantly post-TKA without any intervention at ankle level. In cases undergoing knee arthroplasty, effect of the acute change in the alignment of the knee on the ankle and hindfoot should be taken into consideration and the amount of correction of knee alignment can be a predictor of correction of ankle and hindfoot malalignment too. The lateral benefit of improvement in ankle pain after TKA is a significant gain in this study.

An unusual form of groin hernia - a case report.

An unusual case of femoral hernia in a tribal female patient is presented which has been left completely unattended and uncared and hence undiagnosed until bizarre complication prompted medical and surgical intervention and finally this reporting. The 37 years old tribal woman presented with an eviscerated small intestine through an opening in the right lower abdominal wall. The eviscerated gut was in fact an intussuscepted portion of the intestine. She was operated upon. The gut was manipulated to get reduced into abdomen. The wound was left open after necessary debridement. It developed healthy graunlation tissue afterwards. Her postoperative recovery was uneventful.

Umbilical nodule, an uncommon presentation of gastric malignancy.

Sister Mary Joseph Nodule refers to an umbilical nodule resulting from metastasis from an intra-abdominal malignancy, either pelvic (common in females), or gastrointestinal system (common in males). We report a case of Sister Mary Joseph Nodule in a lady which resulted from gastric malignancy.

Clinical comparative study: efficacy and tolerability of tolperisone and thiocolchicoside in acute low back pain and spinal muscle spasticity.

STUDY DESIGN: We performed a multicentric, randomized, comparative clinical trial. Eligible patients were randomly assigned to receive 150 mg of Tolperisone thrice daily or 8 mg of Thiocolchicoside twice daily for 7 days. PURPOSE: To assess the efficacy and tolerability of Tolperisone in comparison with Thiocolchicoside in the treatment of acute low back pain with spasm of spinal muscles. OVERVIEW OF LITERATURE: No head on clinical trial of Tolperisone with Thiocolchicoside is available and so this study is done. METHODS: The assessment of muscle spasm was made by measuring the finger-to-floor distance (FFD), articular excursion in degrees on performing Lasegue's maneuver and modified Schober's test. Assessment of pain on movement and spontaneous pain (pain at rest) of the lumbar spine was made with the help of visual analogue scale score. RESULTS: The improvement in articular excursion on Lasegue's maneuver was significantly greater on day 3 (p = 0.017) and day 7 (p = 0.0001) with Tolperisone as compared to Thiocolchicoside. The reduction in FFD score was greater on day 7 (p = 0.0001) with Tolperisone. However there was no significant difference in improvement in Schober's test score on day 3 (p = 0.664) and day 7 (p = 0.192). The improvement in pain score at rest and on movement was significantly greater with Tolperisone ((p) = 0.0001). CONCLUSIONS: Tolperisone is an effective and well tolerated option for treatment of patients with skeletal muscle spasm associated with pain.

Carcinoid tumour of gall bladder--a case report.

Gall bladder carcinoid tumours are rare, constituting less than 1% of all carcinoid tumours arising from different parts of the body. They usually lack specific symptoms as they typically are unassociated with the carcinoid syndrome, despite frequent hepatic spread and mostly detected after cholecystectomy. A case of gall bladder carcinoid is reported in a 35-year-old woman who underwent laparoscopic cholecystectomy for clinical features of cholelithiasis. Several comparative evaluation was attempted mainly between the carcinoid and variant groups (endocrinomas) and occasionally between the typical and atypical carcinoid series to solve the existing serious problem in categorisation of this group of tumours. While the usual criteria for judging malignancy, such as anaplasia and mitotic figures, are unreliable in these sites of carcinoid tumour, malignancy is well determined from evidence of tumour invasion into adjacent structures. This rarity and the ambiguity around it stresses for its documentation and warrants for international agreements and standards on basic criteria for such classification of these endocrine carcinomas.

Docking study of HIV-1 reverse transcriptase with phytochemicals.

Natural products are important sources of drug discovery. In this context groups of different set of phytochemicals were taken and docked into the different cavities of the Reverse transcriptase (PDB ID: 1REV) of Human immunodeficiency virus (HIV) and results were discussed. Natural compounds such as Curcumin, Geranin, Gallotannin, Tiliroside, Kaempferol-3-o-glucoside and Trachelogenin were found to very effective according to its binding energy and ligand efficiency score. Those compounds also were found to have no adverse effect as carcinogenicity and mutagenicity and favorable drug likeness score. Hence, considering the facts those compounds could use effectively for HIV-1 drug discovery.

Foreign bodies in urinary bladders.

We studied the patients admitted in our hospital with intravesical foreign bodies from February 2007 to January 2009 regarding their clinical presentation, nature of the foreign bodies, and methods used to remove them. The patients with intravesical foreign bodies were investigated and underwent cystoscopy for direct visualization of the foreign body and an attempt to remove it through the cystoscope. If cystoscopic removal failed, then suprapubic cystostomy was done to remove it. Nine patients (six males and three females, with a mean age of 24.5 years) with intra-vesical foreign bodies were admitted during the study period. In all the female patients and one male patient, foreign bodies were introduced inside the bladder by the patients themselves. In four cases, the foreign bodies were iatrogenic in nature, and in one case, it migrated accidentally through the urethra. In conclusion, intravesical foreign bodies are not very uncommon. Self-introduced and iatrogenic foreign bodies into the bladder are more common than accidental migration through the urethra. Cystoscopic removal is successful in most of the cases. If cystoscopic removal is not possible, then suprapubic cystostomy is required to accomplish this task.

Eviscerated 'amyand' incisional hernia.

The presence of an inflamed appendix in an inguinal hernia sac is known as "Amyand" hernia. The appendix within an umbilical incisional hernia sac is rare, and its evisceration is even rarer. Here we report a case of spontaneous evisceration of an appendix through an umbilical incisional hernia following laparoscopic cholecystectomy.