Fresh osteochondral allograft transplantation (FOCAT) for definitive management of a 198 square millimeter osteochondral lesion of the talus (OLT): A case report.

An osteochondral lesion of the talus (OLT) is an idiopathic acquired lesion of the subchondral bone that can lead to debilitating sequelae. The causes of OLT's are still debatable, however, most agree that the etiology is repetitive microtrauma associated with vascular impairment. OLTs are most commonly described in the medial portion of the talus, while lateral involvement is less frequent. If not properly recognized and treated, an OLT may lead to numerous secondary conditions including premature osteoarthritis and functional limitations of the ankle joint. Multiple surgical and non-surgical treatment modalities have been described with varying results. Treatments are usually guided by the patients age, onset of symptoms, severity, and the disease stage according to the Berndt and Harty classification. Recent literature recommends curettage, drilling, or microfracture techniques for lesions which are no larger than 15mm in diameter and no deeper than 7mm. On the other hand, for large lesions or lesions that failed from primary bone marrow stimulation, surgery should be considered for autologous chondrocyte implantation (ACI), osteochondral autograft transplantation (OATs or mosaicplasty), or osteochondral allograft transplantation [1]. This case study examines surgical treatment of an extensive OLT in a 53 year old man who suffered with continuous ankle pain for over 10 years, misdiagnosed as ankle joint arthritis. Level of clinical evidence: Level of evidence 4.

Publication Rates for Oral and Poster Abstracts from the American Podiatric Medical Association: 2010-2014.

BACKGROUND: The quality of national society conferences is often assessed indirectly by analyzing the journal publication rates for the abstracts presented. Studies have reported rates from 67.5% to 76.7% for oral abstracts and 23.2% to 55.8% for poster abstracts presented at national foot and ankle society conferences. However, no study has evaluated the abstract to journal publication rate for the American Podiatric Medical Association's (APMA's) annual conference. METHODS: All presented abstracts from the 2010 to 2014 conferences were compiled. PubMed and Google Scholar searches were performed, and the number of abstracts presented, publication rate, mean time to publication, and most common journals of publication were determined. These results were then compared with those for the 2010 to 2014 American College of Foot and Ankle Surgeons' conferences. RESULTS: Of 380 abstracts presented, 142 (37.4%) achieved publication, most often in the Journal of the American Podiatric Medical Association. The oral abstract publication rate was 45.2% (14 of 31), with a mean time to publication of 24.2 months (range, 0-47 months). The poster publication rate was 36.7% (128 of 349), with a mean time to publication of 16.3 months (range, 0-56 months). Significant differences were identified between the two societies. CONCLUSIONS: The overall abstract to journal publication rate for the 2010 to 2014 APMA conferences was 37.4%, and, expectedly, oral abstracts achieved publication more often than posters. Moving forward, a concerted effort between competing societies seems necessary to increase research interest, institutional support, and formal mentorship for future generations of foot and ankle specialists.

Schwannoma of the plantarmedial aspect of the foot: A case report.

Schwannomas of the common medial plantar nerve branch are rare solitary nerve sheath tumors. Fewer than a dozen cases have since been described in the literature, most of which were initially misdiagnosed as ganglion cysts. The case of a 56-year-old male who developed a painful mass on the plantar medial hallux, misdiagnosed as a ganglion cyst, is presented. After surgical intervention and pathological analysis the patient was diagnosed as having a schwannoma. A schwannoma is a slowly growing neoplasm of Schwann cell origin. It is very rare for a schwannoma to transform into a malignant lesion and usually occurs in individuals between the ages for 20-50. Schwannomas usually have a predilection for the head and upper extremities and is very rare in the foot and ankle. The principal treatment of a schwannoma is surgical excision, which eliminates symptoms and can correctly diagnose the mass. Even though schwannomas of the foot have been reported in literature, this case demonstrates an abnormal location on a branch of the medial plantar nerve. Level of Clinical Evidence: Level 4 of Evidence.

Pomelo juice, but not cranberry juice, affects the pharmacokinetics of cyclosporine in humans.

BACKGROUND: Cyclosporine (INN, ciclosporin) is a cytochrome P450 (CYP) 3A and P-glycoprotein (P-gp) substrate whose bioavailability increases when administered with grapefruit juice. It is unknown whether pomelo, a closely related citrus fruit, interacts with cyclosporine in humans. In addition, a case study reports that cranberry juice interacts with warfarin, a drug with a narrow therapeutic range. Cranberries have a high content of flavonoids, compounds with various metabolic effects, including interaction with P-gp in vitro. Although the effect of flavonoids is less evident in vivo, cranberry juice has become a very popular beverage, and it was deemed important to investigate whether it has an effect on the disposition of cyclosporine, another drug with a narrow therapeutic range. METHODS: In an open-label, randomized, 3-way crossover study with a 14-day washout period between each dose, 12 healthy male volunteers received single oral 200-mg doses of cyclosporine according to the following regimens: 200 mg cyclosporine administered with 240 mL of pomelo juice, cranberry juice, or water under fasting conditions. Multiple whole blood samples were collected up to 36 hours after each dose. Concentrations were determined via a liquid chromatography-tandem mass spectrometry method. RESULTS: Administration of pomelo juice with cyclosporine increased the area under the curve from time 0 to the last measurable concentration (AUCt), area under the curve from time 0 to infinity (AUCinf), and maximum blood concentration (Cmax) of cyclosporine with ratios of least squares means of 119.4% (95% confidence interval [CI], 113.4%-125.8%), 118.9% (95% CI, 113.8%-124.3%), and 112.1% (95% CI, 102.3%-122.8%), respectively. All 3 variables exhibited statistically significant increases (with Bonferroni adjustment), with P = .0001 for AUCt and AUCinf and P = .0167 for Cmax; however, only the increase in AUCt was judged to be clinically significant with a 95% CI outside the 80% to 125% boundaries. Cranberry juice had no clinically significant effect on the overall disposition of cyclosporine. After administration of cyclosporine with cranberry juice, the ratios of least squares means for AUCt, AUCinf, and Cmax for cyclosporine were 95.0% (95% CI, 90.3%-100.1%), 93.4% (95% CI, 89.2%-97.8%), and 95.2% (95% CI, 86.9%-104.2%), respectively. CONCLUSION: These results suggest that pomelo juice increases the bioavailability of cyclosporine, possibly by inhibiting CYP3A or P-gp activity (or both) in the gut wall. However, drinking a glass of cranberry juice does not appear to significantly influence the disposition of cyclosporine.