Medial gastrocnemius flap for reconstruction of the extensor mechanism of the knee following high-energy trauma. A minimum 5 year follow-up

The purpose of this study was to assess the medium-term results of reconstruction of the extensor mechanism using the medial gastrocnemius while also providing soft tissue coverage.This retrospective review consisted of a consecutive series of four patients (age 28-40 years) with complex high energy traumatic injuries to lower extremity including both soft tissue loss and disruption of the knee extensor mechanism. The medial gastrocnemius rotational flap was used to reconstruct the patellar tendon and restore soft tissue coverage simultaneously. Range of motion and extensor lag; functional recovery was judged by return to work and sports activity. Validated measures included the Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score, and the modified Cincinnati Score.At the final follow up was 61.5 (57-66) months after reconstruction, the mean SF 12 physical component score ranged from 21.7 to 56.8 with a median of 55.3; the mental component from 42.8 to 60.7 with a median of 58.6. The KSS knee score ranged from 50 to 78 with a median of 68; the function score from 65 to 90 with a median of 85. The Oxford knee score ranged from 22 to 45 with a median of 33.5. The KOOS ranged from 28 to 82.7 with a median of 73.7 and the modified Cincinnati score from 38 to 82 with a median of 76.5. Knee range of motion ranged from 0 to 120°. Of the four patients three returned to working fulltime in their profession and returned to sports, including mountain biking and fitness training.For severe traumatic knee injuries with the combination of soft tissue defects and disruption of the extensor mechanism, the medial gastrocnemius flap provides an excellent reconstructive option to address both problems simultaneously. The results of this small case series support the use of this limb salvage technique

The Limits to Health Care Planning

SUMMARY Health care is not a ‘thing’ to be ‘delivered’ to other people. Current approaches to health care planning in many countries are criticized. The lessons that could be derived from the Chinese model are reviewed and their broader socio?political context identified. RESUME Les Limites de la Planification dans la Protection de la Santé La Protection de la Santé pas un ‘produit’ que l'on peut ‘livrer’ à autrui. On critique ici les méthodes courantes d'approche de cette planification dans plusieurs pays. Les lecons que l'on pourrait tirer de l'exemple Chinois sont passées en revue, et leur contexte élargi, aussi bien politique que social est identifié. RESUMEN Los Límites de la Planificación de la Atencío? de la Salud La atención de la salud no es una ‘cosa’ que pueda ser ‘entregada’ a la demás gente. El articulo critica los enfoques sobre planificación de la atención de la salud que prevalecen en varios países. Se revisan las lecciones que pueden extraerse del modelo chino y se identifica su contexto socio?político más amplio

Peripheral primitive neuroectodermal tumour - A rare cause of a popliteal fossa mass: A case report and review of the literature

A literature review of peripheral primitive neuroectodermal tumours, illustrated with an index case report describing an 80-year-old woman who presented with a mass in the left popliteal fossa, is reported. An excision biopsy was performed, revealing a possible peripheral primitive neuroectodermal tumour as the primary pathology. Normally confined to the chest wall and axial soft tissues of children and young adults, reports of this tumour existing in other areas and in the elderly population are scarce

Regulation of O-glycosylation through Golgi-to-ER relocation of initiation enzymes

Growth factor stimulation moves O-glycosylation initiation enzymes (GalNac-Ts) from the Golgi to the ER in a Src-dependent fashion, increasing protein O-glycosylation

Environmental changes in irrigation and flood control schemes: a case study of Gin Ganga regulation project

Gin River which is 113km long is situated in the South-West of Sri Lanka. Its lower basin has a flood history, which usually destroys about 6000ha of paddy and 3000ha of highland crops. The South-West of Sri Lanka receives an annual average rainfall of 2600mm. Gin River flood control project was completed in 1980. Lower basin of the catchment was protected by electric pumps in 3000ha and gravity drainage was newly provided for 1740ha of Holuwagoda Tract. The project occupied 250ha in between flood bunds in the flood corridor on each river bank. 78ha of paddy lands in the upper catchment were subjected to added flooding and backwater effect after the project. New 800ha of marshy lands were converted in to paddy lands. Normal drainage was provided during non-flood periods. The Project is presently maintained by Irrigation Department. Many paddy tracts were abandoned after the drought in 1992. Many environmental issues have contributed to present situation. The achievements and adverse effects are studied to identify the needs in planning and designs of flood control projects. The objectives of this study could be listed as: 1) Identification of environmental issues prior to the implementation of the irrigation and flood control project. 2) Identification of present environmental issues after the completion of the irrigation and flood control project. 3) Identifying the environmental issues, which require to be considered in case of irrigation and flood control projects. In order to carry out this as a case study, Gin Ganga Regulation Project (GRP) was selected as the project area. 1 Literature survey identified many environmental issues and initial site visits were used to compile all possible issues related to the project area. The issues were separated into processes and were summarised for analysis. Environmental changes due to the project were assessed using these issues. Assessment Site visits were carried out to assess the changes in selected locations. Significant issues were listed and micro analysis was done for every locality of the project using a questionnaire. Verification was done using collected data. The main achievements of GRP are, an increase in land value (150%) and infrastructure development (28%). The social processes are improved due to this project. The land use for rice was improved initially and two seasons per annum were properly cultivated. After 15 years some areas were abandoned due to low income. Some areas were rejected as planned by the project in the unprotected area. Some areas can be cultivated after desilting of canals. Soil subsidence has led to abandoning of some areas. Anticipated targets were reduced by abandoning of lower Holuwagoda tract. Soil subsidence has caused waterlogging in this area. Ganegama lower tract has lost cultivation due to subsidence. An overall assessment 84% of land use was retained for paddy under GRP. If the project was not effective this value will be reduced to 50% as in Bentara Dedduwa Scheme.