Peri-articular diseases of the hip: emerging frontiers in arthroscopic and endoscopic treatments

The precise diagnosis of both intra and extra-capsular disease of the hip is now possible because of commonly available advanced diagnostic imaging techniques. An increasing number of reports in the orthopedic literature describe new endoscopic and arthroscopic techniques to address peri-articular pathology of the hip. The purpose of this paper is to review current techniques in the management of extra-articular hip conditions

Patients' Perception of Bone and Tissue Excision, and the Size and Weight of Prostheses at Total Knee Arthroplasty.

The aim of this study is to ascertain patients' perception of the amount of bone and tissue excision and size and weight of their implanted prostheses at total knee arthroplasty (TKA). To our knowledge, no prior study in the English orthopaedic literature has analyzed these parameters against patient perception of TKA. In a prospective study of eight consecutive TKA (six primary and two single-stage revision TKA procedures) by a single surgeon, patients estimated the weight of their implanted knee. We assessed actual weights of their implants and bone cement. Patients estimated the size of their prostheses by sketching the tibial and femoral bone cuts upon a printout of an anteroposterior and lateral radiographs of their preoperative knee. We utilized an articulated plastic model knee for patient reference. Our study shows almost half a kilogram of weight is added postoperatively to the surgical site as a result of tissue excision, explanted material, and implanted prosthesis and cement. All patients overestimated the weight of their implanted prostheses and extent of bone excision. Thus, even 'well-informed' patients overestimate their bone resection and weight of implanted prosthesis at TKA. We postulate such misconceptions among TKA patients are common, and may impact negatively upon patient perception of TKA, their postoperative recovery and outcome.This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site

Histoplasmosis in Sri Lanka - a masquerader in a strange land: A Case Report

We present a patient with an oral mucosal ulcer who was diagnosed with disseminated histoplasmosis. This fungal infection is endemic in the United States, and thus may be not considered in the differential diagnosis of oral ulcers in Sri Lanka. Furthermore, it may mimic many common diseases found in Sri Lanka. It is therefore important to be aware of this entity, since it is potentially curable if diagnosed and treated early.</p

Sepsis with cerebral lupus…. or is it? A case report on Cryptococcaemia

We present a patient with SLE, with multiple comorbidities, whose blood cultures yielded Cryptococcus neoformans. Blood cultures became positive only after twelve days of hospital admission. The patient died within two days of starting Amphotericin B. Cryptococci are an important cause of infection in SLE. Only about 10% to 30% of those with cryptococcal disease have the organism isolated by blood cultures. Due to its non-specific clinical presentation, cryptococcal infection in SLE can be misdiagnosed as psychosis due to steroids, cerebral lupus and infections due to other non-fungal pathogens. This may lead to inappropriate therapy and delays in administration of antifungal agents. Therefore, cryptococcal infection should be considered when SLE patients present with sepsis irrespective of the presence of features of meningis

Evaluation of pigeonpea accessions and selected lines for reaction to Maruca

Maruca vitrata (Geyer) is a serious insect pest of tropical legumes. In Sri Lanka, yield losses due to Maruca damage in pigeonpea [Cajanus cajan (L.) Millsp.] range up to 100%. The development of resistant cultivars and germplasm is one of the best means of control. The objectives of this study were to screen 271 accessions for resistance to M. vitrata and evaluate reaction of lines selected from the promising accessions. The high level of natural incidence of Maruca in Sri Lanka provided an opportunity for evaluation of germplasm at Field Crops Research and Development Institute, Maha Illuppallama. Screening of the germplasm accessions revealed large variation in Maruca damage to flowers and pods. On average, the Maruca damage in determinate accessions (66–75%) was higher than that of nondeterminate accessions (41–50%). Resistant plants from four determinate and 12 nondeterminate accessions were selected. Further selection for resistance to Maruca damage among and within lines derived from the resistant plants was exercised for six generations under nonsprayed field conditions. Under insecticide-free conditions, the selections from two accessions showed significant yield advantages over controls. Data on pod damage and larval counts indicated that the resistance was conditioned through yield compensation mechanisms. In pigeonpea, this is the first report of the selection of Maruca resistant lines. Further studies showed that by using the resistant genotypes it is possible to reduce the number of insecticide sprays for economic yields

Primary coronary artery bypass surgery in the presence of decreasing preoperative renal function: effect on short-term outcomes

Background: This study evaluated the impact of decreasing renal function on short-term outcomes in patients undergoing primary coronary artery bypass grafting (CABG). Methods: The study period was from February 1999 to February 2009. Data on 4050 patients undergoing primary CABG were prospectively collected and analyzed retrospectively. The study population was divided into 3 groups: the CABG:N group, patients with preoperative serum creatinine levels 2 mg/dL (n = 87); and the CABG:D group, patients on dialysis (n = 16). Results: The significant differences between the groups (CABG:D > CABG:RF > CABG:N) in short-term outcomes were with respect to blood product use (P < .001), postoperative acute myocardial infarction (P < .001), pulmonary complications (P .001), infection (P < .001), and death (P < .001). The risk of short-term death (30 days) in the CABG:D group (4/16, 25%) was 25 times greater than that in the CABG:N group (38/3947, 0.96%). Conclusion: CABG in the presence of renal failure is associated with significant morbidity and mortality

Study of avidity of antigen-specific antibody as a means of understanding development of long-term immunological memory after Vibrio cholerae O1 infection

The avidity of antibodies to specific antigens and the relationship of avidity to memory B cell responses to these antigens have not been studied in patients with cholera or those receiving oral cholera vaccines. We measured the avidity of antibodies to cholera toxin B subunit (CTB) and Vibrio cholerae O1 lipopolysaccharide (LPS) in Bangladeshi adult cholera patients (n = 30), as well as vaccinees (n = 30) after administration of two doses of a killed oral cholera vaccine. We assessed antibody and memory B cell responses at the acute stage in patients or prior to vaccination in vaccinees and then in follow-up over a year. Both patients and vaccinees mounted CTB-specific IgG and IgA antibodies of high avidity. Patients showed longer persistence of these antibodies than vaccinees, with persistence lasting in patients up to day 270 to 360. The avidity of LPS-specific IgG and IgA antibodies in patients remained elevated up to 180 days of follow-up. Vaccinees mounted highly avid LPS-specific antibodies at day 17 (3 days after the second dose of vaccine), but the avidity waned rapidly to baseline by 30 days. We examined the correlation between antigen-specific memory B cell responses and avidity indices for both antigens. We found that numbers of CTB- and LPS-specific memory B cells significantly correlated with the avidity indices of the corresponding antibodies (P < 0.05; Spearman's ρ = 0.28 to 0.45). These findings suggest that antibody avidity after infection and immunization is a good correlate of the development and maintenance of memory B cell responses to Vibrio cholerae O1 antigens

The pre-concept design of the DEMO tritium, matter injection and vacuum systems

In the Pre-Concept Design Phase of EU-DEMO, the work package TFV (Tritium – Matter Injection – Vacuum) has developed a tritium self-sufficient three-loop fuel cycle architecture. Driven by the need to reduce the tritium inventory in the systems to an absolute minimum, this requires the continual recirculation of gases in loops without storage, avoiding hold-ups of tritium in each process stage by giving preference to continuous over batch technologies, and immediate use of tritium extracted from tritium breeding blankets. In order to achieve this goal, a number of novel concepts and technologies had to be found and their principal feasibility to be shown. This paper starts from a functional analysis of the fuel cycle and introduces the results of a technology survey and ranking exercise which provided the prime technology candidates for all system blocks. The main boundary conditions for the TFV systems are described based on which the fuel cycle architecture was developed and the required operational windows of all subsystems were defined. To validate this, various R&D lines were established, selected results of which are reported, together with the key technology developments. Finally, an outlook towards the Concept Design Phase is given