Proprioceptive changes in the contralateral knee joint following anterior cruciate injury.

Loss of proprioception following an anterior cruciate ligament (ACL) injury has been well documented. We evaluated proprioception in both the injured and the uninjured limb in 25 patients with ACL injury and in 25 healthy controls, as assessed by joint position sense (JPS), the threshold for the detection of passive movement (TDPM) and postural sway during single-limb stance on a force plate. There were significant proprioceptive deficits in both ACL-deficient and uninjured knees compared with control knees, as assessed by the angle reproduction test (on JPS) and postural sway on single limb stance. The degree of loss of proprioception in the ACL-deficient knee and the unaffected contralateral knee joint in the same patient was similar. The TDPM in the injured knee was significantly higher than that of controls at 30° and 70° of flexion. The TDPM of the contralateral knee joint was not significantly different from that in controls. Based on these findings, the effect of proprioceptive training of the contralateral uninjured knee should be explored.

Granulomatous hepatitis following open heart surgery with cardiopulmonary bypass.

BACKGROUND: Cardiopulmonary bypass (CPB) initiates an inflammatory cascade, predisposing the patient to a number of infections. The stress of surgery and anaesthesia further expose the patient to a variety of non-infectious complications. We report a group of patients who developed granulomatous disease after open heart surgery. METHODS: We retrospectively analysed a subset of patients who developed a syndrome of fever, jaundice and hepatomegaly after open heart surgery. We recruited age- and sex-matched controls who underwent open heart surgery during the same period (July 2002-July 2004). Details of demographic profiles, diagnostic evaluation and drug treatment were noted and compared between the two groups using the SPSS software. RESULTS: Five patients were identified to have the specific syndrome of high grade intermittent fever with jaundice and hepatomegaly with investigations revealing an intrahepatic cholestasis. A detailed evaluation revealed granulomas in tissue specimens of the bone marrow and/or liver in these patients. An extensive evaluation for an alternative aetiological agent was non-contributory. CONCLUSION: We found granulomatous hepatitis in 5 patients following open heart surgery and they were given conventional antituberculous therapy to which they responded. It is possible that in these patients, tuberculosis was re-activated from a dormant focus due to a period of transient immunodeficiency caused by an extracorporeal circulation.

Chronic rupture of the extensor apparatus of the knee joint.

Chronic ruptures of the extensor mechanism of the knee are uncommon injuries, and previously reported literature assumes the presence of an intact patella for repair. We present a case of chronic rupture following patellectomy done twelve years previously. The defect in the extensor apparatus was extensive (18cm), and this was bridged using a large fascia lata graft from the opposite thigh, with reasonably successful results.

Mycobacterium leprae binds to a 25-kDa phosphorylated glycoprotein of human peripheral nerve.

Mycobacterium leprae, the causative agent of leprosy, specifically invades and destroys the peripheral nerve, which results in the main clinical manifestation of the disease. Little is known about the bacteria-nerve protein interaction. We show in the present work that M leprae binds to a 25 kDa glycoprotein from human peripheral nerve. This protein is phosphorylatable and it binds to lectins which have alpha-mannose specificity. This M leprae-protein interaction could be of importance in the pathogenesis of leprosy.

Echinococcosis with concurrent phaeohyphomycosis.

A double infection in the same organ, echinococcosis associated with phaeohyphomycosis in the lungs, is reported.

Mechanisms of cardiac perforation leading to tamponade in balloon mitral valvuloplasty.

Mechanisms of cardiac perforation in 10 cases of cardiac tamponade encountered in a single-center series of 903 balloon mitral valvuloplasty procedures were elucidated by precise localization of the site of perforation at subsequent surgery. These mechanisms were perforation of the aortic root and adjacent right atrium by sliding up of the transseptal set (2), apical tears by straight-tip balloon catheters driven distally during mitral valve dilatation (3), apical perforations by guidewires introduced through catheters wedged in the apex (2), tear of the posterior right atrial wall by dilatation of the track produced by very low septal punctures (2), and right ventricular perforation by a pacing catheter (1). Multivariate analysis showed cardiac perforation to be significantly related to the total experience at the center (inversely) and to patient age (directly). Left ventricular perforation occurred exclusively in patients > 40 yr of age. Understanding these mechanisms has enabled formulation of effective strategies to prevent cardiac perforation.

An outbreak of post-streptococcal reactive arthritis.

We describe an outbreak of an illness with fever, mono-, pauci- or polyarticular arthritis, and high antideoxyribonuclease B (ADNB) titres in 11 patients. Two patients had concomitant non-purulent conjunctivitis and one had endogenous endophthalmitis. There was no clinical or echocardiographic (6 patients) evidence of carditis. Blood culture grew Group A beta haemolytic streptococci in one patient. A simultaneous synovial fluid culture in this patient and similar cultures in four more patients yielded no microorganism. Most patients recovered completely, but one developed rheumatoid factor negative spondyloarthropathy. Monoarticular arthritis in several patients, the absence of carditis, and the presence of high ADNB titres without high anti-streptolysin O titres indicate that this was not acute rheumatic fever but post-streptococcal reactive arthritis (PSRA).

Epithelioid haemangioma (benign haemangioendothelioma of bone)--a case report.

A case of epithelioid Haemangioma of the femur is presented. The patient, a 29 year old woman, was treated by curettage and bone grafting, following which two "recurrent" tumours appeared. These were successfully removed by repeat curettage.

Protein phosphorylation in human peripheral nerve: altered phosphorylation of a 25-kDa glycoprotein in leprosy.

Protein phosphorylation in a low speed supernatant of human peripheral nerve (tibial and sural) homogenate was investigated. The major phosphorylated proteins had molecular mass in the range of 70, 55, 45, and 25 kDa. Mg2+ or Mn2+ was essential for maximum phosphorylation although Zn2+, Co2+, and Ca2+ could partially support phosphorylation. External protein substrates casein and histone were also phosphorylated. The protein phosphatase inhibitor orthovanadate enhanced the phosphorylation of the 45 and 25 kDa proteins significantly. Concanavalin A-Sepharose chromatography of the phosphorylated peripheral nerve proteins showed that the 25 kDa protein was a glycoprotein. Protein phosphorylation of peripheral nerves from leprosy affected individuals was compared with normals. The phosphorylation of 25 kDa protein was decreased in most of the patients with leprosy.

Computed tomographically guided biopsy of the spine.

STUDY DESIGN: Efficacy of the percutaneous biopsy of the spine under computed tomographic guidance was investigated. Seventy-five patients, ranging in age from 7 to 72 years, underwent this procedure. OBJECTIVES: To determine the usefulness of computed tomographically guided biopsies in the treatment of patients with spinal disorders. SUMMARY OF BACKGROUND DATA: The results of 68 biopsies (90.6%) were judged to be accurate insofar as the samples of tissue obtained could be diagnosed as specific types of neoplasm, infective lesions, reactive lesions of nonspecific type, or normal bone. METHODS: Biopsies that yielded a specific abnormality were categorized as true positives. The "normal" biopsies were followed for 6-18 months and were then deemed true negatives. Nondiagnostic ones were considered false negatives. RESULTS: The results are acceptable with an accuracy rate of 90.6%. It is a safe and simple procedure with a short learning curve. CONCLUSIONS: Computed tomographically guided biopsy of the spine is recommended as a procedure of choice, especially in cervical and thoracic lesions. Computed tomography is superior to fluoroscopy when dealing with small, deep-seated lesions especially in the cervical and thoracic regions and with lesions picked up on bone scan only, radiographs being negative. Needle biopsy under computed tomographic guidance is safe and precise.

Salmonellosis complicating aortic aneurysms.

We present our experience with two cases of salmonella infected aortic aneurysms. The treatment of salmonella infected aortic aneurysms has been associated with a high mortality, primarily due to the rapidity with which the post-infective complications of salmonellosis develop. Early diagnosis, adequate anti-microbial therapy and improved vascular surgical methods have resulted in a better prognosis for salmonella infected aortic aneurysms.

Reconstruction of the quadriceps apparatus following open injuries to the knee joint using pedicled gastrocnemius musculotendinous unit as bridge graft.

The objectives of treating open knee joint injuries with disruption of the distal quadriceps mechanism are to ensure rapid wound healing and to restore joint function. For this it is necessary to provide soft tissue cover, control infection, restore full extension of the knee by reconstruction of the extensor apparatus and prevent joint stiffness by early mobilisation. Two cases are presented where the gastrocnemius (medial half) musculotendinous unit has been used to reconstruct, in one stage, the extensor apparatus and at the same time to provide soft tissue cover.

Single-stage reconstruction of soft-tissue defects including the Achilles tendon using the dorsalis pedis arterialized flap along with the extensor digitorum brevis as bridge graft.

Open ruptures of the Achilles tendon with loss of the tendon and the overlying skin are very difficult to treat. They pose the problems of (1) combating infection, (2) providing soft-tissue cover, and (3) bridging the gap in the tendon. They are generally managed as multi-staged procedures. Once the infection is brought under control with debridement and antibiotics, skin cover is provided by local transposition flaps, distant pedicle flaps, or free-tissue transfer with microvascular anastomoses. The tendon itself is repaired later by one of the conventional techniques. More recently, composite free-tissue transfers repairing the skin and tendon in a single stage have been reported. We describe a simple and very reliable procedure using a dorsalis pedis island flap which provides a vascularized, innervated musculotendinous unit (i.e., extensor digitorum brevis) to bridge the gap in the Achilles tendon and thin, mobile skin and fascia to close the defect in the skin. Two cases are presented, including the technical details, advantages, and limitations of this procedure.

Multicentric giant cell tumour of bone--a report of two cases.

Two cases of metachronous multicentric giant cell tumour of bone are reported. One patient had tumours in the tibia and the femur, the second tumour appearing five years after the first. The other patient developed tumours in the tibia and the radius, the second tumour appearing two years and nine months after the first. The metachronous tumours, in both cases, were clinically and radiologically more aggressive than the initial tumours. Treatment with curettage and bone grafting proved to be ineffective for these tumours and en-bloc excision was required for cure.

Interrupted aortic arch with tetralogy of Fallot. A report of an unsuccessful surgically treated case.

Interrupted aortic arch is a complete discontinuity of two segments of the aorta. Although associated with a number of conditions, it does not occur in association with pulmonary stenosis. We report a case unsuccessfully treated but from which we have learnt a lesson.

A bypass technique for aneurysms of descending aorta.

Uniformity of opinion does not exist regarding optimal surgical strategy for descending aortic aneurysms. We present a surgical technique for bypass during aortic cross clamp while operating on such aneurysms. Five patients have undergone surgery using this technique. All of them are alive, doing well with no complications.