Giant cell tumor of flexor tendon sheath of little finger: a case report

Giant cell tumor of the tendon sheath is a benign proliferative lesion of synovial origin that may affect the joints, bursae and tendon sheaths. We report the case of a giant cell tumor of the tendon sheath arising from the flexor tendon sheath of 5th finger of left hand of a 44 year old male patient. The patient underwent ultrasound examination and subsequently magnetic resonance imaging

Surgical management of fractures of distal end radius using uniplanar external fixator augmented with percutaneous kirschner wire fixation

Background: Distal end radius fractures is one of the most common fractures of the upper limb especially in the elderly population, accounting for about 17% of all upper limb fractures. Surgical stabilization of these fractures remains a challenge even today. Although the recent trend is towards internal fixation with locking plates, the external fixator itself has its own advantages in the treatment of these fractures.Methods: This study is a prospective, time bound, hospital based study conducted in Kempegowda Institute of Medical Sciences and Research Center, Bangalore, between November 2014 to April 2016. The study included 30 cases of distal end radius fractures that were operated with the closed reduction and uniplanar external fixator augmented with k-wire for distal end radius by the principle of ligamentotaxis.Results: In our study, 14 (46.6 %) patients had excellent results. Whereas, 11 (36.7%) patients had good results and 3 (10%) had fair and only 2 (6.7%) patients had poor results. Most of the fractures united by 12 weeks. Complications associated with the study was stiffness, malunion, sudeck’s  osteodystrophy and pin tract infection. Conclusions: The uniplanar external fixator augmented with k-wire is a good choice in the treatment of distal end radius fractures  in terms of providing a good functional outcome if proper preoperative planning, good reduction and surgical technique are followed, leading to high rate of bone union, minimal soft tissue damage and complications

A comparative study between intraarticular infiltration of platelet rich plasma and hyaluronic acid in osteoarthritis knee

Background: Osteoarthritis (OA) is the most common progressive musculoskeletal condition that can affect joints, but it mainly affects the hips and knees as predominant weight-bearing joints and is characterized by structural modifications to primarily articular cartilage and subchondral bone, Hoffa’s fat pad, synovia, ligaments and muscles, leading to the concept of OA as a whole joint disease. Hence the present study was undertaken to evaluate the outcomes of platelet rich plasma (PRP) and hyaluronic acid (HA) intra-articular injections in patients with OA in terms of pain by numerical pain score and VAS and to evaluate the outcomes of PRP and HA intra-articular injections in patients with OA in terms of functional outcome by WOMAC scores. Methods: The study was a prospective hospital-based study in Kempegowda Institute of Medical Sciences between 2020 to 2022. The study was conducted on 100 patients, more than the age of 50 years of either gender with grade I-III OA of the knee fulfilling the inclusion and exclusion criteria. Patients were followed up at 6, 12 and 24 weeks for data collection and data was analyzed after follow-up visits were completed for all patients. Results: On intragroup analysis, there was significant reduction in the mean WOMAC score in both the study groups across time-points (p<0.05). On intragroup analysis, there was significant reduction in the mean VAS score in both the study groups across time-points (p<0.05). On intergroup analysis at any time point of follow-up, the mean WOMAC score was noted to be statistically comparable between the study groups (p>0.05). Conclusions: In patients with symptomatic knee OA, intra-articular HA and PRP provide short term improvement in pain and function. Both the therapy agents for OA were associated with equivalent safety, with no complications

Malignant transformation of a recurrent giant cell tumor of bone with lung metastasis: a case report

Giant cell tumors (GCT) are benign tumors with potential for aggressive behaviour and capacity to metastasize. It is a locally destructive tumor that occurs predominantly in long bones of adolescents and young adults in the epiphysis. Although rarely lethal, benign bone tumors may be associated with a substantial disturbance of the local bony architecture that can be particularly troublesome in peri-articular locations. It is characterized by a proliferation of mononuclear stromal cells and the presence of many multi-nucleated giant cells with homogenous distribution. There are varying surgical techniques ranging from intra-lesional curettage to wide resection. As most giant cell tumors are benign and are located near a joint in young adults, several authors favour an intralesional approach that preserves anatomy of bone. Although GCT is classified as a benign lesion, few patients develop progressive lung metastases with poor outcomes. Malignant transformation without radiotherapy exposure, is an uncommon event, occurring in less than 1% of giant cell tumors of bone. Here we reported a case of recurrent GCT of tibia that at the time of final recurrence was found to have undergone malignant transformation over a period of 6 years following several limb salvaging procedures. Concurrent metastases were found in the lung, but these were non-transformed GCT following which the patient has undergone above knee amputation

Clonally expanded CD8 T cells patrol the cerebrospinal fluid in Alzheimer’s disease

Alzheimer's disease is an incurable neurodegenerative disorder in which neuroinflammation has a critical function1. However, little is known about the contribution of the adaptive immune response in Alzheimer's disease2. Here, using integrated analyses of multiple cohorts, we identify peripheral and central adaptive immune changes in Alzheimer's disease. First, we performed mass cytometry of peripheral blood mononuclear cells and discovered an immune signature of Alzheimer's disease that consists of increased numbers of CD8+ T effector memory CD45RA+ (TEMRA) cells. In a second cohort, we found that CD8+ TEMRA cells were negatively associated with cognition. Furthermore, single-cell RNA sequencing revealed that T cell receptor (TCR) signalling was enhanced in these cells. Notably, by using several strategies of single-cell TCR sequencing in a third cohort, we discovered clonally expanded CD8+ TEMRA cells in the cerebrospinal fluid of patients with Alzheimer's disease. Finally, we used machine learning, cloning and peptide screens to demonstrate the specificity of clonally expanded TCRs in the cerebrospinal fluid of patients with Alzheimer's disease to two separate Epstein-Barr virus antigens. These results reveal an adaptive immune response in the blood and cerebrospinal fluid in Alzheimer's disease and provide evidence of clonal, antigen-experienced T cells patrolling the intrathecal space of brains affected by age-related neurodegeneration