Restoring Functionality: Humeroradial Total Elbow Revision for Salvaging Total Elbow Arthroplasty Failure and Ulnar Bone Loss.

As the number of total elbow arthroplasty (TEA) continues to increase worldwide, one might predict the number of revision TEA would rise as well. The most common indications for revision TEA include (a) loosening, (b) infection, and (c) periprosthetic fracture. Although the rate of revision TEA procedures continues to rise due to the infrequency in which they are performed compared to other arthroplasty surgeries, no gold standard algorithm or procedure for managing severe ulnar bone loss in revision TEA has been determined. Various surgical techniques and strategies including allograft-prosthesis composite, custom long prosthesis with or without allograft, and resection arthroplasty have all been employed in attempting to address severe ulnar bone loss in revision TEA. Though the reported outcomes are mixed at best between each treatment strategy with similar complication rates. Another option is implanting the ulnar component into the radius. In those patients with severe ulnar bone loss, a humeroradial TEA revision can provide stability, restore range of motion, and provide pain relief.

Postoperative Peritoneal Granulomatous Inflammation After the Application of Potato Starch-Based Anti-Adhesive Agent in Laparoscopic Endometriosis Surgery.

Background: Endometriosis is a chronic inflammatory oestrogen-dependent disease. It is characterised by elevated inflammatory markers in the peritoneal milieu with subsequent adhesiogenesis. Nowadays, excisional, and ablative surgeries are considered the main treatment of endometriosis, and adhesiolysis is being performed almost routinely during these procedures. Postoperative adhesion formation is a significant concern for many surgeons, especially as endometriosis patients are assumed to be predisposed to adhesiogenesis. In order to minimise adhesiogenesis after endometriosis surgery, the usage of different barrier methods have been discussed in the literature. Recent studies aim to investigate the effect of potato starch preparations on adhesion formation in endometriosis patients. Objectives: We aim to describe the findings of a second-look laparoscopy on patients who received a starch-based anti-adhesive agent. Materials and Methods: We present a retrospective case series that included the medical, surgical, and histopathologic data of three patients. Main outcome measures: Intraperitoneal adhesion formation and peritoneal inflammation. Results: All three patients had de-novo adhesions during the second-look laparoscopy. Pathological examination revealed noncaseating granulomatosis of the peritoneum in all patients. Conclusion: The use of potato starch-based agents as a peritoneal adhesion prophylaxis in laparoscopic endometriosis surgery could lead to granulomatous peritoneal inflammation. Correct application by avoiding powder remnants through complete rinsing and transformation to gel seems to be an important factor to avoid this adverse effect. What is new?: We aim to highlight that potato starch-based anti-adhesive agents similar to the one used in this study could be a cause of adhesiogenesis and peritoneal inflammation.

Oxidized Zirconium Bearing Surface Failure in Total Knee Arthroplasty: A Unique Case Report of Isolated Medial Compartment with Catastrophic Results.

Introduction: Oxidized Zirconium (OXINIUM™) is a metal alloy with a ceramic surface, utilized to increase the longevity of knee and hip implantations and reduce polyethylene wear. Polyethylene-based spacers are effective in infection control and prosthetic stability. Therefore, understanding the interactions between the polyethylene spacer and metallic counterparts is essential in surgical decision-making. Furthermore, understanding how patients may present when catastrophic failure of these components arises is imperative. Herein, we present a unique case of atraumatic OXINIUM™ wear in a middle-aged female after uneventful primary total knee arthroplasty (TKA), highlighting atypical clinical features and addressing the surgical management of this unexpected implant failure. Case Report: A 51-year-old African American female presented from an outside facility with persistent left knee pain after undergoing a TKA with a Smith and Nephew OXINIUM™ coated knee. The patient presented to the senior author's clinic with worsening symptoms 2-year postoperatively from her primary left TKA by another surgeon. After a thorough work-up which was essentially unremarkable-3 years from her initial surgery - the recommendation was made for surgical revision given clinical concern for instability. During the initial surgical approach, significant sparking of the tissue was noted on the use of electrocautery. Once the capsule was dissected, black synovial fluid with soft tissue involvement was noted. Intraoperative analysis of the polyethylene spacer revealed disintegration in the medial compartment with loss of the zirconium coating along the femoral component. There was no evidence of polyethylene spacer wear within the lateral compartment. The primary components were explanted and replaced with a nickel-free implant. Following revision, the patient reported complete resolution of her symptoms with improvement in active range of motion. Conclusion: This case illustrates a unique presentation of atraumatic prosthetic surface coating failure after an uneventful primary TKA with well-aligned post-operative radiographs. Instability in the posterior stabilized total knee caused the polyethylene liner to come out of place, causing articulation of femoral and tibial components, creating the metal debris. Patients who present with persistent symptoms-of unknown etiology - after primary TKA should be considered for enhanced screenings and early surgical intervention.

Subchondroplasty - A Viable Treatment Option for Transient Bone Marrow Edema Syndrome of the Navicular in an Adolescent: A Case Report.

Introduction: Transient bone marrow edema (TBME) is a condition that typically presents in middle-aged adults with a male to female ratio of 3:1. Cases have also been noted in females during the third trimester of pregnancy. Vitamin D deficiency has been linked to this condition as the pathophysiology demonstrates poorly mineralized osteoid in presenting lesions. It is rare for a healthy child or adolescent to present with TBME introducing the purpose of this case study. This case report aims to provide medical and surgical education on TBME in a young and healthy adolescent. To our best knowledge, this is the first report on the use of subchondroplasty to treat transient bone marrow of the navicular in an adolescent male. Case Report: A 16-year-old adolescent male with foot and ankle pain is treated from September of 2017 to September of 2019. The patient failed initial conservative treatments. His treatment concluded with subchondroplasty of the navicular bone, typically contraindicated due to the risk of avascular necrosis (AVN). The patient received follow-up in March of 2020, which included additional magnetic resonance imaging (MRI) for long-term treatment outcome data. Conclusion: The patient was successfully treated with subchondroplasty after conservative therapy failed. In patients with TBME, subchondroplasty may not be the best option due to risk of AVN. At 1-year follow-up, our patient was asymptomatic and MRI showed reduction in edema.

Ginger root powder enhanced the growth productivity, digestibility, and antioxidative capacity to cope with the impacts of heat stress in rabbits.

Heat stress is the most significant environmental factor involved in the impairment of the health status of rabbits and lowering their productivity. Using medicinal feed additives is suggested to relieve heat stress-induced oxidative stress in rabbits. The study investigated the possible protective role of ginger root (Zingiber officinale) against heat stress in rabbits. Five week old rabbits were assigned randomly into four groups (48 rabbits each) and fed a basal diet supplemented with 0, 2.5, 5.0, and 7.5 g ginger powder/kg diet. The temperature and relative humidity inside the rabbitry units were kept at 33.0 ± 5.5 °C and 74.5 ± 4.5%, respectively, during 8 weeks fattening period. The results showed that rabbits that received the 7.5 g ginger powder/kg supplement had the highest final body weight. Rabbits that received different ginger powder levels recorded lower mortality values during the experimental period compared to that received the control diet, but the differences were not significant (5.0 vs. 10.0%, respectively). Rabbits fed 5.0 and 7.5 g ginger diet recorded the best food conversion ratio (P < 0.001). The weight of the carcass was significantly increased (P < 0.01) by supplementing ginger powder in diets. The digestibility of dry matter, organic matter, crude protein, and nitrogen free extracts nutrients was increased, but ether extract was significantly decreased (P < 0.001) by using ginger powder in diets. The detected blood metabolites displayed increased total protein but decreased triglycerides, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) in rabbits treated with ginger. Rabbits fed 5.0 and 7.5 g ginger powder had the highest plasma total antioxidative capacity (TAC) and the lowest (P < 0.01) plasma malondialdehyde (MDA) concentration compared to those fed control diet. Conclusively, supplementing ginger powder up to a 5.0 g/kg diet for growing rabbits is recommended to improve the growth performance and enhanced viability under heat stress conditions.

Detection of sugars and aminoacids in antigens of Trichophyton mentagrophytes var. erinacei.

Crude antigen extracted from mycelium of Trichophyton mentagrophytes var. erinacei by means of phenol and ethylene glycol was studied for sugar and amino acid constituents using DEAE-Sephadex A-50 column chromatography for fractionation. The results revealed that the crude antigen contains 13 sugars and 15 amino acids. It is presumed that the antigenicity is based on glycopeptide fractions.