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Synovial chondromatosis is a rare, benign condition occurring due to metaplasia of synovium. A 65-year-old woman presented with pain in her right hip for 6 years. On examination, a swelling was palpable at the base of scarpa’s triangle and her right hip movements were restricted. Imaging modalities showed ossified nodules in the antero-inferior aspect of the hip joint, joint effusion and arthritic changes. We diagnosed the patient to have synovial chondromatosis with secondary arthritis of the hip joint. We performed a total hip arthroplasty with simultaneous synovectomy and extraction of the osteochondral loose bodies, 5 of which were about 2×2 cm in size. We found that excessive acetabular reaming was required due to craters, the osteochondral masses formed on the acetabular surface. Histopathological analysis confirmed the diagnosis. The patient had an excellent functional outcome and no recurrence 5 years following the surgery.

An 11-year-old girl was brought to us with complaints of restriction of movements of the left shoulder and a deformity of the back for the past 1 year, which had gradually progressed over 1 year. The child was yet to attain menarche. On examination, her physical development was found to be Tanner

The aim of this study was to develop and validate a questionnaire assessing knowledge of signs and symptoms of relative energy deficiency in sport among healthcareprofessionals and physically active individuals.Cross-sectional study.The questionnaire was created in two phases: 1)Item development was established through a literature review, expert review (n = 4), and pre-testing among healthcare professionals, dietetic students, and the general population (n = 35). 2) Validity (item analysis, construct validity) and internal reliability were assessed by administrating the questionnaire to healthcare professionals (n = 97) and physically active individuals who engaged in moderate to intense physical activity (n=77). The questionnaire was re-administered in a subset of the same groups (n = 88) for test-retest reliability.The expert responses showed80% acceptability and pretesting through interviews indicated good content and face validity. Item response analysis resulted in removal of 6 items due to low discrimination ability. Significantly higher knowledge scores in health professionals compared with non-health professionals (mean difference (95% CI) = 2.8 (1.9, 3.7)) confirmed construct validity. Internal consistency, assessed using Cronbach's alpha (α = 0.79), and test-retest reliability using intra-class correlation coefficients (intra-class correlation coefficients = 0.80; Spearman's correlation = 0.84, p 0.001) were good. The final questionnaire had 18 items assessing knowledge of signs and symptoms of Relative Energy Deficiency in Sport.The questionnaire provides a valid and reliable tool to assess knowledge of signs and symptoms of Relative Energy Deficiency in Sport among health professionals and physically active individuals, which could guide future education requirements by assessing current knowledge.

INTRODUCTION Lipoma Arborescens is an extremely rare, benign lesion effecting the synovial tissue of joints. It is characterized by villous lipomatous proliferation of the synovial tissue. The aim of our study was to evaluate its diagnostic features and analyse the functional outcome of arthroscopic management. METHODS We studied 13 patients who were diagnosed to have lipoma arborescens at our institution during the period from October 2005 to October 2019. All patients underwent arthroscopic synovectomy. Histopathological examination confirmed the diagnosis. Pre-operative and post-operative functional assessment was done using Tegner Lysholm score. RESULTS Mean age was 46.6 years. All patients presented with progressive swelling of knee joint, while 6 patients also complained of pain. Average duration of symptoms was 34 months. All the patients were diagnosed based on MRI findings. Tegner Lysholm scoring at last follow up visit, had 11 patients with excellent outcome, 1 patient with good outcome, and 1 patient with fair outcome. None of the patients had recurrence, nor underwent any subsequent procedure of the operated joint. CONCLUSIONS Lipoma arborescens is a rare condition which should be a differential in patients with mono-articular swelling of the knee joint, and can be confirmed with MRI. It should not be misdiagnosed or missed at early stages as prolonged duration of symptoms and delay in treatment is likely to lead to development of secondary arthritis of the joint. Arthroscopic synovectomy showed good functional outcome and no recurrence.

The treatment and outcome of tibial stress fractures concomitant with knee osteoarthritis (OA) are complicated. The aim of this study was to evaluate the functional and radiological outcome of total knee arthroplasty with long tibial stem as a treatment for patients having knee OA and tibial stress fracture.Patients who were diagnosed to have proximal tibia stress fracture along with knee OA at our institution between June 2013 and November 2018 were included in our study. All patients underwent total knee arthroplasty with long tibial stem. Preoperative and postoperative functional assessments were done according to range of movement of the knee joint, knee society score and knee injury and OA outcome score. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Twelve patients were included in the study. All patients were found to have stress fractures in the proximal half of tibia and extra-arthrosis. Four patients had non-union/delayed union, and 8 patients had acute fractures. The average preoperative range of movement was 88.1°, which improved to 116.3° at 3 months following surgery. It was found that the fracture has healed in all cases. Mean knee society score improved from 32.9 preoperatively to 89.3 at 1 year follow-up. Knee injury and OA outcome score improved from a mean score of 28.3 preoperatively to 81.1 at 1 year follow-up.Stress fractures can occur in the proximal tibia in patients with knee OA. Total knee arthroplasty with tibial stem provides a suitable solution for both conditions. Additional plating or bone graft is unlikely to be required.

A 63-year-old man who was known to have chronic liver disease underwent a CT of the abdomen for evaluation of liver morphology. In the CT abdomen, he was coincidentally found to have an osteolytic lesion of the left proximal femur. He did not have any problems involving his left hip or thigh. On

Introduction: In patients with advanced cancer, prolongation of life with treatment often incurs substantial emotional and financial expense. Among hospitalized patients with cancer since acute kidney injury (AKI) is known to be associated with much higher odds for hospital mortality, we investigated whether renal replacement therapy (RRT) use in the intensive care unit (ICU) was a significant independent predictor of worse outcomes. Methods: We retrospectively reviewed patients admitted in 2005 to 2014 who were diagnosed with stage IV solid tumors, had AKI, and a nephrology consult. The main outcomes were survival times from the landmark time points, inpatient mortality, and longer term survival after hospital discharge. Logistic regression and Cox proportional regression were used to compare inpatient mortality and longer term survival between RRT and non-RRT groups. Propensity score-matched landmark survival analyses were performed with 2 landmark time points chosen at day 2 and at day 7 from ICU admission. Results: Of the 465 patients with stage IV cancer admitted to the ICU with AKI, 176 needed RRT. In the multivariate logistic regression model after adjusting for baseline serum albumin and baseline maximum Sequential Organ Failure Assessment (SOFA), the patients who received RRT were not significantly different from non-RRT patients in inpatient mortality (odds ratio: 1.004 [95% confidence interval: 0.598-1.684], P = .9892). In total, 189 patients were evaluated for the impact of RRT on long-term survival and concluded that RRT was not significantly associated with long-term survival after discharge for patients who discharged alive. Landmark analyses at day 2 and day 7 confirmed the same findings. Conclusions: Our study found that receiving RRT in the ICU was not significantly associated with inpatient mortality, survival times from the landmark time points, and long-term survival after discharge for patients with stage IV cancer with AKI.

BACKGROUND This study aimed to compare the predictive value of muscle power (peak power, mean power until the peak-velocity or mean propulsive power) in relation to the jump height achieved during the jump squat performed at different loads. METHODS One hundred and ninety-four elite athletes performed jump squats against loads corresponding to 40%, 60%, and 80% of their respective body mass. A linear regression analysis was performed to establish the relationship between muscle power expressions and jump squat height. RESULTS The coefficient of determination (R2) in the different linear regression models between muscle power-related variables and jump squat height, for the different load ranges, varied from 0.50 to 0.57 (for absolute power values) and from 0.72 to 0.78 (for relative power values [W/kg]). The mean propulsive power presented similar capacity to predict the jump squat height as the peak power-related values. For all analyzed variables, this prediction power was increased when the absolute power values were normalized by the individuals' body mass. CONCLUSIONS Selection of the values related to the mean propulsive phase to assess top-level athletes might be considered as an advantageous alternative, due to its adequacy to properly reflect the neuromuscular potential of the subjects in both ballistic and traditional exercises.

Background: There are many forms of topical fluoride available today, making the decision as to which is most effective to manage the immediate caries risk problem at hand, very difficult. The objective of this project was to determine the concentration and pattern of fluoride ion uptake into enamel from a variety of categories of topical fluoride recently available in Australia. Methods: Extracted, intact molar teeth were sectioned to provide six plates of smooth surface enamel. Windows of enamel 2 times 6mm were exposed to a variety of topical fluorides for periods simulating those used in vivo. Following drying, the slates of enamel were exposed to 2ml of 0.1M HCl as a chemical biopsy agent for incremental periods of time. The concentrations of fluoride ion in the biopsy solutions for both test and background (control) slates of enamel were determined directly using a fluoride combination selective electrode in conjunction with a high impedance pH meter. Cumulative amounts of fluoride were determined for each topical fluoride agent. Results: The concentrations of fluoride ion taken up into enamel were generally proportional to those present in each agent. However, those from APF gel greatly exceeded the amounts taken up from NaF gel. Also, the concentrations taken up from some of the highly concentrated metal fluorides were surprisingly low. Prior etching of enamel increased uptake and prolonged application of APF gel provided no extra benefit. Conclusions: Some topical fluorides, e.g., APF gel, provided a greatly increased uptake and to a greater depth than other self-application products. However, the frequency of its use should be considered with caution where patients have glass-based restorations.

Case: A 25-year-old man with no known comorbidities presented with pain and swelling of the left ankle following a twisting injury that had occurred during a road traffic accident. On examination, a 1 × 1-cm abrasion was noted on the medial malleolus and tenderness was noted over the medial and lateral malleoli. A radiograph of the left ankle revealed a fracture of the medial malleolus and an infrasyndesmotic avulsion fracture of the lateral malleolus (a supination-adduction injury). Immediate surgery was performed for the treatment of the medial malleolar fracture. On exploration, the posterior tibial tendon was found to be severed and frayed 2 cm proximal to the medial malleolar fracture. The medial malleolus was fixed with 2 parallel malleolar screws. The ruptured tendon was explored proximally, and the ends were debrided and repaired. Conclusion: At 1 year of follow-up, the ankle had good union and function of the tendon was restored. Posterior tibial tendon ruptures, although rare, should be suspected in cases of closed ankle fracture, irrespective of the mechanism of injury.

Dirofilaria is parasitic nematodes of domestic and wild animals that can infect humans accidentally via vectors. Its occurrence in the oral cavity is extremely rare. The most frequent presentation of human dirofilariasis is a single submucosal nodule without signs of inflammation. We hereby, report a case of human dirofilariasis affecting the buccal mucosa in a 32-year-old farmer caused by D. repens.

Background The role of probiotics in allergy prevention remains uncertain but has been shown in some studies to have a possible protective effect on eczema. Objective We aimed to assess the effect of probiotic supplementation in the first 6 months of life on eczema and allergic sensitization at 1 year of age in Asian infants at risk of allergic disease. Methods A double-blind, placebo-controlled randomized clinical trial involving 253 infants with a family history of allergic disease was carried out. Infants received at least 60 mL of commercially available cow's milk formula with or without probiotic supplementation [Bifidobacterium longum (BL999) 1 x 10(7) colony forming unit (CFU)/g and Lactobacillus rhamnosus (LPR) 2 x 10(7) CFU/g] daily for the first 6 months. Clinical evaluation was performed at 1, 3, 6 and 12 months of age, with serum total IgE measurement and skin prick tests conducted at the 12-month visit. The primary and secondary end-points were eczema and allergen sensitization, respectively. Results The incidence of eczema in the probiotic (22%) group was similar to that in the placebo group (25%) (P=0.53). The median Scoring Atopic Dermatitis score at 12 months was 17.10 (9.74) in the probiotic group and 11.60 (8.40) in the placebo group (P=0.17). The prevalence of allergen sensitization showed no difference (probiotic=24% vs. placebo=19%, P=0.26). The total IgE geometric mean (95% confidence interval) was 18.76 (12.54-24.98) kU/L in the probiotic group and 23.13 (16.01-30.24) kU/L in the placebo group (P=0.15). Atopic eczema (with sensitization) in the probiotic (7.3%) group was comparable to the placebo group (5.8%) (P=0.86). Conclusion Early life administration of a cow's milk formula supplemented with probiotics showed no effect on prevention of eczema or allergen sensitization in the first year of life in Asian infants at risk of allergic disease. Further work is needed to determine whether timing of supplementation, dose and probiotic strain are important considerations.

Between June 1994 and December 1995, one hundred and fifteen tumours and tumour-like lesions of the breast were studied in the Department of Pathology, Kasturba Medical College, Mangalore. Neoplasms constituted 80.9% and tumour like lesions accounted for 19.13%. Among the tumours, 51.6% were benign and 48.4% were malignant. Tumour-like lesions included the entire spectrum of fibrocystic disease. Tumours were common between 2nd and 8th decades while tumour-like lesions were uncommon above 6th decade. Whereas benign tumours exhibited ground substance, collagen and reticulin fibres in varying amounts, tumour-like lesions and carcinoma showed more of collagen fibres and less of ground substance. Elastosis and lymphoplasmacytic infiltrate were prominent features in carcinomas rather than in benign lesions.

Cyclosporin is an immunosuppressant that acts by selectively inhibiting the activation of T lymphocytes. Its effects on monocytes and neutrophils are not well explored. We investigated the in vitro effects of cyclosporin on these cells, harvested from venous blood from nine healthy, non-smoking volunteers. In vitro incubation of monocytes with increasing concentrations of cyclosporin (5, 25 and 625 micrograms) depressed their phagocytosis by 22%, 32% and 49%, respectively, compared to the control values. The intracellular killing capacity of monocytes decreased by 26%, 31% and 43% with these doses, and neutrophil phagocytosis was depressed in a similar manner (16%, 30% and 40%). Patients receiving cyclosporin are susceptible to infections, and inhibition of these phagocytic cells by cyclosporin may be partly responsible for this. Neutrophil chemotaxis is reduced in patients with impaired renal function. Treating these patients with cyclosporin may in addition suppress the phagocytic function of these cells.

The cytologic examination of smears prepared from the sediment of biopsy specimen fixatives ("sediment cytology") was used to study 70 bone lesions biopsied with a suspicion of malignancy. The smears were adequately cellular in most cases and showed good morphologic preservation; some contained fragments of tissue. Cytology was able to identify the smears from the 47 malignant lesions as malignant, but was not always able to identify the histologic type. While the osteoclastomas, Ewing's sarcomas and metastatic carcinomas were accurately diagnosed, the osteogenic sarcomas could only be identified as sarcomas and the scanty smears from chondrosarcomas only permitted a diagnosis of malignancy. The latter was also true for soft tissue lesions and lymphoma involving the bones. The 12 benign lesions yielded less cellular specimens and were more difficult to cytologically diagnose. The 11 inflammatory lesions were identified as nonmalignant. While this simple technique of sediment cytology can provide an early diagnosis for bone lesions, the final diagnosis requires the histopathologic study of the actual biopsy specimen.

To evaluate and compare the safety and effectiveness of laparoscopic application of the spring-loaded clip and the tubal ring 300 immediate postabortion patients were studied in Bombay India. The 2 groups were randomly assigned to the study subjects and to minimize interoperation variability performed by the same operator. Another physician unaware of the procedure used evaluated and cared for ther patient after surgery. All but 1 of these women returned for follow-up 7-21 days after sterilization and 74.7% and 81.3% respectively of the clip and tubal ring groups reported for the 6- and 12-month follow-up visits. There was 1 technical failure among the tubal ring cases. Surgical difficulties were encountered in 7.3% of the clip and 8.0% of the ring procedures. The incidence of complications until the 1st follow-up visit was significantly higher for the clip (9.3%) than for the ring (4.7%) cases although none of a serious nature were reported. There were significantly more immediate postoperative complaints among subjects sterilized with the ring than with the clip but the incidence of early postoperative complaints was similar for the 2 groups. The rate of pelvic pathology was low at 6 and 12 months after sterilization and none of these patients required surgery within a year of sterilization. 3 of the women sterilized with the spring-loaded clip but none of those sterilized with the tubal ring became pregnant. Thus while both devices were associated with clinically acceptable morbidity the tubal ring was found to be the more effective.(AUTHORS)

In September 1972, clinical trials of a spring-loaded clip for laparoscopic sterilization were begun and extended to a number of centers in the United States and overseas. As of March 1974, more than 1000 patients had undergone the procedure, usually performed under local anesthesia in an outpatient setting, with no fixed contraindications. Complications and pregnancy rates based on a preliminary 6-month follow-up are presented. Complications due to application of the clip appeared to be limited to postoperative cramps lasting 24 to 48 hours (26% of the patients). No ectopic pregnancies were reported. Pregnancies, when corrected for unsuspected pregnancies and misapplication of the clip, occurred in 2 of these first 1000 patients. The difficulties and relative contraindications learned from this unselected series and the advantages over electrocagulation techniques are discussed.Between September 1972 and March 1974 more than 1000 patients had undergone laparoscopic sterilization by spring-loaded clip under local anesthesia in outpatient settings in the United States and overseas. No fixed contraindications were noted. Complications and pregnancy rates based on a 6-month follow-up were as follows: 1 death of a patient with artificial mitral and aortic valves resulted 5 days after surgery; cramps similar to menstrual cramps were reported in 26% of patients for 24-48 hours after clip application; some prototype complications occurred. The centers with the highest pregnancy rates were teaching centers employing experienced electrocoagulation physicians with the highest rate occurring at Chapel Hill where physicians were becoming familiar with the new technique. Of 24 pregnancies, 3 women were pregnant at the time of clip application, 11 resulted from improper placement of the clips, 5 pregnancies followed correct clip application and 3 resulted from weak springs (a manufacturing defect). The corrected pregnancy rate counting only those good and properly applied clips was 2/1000. Contraindications to this procedure include the presence of adhesions preventing visualization of the isthmic portion of the tube, obesity and enlarged uteri. The clip, designed to eliminate the need for electrocoagulation, thus eliminates possible bowel burn, mesosalpingeal hemorrhaging, pain and general anesthesia. Use factors combined with the advantage of potential reversibility via end-to-end anastomosis make sterilization by spring clip an effective possibility.

An 85-year-old woman with intractable malignant ascites secondary to ovarian carcinoma underwent peritoneovenous shunting (Denver shunt) in an attempt to alleviate the ascites. Implantation of the shunt resulted in massive embolization of tumor cells to the pulmonary vasculature. Postoperatively, she developed increasing hypoxia with progressive rises in pulmonary artery pressure, and died 48 hours after surgery as a result of occlusion of the pulmonary vascular bed by tumor emboli. This is the sixth reported instance of massive tumor embolization to the pulmonary circulation in patients with peritoneovenous shunting for malignant ascites.

The effects of socioeconomic factors on reproduction were studied using data from 664 patients at a free general hospital and 207 patients at 2 private hospitals. Women were divided into 5 classes based on income. Those in the upper 2 classes were all private patients, those in the lower 2 were all general hospital patients. There was no difference in the mean age of the mothers, but private patients married an average of 4 years later. Previous reproductive loss increased significantly as income decreased, and mortality of the offspring to 1 year was 15.5% in general hospital patients as compared with 8.7% in private patients. No difference in spacing of children was found. While the difference in incidence of low birth weight was only marginally significant between the 2 groups, type of family, housing, density and type of work done by mother had a significant effect on birth weight. Stillbirth and neonatal death rates showed a highly significant increase in general hospital patients, and were affected by type of family, density, and type of work. Complications associated with pregnancy occurred twice as often in general hospital patients, but instances of difficult labor as well as forceps and Caesarian deliveries were higher in private patients. There was a good awareness about family planning in all but the least educated of these women.