Arthroscopic decompression and notchplasty for long-standing anterior cruciate ligament impingement in a patient with multiple epiphyseal dysplasia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Multiple epiphyseal dysplasia is a genetically and clinically heterogeneous osteochondroplasia with symmetrical involvement. It is characterized by joint pain in childhood and early adulthood with early onset of osteoarthritis, mainly affecting the hips.</p> <p>Case presentation</p> <p>We report the case of a 20-year-old man of Asian origin with multiple epiphyseal dysplasia presenting with bilateral knee pain, stiffness and instability found to be caused by bilateral anterior cruciate ligament impingement on abnormal medial femoral condyles. Bilateral staged arthroscopic notchplasty was performed successfully, resulting in subjective relief of pain, and improved range of movement and stability.</p> <p>Conclusion</p> <p>Care should be taken not to exclude a diagnosis of multiple epiphyseal dysplasia when few of the characteristic radiographic features are evident but clinical suspicion is high. This case highlights the scope for subjective symptomatic improvement following a minimum of surgical intervention. We recommend limiting early intervention to managing symptomatic features rather than radiographic abnormalities alone.</p

A MODIFIED WATER INJECTION TECHNIQUE TO IMPROVE OIL RECOVERY: MISHRIF CARBONATE RESERVOIRS IN SOUTHERN IRAQ OIL FIELDS, CASE STUDY

A modified water injection technique has organized by this study to improve oil recovery of the Mishrif reservoirs using polymerized alkaline surfactant water (PAS-Water) injection. It is planned to modify the existing water injection technology, first to control and balance the hazardous troublemaker reservoir facies of fifty-micron pore sizes with over 500 millidarcies permeability, along with the non-troublemaker types of less than twenty micron pore sizes with 45 to 100 millidarcies permeability. Second to control Mishrif reservoirs rock-wettability. Special core analysis under reservoir conditions of 2250 psi and 90 °C has carried out on tens of standard core plugs with heterogeneous buildup, using the proposed renewal water flooding mechanism. The technique assures early PAS-water injection to delay the water-breakthrough from 0.045 – 0.151 pore volumes water injected with 8 – 25% oil recovery, into 0.15 – 0.268 pore volumes water injected with 18 to 32% improved oil recovery. As well as, crude oil-in-water divertor injection after breakthrough, within 0.3 to oil0.65 – 0.85-pore volume of water injected to decrease water cut 1 four 0 to 15%. The overall progress of the PAS-water injection has achieved residual oil mobility of 65%, and upgraded the 35 – 50% oil recovery range by less than three pore volume water injected with 20 – 60% water cut, compared with the same oil recovery range by more than ten pore volume water injected with around 70% water cut. The ultimate oil recovery improved by this technique is from 70% via more than 20 pore volume water injected with over 95% water cut by usual water injection, to 85 – 90% via 6.4 pore volume water injected with over 90% water cut by the modified water injection. The technique succeeded to lower the end-point mobility ratio to 1.5 from above five by usual water injection. It is highly recommended to use ten micron mesh filter at the main injection site and four or five micron mesh filter at the injector sites; to avoid more than 80% of the suspended particles and save as much as possible the overall reservoir facies from permeability damage

Inactivation of <i>Cronobacter sakazakii</i> in reconstituted infant milk formula by plant essential oils

This study aimed to screen the in vitro antimicrobial activity of 10 plant essential oils (EOs) against 4 Cronobacter sakazakii strains, and use these oils or their combination to control C. sakazakii cocktail at low (3 log10 CFU/ml) and high (6 log10 CFU/ml) contamination levels in reconstituted infant milk formula (RIMF). Cinnamon and fir oils were the most inhibitory to C. sakazakii strains with inhibition zone of 32 to 40 mm at 20 µl/disc (the minimum inhibitory concentrations were 0.16 and 0.625 µl/ml, respectively). The addition of each of cinnamon or fir oil at 1% (v/v) reduced the C. sakazakii numbers in RIMF by 0.7-0.8 log10 CFU/ml when inoculated with high contamination level and by 2.5-3.1 log10 CFU/ml when inoculated with low contamination level. However, the combination of cinnamon and fir oils reduced C. sakazakii numbers at both inoculum levels to undetectable levels after 3 h of incubation at 37°C. The results of the current study indicated that a combination of cinnamon and fir oils has a potent antimicrobial activity which may potentially be used to control C. sakazakii in RIMF

GABBY: An ex vivo model for learning and refining the technique of preformed silo application in the management of gastroschisis

Background: Gastroschisis (GS) is a congenital full-thickness defect of the anterior abdominal wall, whose incidence is increasing. Traditional postnatal management options include primary reduction and closure under general anaesthetic or operative silo construction for defects judged to be unsuitable for immediate repair. The cot-side application of the preformed silo (PFS) with delayed abdominal wall closure has recently been advocated as the management method of choice for infants with GS. We report a novel trainer designed to facilitate acquisition and refinement of the skills to apply the PFS. Materials and Methods: A model of an infant with GS was constructed to allow application of a PFS. Each step of the clinical application of a PFS could be simulated. Paediatric surgeons at a regional meeting participated in evaluating the model. This cohort was surveyed with regards to previous clinical experience applying the PFS, invited to apply the silo on the model and then resurveyed with regard to the technique, ease of the application of the PFS on the model, its robustness and potential use as a training tool. Results: Seventeen paediatric surgeons completed the surveys and applications of the PFS on the model. Under supervision, each step of the procedure was completed by all participants. Feedback was enthusiastic and positive and participants judged the model to be realistic and potentially very useful as a training tool (median score 8 out of 10). Conclusions: We have developed and evaluated a reproducible, low-cost model of an infant with GS. This ex vivo trainer may be a useful adjunct in the acquisition and refinement of the skills of surgeons who manage GS using a PFS

Repeat surgery following breast conservation and intra-operative sentinel lymph node analysis for breast cancer

Introduction: Intra-operative sentinel node analysis (IOA) for breast cancer reduces the need for a second operation by revealing metastasis intra-operatively, allowing immediate axillary clearance. Critics argue that the number of patients deriving benefit is limited, as further surgery is often required for reasons other than nodal status.Aim: To identify the proportion of women avoiding further surgery by using IOA excluding those who require further surgery for reasons other than axillary node metastasis.Patients and Methods: All patients undergoing sentinel node biopsy with IOA over one year were reviewed. Patient demographics, margin positivity, sentinel node metastasis, requirement for further surgery, and cavity shave involvement were analysed.Results: 322 patients were analysed: 253 undergoing breast-conserving surgery [BCS] and 69 undergoing mastectomy). IOA revealed metastasis in 81 (25.2.%) patients [25 undergoing mastectomy and 56 undergoing BCS], who underwent immediate axillary clearance. 43 BCS patients (17%) did not require further surgery other than for sentinel node involvement. 39 patients required further oncological surgery: 16 excision of margins; 13 completion mastectomy; 6 excision of margins followed by mastectomy; 3 completion axillary clearance; and 1 excision of recurrence. 20.6% had involvement of any circumferential histological margin. Cavity shaves were performed in 28.5% patients at initial surgery, the majority of which were clear of malignancy. 20 mastectomy patients had concordant definitive histology, avoiding a second operation. In total, 19.6% of this cohort avoided a second operation through the use of IOA.Discussion: Approximately 15% of patients undergoing breast conservation surgery for breast cancer require further surgery. However, a further 17% were saved subsequent surgery by utilising IOA, since they had immediate axillary clearance. When also considering patients undergoing mastectomy, this proportion is even higher

Dissection of the carotid artery as a cause of fatal airway obstruction

Carotid artery dissection is a rare entity, and most cases are attributable to causative factors, which include trauma and local malignancy. The vast majority of dissections present with cerebral infarct; those few that present with local mass effect and respiratory compromise may deteriorate rapidly, requiring urgent resuscitation and consideration of endotracheal intubation, which is often dangerous and/or impossible. The case of a spontaneous internal carotid artery dissection in an otherwise healthy young man, leading to gross mass effect and eventual fatal airway obstruction, is presented here. The need for a high index of suspicion for cervical vascular injury in cases of neck injury (even trivial), known head and neck malignancy/irradiation, or coagulopathy is highlighted. Patients presenting with unilateral neck swelling and symptoms related to mass effect must be assumed to have progressive airway obstruction, and difficult intubation should be anticipated