Partial rupture of the quadriceps muscle in a child

<p>Abstract</p> <p>Background</p> <p>The quadriceps femoris muscle ruptures usually occur in the middle-aged population. We present a 4-year-old patient with partial rupture of the quadriceps femoris muscle. To our knowledge, this is the youngest patient reported with a quadriceps femoris muscle rupture.</p> <p>Case Presentation</p> <p>A 4-year-old girl admitted to our clinic with left knee pain and limitation in knee movements. Her father reported that she felt pain while jumping on sofa. There was no direct trauma to thigh or knee. We located a palpable soft tissue swelling at distal anterolateral side of thigh. The history revealed that 10 days ago the patient was treated for upper tract respiratory infection with intramuscular Clindamycin for 7 days. When we consulted the patient with her previous doctor and nurse, we learnt that multiple daily injections might be injected to same side of left thigh. MRI showed a partial tear of vastus lateralis muscle matching with the injection sites. The patient treated with long leg half-casting for three weeks. Clinical examination and knee flexion had good results with conservative treatment.</p> <p>Conclusions</p> <p>Multiple intramuscular injections may contribute to damage muscles and make prone to tears with muscle contractions. Doctors and nurses must be cautious to inject from different parts of both thighs.</p

Bilateral simultaneous rupture of the quadriceps tendon in a patient with psoriasis: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Bilateral quadriceps tendon rupture is not common in the absence of systemic disease. Patients with chronic systemic diseases such as uremia and systemic lupus erythematosus and patients who are being treated with systemic steroids or local steroid injections are more prone to tendon rupture. The tendon can rupture spontaneously or as a result of trauma. We report an unusual case of simultaneous bilateral traumatic quadriceps tendon rupture in a patient with psoriasis who was being treated with topical steroid preparations.</p> <p>Case presentation</p> <p>A 57-year-old Caucasian man with a known history of psoriasis, for which he was being treated with topical steroid preparations, presented to our hospital with clinical signs of bilateral quadriceps tendon rupture after he fell while walking down stairs. The diagnosis was confirmed by bilateral ultrasound scans of the thighs. The patient underwent surgery to repair both quadriceps tendons. Post-operatively, the patient was immobilized first in bilateral cylinder casts for six weeks, then in knee braces for the next four weeks. His knees were actively mobilized during physiotherapy.</p> <p>Conclusion</p> <p>Bilateral quadriceps tendon rupture is a rare occurrence in patients with psoriasis who are being treated with topical steroids.</p

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

BACKGROUND: Periprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates. METHODS: A systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded. RESULTS: 63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies. CONCLUSIONS: Evidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority

Utilization of nanomaterials in accelerating the production process of sustainable biofuels

Around 84 % of the global energy needs are met by fossil fuels, notwithstanding their several drawbacks. Dependence on fossil fuels can be reduced when biofuels become more widely used. Compared to fossil fuel, biofuel is substantially less combustible and derived from renewable resources. Biofuel production from non-edible feedstocks can be enhanced by utilizing nanotechnology. Biofuel research to date has produced promising results, but very few recent studies have underlined the use of nanotechnology to enhance the biofuel production process. This study comprehensively reviews the potential use of nanotechnology in improving biofuel production processes. It also highlights the factors that affect nanomaterial performance in the biofuel production process. The nickel oxide (NiO) nanoparticles (NPs) are shown to be highly efficient, with harvesting Chlorella vulgaris biomass at an efficiency of 98.75 % in 1 min at pH 7. In terms of cost-effectiveness, naked modified magnetic nanoparticles (MNPs) cost significantly less, ranging from £3-500 to £0.5–108 per kg following nanoparticle reactivation. Due to their toxicity, nanomaterials used in biofuel production systems have several detrimental effects on living organisms, the environment, and the economy. Developing non-toxic nanomaterials, utilizing cheaper nanoparticles, and doing additional research might increase knowledge availability and understanding to address the current issues

Early Motion after Quadriceps and Patellar Tendon Repairs

Background Complications of immobilization after quadriceps and patellar tendon repairs include decreased patellar mobility, limited flexion, persistent pain, muscle weakness, and patella baja. In contrast, early motion limits muscle atrophy, accelerates tendon healing, and prevents joint stiffness. Hypothesis Quadriceps and patellar tendon repairs protected with a “relaxing suture” are strong enough to safely permit early motion, full weightbearing, and brace-free ambulation. Study Design Case series; Level of evidence, 4. Methods Twenty quadriceps and 30 patellar tendon ruptures were treated with a primary repair augmented with a single No. 5 Ethibond suture, a postoperative regimen of controlled motion and full weightbearing at 7 to 10 days, and brace-free ambulation at 6 weeks after surgery. At a minimum follow-up of 12 months, results of surgery were assessed with the Lysholm knee rating system. Results Six weeks after surgery, 120° of flexion and brace-free ambulation were the goals and were achieved at a mean of 7.2 and 7.7 weeks, respectively. By 6 months, all patients reached their preinjury levels of activity (eg, basketball, Softball, Rocky Mountain tour guide), 40 had full active extension, and 10 lacked 3° to 10° of active extension. There were no postoperative complications. At a mean follow-up of 4 years (range, 1–12 years), the Lysholm scores averaged 92 points (range, 84–100 points), and there were 35 excellent, 15 good, and no fair or poor results. Conclusion Quadriceps and patellar tendon repairs protected by a relaxing suture were strong enough to safely permit early motion, weightbearing, and brace-free ambulation while producing good and excellent results

A Simultaneous Multiparametric 18F-FDG PET/MRI Radiomics Model for the Diagnosis of Triple Negative Breast Cancer.

PURPOSE: To investigate whether a machine learning (ML)-based radiomics model applied to 18F-FDG PET/MRI is effective in molecular subtyping of breast cancer (BC) and specifically in discriminating triple negative (TN) from other molecular subtypes of BC. METHODS: Eighty-six patients with 98 BC lesions (Luminal A = 10, Luminal B = 51, HER2+ = 12, TN = 25) were included and underwent simultaneous 18F-FDG PET/MRI of the breast. A 3D segmentation of BC lesion was performed on T2w, DCE, DWI and PET images. Quantitative diffusion and metabolic parameters were calculated and radiomics features extracted. Data were selected using the LASSO regression and used by a fine gaussian support vector machine (SVM) classifier with a 5-fold cross validation for identification of TNBC lesions. RESULTS: Eight radiomics models were built based on different combinations of quantitative parameters and/or radiomic features. The best performance (AUROC 0.887, accuracy 82.8%, sensitivity 79.7%, specificity 86%, PPV 85.3%, NPV 80.8%) was found for the model combining first order, neighborhood gray level dependence matrix and size zone matrix-based radiomics features extracted from ADC and PET images. CONCLUSION: A ML-based radiomics model applied to 18F-FDG PET/MRI is able to non-invasively discriminate TNBC lesions from other BC molecular subtypes with high accuracy. In a future perspective, a "virtual biopsy" might be performed with radiomics signatures