Femoral Nerve Compression due to Adverse Local Tissue Reaction After Ceramic-on-ceramic Total Hip Arthroplasty.

The use of metal bearings in total hip arthroplasty (THA) has been linked with adverse local tissue reactions (ALTRs). There is 1 reported case of ALTR from a ceramic-on-ceramic (CoC) bearing and none that resulted in nerve compression. In this case, a 71-year-old man presented with an ALTR after a CoC THA that resulted in femoral nerve compression. An anterior approach was utilized to revise his THA, which resulted in nerve decompression and near-resolution of his preoperative symptoms. We conclude that CoC bearings may not be completely inert and can result in ALTRs and nerve compression.

Anti-N-Methyl-D-Aspartate Receptor Encephalitis: Neuropsychiatric and Multidisciplinary Approach to a Patient Not Responding to First-Line Treatment.

The understanding of anti-NMDA (N-methyl-D-aspartate) receptor encephalitis, recognized by Dalmau and colleagues in 2007, has come a long way in helping clinicians to recognize the significance of rapidly progressive psychiatric symptoms in patients who are actually suffering from autoimmune disease. This subtype of autoimmune encephalitis manifests from antibodies that target the NR1 and/or NR2 subunits of NMDA receptors in serum or cerebrospinal fluid. Since gaining notoriety among neurologists, it has shown an etiologic predilection for children, adolescents, and young adult females, often associated with ovarian teratomas. Conversely, it affects young males as well, though it is rarer to find co-occurring tumors. It is a multistage disorder, initially presenting with psychiatric symptoms that progress in varying fashion, including headache, fever, nuchal rigidity, emesis, seizure, autonomic instability, auditory and visual hallucinations, delusional ideation, agitation, altered sensorium, and motor disturbances (i.e. dyskinesia, catatonia, etc.). Early diagnosis is critical due to the relatively high (25%) mortality rate. In this case, we present the case of a 30-year-old male who presented to our institution's Comprehensive Psychiatric Emergency Program (CPEP) exhibiting bizarre behavior and visual hallucinations, and was later confirmed to have anti-NMDA receptor encephalitis. The case report highlights the risk factors, disease course, and treatment modalities of anti-NMDA receptor encephalitis with special emphasis on the subsect of patients who may not respond to first-line therapies.

Musculoskeletal Manifestations of Amyloidosis: A Focused Review.

Amyloidosis is a poorly understood condition that can wreak havoc on numerous systems within the human body. In addition, this disease can present in multiple forms which each have their own unique physiology and subsequent effects. However, while the literature on the etiology and effect of amyloidosis on various organ systems is numerous, few have highlighted the musculoskeletal manifestations of this devastating disease. This review focuses on the recent research on amyloid deposition in the musculoskeletal system. Additionally, risk factors, classification, differential diagnoses, indications for biopsy, and manifestations of amyloidosis in the musculoskeletal system as well as in other tissues are discussed. Furthermore, the surgical and nonsurgical approaches to treatment are covered. (Journal of Surgical Orthopaedic Advances 27(1):1-5, 2018).

Decreasing the Incidence of Surgical-Site Infections After Total Joint Arthroplasty.

Surgical-site infection (SSI) after total joint arthroplasty (TJA) continues to pose a challenge and place a substantial burden on patients, surgeons, and the healthcare system. Given the estimated 1.0% to 2.5% annual incidence of SSI after TJA, orthopedists should be cognizant of preventive measures that can help optimize patient outcomes. Advances in surgical technique, sterile protocol, and operative procedures have been instrumental in minimizing SSIs and may account for the recent plateau in rising rates. In this review, we identify and discuss preoperative, intraoperative, and postoperative actions that can be taken to help reduce the incidence of SSIs, and we highlight the economic implications of SSIs that occur after TJA.

Anti-infective, cytotoxic and antioxidant activity of Ziziphus oxyphylla and Cedrela serrata

Objective: To search for the most active antimicrobial and antioxidant sub-fractions related to traditional use of Ziziphus oxyphylla (Z. oxyphylla) and Cedrela serrata (C. serrata) in Pakistan against infectious and liver diseases. Methods: Factions of different polarity were tested in vitro for their antiprotozoal, antimalarial, antibacterial and antifungal activity against different pathogens. Cytotoxicity on MRC-5 cell lines (human lung fibroblasts) as well as, in vitro radical scavenging activity was evaluated using the 1, 1-diphenyl-2-picrylhydrazyl radical assay. Results: The highest antiprotozoal activity was observed for the CHCl3 fractions of Z. oxyphylla roots and leaves, and C. serrata bark. The CHCl3 and EtOAc fractions of Z. oxyphylla roots, the CHCl3 fraction of Z. oxyphylla leaves, the EtOAc and the residual MeOH: H2O fraction of C. serrata bark showed antibacterial activity against Staphylo-coccus aureus. The same residual MeOH: H2O fraction of C. serrata bark was active against Candida albicans. The highest antioxidant activity was observed for the more hydrophilic EtOAc fractions of Z. oxyphylla leaves, C. serrata bark and leaves, and the residual MeOH:H2O fraction of C. serrata bark. Conclusions: This study supports at least in part the traditional uses of these plants for antimicrobial purposes and against liver diseases.

The utility of obtaining routine hematological laboratory values following an anterior cervical diskectomy and fusion.

STUDY DESIGN: Retrospective analysis of a prospectively maintained database. OBJECTIVE: To characterize the utility of obtaining routine postoperative laboratory studies after an anterior cervical diskectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: ACDF is typically associated with minimal blood loss and morbidity. However, at many institutions, postoperative laboratory studies are conducted routinely. This study aims to characterize the utility of these tests in the postoperative setting. METHODS: A retrospective analysis of a prospectively maintained database of 332 patients who underwent an ACDF for degenerative cervical spine disease between 2007 and 2014 was performed. Patients with a concurrent corpectomy, posterior fusion, or revision procedure were excluded. Patient demographics, comorbidities, visual analogue scale scores, surgical and hospitalization parameters, complications, and transfusion volumes were assessed. The patient's postoperative laboratory studies were compared with preoperative values. Statistical analysis was performed with independent sample T tests for continuous variables and χ analysis for categorical data. An α level of less than 0.05 denoted statistical significance. RESULTS: A total of 332 patients were included with a mean age of 51.1 ± 11.7 years. The overall mean procedural time, estimated blood loss, and length of stay were 60.0 ± 30.1 minutes, 69.4 ± 36.2 mL, and 40.2 ± 20.3 hours, respectively. Overall, 98.1% of patients demonstrated radiographical arthrodesis at 1 year. After a 1- or 2-level ACDF, the postoperative hemoglobin, hematocrit, blood urea nitrogen, sodium, and calcium levels significantly decreased, whereas glucose and chloride levels increased when compared with the preoperative values (P < 0.05). In addition, the 1-level ACDF cohort was also associated with reduced postoperative potassium level (P < 0.05). However, none of the patients required intraoperative or postoperative blood product transfusion or demonstrated evidence of postoperative anemia. Two patients (0.89%) required postoperative potassium replacement based upon laboratory values alone without clinical symptomatology. There were no complications that were related to the patient's hemodynamic status or fluid and electrolyte balance. CONCLUSION: In the majority of cases after an ACDF, no action was taken n the basis of the patient's routine postoperative laboratory data. None of the patients required blood product transfusion, whereas only 0.89% (n = 2) required potassium replacement for laboratory anomalies without clinical symptomatology. These findings suggest that routine postoperative complete blood counts do not change postoperative management after an ACDF unless intraoperative bleeding is noted or the patient carries risk factors for postoperative hemorrhagic anemia. LEVEL OF EVIDENCE: 3.

Role of ultrasound guided fine needle aspiration cytology in diagnosis of space occupying lesions of liver.

BACKGROUND: Ultrasound guided fine needle aspiration cytology (FNAC) is a valuable techhique for diagnosing benign and malignant space occupying masses of liver. It is a cost effective and safe method that can differentiate benign and malignant lesions accurately. The objective of this study was to analyse cases of radiologically guided fine needle aspiration cytology of space occupying lesions of liver. METHODS: Ultrasound guided FNAC of liver masses was carried out on 450 admitted patients with focal lesions liver on ultrasound. Patients of all ages and both sexes were included. The study was conducted in department of Diagnostic radiology in collaboration with the Pathology Department at Nishtar Medical College & Hospital, Multan over a period of two years from August, 2009 to August, 2011. The aspirates were done by senior radiologist in - Radiology Department. RESULTS: Most of the aspirates were from males. Ten cases were considered inadequate. There were more malignant cases (320 cases) as compared to benign lesions (120 cases). Metastatic lesions were more common as compared to hepatocellular carcinoma (HCC); however the ratio of metastatic adenocarcinoma and primary HCC was almost equal. CONCLUSION: Ultrasound guided FNAC is a simple, quick and complication free procedure for diagnosing space occupying lesions of liver.