Epidural bleeding after ACL reconstruction under regional anaesthesia: a case report

Introduction: Epidural bleeding as a complication of catheterization or epidural catheter removal is often associated with perioperative thromboprophylaxis especially in adult reconstructive surgery. Case presentation: We report on a case of a 19 years old male athlete that underwent anterior cruciate ligament reconstruction, receiving low molecular weight heparin for thromboprophylaxis and developed an epidural hematoma and subsequent cauda equina syndrome two days after removal of the epidural catheter. An urgent magnetic resonance imaging scan revealed an epidural hematoma from the level of L3 to L4. Emergent decompression and hematoma evacuation resulted in patient's significant neurological improvement immediately postoperatively. Conclusion: A high index of clinical suspicion and surgical intervention are necessary to prevent such potentially disabling complications especially after procedures on a day-case basis and early patient's discharge. © 2009 Roidis et al; licensee Cases Network Ltd

Distal ulnar implant arthroplasty as a definitive treatment of a recurrent giant-cell tumor

Giant-cell tumors of the distal ulna are frequently recurrent and difficult to treat. A Darrach-type resection can lead to functional impairments of the wrist and hand. A case of a 42-year-old man, who underwent a distal ulna arthroplasty for recurrent giant-cell tumor of the distal ulna, is presented. The patient had two previous operations in an attempt to curette the cavity, either alone or filled with allograft bone chips. En bloc resection and distal ulnar implant arthroplasty provided a good functional outcome without any evidence of tumor recurrence at a 2-year follow-up evaluation

Incision stretching in primary TKA: What is the real length of our approach?

This article examines the extent of anterior knee soft-tissue stretching. that occurs in patients undergoing primary total knee arthroplasty for 331 consecutive patients. At the time of surgery, an anterior knee incision was drawn on the knee. Measurements Were taken of the length of the incision with the knee in maximum extension and 90 degrees degrees of flexion. Incision length was 5.7 cm longer in flexion than extension. The surgical incision. site stretched an average of 23.6% in flexion compared to the resting extension length

The influence of the acromioclavicular joint degeneration on supraspinatus outlet impingement and the acromion shape

PURPOSE: To assess the anatomic association of acromioclavicular joint degeneration to supraspinatus outlet impingement and the acromion shape. METHODS: Sagittal oblique magnetic resonance images of 49 shoulders in 49 patients were reviewed. 29 of them (mean age, 59 years) underwent surgery for impingement with or without rotator cuff tear (group 1), whereas the 20 controls (mean age, 27 years) were treated for shoulder instability without rotator cuff disease or acromioclavicular joint derangement (group 2). The supraspinatus outlet and the acromion shape of the 2 groups were compared. RESULTS: The difference in the mean supraspinatus outlet between groups 1 and 2 was 11% (514 vs 577 mm[2], p=0.095) and between the subgroup (of group 1) with full thickness rotator cuff tears and group 2 was 17% (481 vs 577 mm[2], p=0.036). Six of the acromions in group 1 were type III (hooked) compared to none in group 2. CONCLUSION: In severe acromioclavicular degeneration, distal clavicular excision is recommended, even in cases with an asymptomatic acromioclavicular joint, so as to prevent further osteophyte formation

A radiographic study of proximal radius anatomy with implications in radial head replacement

Anteroposterior (AP) and lateral radiographs of 20 healthy volunteers' forearms were taken in three views (full supination, neutral rotation, and full pronation). Radial head maximum diameter and angular measurements between the axis of forearm rotation (AFR) and the radial neck axis (RNA) were made with digital calipers. Repeated-measures analysis of variance revealed a statistically significant difference between the three AP groups, with supination having the smallest values (P < .0001), but not for the lateral groups (P=128). Comparison of the AFR-RNA angle between the AP supinated position and the three lateral views revealed a statistically significant difference among all of the pairs, with the AP supinated Position having the smallest values. The RNA most closely approximated the AFR with the forearm in the supinated position. For best approximating the native AFR during radial head replacement, the Cut should be made perpendicular to the neck axis with the elbow extended and the forearm in the supinated position

Purification, crystallization and preliminary X-ray analysis of the peptidoglycan N-acetylglucosamine deacetylase BC1960 from Bacillus cereus in the presence of its substrate (GlcNAc)6

The peptidoglycan N-acetylglucosamine (GlcNAc) deacetylase BC1960 from Bacillus cereus (EC 3.5.1.33), an enzyme consisting of 275 amino acids, was crystallized in the presence of its substrate (GlcNAc)(6). The crystals belonged to the tetragonal space group P4(1)2(1)2, with unit-cell parameters a = b = 92.7, c = 242.9 A and four molecules in the asymmetric unit. A complete data set was collected at 100 K to a resolution of 2.38 A using synchrotron radiation

Purification, crystallization and preliminary X-ray analysis of the peptidoglycan N-acetylglucosamine deacetylase BC1960 from Bacillus cereus in the presence of its substrate (GlcNAc)6

The peptidoglycan N-acetylglucosamine (GlcNAc) deacetylase BC1960 from Bacillus cereus (EC 3.5.1.33), an enzyme consisting of 275 amino acids, was crystallized in the presence of its substrate (GlcNAc)(6). The crystals belonged to the tetragonal space group P4(1)2(1)2, with unit-cell parameters a = b = 92.7, c = 242.9 A and four molecules in the asymmetric unit. A complete data set was collected at 100 K to a resolution of 2.38 A using synchrotron radiation

Analgesic effect of salmon calcitonin suppositories in patients with acute pain due to recent osteoporotic vertebral crush fractures: A prospective double-blind, randomized, placebo-controlled clinical study

Objective: To evaluate the analgesic efficacy of calcitonin suppositories (200 IU)in comparison with bed rest and paracetamol tablets, as a rescue analgesic. Design: A prospective, double-blind, randomized, placebo-controlled, clinical trial. Patients: Forty patients (8 men and 32 postmenopausal women), who had recently (within the last 5 days) suffered a nontraumatic osteoporotic vertebral fracture. Setting and Interventions: All patients were admitted to the hospital, divided randomly into two groups and received either one calcitonin or placebo suppository once a day, respectively, for 28 days. All patients were allowed to take paracetamol tablets (500 mg), with a maximum dose of six tablets daily. Outcome Measures: Spinal pain evaluation was performed at the beginning of the study (before the initiation of treatment) and then daily until the end of the study (day 28) using the Huskinsson’s visual analog scale (VAS) and a painmeter device, by direct pressure on the fractured vertebra. Pain was evaluated with the patients attempting or performing four different locomotor functions, e.g., bed rest, sitting, standing, and walking functions. Biochemical urine and plasma measurements were carried out before the initiation of treatment and on days 14 and 28. Results: All calcitonin-treated patients experienced an overall statistically significant tall p values &lt; 0.001) decrease of spinal pain as assessed by the VAS and the painmeter device. Pain relief allowed for early mobilization and the gradual restoration of the locomotive functions in the calcitonin-treated group. Placebo-treated patients remained in bed for almost the whole of the observation period. At the end of the study (28th day), Fasting osteocalcin, hydroxyproline/creatinine, and calcium/creatinine ratio values were statistically significantly (all p values &lt; 0.001), lower in the calcitonin-treated than in the placebo-treated patients. In the placebo group these values showed a gradual increase. In the calcitonin-treated group side effects mainly included dizziness and enteric irritation caused by the suppositories. Enteric irritation was also present in the placebo-treated group. Conclusions: Salmon calcitonin suppositories (200 TU daily) caused a dramatic decrease in spinal pain in patients with recent osteoporotic vertebral fractures and influenced the early mobilization and the gradual restoration of their locomotor functions

Expression patterns of endothelin-1 and its receptors in colorectal cancer

Background and Objectives Endothelin-1 (ET-1), a potent vasoconstricting peptide, plays an important role in carcinogenesis. Previous in vitro studies have shown that colorectal cancer cells produce ET-1. Methods ET-1 and its receptors ET-A (ETAR) and ET-B (ETBR) were analyzed in colorectal cancer cell lines and tumors by Western blot and immunohistochemistry. Also, ET-1 levels were measured by ELISA in blood samples collected before and after tumor resection. Results ET-1 was immunohistochemically expressed by tumor cells at a variable level in 39 cases tested. The adjacent normal mucosa was negative for ET-1 expression. Strong ETAR expression observed in the deeper infiltrating areas at the periphery of neoplastic tissue correlated significantly with tumor stage. ETBR levels were very low or undetectable. Western blot analysis in paired (normal, tumor) fresh-frozen samples of colorectal cancers and in four colon carcinoma cell lines confirmed these findings. In addition, lower levels of ET-1 in the peripheral circulation after the tumor resection were found by ELISA as compared to those observed before surgery. Conclusions ET-1 and ET AR, but not ETBR, are expressed at a higher level in primary and cultured colon carcinoma cells as compared to normal colon mucosa cells. Further functional studies are needed to explore the role of ET-1/ET AR axis in colon carcinogenesis. Copyright © 2011 Wiley Periodicals, Inc