scholarly journals Treatment of Symptomatic Bipartite Patella by Fragment Excision, Capsular Repair and Novel ITB Release

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0019
Author(s):  
Bruce Caldwell ◽  
Sarah O’Reilly-Harbridge
Keyword(s):  
Bone Scan ◽  
Absorbable Suture ◽  
Capsular Repair ◽  
Bipartite Patella ◽  
Average Improvement ◽  
History Of ◽  
Lateral Patella ◽  
Capsular Incision ◽  
Patella Tracking ◽  
Fragment Excision

Objectives: The aim of this paper is to present the mid-term results of a novel technique used to treat symptomatic bipartite patella. Methods: Diagnosis of symptomatic bipartite patella was made by history, examination, Xray, MRI and/or bone scan. Patients with typical localised pain, pain on manually stressing the fragment, a positive ITB tightness test, a typical Xray and either, a hot bone scan or bone oedema on MRI were considered for treatment. All patients had a pre-op Kujala and Lysholm score recorded. Surgical Technique: Under GA and tourniquet a 4 part procedure was performed: Routine arthroscopy to assess patella tracking and fragment stability A 2 cm incision was made on the distal thigh 10-12 cm above the joint line over the ITB. A zig-zag incision was made across the ITB/IPB from anteriorly to the corner of the intermuscular septum. A 4 cm incision was made over the edge of the lateral patella. A longitudinal capsular incision was made at the edge of the patella. The capsule was reflected off the dorsal patella by sharp dissection and the bipartite fragment was excised through the synchondrosis. A watertight repair of the lateral capsule was performed with absorbable suture. Routine closures were performed. Comment: The author considers the ITB/IPB to be an important factor in the development and progression of the disorder. The addition of the novel release allows a tension-free capsular repair, reducing lateral facet loads, improving patella tracking without affecting patella stability Results: Over an 11 year period twenty patients underwent the procedure. 15 were available with a minimum 2 year and mean 6.35 year follow-up. Pre-op and post-op Kujala and Lysholm scores were compared. Patients were predominantly male (14:1) between ages 10-54 years. A clear history of trauma was present in 6 patients while in 9 symptoms were related to overuse. The pre-op Kujala score ranged from 28-90 with an average of 59. Post-op scores improved markedly with range 70-100 with 12 patients (80%) scoring >90 and an average improvement of 32 pts. Lysholm scores similarly improved significantly, with an average 32 pts improvement (range 1-66). Complications were minimal. Conclusion: Fragment excision, capsular repair and novel ITB release resulted in significant reproducible improvements in both objective and subjective outcome measures. Resolution of symptoms occurred in all patients suggesting the technique is a useful option in the treatment of symptomatic bipartite patella.

An interesting case of left paraduodenal hernia.

2021 ◽  
Vol 28 (05) ◽  
pp. 755-758
Author(s):  
Sahar Saeed ◽  
Abeera Butt ◽  
Syed Asghar Naqi ◽  
Muhammad Mohsin Ali
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Interesting Case ◽  
Paraduodenal Hernia ◽  
Absorbable Suture ◽  
Internal Hernias ◽  
Plain Abdominal Radiography ◽  
History Of ◽  
Operative Recovery

Paraduodenal fossa hernias (PDFHs) represent 53% of all congenital internal hernias and 0.2-0.9% of all small bowel obstructions. Most of these hernias are diagnosed incidentally on laparotomy, and carry up to 50% lifetime risk of development of small bowel obstruction. We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia in a 17 year male, containing over 30% of the small bowel (jejunum and ileum), presenting with a history of recurrent incomplete small bowel obstruction. Plain abdominal radiography showed distended loops of jejunum and few air fluid levels. After laparotomy and identification of hernia, small gut was reduced and examined, which was found to be structurally and functionally intact with normal vascularity. The defect was closed with continuous absorbable suture (Vicryl 2-0) sparing the inferior mesenteric vessels. Patient’s post-operative recovery remained uneventful and he was discharged on 4th post-operative day.

scholarly journals A Role for CD154, the CD40 Ligand, in Granulomatous Inflammation

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Julien Villeneuve ◽  
Alexis Desmoulière ◽  
Antoine Dewitte ◽  
Nelly Bordeau ◽  
Pierre Costet ◽  
...  
Keyword(s):  
Carbon Tetrachloride ◽  
Granulomatous Inflammation ◽  
Cd40 Ligand ◽  
Giant Cells ◽  
Absorbable Suture ◽  
Epithelioid Cells ◽  
History Of ◽  
Toxic Liver Injury ◽  
Deficient Mice

Granulomatous inflammation is a distinctive form of chronic inflammation in which predominant cells include macrophages, epithelioid cells, and multinucleated giant cells. Mechanisms regulating granulomatous inflammation remain ill-understood. CD154, the ligand of CD40, is a key mediator of inflammation. CD154 confers a proinflammatory phenotype to macrophages and controls several macrophagic functions. Here, we studied the contribution of CD154 in a mouse model of toxic liver injury with carbon tetrachloride and a model of absorbable suture graft. In both models, granulomas are triggered in response to endogenous persistent liver calcified necrotic lesions or by grafted sutures. CD154-deficient mice showed delayed clearance of carbon tetrachloride-induced liver calcified necrotic lesions and impaired progression of suture-induced granuloma. In vitro, CD154 stimulated phagocytosis of opsonized erythrocytes by macrophages, suggesting a potential mechanism for the altered granulomatous inflammation in CD154KO mice. These results suggest that CD154 may contribute to the natural history of granulomatous inflammation.

scholarly journals Metachronous or synchronous male breast and prostate cancers a duality to lookout for.

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1825
Author(s):  
Alain Mwamba Mukendi ◽  
Eunice Van Den Berg ◽  
Sugeshnee Pather ◽  
Rushen Siva Padayachee
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Bone Scan ◽  
Digital Rectal Examination ◽  
Radical Mastectomy ◽  
Modified Radical Mastectomy ◽  
Breast Lump ◽  
History Of ◽  
Prostate Cancers

Introduction: Breast cancer is well known as the stereotypical women's cancer, and prostate cancer represents the well-known stereotypical male counterpart. While prostate cancer carries the potential to metastasize to the breast, the synchronous or metachronous co-occurrence of primary breast and primary prostate cancers is quite unusual. Prostate cancer in men of African descent may have its own behavior with regards to its relationship with male breast cancer. Case presentation: Case 1: A 64 year old male presented to Chris Hani Baragwanath Hospital (CHBAH) with a 2 years history of a painless left breast lump. A core biopsy was confirmed breast carcinoma. Tamoxifen was started but, due to disease progression, he underwent left modified radical mastectomy followed by chemotherapy. Prostate biopsy was done for raised Prostate Specific Antigen (PSA) and suspicious prostate on digital rectal examination. A prostatic adenocarcinoma was subsequently diagnosed with bone metastasis on bone scan. He was started on Androgen deprivation therapy and followed up every 3 months. Case 2: A 68 year old male presented to CHBAH with a 1 year history of a painless right breast lump. A core biopsy confirmed breast cancer. Tamoxifen was started, followed by right modified radical mastectomy and chemotherapy for disease progression. A raised PSA and suspicious prostate on digital rectal examination prompted a prostate biopsy revealing a prostatic adenocarcinoma. Bone scan was negative for metastasis. He is currently on 3 monthly Androgen deprivation therapy and awaiting radiation. Conclusion: This clinical practice article not only presents this exceptionally rare duality but highlights that both cancers can coexist either as sporadic conditions, or as a result of genetic mutations. Thus, we suggest that men with prostate cancer be screened clinically, biochemically and genetically for breast cancer and vice versa.

scholarly journals Significantly delayed polyglactin 910 suture-related pseudoinfection in a Yucatan pig

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Dalis Collins ◽  
Brian Simons
Keyword(s):  
The Body ◽  
Absorbable Suture ◽  
Critical Research ◽  
Polyglactin 910 ◽  
Pain Medications ◽  
Published Report ◽  
History Of ◽  
Ovarian Pedicle ◽  
Yucatan Pig ◽  
Infectious Etiology

Abstract Background Polyglactin 910 is a synthetic braided, absorbable suture commonly used in surgery. Though polyglactin 910 suture-related pseudoinfection is well documented in the human literature, it has not been previously reported in the veterinary literature. Case description A 3-year-old female, ovariectomized but otherwise experimentally naïve Yucatan pig was evaluated for a several week history of bilateral multifocal abscesses in the area of the paralumbar fossa, which continued to worsen despite oral antibiotics and non-steroidal anti-inflammatory medications. The multi-focal abscesses continued to worsen and additional diagnostics were pursued including cytology, culture (aerobic, anaerobic and fungal), and bloodwork. All supported a non-infectious etiology. Biopsy results indicated a suture-related pseudoinfection. Despite treatment including parenteral antibiotics, pain medications and superficial surgical debridement, the dermatologic lesions worsened. Euthanasia was elected. Post-mortem necropsy demonstrated a suture-related pseudoinfection with extrusion of suture material from the ovarian pedicle ligatures through the body wall and skin leading to numerous sterile abscesses in the bilateral paralumbar fossa. Conclusions This is the first published report of a significantly delayed polyglactin 910 suture-related pseudoinfection in a Yucatan pig. While likely an isolated incident, it supports further research into this area. Additionally for critical research studies using Yucatan pigs, pre-surgical assessment with hypersensitivity patch testing may be appropriate.

Surgical management of perineal laceration in a cow affected with cervico vaginal prolapse

2017 ◽  
Author(s):  
U. Lakshmikantan ◽  
M. Murugan ◽  
A. Ganesan ◽  
T. Sathiamoorthy
Keyword(s):  
Suture Material ◽  
Lateral Wall ◽  
Vaginal Prolapse ◽  
Absorbable Suture ◽  
Perineal Laceration ◽  
Perineal Repair ◽  
Second Stage ◽  
Interrupted Suture ◽  
Left Lateral Wall ◽  
History Of

A five year old cow was brought with the history of delivering the calf without untying Buhner’s suture which was applied to retain the recurrent cervico vaginal prolapse, resulting in rare occurrence of extensive laceration of perineum accompanied with cervico vaginal prolapse. Examination of perineum revealed two tears on the left lateral wall of the vagina. Absorbable suture material, poly glycolic acid (PGA) was used to appose the vaginal tears. Vulval labium was applied with simple interrupted suture using silk. Perineal repair was helpful in reconstructing the vagina and vulva. In conclusion, proper surgical apposition would restore the normal conformation of reproductive passage in cows affected with perineal laceration and Buhner’s suture should essentially be removed to avoid extensive damage to the perineum at the time of second stage parturition.

scholarly journals Gout tophus in transferred tendons after 33 years: A case report

2021 ◽  
Author(s):  
Fethiye Damla Menkü Özdemir ◽  
Barış Kafa ◽  
Erdi Özdemir ◽  
Nazlı Eylem Alkanat ◽  
Ali Emre Aksu
Keyword(s):  
Histopathological Examination ◽  
Wrist Joint ◽  
Rare Complication ◽  
Previous History ◽  
Excisional Biopsy ◽  
Absorbable Suture ◽  
Suture Materials ◽  
Initial Surgery ◽  
History Of ◽  
The Right

Surgical site gout is an extremely rare complication that is difficult to diagnose, particularly in patients without a history of gout. A 57-year-old male patient was admitted with no previous history of gout, complaining of surgical site gout located at the junction where flexor carpi ulnaris tendon was transferred to extensor digitorum communis tendon after 33 years of the initial surgery. The patient was presented with a progressive swelling over the last three months which was located on the dorsoulnar side of the right wrist joint. Magnetic resonance imaging revealed an iso/hypointense mass. During the excisional biopsy, retained non-absorbable suture materials were observed within the mass. Histopathological examination result was reported as a typical gout tophus. No recurrence was observed after 18 months of follow-up. In conclusion, surgical site gout may be observed at transferred tendons years after the initial surgery.

scholarly journals A case en pointe

2003 ◽  
Vol 4 (5) ◽  
pp. 167-168
Author(s):  
A Ng ◽  
Y Cemel ◽  
DQ Donaldson ◽  
V Bothra
Keyword(s):  
Septic Arthritis ◽  
Bone Scan ◽  
Incision And Drainage ◽  
Diagnosis And Management ◽  
First Metatarsal ◽  
Intravenous Antibiotics ◽  
History Of ◽  
Increased Activity

Septic arthritis of the first metatarsal-phalangeal joint (MTPJ) is rare. Such a case is reported in a 14-year-old female ballerina who presented with a one-week history of big toe pain and being systematically unwell. Radioisotope bone scan showed increased activity localised to the first MTPJ. The patient was treated with urgent incision and drainage and intravenous antibiotics. She was able to return to full training eight weeks later. This case highlights the difficulty in diagnosis and management.

The probability of a positive bone scan in patients who were treated with adrogen ablasio therapy for rising PSA after radical prostatectomy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4574-4574
Author(s):  
Z. A. Dotan ◽  
K. Sathyamoorthy ◽  
F. J. Bianco ◽  
A. J. Stephenson ◽  
J. A. Eastham ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Predictive Model ◽  
Bone Scan ◽  
Surgical Margin ◽  
Patient Characteristics ◽  
Bootstrap Analysis ◽  
Ablation Therapy ◽  
Androgen Ablation ◽  
History Of ◽  
Androgen Ablation Therapy

4574 Background: Physicians often order periodic bone scans to check for metastases in patients treated with androgen ablation therapy (ADT) for rising PSA (biochemical recurrence; BCR) following radical prostatectomy. However, most of these scans are negative. We studied patient characteristics to build a predictive model for a positive scan (+BS) in that setting. Methods: From our prostate cancer database we identified all patients with detectable PSA after radical prostatectomy that were treated by ADT for BCR only. There were 511 BS performed in patients treated with ADT for BCR. Among them, 151 BS were performed for patients with BCR only with out previous evidence of bone metastases (1–8 BS for patient with median of one). We analyzed the following potential predictors for a positive bone scan at the time of each bone scan: preoperative PSA, history of neoadjuvant ADT (NA-ADT), time to BCR, pathologic findings (surgical margin, extracapsular extension, seminal vesicle invasion, lymph node metastases, and Gleason score), PSA before the BS (trigger PSA), PSA doubling time and time from BCR to BS. The results were incorporated into a predictive model. Results: Among the 151 BS, only 35 (23%) were positive for metastases. In multivariate analysis, only trigger PSA (P < 0.001, OR 1.84) and NA-ADT (P = 0.02, OR 1.32) predicted a +BS. Probability of +BS according to PSA of 0–2, 2.1–4, 4.1–10, 10.1–20 and above 20.1 were 4.7%, 15.3%, 29.6%, 46.1% and 63.3% respectively. A nomogram was constructed for predicting the probability of +BS, and was found to have a concordance index of 0.83. Calibration of the nomogram according to bootstrap analysis showed that the nomogram is reasonably accurate. Conclusions: Trigger PSA and a history of neoadjuvant ADT were associated with a +BS. Omitting scans in low-risk patients could reduce substantially the number of scans ordered. No significant financial relationships to disclose.

scholarly journals PRESENTING FEATURES, CLINICAL COURSE, SURGICAL TECHNIQUES, AND OUTCOMES ASSOCIATED WITH OPERATIVE TREATMENT OF BIPARTITE PATELLA IN PEDIATRIC AND ADOLESCENT ATHLETES: A RETROSPECTIVE COMPARISON TO A NON-OPERATIVELY TREATED COHORT

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0024
Author(s):  
Jennifer Kallini ◽  
Lyle J. Micheli ◽  
Dennis E. Kramer ◽  
Mininder S. Kocher ◽  
Benton E. Heyworth
Keyword(s):  
Operative Treatment ◽  
Knee Pain ◽  
Clinical Course ◽  
Surgical Techniques ◽  
Lateral Release ◽  
Minor Trauma ◽  
Adolescent Athletes ◽  
Bipartite Patella ◽  
Competitive Athletes ◽  
Fragment Excision

Background: The bipartite patella is a developmental variant in which incomplete ossification leads to a fibrocartilaginous synchondrosis between ossification centers; repetitive traction on the synchondrosis in young athletes may lead to pain. Few series of surgical cases exist to guide treatment approaches to refractory pain. Hypothesis/Purpose: To investigate the presenting features, clinical course, surgical techniques, and outcomes associated with operative treatment of symptomatic bipartite patella in pediatric and adolescent athletes, with comparison to a control group of symptomatic, non-operative patients. Methods: A retrospective medical record review of patients ≤20 years-old diagnosed with symptomatic, radiographically-confirmed bipartite patellae between 2003 and 2018 at a single tertiary-care pediatric hospital was conducted. Patients for whom knee pain could not be attributed to bipartite patella were excluded. Additional clinical and operative variables were collected for the subset that underwent surgical treatment. Outcomes analyzed included time to return to sport (RTS) and re-operation. Results: 278 patients (37.8% females; mean age: 12.7 years, range 7-20 years) were included, 27 (mean age: 15.3 years, range 10-20 years) of whom were treated operatively (9.7%). Compared to the 251 patients who underwent non-operative treatment (consisting of physical therapy, activity modification, non-steroidal anti-inflammatory medicines, and cryotherapy), the operatively treated patients were more likely to be older (mean age 12.4 years vs. 15.3 years, p<0.001), female (35.5% vs. 59.3%, p=0.02) and competitive athletes (83.6% vs. 100%, p=0.10). Of the operative patients, 16 (59%) had Saupe III (superolateral) ossicles, 8 (30%) had Saupe II (lateral) ossicles, and 3 (11%) had Saupe I (inferior) ossicles. Most operative patients (79%) reported insidious onset of pain, with minor trauma precipitating symptom onset in the remainder (21%). Symptom duration prior to surgery was 2.2 years (range 1.7 mo-10.1yrs). Procedures were categorized as isolated fragment excision (n=10), fragment excision with lateral release (n=9), isolated lateral release (n=4), ORIF (n=3), and arthroscopic drilling (n=1). Operative outcomes are found in Table 1. Conclusions: Bipartite patella may be an underappreciated cause of knee pain in adolescent athletes. Patients who underwent surgery displayed symptoms lasting >2 years, representing ˜10% of cases, and were most likely to have superolateral bipartite fragments with a mean size of ˜1cm2. Surgery was more common amongst females, competitive athletes, and older adolescents. There was an overall 11% risk of persistent or recurrent symptoms warranting re-operation. Prospective multi-center investigations may be warranted to identify optimal candidates for earlier interventions, as well as optimal non-operative and operative treatment techniques. [Table: see text]

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