Anterior cruciate ligament reconstruction without the use of a tourniquet.

INTRODUCTION: Anterior cruciate ligament tears are a common ligamentous knee injury and are usually managed with arthroscopic reconstruction surgery using a tourniquet. The employment of a tourniquet in the management of an anterior cruciate ligament tear has been a debatable topic for some time. Here, we discuss our technique in the reconstruction of anterior cruciate ligament tears without the use of a tourniquet. MATERIALS AND METHODS: We performed 26 anterior cruciate ligament reconstruction surgeries using hamstring grafts without the use of a tourniquet. The outcomes measured were pain using the visual analogue scale, knee swelling, range of movement and bleeding. RESULTS: Using this technique, we have noted considerable reduction in knee swelling and pain. In addition, there was considerable improvement in the range of movement postoperatively, and there were no bleeding complications noted. CONCLUSIONS: We consider ACL reconstruction without a tourniquet to be an excellent alternative to conventional reconstruction with the use of tourniquet.

Seasonal variation of indoor radon concentration in a desert climate.

Radon is one of the sources that negatively affect dwellings air quality and is ranked as a main cause of lung cancer after cigarette smoking. The indoor radon concentrations usually affected by the conditions of the environment surrounding the dwellings. Seasonal variations can have a significant impact on the indoor radon concentrations. In this article, we studied the seasonal variations of indoor radon concentration in a desert climate, particularly in gulf countries that usually leave the windows and doors closed all over the time. Four hundred dosimeters containing CR-39 detectors were planted for three months to measure the variation in radon concentration between winter and summer seasons. Our measurements showed that a building with a basement revealed a significant variation between radon concentration in winter (44.3 ± 3.1Bqm-3) and in summer (26.1 ± 1.7Bqm-3). Buildings without basements showed that the indoor radon concentration in winter (16.1 ± 1.7Bqm-3) is very much close to that in summer (16.7 ± 1.8Bqm-3). Our results indicated that seasonal variations can significantly affect indoor radon concentration for buildings established with basements. However; in the study region, the average indoor radon concentration as well as the annual effective dose rate are found to be below the action level recommended by ICRP.

Single-stage revision for peri-prosthetic shoulder infection: outcomes and results.

There have been only a few small studies of patients with an infected shoulder replacement treated with a single-stage exchange procedure. We retrospectively reviewed 35 patients (19 men and 16 women) with a peri-prosthetic infection of the shoulder who were treated in this way. A total of 26 were available for clinical examination; three had died, two were lost to follow-up and four patients had undergone revision surgery. The mean follow-up time was 4.7 years (1.1 to 13.25), with an infection-free survival of 94%. The organisms most commonly isolated intra-operatively were Staphylococcus epidermidis and Propionibacterium acnes; two patients developed a recurrent infection. Three different types of prosthesis were used: a hemiarthroplasty, a hemiarthroplasty with a bipolar head and reverse prosthesis. The mean Constant-Murley score at final follow-up was 43.3 (14 to 90) for patients with a hemiarthroplasty, 56 (40 to 88) for those with a hemiarthroplasty with a bipolar head and 61 (7 to 90) for those with a reverse prosthesis. The mean hospital stay was 10.6 days (5 to 29). Single-stage exchange is a successful and practical treatment for patients with peri-prosthetic infection of the shoulder.

Importance of preoperative imaging in acetabular revision surgery - a case report.

Acetabular defects, particularly as a result of protrusion of acetabular components into the hemipelvis, may cause serious complications during revision procedures as a result of iatrogenic injury to surrounding anatomical structures. In these challenging cases, we advocate the utilisation of preoperative three dimensional imaging. MRI and CT- imaging offer superior understanding of the three-dimensional quality of bony defects and the relationship of implants to important anatomical structures. Appropriate preoperative planning may also prevent major complications during the removal of the pre-existing hardware, prior to re-implantation of implants. Potential complications include injury of nerves, blood vessels and other intrapelvic structures.In our case, a major bony defect of the acetabulum was a result of the protrusion of an implanted reinforcement ring. A preoperative, contrast-enhanced CT scan showed that the urethra was in close proximity to the hook of the reinforcement ring.The preoperative imaging aided in identifying and understanding the potential complications that could occur intraoperatively. Additionally, it delineated the intact anatomic structures prior to surgery, which could have medico-legal implications.The importance of preoperative imaging and the existing literature is discussed within this case description.

Radon concentration and radon effective dose rate in dwellings of some villages in the district of Ajloun, Jordan.

Indoor and soil radon concentrations were measured in the villages of Ayn-Jana, Ishtafena, Samta and Umm-Yanabe' in the district of Ajloun, Jordan. Several factors that are strongly related to the radon concentrations are considered whether in soil such as its type or indoors such as room occupation type, floor level and building materials. In the village of Ayn-Jana, our results showed that the average radon concentration decreases gradually as the floor level increases. The highest concentration was found to be in the ground floor (35.5 ± 5.0 Bqm(-3)) and the lowest was in the second floor (22.9 ± 3.2 Bqm(-3)). Regarding the effect of ventilation rate in the same village, storage rooms revealed the highest concentration (38.8 ± 5.4 Bqm(-3)) while the lowest concentration was in living rooms (33.8 ± 4.4 Bqm(-3)). In the four villages, it was found that the highest radon concentration was in the dwellings made of clay (45.7 ± 6.7 Bqm(-3)) and the lowest was in dwellings made of brick (33.9 ± 6.4 Bqm(-3)). In general, the average indoor radon concentration in these villages was 36.3 ± 2.3 Bqm(-3) and it corresponds to an average effective dose rate of 0.92 ± 0.06 mSvyr(-1). These indoor radon concentrations as well as the annual effective dose are below the action level recommended by ICRP. The average radon concentration in soil of these villages was about 2.55 ± 0.20 kBqm(-3), and it ranges from 2.08 ± 0.12 kBqm(-3) in the village of Ayn-Jana to 3.62 ± 0.13 kBqm(-3) in the village of Ishtafena.

Custom rotating-hinge total knee replacement in patients with spina bifida and severe neuromuscular dysfunction.

Spina bifida (SB) is a congenital disorder which may result in a number of musculoskeletal problems. Total knee replacement (TKR) in this patient group is technically demanding due to bone deformity, soft tissue contracture, muscle tone abnormality and ligament insufficiency. This is a retrospective review of three patients with SB and disabling knee arthritis who were managed with a custom rotating-hinge (RHK) total knee system. All patients reported an improvement in knee pain and stability at mean follow-up 47 months (43-53). Mean Oxford Knee score improved from 21 preoperatively to 32 at final follow-up. One patient required revision of tibial and patella components at 37 months for lateral patella instability and excessive wear. Custom RHK for patients with SB, severe neuromuscular dysfunction and bone deformity relieves pain, restores stability and improves early knee function; however there is a significant risk of extensor mechanism complications and functional outcome is worse than primary TKR in the general population.

Custom rotating-hinge primary total knee arthroplasty in patients with skeletal dysplasia.

Patients with skeletal dysplasia are prone to developing advanced osteoarthritis of the knee requiring total knee replacement (TKR) at a younger age than the general population. TKR in this unique group of patients is a technically demanding procedure owing to the deformity, flexion contracture, generalised hypotonia and ligamentous laxity. We retrospectively reviewed the outcome of 11 TKRs performed in eight patients with skeletal dysplasia at our institution using the Stanmore Modular Individualised Lower Extremity System (SMILES) custom-made rotating-hinge TKR. There were three men and five women with mean age of 57 years (41 to 79). Patients were followed clinically and radiologically for a mean of seven years (3 to 11.5). The mean Knee Society clinical and function scores improved from 24 (14 to 36) and 20 (5 to 40) pre-operatively, respectively, to 68 (28 to 80) and 50 (22 to 74), respectively, at final follow-up. Four complications were recorded, including a patellar fracture following a fall, a tibial peri-prosthetic fracture, persistent anterior knee pain, and aseptic loosening of a femoral component requiring revision. Our results demonstrate that custom primary rotating-hinge TKR in patients with skeletal dysplasia is effective at relieving pain, with a satisfactory range of movement and improved function. It compensates for bony deformity and ligament deficiency and reduces the likelihood of corrective osteotomy. Patellofemoral joint complications are frequent and functional outcome is worse than with primary TKR in the general population.

Molecular subtype analysis determines the association of advanced breast cancer in Egypt with favorable biology.

BACKGROUND: Prognostic markers and molecular breast cancer subtypes reflect underlying biological tumor behavior and are important for patient management. Compared to Western countries, women in North Africa are less likely to be prognosticated and treated based on well-characterized markers such as the estrogen receptor (ER), progesterone receptor (PR) and Her2. We conducted this study to determine the prevalence of breast cancer molecular subtypes in the North African country of Egypt as a measure of underlying biological characteristics driving tumor manifestations. METHODS: To determine molecular subtypes we characterized over 200 tumor specimens obtained from Egypt by performing ER, PR, Her2, CK5/6, EGFR and Ki67 immunohistochemistry. RESULTS: Our study demonstrated that the Luminal A subtype, associated with favorable prognosis, was found in nearly 45% of cases examined. However, the basal-like subtype, associated with poor prognosis, was found in 11% of cases. These findings are in sharp contrast to other parts of Africa in which the basal-like subtype is over-represented. CONCLUSIONS: Egyptians appear to have favorable underlying biology, albeit having advanced disease at diagnosis. These data suggest that Egyptians would largely profit from early detection of their disease. Intervention at the public health level, including education on the benefits of early detection is necessary and would likely have tremendous impact on breast cancer outcome in Egypt.

Artificial semi-rigid tissue sensitized with natural pigments: Effect of photon radiations.

BACKGROUND: A new approach for evaluating the optical penetration depth and testing its validity with Monte Carlo simulations and Kubelka-Munk theory is used for artificial semi-rigid tissue sensitized with natural pigments. Photodynamic therapy is a promising cancer treatment in which a photosensitizing drug concentrates in malignant cells and is activated by visible light at certain wavelength. MATERIALS AND METHODS: Cheap artificial semi-rigid tissue incorporated with scattering and absorbing materials along with some other composites comparable to normal human tissue has been performed. The optical parameters as measured with different conditions and calculated with various techniques are investigated. RESULTS: The probability of interaction of light with tissue is very high when exposed to light in presence of Cichorium pumilum and RBCs followed by photohemolysis or/and photodegradation. The optical penetration depth calculated by linear absorption coefficient ranges from 0.63 to 2.85 mm is found to be comparable to those calculated using Kubelka-Munk theory or Monte Carlo simulation (range from 0.78 to 2.42 mm). The ratio of absorption to the scattering is independent of thickness and decreases with increasing irradiation time. Moreover, the optical parameters as well as their ratios are in very good agreement in the two approaches of calculation. The values of absorption and scattering coefficients are independent of thickness. Furthermore, the average photon ranges in the samples containing no scattering and absorbing materials are about three times greater than those samples containing scattering materials. CONCLUSION: Our results suggest that light propagation with optical properties presented in this work could be applicable in diagnostic and therapeutic of the human biological tissue for photodynamic therapy.

Short communication: Validation of in vitro fertility genes in a Holstein bull population.

Previously, we constructed an in vitro fertilization system for the identification of genes affecting fertility traits in dairy cattle. The efficiency of this system has been demonstrated by the identification of several genes affecting fertilization rate and early embryonic survival. However, to employ these genetic markers in marker- and gene-assisted selection programs, there is a need to validate in vitro results in phenotypic data sets collected in vivo. Thus, the objective of this study was to validate, in a population of Holstein bulls, the fertility trait genes we previously identified in an in vitro system. Estimated relative conception rate (ERCR) data from 222 Holstein bulls were obtained from 5 different artificial insemination companies in the United States. Bulls were genotyped for the genes FGF2, POU1F1, PRL, PRLR, GH, GHR, STAT5A, OPN, and UTMP, and the data were analyzed for association with ERCR using a mixed effects sire model. A stepwise model selection procedure revealed evidence of association with ERCR for FGF2 and STAT5A polymorphisms. The in vivo validation suggests that these genes can be used in gene-assisted selection programs for reproductive performance in dairy cattle. The genotypes found to be associated with low bull fertility in this study have been reported to be associated with high milk composition in previous studies. These findings provide molecular evidence for the antagonistic relationship between milk production and fertility observed for many years in different breeds of dairy cattle.

Bilateral periprosthetic stress fractures in a juvenile chronic arthritis patient secondary to bilateral genu valgum.

Lateral insufficiency fractures following total hip replacement have been reported with the femoral stems positioned in varus, together with osteopenia of the lateral femoral cortex. Any abnormal alignment of the lower limbs, such as genu valgum, will alter the load distribution across the femoral cortices, and repetitive loading during walking will predispose the bones to stress fractures at any stress riser point, such as the tip of a femoral component. Bilateral femoral stress fractures post total hip replacements have not been previously described. We present a 55-year-old woman, diagnosed with juvenile idiopathic arthritis, who had undergone bilateral total hip replacements and bilateral knee replacements. The knees 15 years postoperatively were in valgus and the left knee was extremely stiff, flexing to just 5. The patient presented with bilateral thigh pain, with plain radiographs confirming bilateral periprosthetic fractures of the femur at the tip of well-fixed femoral components. There was no history of injury and her hips were functioning well up to this time. The patient required revision of both hips to long-stem uncemented components, bypassing the fractures, and revision of both knees to stemmed semi-constrained implants, thereby correcting the alignment of both lower limbs. Both fractures healed and the patient is currently pain-free and mobile with walking aids. Surgeons must remain aware that when implants are in situ, abnormal alignments will lead to abnormal forces, and stress fractures are likely to occur at any stress riser around the implant. Avoiding malalignment will avoid this complication.

Angular momentum partitioning and hexacontatetrapole moments in impulsively excited argon ions.

We have studied polarized electron collisions with Ar in which the target is simultaneously ionized and excited to form Ar+(3p(4)(1D)4p) states. We measured the integrated Stokes parameters of the subsequent fluorescence emitted by the (2)F(7/2), (2)F(5/2), (2)D(5/2), and (2)P(3/2) states along the direction of electron polarization. The Rubin-Bederson hypothesis is shown to hold for the L and S multipoles of these states. The electric quadrupole and hexadecapole of the 1D core are derived. By recoupling these moments with the electric quadrupole moment of the 4p electron, we calculate higher moments of the total ionic orbital angular momentum, including its hexacontatetrapole (64-pole) moment.

Early cardiac catheterisation and coronary angiography in acute myocardial infarction.

79 consecutive patients with documented acute myocardial infarction were admitted. 29 of these patients underwent early cardiac catheterisation, coronary arteriography and intracoronary streptokinase injection usually in response to post-myocardial infarction angina. Satisfactory reperfusion occurred in 80% of the patients with the least morbidity and mortality rate compared with medically anticoagulation treated group. 32 patients underwent elective catheterisation and coronary angiography between 1-16 days (average 7.6 days). 18 patients were not catheterised at all. This study evaluates our results of early thrombolytic, angioplastic or surgical revascularisation, and reviews the risk benefit value of early cardiac catheterisation and coronary angiography in patients with acute myocardial infarction.

Mitral valve replacement in children.

Rheumatic fever leading to advanced valvular heart disease, in adults and children, is still frequently seen in developing countries. In the period 1981-87, 1137 patients underwent open heart surgery for either repair (489 patients), or replacement (639 patients) of defective cardiac valves. The experience with 75 children who underwent mitral valve replacement among this group is reviewed. The aetiology of mitral valve disease was rheumatic in 71, and infective endocarditis in four; 85% of the children were in NYHA functional class III, and 15% in class IV. Seven children had intra-operative findings of rheumatic activity. Pure mitral regurgitation was seen in 41, while mixed mitral valve disease was observed in 34 children. Twenty-seven children underwent mitral valve replacement with Ionescu-Shiley bovine pericardial valves, and 48 with mechanical Bi-leaflet valves. The operative mortality was 9.3%, and the actuarial survival rate, calculated by the Cutler and Ederers method, was 87% at 5 years.