Pseudotumor recurrence in a post-revision total hip arthroplasty with stem neck modularity: A case report.

BACKGROUND: This unique presentation of hip swelling is only the seventh reported case of pseudotumor recurrence in a non-metal-on-metal total hip arthroplasty (THA) construct. The constellation of patient symptoms and laboratory findings contradict the expected elevated serum metal ion levels associated with the formation of pseudotumor. The presentation, lab trends, and imaging findings contribute to the growing base of knowledge surrounding the effects of corrosion in arthroplasty constructs with stem-neck modularity. CASE SUMMARY: A 74-year-old man status post primary THA presented with left hip swelling and elevated serum metal ions five years after implantation of a modular stem-neck prosthesis. The swelling was diagnosed as pseudotumor based on laboratory trends and imaging findings and was treated with revision arthroplasty that completely resolved the initial hip swelling. The patient presented with recurrent hip swelling and recurrent pseudotumor findings on imaging in the same hip four months later. Non-operative management with ultrasound-guided hip aspiration resulted in symptom relief and resolution of the recurrent swelling. After one year of follow-up, the patient had no further recurrences of hip swelling. CONCLUSION: This case of post-revision pseudotumor recurrence elucidates attributable patient, surgical, and implant factors with a discussion of diagnostics, management, and prognosis for patients with pseudotumor in non-metal-on-metal arthroplasty constructs.

Extraskeletal Osteosarcoma of the Hand.

Extraskeletal osteosarcoma is a rare disease that uncommonly affects the upper extremity. A 46-year-old African American man presented for evaluation of a right middle finger mass. Excisional biopsy demonstrated extraskeletal osteosarcoma of the soft tissues. We performed a transmetacarpal ray resection.

Improving human health through understanding the complex structure of glucose polymers.

Two highly branched glucose polymers with similar structures--starch and glycogen--have important relations to human health. Slowly digestible and resistant starches have desirable health benefits, including the prevention and alleviation of metabolic diseases and prevention of colon cancer. Glycogen is important in regulating the use of glucose in the body, and diabetic subjects have an anomaly in their glycogen structure compared with that in healthy subjects. This paper reviews the biosynthesis-structure-property relations of these polymers, showing that polymer characterization produces knowledge which can be useful in producing healthier foods and new drug targets aimed at improving glucose storage in diabetic patients. Examples include mathematical modeling to design starch with better nutritional values, the effects of amylose fine structures on starch digestibility, the structure of slowly digested starch collected from in vitro and in vivo digestion, and the mechanism of the formation of glycogen α particles from ß particles in healthy subjects. A new method to overcome a current problem in the structural characterization of these polymers using field-flow fractionation is also given, through a technique to calibrate evaporative light scattering detection with starch.