Acute Pancreatitis Secondary to a Perivaterian Duodenal Diverticular Abscess

A 46-year-old previously fit lady was admitted with acute pancreatitis. She had no history of gallstones. She was not on any medications and consumed minimal amounts of alcohol. On subsequent investigations as to the causative factor, she was found at ultrasound to have an air-fluid filled cystic structure posterior to the head of pancreas which was compressing the common bile duct. Further magnetic resonance imaging and computer tomography scans showed that this cystic lesion was located around the ampulla of Vater. A diagnosis of a perivaterian abscess was made. At endoscopy, a large contained abscess was seen which was successfully drained. She made a full and uneventful recovery

The Use of the S-Quattro Dynamic External Fixator for the Treatment of Intra-Articular Phalangeal Fractures: A Review of the Literature

Intra-articular phalangeal fractures are a common injury. If left untreated, these injuries can lead to poor functional outcome with severe dehabilitating consequences, especially in younger patients

The use of mesenchymal stem cells for cartilage repair and regeneration: a systematic review.

BACKGROUND: The management of articular cartilage defects presents many clinical challenges due to its avascular, aneural and alymphatic nature. Bone marrow stimulation techniques, such as microfracture, are the most frequently used method in clinical practice however the resulting mixed fibrocartilage tissue which is inferior to native hyaline cartilage. Other methods have shown promise but are far from perfect. There is an unmet need and growing interest in regenerative medicine and tissue engineering to improve the outcome for patients requiring cartilage repair. Many published reviews on cartilage repair only list human clinical trials, underestimating the wealth of basic sciences and animal studies that are precursors to future research. We therefore set out to perform a systematic review of the literature to assess the translation of stem cell therapy to explore what research had been carried out at each of the stages of translation from bench-top (in vitro), animal (pre-clinical) and human studies (clinical) and assemble an evidence-based cascade for the responsible introduction of stem cell therapy for cartilage defects. This review was conducted in accordance to PRISMA guidelines using CINHAL, MEDLINE, EMBASE, Scopus and Web of Knowledge databases from 1st January 1900 to 30th June 2015. In total, there were 2880 studies identified of which 252 studies were included for analysis (100 articles for in vitro studies, 111 studies for animal studies; and 31 studies for human studies). There was a huge variance in cell source in pre-clinical studies both of terms of animal used, location of harvest (fat, marrow, blood or synovium) and allogeneicity. The use of scaffolds, growth factors, number of cell passages and number of cells used was hugely heterogeneous. SHORT CONCLUSIONS: This review offers a comprehensive assessment of the evidence behind the translation of basic science to the clinical practice of cartilage repair. It has revealed a lack of connectivity between the in vitro, pre-clinical and human data and a patchwork quilt of synergistic evidence. Drivers for progress in this space are largely driven by patient demand, surgeon inquisition and a regulatory framework that is learning at the same pace as new developments take place

Tendon and Ligament Injuries: The Evolving Role of Stem Cells and Tissue Engineering

Aims: Musculoskeletal injuries are a common injury associated with a reduction in quality of life, increased morbidity and social and financial implications. Although surgical reconstruction is a well established option, outcomes are variable. There is a growing body of interest in the potential of mesenchymal stem cells (MSCs) in the management of tendon and ligament injuries. This review aims to summarise the information in the literature on the evolving role of these. Study design: Review Article. Place and Duration of Study: University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, United Kingdom. Methodology: We reviewed the literature to identify studies on the use of MSCs for the management of tendon and ligament injuries. Results: There is an increasing and encouraging body of evidence to suggest that MSCs have a significant role in the management of musculoskeletal injuries involving tendons and ligaments. They not only appear to promote healing but can be adapted to have further benefits such as osteointegration at the tendon-bone interfaces. Conclusion: MSCs appear to provide an encouraging treatment option for the treatment, repair and augmentation of tendon and ligament injuries. Their autologous nature make them a safe and viable option, however more studies are needed to evaluate their future role

Rotator Cuff Injuries: The Evolving Role of Tissue Engineering

Aims: Rotator cuff injuries are a common injury associated with a combination of intrinsic and extrinsic causative factors. Although surgical reconstruction is a well established option, this is associated with variable re rupture rates. There is a growing body of interest in the potential tissue engineering in the management of rotator cuff injuries. This review aims to summarise the information in the literature on the evolving role of these techniques. Study design: Review Article Place and Duration of Study: University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, United Kingdom. Methodology: We reviewed the literature to identify studies on the use of tissue engineering therapy for the management of rotator cuff injuries Results: There is an increasing body of evidence suggesting that stem cell techniques, augmented by the use of appropriate scaffolds and the influence of growth factors may promote healing in rotator cuff injuries. Conclusion: Tissue engineering holds enormous promise to improve human health through prevention of disease and the restoration of healthy tissue functions. However to date, there is insufficient evidence to draw a solid conclusion. This field however presents a huge potential and warrants larger human studies to confirm any potential benefit

Stem cell therapy for human cartilage defects: a systematic review.

OBJECTIVES: The use of stem cell therapy for the repair of cartilage defects has shown promising results in in vitro and animal studies. However, only a small number of studies have been performed to evaluate the benefits in human subjects. The aim of this study is to systematically review studies that focus on the clinical application of stem cell therapy to treat cartilage defects in human subjects. DESIGN: A literature search was performed, adhering to the PRISMA guidelines, to review any studies using such techniques in humans. Our initial search retrieved 105 articles listed on MEDLINE, EMBASE, Google Scholar, CINHal and SPortDiscus. From these studies, 11 studies meeting the eligibility criteria were selected and formed the basis of our systematic review. RESULTS: There is limited evidence showing the benefit in humans. The study designs, follow-up methods and criteria reporting and evaluation vary greatly between the studies and are outlined in our systematic review. CONCLUSION: With an increasing body of evidence in non-human and in vitro studies, more human trials are required. More high level studies with extensive and robust validated reporting methods should be conducted to evaluate the true effect of such techniques in human cartilage defect repairs