Preoperative evaluation of red blood cell distribution width as a promising biomarker for discriminating between benign and malignant breast tumors and assessing breast cancer activity.

BACKGROUND: The red cell distribution width (RDW) has been recognized as a new prognostic factor in various pathophysiological states including breast cancers. The aim of this study was to compare the RDW values between patients diagnosed with benign and malignant breast tumors and to evaluate the potential of elevated RDW as a biomarker for breast cancer activity. MATERIALS AND METHODS: A cross-sectional study compared RDW values in age-matched cohorts diagnosed with benign and malignant breast lesions and correlated them with prognostic factors for malignant breast tumors. The study excluded individuals with inflammatory disorders, pre-neoplastic disease, hematological disorders, or those taking immunosuppressive or anti-inflammatory medications. The RDW values were measured using an automated hematology analyzer. The study's statistical analysis was conducted using SPSS software at a significance level of 0.05. RESULTS: RDW demonstrated a statistically significant elevation in the cohort of patients with malignant breast tumors, those with metastatic breast tumors, a greater number of infiltrated axillary lymph nodes, larger tumor diameter, and a higher grade of the primary tumor mass. CONCLUSIONS: The findings of this study suggest that RDW has the potential to serve as a biomarker for assessing breast cancer activity and could offer substantial advantages in clinical contexts. The present study is not without limitations, and the authors suggest that a larger multicenter prospective study be conducted to further validate it's efficacy over an extended duration.

The application of low-dose dexamethasone in total knee arthroplasty: finding out the best route and dosage schedule.

BACKGROUND: The use of dexamethasone as additive to multimodal analgesic regimen in total knee arthroplasty has been well established, but the most suitable route, effectiveness, safety and dose schedule of low-dose dexamethasone is not known. METHODS: We conducted a prospective, randomized, double-blinded trial to investigate and compare the analgesic and antiemetic effects and safety of low-dose (8 mg) dexamethasone introduced as periarticular injection or intravenous (as a single dose or in two divided doses of 4 mg separated by 24 h) in unilateral total knee arthroplasty patients. RESULTS: The single dose intravenous administration as well as the periarticular administration of dexamethasone had similar mean visual analogue scores which were significantly lower than divided dose group at 24 and 48 h postoperatively. The rate of postoperative nausea and vomiting was lowest among single intravenous dose group and highest among interval dose group at 24 h, while no difference was noted at 48 h. No significant differences were noted in terms of knee flexion angle at 48 h and modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 6 weeks. CONCLUSION: Single low-dose intravenous dexamethasone is the most appropriate dose which can safely be given to TKA patients and is only moderately associated with rise in blood sugar not causing any significant complication. Alternatively, periarticular infiltration of low-dose dexamethasone can produce equivalent analgesic effect as SDIV in first 24 h without causing significant blood sugar rise and wound complications, but its antiemetic effect remains subtle. Therefore, it is recommended to further study the combination of intraoperative periarticular and postoperative intravenous dexamethasone for their possible additive effect.

Analysis of clinical and radiological outcomes of long tibial stemmed total knee arthroplasty in knee osteoarthritis complicated by tibial stress fracture.

OBJECTIVE: Knee arthritis associated with tibial stress fractures represents an uncommon and difficult clinical scenario to treat. The use of long, fluted tibial extension rods has been vital in the management of such cases owing to immediate fracture stability and single-stage surgery without the need to open the fracture site. This study investigates clinical and radiological outcomes following total knee arthroplasty using a tibial extension stem in cases of knee osteoarthritis with tibial stress fracture. METHODS: From February 2015 to December 2020, 17 patients who had total knee arthroplasty implanted with a long stemmed tibial component were included in the study. Patient data were analyzed for knee range of motion, deformities, Knee Society score, knee function score, and time to fracture union in the pre- and postoperative periods. RESULTS: The mean follow-up duration was 22.7 ± 11.68 months (range 12-60 months), and mean time to fracture healing was 10.23 ± 2.81 weeks (range 8-20 weeks). The preoperative mean fixed flexion deformity improved from 8.53 ± 3.43° to a mean of 0.29°, and knee flexion improved from 79.4 ± 13.90° to 125.29 ± 8.74° on postoperative assessment. The Knee Society score improved from a mean preoperative score of 18.94 ± 5.55 (range 8-28) to 89.41 ± 7.5 (range 74-102, p value < 0.001). Similarly, the knee function score improved significantly from a mean preoperative score of 15.5 ± 4.48 (range 8-26) to a mean of 85 ± 6.09 (range 72-94, p value < 0.001). CONCLUSION: Total knee arthroplasty using long tibial extenders has been an effective and safe surgical option for patients with advanced osteoarthritis with tibial stress fractures.

The pelvic digit "eleventh finger".

Described as asymptomatic and an incidental finding on a plain x-ray film, the "pelvic digit" is a rare congenital anomaly. A 35-year-old man is of a rare symptomatic pelvic digit that warranted surgical excision. Its importance lies in its differentiation from acquired abnormalities due to trauma such as myositis ossificans and avulsion injuries of pelvis. If this entity is kept in mind, unnecessary investigations or interventions can be avoided.