Technical Considerations for an Anteromedializing Tibial Tubercle Osteotomy

Background: Tibial tubercle osteotomy and distal realignment allows for adjustment to the patellofemoral articulation in order to improve patellar tracking and redistribute patellar contract pressures. Indications: A healthy, active 39-year-old woman status post right knee tibial tubercle osteotomy presented with >2 years of patellar instability symptoms in the left knee. Imaging revealed a tibial tubercle to trochlear groove (TT-TG) distance of 21 mm and patellar tendon lateral trochlear ridge (PT-LTR) distance of 14 mm. Technique Description: After knee arthroscopy is performed, an open incision is made along the inferomedial patellar tendon. Two pilot holes are created before a sagittal saw is used to make the tibial tubercle osteotomy, before completing it with an osteotome. Anteromedialization and/or distalization of the osteotomy is performed relative to templated values in order to improve patellar articulation. After correction, 3 bicortical screws are placed to achieve stable fixation. Results: There were no immediate complications following surgery. Surgical management led to improvement of the patient’s patellofemoral pain, which allowed return to prior baseline level of function. Discussion/Conclusion: The preferred technique for an anteromedialzing tibial tubercle osteotomy is presented. An anteromedializing tibial tubercle osteotomy is an effective surgical option for patients with evidence of patellar maltracking or central or lateral patellar chondromalacia whom have failed conservative management. This case demonstrates the efficacy of an anteromedializing tibial tubercle osteotomy to provide pain relief by improving patellar tracking and offloading patellar contact pressures on areas of prominent chondral wear.

Hydro-dissection of Dorsal Scapular Nerve for Neuropathy Post Radical Neck Dissection and Radiation: A Case Report

Neuropathy of dorsal scapular nerve (DSN) following neck dissections or radiotherapy has not been reported so far nor has its treatment in the form of hydro-dissection. Hydro-dissection of nerve under ultrasound guidance has been receiving more attention in the recent past and it is a minimally invasive procedure. We report here a case of neuropathy of DSN following radiotherapy in a patient for whom we could at least provide pain relief as a palliative measure during his past 6 months of life.

PHYSIOTHERAPY REHABILITATION OF DISTAL RADIAL FRACTURE TO ENHANCE THE ACTIVITY OF DAILY LIVING

Fracture of distal radius is the commonest fracture present in the upper limb. In fact, it is most commonly treated by the doctor. An outstretched hand is the most common cause of distal radius or wrist fractures. The fracture of distal radius can also lead to nerve injury mostly median nerve. Physical Therapy plays important role which provides positive effect in treating post fracture cases. A case of 45 years female is presented in this report who had an fall over right wrist joint and diagnosed with distal radius fracture and operated conservatively results into pain over wrist joint, decrease in physical activities. Rehabilitation protocol is explained below in the report. We report that there were improvement in patient outcomes level increases in muscles strength, provide pain relief and improvement in patient functional Independence.

QSAR STUDIES OF SOME SUBSTITUTED IMIDAZOLE DERIVATIVES AS POTENT ANTIFUNGAL AGENTS

Fracture of distal radius is the commonest fracture present in the upper limb. In fact, it is most commonly treated by the doctor. An outstretched hand is the most common cause of distal radius or wrist fractures. The fracture of distal radius can also lead to nerve injury mostly median nerve. Physical Therapy plays important role which provides positive effect in treating post fracture cases. A case of 45 years female is presented in this report who had a fall over right wrist joint and diagnosed with distal radius fracture and operated conservatively results into pain over wrist joint, decrease in physical activities. Rehabilitation protocol is explained below in the report. We report that there were improvement in patient outcomes level increases in muscles strength, provide pain relief and improvement in patient functional Independence.

Pulsed Radiofrequency of Stellate Ganglion for Neuropathic Pain Associated with Recurrent Pleural Leiomyosarcoma - A Case Report

Pleural leiomyosarcomas are rare soft-tissue sarcomas. Neuropathic pain associated with such tumours can be quite debilitating. We present the case of a 62-year-old woman with chronic neuropathic pain refractory to pharmacologic interventions in association with recurrent pleural leiomyosarcoma. Pulsed radio-frequency of the stellate ganglion was performed after due consideration and planning as a palliative measure to provide pain relief. The patient was discharged the same day with pain score 0/10 and followed up for 3 years. The unique features of this case report are: (1) Different approach of the treatment modality and (2) longer follow-up.

The Surgical Management of Proximal Femoral Metastases: A Narrative Review

The proximal femur is a common location for the development of bony metastatic disease. Metastatic bone disease in this location can cause debilitating pain, pathologic fractures, reduced quality of life, anemia or hypercalcemia. A thorough history, physical examination and preoperative investigations are required to ensure accurate diagnosis and prognosis. The goals of surgical management is to provide pain relief and return to function with a construct that provides stability to allow for immediate weightbearing. Current surgical treatment options include intramedullary nailing, hemiarthroplasty or total hip arthroplasty and endoprosthetic reconstructions. Oligometastatic renal cell carcinoma must be given special consideration as tumor resection and reconstruction has survival benefit. Both tumor and patient characteristics must be taken into account before deciding on the appropriate surgical intervention.

Electrochemical determination of acetaminophen at a carbon electrode modified in the presence of β-cyclodextrin: role of the activated glassy carbon and the electropolymerised β-cyclodextrin

Acetaminophen is a well-known drug commonly used to provide pain relief, but it can also lead to acute liver failure at high concentrations. Therefore, there is considerable interest in monitoring its concentrations. Sensitive and selective acetaminophen electrochemical sensors were designed by cycling a glassy carbon electrode (GCE) to high potentials in the presence of β-CD in a phosphate electrolyte, or by simply activating the GCE electrode in the phosphate solution. Using cyclic voltammetry, adsorption-like voltammograms were recorded. The acetaminophen oxidation product, N-acetyl benzoquinone imine, was protected from hydrolysis, and this was attributed to the adsorption of acetaminophen at the modified GCE. The rate constants for the oxidation of acetaminophen were estimated as 4.3 × 10–3 cm2 s–1 and 3.4 × 10–3 cm2 s–1 for the β-CD-modified and -activated electrodes, respectively. Using differential pulse voltammetry, the limit of detection was calculated as 9.7 × 10–8 M with a linear concentration range extending from 0.1 to 80 μM. Furthermore, good selectivity was achieved in the presence of caffeine, ascorbic acid and aspirin, enabling the determination of acetaminophen in a commercial tablet. Similar electrochemical data were obtained for both the β-CD-modified and activated GCE surfaces, suggesting that the enhanced detection of acetaminophen is connected mainly to the activation and oxidation of the GCE. Using SEM, EDX and FTIR, no evidence was obtained to indicate that the β-CD was electropolymerised at the GCE.

Combination of Dexmedetomidine and Bupivacaine for Caudal Anesthesia In Children

Background: Caudal anesthesia is one of the most popular, reliable and safe methods of pain relief in children and can provide pain relief for various surgical procedures below the navel. Aim: To evaluate the efficacy and safety of the caudal use of dexmedetomidine in caudal anesthesia in children. Methods: The subject of the study was 46 children with physical status I and II class of the American Society of Anesthesiologists (ASA), aged 0 to 12 years, who underwent elective surgeries below the navel, such as hernia repair, orchiopexy, hypospadias repair, epispadias, etc. Results: The duration of caudal analgesia was determined from the moment the anesthetic was injected until the moment the child first complained of pain or the time when the first postoperative analgesia was required. The average duration of postoperative caudal analgesia in patients of group A was 4.21 ± 0.88, while in patients of group B this duration was 10.18 ± 0.85 hours. Conclusions. Our results show that the addition of dexmedetomidine to the local anesthetic for caudal block significantly increases the duration of analgesia and reduces the need for analgesics. More data is also needed on the neurological safety of dexmedetomidine. Key words: dexmedetomidine,caudal block, bupivacaine.

Therapeutics including gene therapy for osteoarthritis as a concept

Even after many study outcomes, there is no consensus model for Osteoarthritis (OA) that properly matches human pathophysiology. While lack of consistency in an OA model makes it difficult to compare and evaluate results across research, the multiple benefits and downsides of using various cells may be assessed and weighed to help identify the optimal therapy. In addition, a higher dose of adipose-derived stem cells are the most prevalent sources of MSCs for cartilage repair (ADSCs), equivalent to Bone marrow-derived stromal cells (BMSCs), may be necessary to promote cartilage formation while both types of cells provide pain relief. Donor characteristics influence MSC properties (such as age, sex, and medical history). Stem-cell heterogeneity influences the outcome of cell therapy. Several investigations indicated that precise sorting based on cell surface markers improved chondrogenesis, showing that pretreatment of cells is critical. Furthermore, advancing to clinical trials demands deep process expertise. Osteoarthritis gene therapy is also a potential possibility. Since the existing genetic basis of OA is unclear, the technique of replacing/knocking out causal genes was not employed in therapy. On the other hand, OA gene therapy focuses on overexpressing therapeutic proteins and/or degenerative/pro-inflammatory factors . In terms of cell-based treatment, in addition to knowing the mechanism of therapeutic action, additional investigation will be necessary in animal models and/or in vitro models on safety, efficacy, and regulated destiny decisions of each cell type. Developing less invasive applications offers a potential approach to OA therapy, with special attention to cell-based therapies and pathways involving OA etiology.