Haemosiderotic Synovitis Secondary to Anticoagulant Use: An Unusual Mechanism of Failure of a Unicompartmental Knee Replacement.

Haemosiderotic synovitis is a rare condition caused by recurrent or chronic haemarthroses. This may lead to intra-articular destruction, a painful joint, and, if untreated, ankylosis of the joint. We highlight a case of an elderly lady who presented to an orthopaedic clinic with left knee pain, following recurrent left knee atraumatic haemarthroses secondary to oral anticoagulant use. At her presentation, she had a left medial unicompartmental knee prosthesis in situ. Weight bearing radiographs of the left knee showed marked loss of lateral joint space with valgus alignment. These radiographic findings were not present on the radiographs taken at her first presentation with haemarthrosis nine months previously. A left revision total knee arthroplasty was performed, and a diagnosis of haemosiderotic synovitis was made following histological analysis of intraoperative tissue samples. This case highlights an unusual mechanism of failure of a unicompartmental knee replacement. Though haemosiderotic synovitis is an exceedingly rare condition, it must be considered following recurrent haemarthrosis as, due to its destructive nature, prompt recognition and treatment is paramount

Chronic asymptomatic dislocation of a total hip replacement: a case report

<p>Abstract</p> <p>Introduction</p> <p>Dislocation of a prosthetic hip is the second most common complication after thromboembolic disease in patients undergoing total hip arthroplasty, with an incidence reported as 0.5 to 20%. Although the period of greatest risk for dislocation has been reported to be within the first few months after surgery, late dislocation occurs more commonly then previously thought.</p> <p>Case presentation</p> <p>A 60-year-old man underwent a right Exeter cemented total hip replacement and was subsequently discharged after appropriate follow-up. He next presented 8 years later complaining of pain in the left groin. An anterioposterior radiograph of the pelvis revealed degenerative changes in the left hip and a dislocated right total hip replacement. The dislocated femoral component had formed a neoacetabulum within the ilium, in which it was freely articulating. He remained pain-free on this side, had 5 cm of true leg length shortening with a good range of movement and was very pleased with his hip replacement. He was later placed on the waiting list for a left total hip replacement.</p> <p>Conclusion</p> <p>This case illustrates that a dislocated total hip replacement may occasionally not cause symptoms that cause significant discomfort or reduction in range of movement. The prosthetic femoral head can form a neoacetabulum allowing a full range of pain-free movement. Furthermore it emphasises that with an increased trend to earlier hospital discharge and shorter follow-up, potential complications may be missed. We urge a low index of suspicion for potential complications and suggest that regular review with radiographic follow-up should be made.</p

Rapidly Evolving Giant Dermatofibroma

Dermatofibroma, also known as “fibrous histiocytoma”, is a benign dermal or subcutaneous poorly circumscribed proliferation of spindle-shaped fibroblasts and macrophages in the dermis. Although it is commonly present as a brownish nodule the legs of females, it may also arise on the upper extremities, trunk, and rarely on the head. The exact pathogenesis is unclear. However, it is widely believed that the originating insult to the dermis is a folliculitis, an arthropod bite, or an unspecified initial inflammatory condition. Giant dermatofibromas of greater than 5 cm in diameter are rare, with only 22 cases reported in the literature. We present a case of a rapidly evolving pedunculated mass in the groin of a male patient. Histological examination confirmed this to be a giant dermatofibroma. Though this specimen cannot is not confirmed as such, the cellular subtype is sometimes present as a larger lesion with anecdotal reports of local recurrence and distant metastases. The clinical and radiological features which were somewhat suspicious of malignancy are considered in the context of the definitive pathological diagnosis of a benign lesion

Cholecystocutaneous Fistula Secondary to Chronic Calculous Cholecystitis

Spontaneous cholecystocutaneous fistula is an exceptionally unusual complication of chronic calculous cholecystitis now. The remarkable drop in incidence is probably associated with the introduction of antimicrobial therapy and early surgical management of biliary tract disease. We report a case of spontaneous cholecystocutaneous fistula in a patient who presented with an abscess in the right upper quadrant

The role of synovial fluid markers of catabolism and anabolism in osteoarthritis, rheumatoid arthritis and asymptomatic organ donors

Introduction: The purpose of this study was to correlate the level of anabolic and catabolic biomarkers in synovial fluid (SF) from patients with rheumatoid arthritis (RA), patients with osteoarthritis (OA) and asymptomatic organ donors.Methods: SF was collected from the knees of 45 OA, 22 RA patients and 20 asymptomatic organ donors. Eight biomarkers were selected and analyzed by using an enzyme-linked immunosorbent assay: interleukin (IL)-1, IL-6, IL-8 and IL-11; leukemia-inhibitory factor (LIF); cartilage oligomeric protein (COMP); osteocalcin; and osteogenic protein 1 (OP-1). Data are expressed as medians (interquartile ranges). The effects of sex and disease activity were assessed on the basis of the Western Ontario and McMaster Universities index score for patients with OA and on the basis of white blood cell count, erythrocyte sedimentation rate and C-reactive protein level for patients with RA.Results: The mean ages (± SD) of the patients were as follows: 53 ± 9 years for patients with OA, 54 ± 11 years for patients with RA and 52 ± 7 years for asymptomatic organ donors. No effect of participants' sex was identified. In the SF of patients with RA, four of five cytokines were higher than those in the SF of patients with OA and those of asymptomatic organ donors. The most significant differences were found for IL-6 and IL-8, where IL-6 concentration in SF of patients with RA was almost threefold higher than that in patients with OA and fourfold higher than that in asymptomatic donor controls: 354.7 pg/ml (1,851.6) vs. 119.4 pg/ml (193.2) vs. 86.97 pg/ml (82.0) (P < 0.05 and P < 0.05, respectively). IL-8 concentrations were higher in SF of patients with RA than that in patients with OA as well as that in asymptomatic donor controls: 583.6 pg/ml (1,086.4) vs. 429 pg/ml (87.3) vs. 451 pg/ml (170.1) (P < 0.05 and P < 0.05, respectively). No differences were found for IL-11 in the SF of patients with RA and that of patients with OA, while a 1.4-fold difference was detected in the SF of patients with OA and that of asymptomatic donor controls: 296.2 pg/ml (257.2) vs. 211.6 pg/ml (40.8) (P < 0.05). IL-1 concentrations were the highest in the SF of RA patients (9.26 pg/ml (11.1)); in the SF of asymptomatic donors, it was significantly higher than that in patients with OA (9.083 pg/ml (1.6) vs. 7.76 pg/ml (2.6); P < 0.05). Conversely, asymptomatic donor control samples had the highest LIF concentrations: 228.5 pg/ml (131.6) vs. 128.4 pg/ml (222.7) in the SF of patients with RA vs. 107.5 pg/ml (136.9) in the SF of patients with OA (P < 0.05). OP-1 concentrations were twofold higher in the SF of patients with RA than those in patients with OA and threefold higher than those in asymptomatic donor control samples (167.1 ng/ml (194.8) vs. 81.79 ng/ml (116.0) vs. 54.49 ng/ml (29.3), respectively; P < 0.05). The differences in COMP and osteocalcin were indistinguishable between the groups, as were the differences between active and inactive OA and RA.Conclusions: Activation of selected biomarkers corresponds to the mechanisms that drive each disease. IL-11, LIF and OP-1 may be viewed as a cluster of biomarkers significant for OA; while profiling of IL-1, IL-6, IL-8, LIF and OP-1 may be more significant in RA. Larger, better-defined patient cohorts are necessary to develop a biomarker algorithm for prognostic use. © 2011 Kokebie et al.; licensee BioMed Central Ltd

Food and agricultural innovation pathways for prosperity

This introduction to the special issue deploys a framework, inspired by realist synthesis and introduced in Section 1, that aims to untangle the contexts, mechanisms, and outcomes associated with investments that link poverty reduction and rural prosperity within a broad agri-food systems perspective. Section 2 considers changes in contexts: Where are agricultural research investments most likely to be an engine of poverty reduction? Over the past 25 years, there have been profound changes in the development context of most countries, necessitating an update on strategic insights for research investment priorities relevant for the economic, political, social, environmental, and structural realities of the early 21st Century. Section 2 briefly surveys changes in these structural aspects of poverty and development processes in low-income countries, with particular attention to new drivers (e.g., urbanization, climate change) that will be of increasing salience in the coming decades. In Section 3, we turn to mechanisms: What are the plausible impact pathways and what evidence exists to test their plausibility? Poor farmers in the developing world are often the stated focus of public sector agricultural research. However, farmers are not the only potential beneficiaries of agricultural research; rural landless laborers, stakeholders along food value chains, and the urban poor can also be major beneficiaries of such research. Thus, there are multiple, interacting pathways through which agricultural research can contribute to reductions in poverty and associated livelihood vulnerabilities. This paper introduces an ex ante set of 18 plausible impact pathways from agricultural research to rural prosperity outcomes, employing bibliometric methods to assess the evidence underpinning causal links. In Section 4, we revisit the concept of desired impacts: When we seek poverty reduction, what does that mean and what measures are needed to demonstrate impact? The papers in this special issue are intended to yield insights to inform improvements in agricultural research that seeks to reduce poverty. History indicates that equity of distribution of gains matters hugely, and thus the questions of “who wins?” and “who loses?” must be addressed. Moreover, our understanding(s) of “poverty” and the intended outcomes of development investments have become much richer over the past 25 years, incorporating more nuance regarding gender, community differences, and fundamental reconsideration of the meaning of poverty and prosperity that are not captured by simple head count income or even living standard measures

Food and agricultural innovation pathways for prosperity

This introduction to the special issue deploys a framework, inspired by realist synthesis and introduced in Section 1, that aims to untangle the contexts, mechanisms, and outcomes associated with investments that link poverty reduction and rural prosperity within a broad agri-food systems perspective. Section 2 considers changes in contexts: Where are agricultural research investments most likely to be an engine of poverty reduction? Over the past 25 years, there have been profound changes in the development context of most countries, necessitating an update on strategic insights for research investment priorities relevant for the economic, political, social, environmental, and structural realities of the early 21st Century. Section 2 briefly surveys changes in these structural aspects of poverty and development processes in low-income countries, with particular attention to new drivers (e.g., urbanization, climate change) that will be of increasing salience in the coming decades. In Section 3, we turn to mechanisms: What are the plausible impact pathways and what evidence exists to test their plausibility? Poor farmers in the developing world are often the stated focus of public sector agricultural research. However, farmers are not the only potential beneficiaries of agricultural research; rural landless laborers, stakeholders along food value chains, and the urban poor can also be major beneficiaries of such research. Thus, there are multiple, interacting pathways through which agricultural research can contribute to reductions in poverty and associated livelihood vulnerabilities. This paper introduces an ex ante set of 18 plausible impact pathways from agricultural research to rural prosperity outcomes, employing bibliometric methods to assess the evidence underpinning causal links. In Section 4, we revisit the concept of desired impacts: When we seek poverty reduction, what does that mean and what measures are needed to demonstrate impact? The papers in this special issue are intended to yield insights to inform improvements in agricultural research that seeks to reduce poverty. History indicates that equity of distribution of gains matters hugely, and thus the questions of “who wins?” and “who loses?” must be addressed. Moreover, our understanding(s) of “poverty” and the intended outcomes of development investments have become much richer over the past 25 years, incorporating more nuance regarding gender, community differences, and fundamental reconsideration of the meaning of poverty and prosperity that are not captured by simple head count income or even living standard measures

Dietary fruits and vegetables and cardiovascular diseases risk

Diet is likely to be an important determinant of cardiovascular disease (CVD) risk. In this article, we will review the evidence linking the consumption of fruit and vegetables and CVD risk. The initial evidence that fruit and vegetable consumption has a protective effect against CVD came from observational studies. However, uncertainty remains about the magnitude of the benefit of fruit and vegetable intake on the occurrence of CVD and whether the optimal intake is five portions or greater. Results from randomized controlled trials do not show conclusively that fruit and vegetable intake protects against CVD, in part because the dietary interventions have been of limited intensity to enable optimal analysis of their putative effects. The protective mechanisms of fruit and vegetables may not only include some of the known bioactive nutrient effects dependent on their antioxidant, anti-inflammatory, and electrolyte properties, but also include their functional properties, such as low glycemic load and energy density. Taken together, the totality of the evidence accumulated so far does appear to support the notion that increased intake of fruits and vegetables may reduce cardiovascular risk. It is clear that fruit and vegetables should be eaten as part of a balanced diet, as a source of vitamins, fiber, minerals, and phytochemicals. The evidence now suggests that a complicated set of several nutrients may interact with genetic factors to influence CVD risk. Therefore, it may be more important to focus on whole foods and dietary patterns rather than individual nutrients to successfully impact on CVD risk reduction. A clearer understanding of the relationship between fruit and vegetable intake and cardiovascular risk would provide health professionals with significant information in terms of public health and clinical practice