D-Penicillamine in rheumatoid arthritis

D-penicillamine was administered to 15 patients with rheumatoid arthritis. A fall in the titer of rheumatoid factor was demonstrated in all patients. The sedimentation rate decreased in most patients. There was no consistent alteration in immunoglobulins A, G or M or in lymphocyte transformation attributable to penicillamine. Ceruloplasmin serum levels were lowered significantly in 7 patients. Clinical improvement in the arthritis resulted in 10 patients.     

The Uncertain Significance of Low Vitamin D Levels in African Descent Populations: A Review of the Bone and Cardiometabolic Literature

Vitamin D levels in people of African descent are often described as inadequate or deficient. Whether low vitamin D levels in people of African descent lead to compromised bone or cardiometabolic health is unknown. Clarity on this issue is essential because if clinically significant vitamin D deficiency is present, vitamin D supplementation is necessary. However, if vitamin D is metabolically sufficient, vitamin D supplementation could be wasteful of scarce resources and even harmful. In this review vitamin D physiology is described with a focus on issues specific to populations of African descent such as the influence of melanin on endogenous vitamin D production and lactose intolerance on the willingness of people to ingest vitamin D fortified foods. Then data on the relationship of vitamin D to bone and cardiometabolic health in people of African descent are evaluated.     

Aortopulmonary window with patent ductus arteriosus and interrupted aortic arch: A case report

Indian Journal of Thoracic and Cardiovascular Surgery -     

Prostate specific antigen bounce phenomenon after external beam radiation for clinically localized prostate cancer

PURPOSE: We characterize the prostate-specific antigen (PSA) bounce in patients who underwent external beam radiation therapy for prostate cancer and correlate the PSA bounce with the development of biochemical disease progression. MATERIALS AND METHODS: In this study 964 patients received full dose radiation therapy alone. Followup PSA values were obtained 3 months after completion of radiotherapy and every 3 to 6 months thereafter. Median followup of the entire study group was 48 months. All time intervals were calculated from the completion date of radiation therapy. PSA bounce was defined as an initial increase in serum PSA of at least 0.5 ng./ml., followed by a decrease to pre-bounce baseline serum PSA values no more than 60 months after external beam radiation therapy. RESULTS: Of the 964 patients 119 (12%) had a PSA bounce. PSA bounce was unrelated to age, race, pretreatment PSA, Gleason score, clinical T stage or radiation dose. Mean time to PSA bounce was 9 months from the time of therapy. The respective 1 and 5-year biochemical disease-free survival rates were 100% and 82.1% for patients with PSA bounce and 93.9% and 57.7% for those without PSA bounce (p = 0.0001). CONCLUSIONS: Of men with prostate cancer treated with external beam radiation therapy 12% experienced a transient increase in PSA (PSA bounce) followed by a return to pre-bounce levels after radiation. The PSA bounce phenomenon was not predictive of time to biochemical recurrence.     

Intratendinous strain fields of the supraspinatus tendon: effect of a surgically created articular-surface rotator cuff tear

Articular-surface partial-thickness rotator cuff tears play a significant role in shoulder pathology, but the role of the articular-surface tissue is poorly understood. This investigation assessed the effect of an articular-surface partial-thickness rotator cuff tear on intratendinous strain fields. A magnetic resonance imaging-based technique quantified intratendinous strains in healthy cadaveric shoulders at 15 degrees, 30 degrees, 45 degrees, and 60 degrees of glenohumeral abduction. A second set of magnetic resonance images was acquired after an articular-surface partial-thickness tear was created arthroscopically. Measures of strain were grouped into 3 tendon regions. A 3-factor analysis of variance assessed the effects of joint position, tendon region, and tendon tear. Intratendinous strains were influenced significantly by joint position, but few differences existed between tendon regions. The articular-surface partial-thickness tear increased intratendinous strain for all joint positions except 15 degrees. The results lend insight into the mechanical behavior of the normal and pathologic rotator cuff.     

Iliotibial band reconstruction for treatment of glenohumeral instability associated with irreparable capsular deficiency

The surgical management of patients with recurrent anterior instability after failed surgery can be complicated by the loss of capsular tissue and, in some cases, irreparable tears of the subscapularis tendon. We describe a new surgical technique for reconstruction of the capsular ligaments using the iliotibial band (ITB) to reconstruct deficient capsular tissues, and we report the results of 7 patients. All patients had prior surgery, with a mean of 2.2 procedures, and recurrent instability as the primary indication for their index and revision surgeries. After ITB reconstruction, the patients demonstrated significant improvement in their American Shoulder and Elbow Surgeons (ASES) score (P =.0004), and no patient had any persistent symptoms of instability. Physiologic range of motion and function were maintained. We would recommend our method of ITB reconstruction for patients with instability and capsular deficiency after failed surgery and believe that this procedure has advantages over those previously described. Capsular deficiency and persistent instability after prior surgery can occur after prior open or arthroscopic surgery. Capsular deficiency has been described after thermal capsulorrhaphy and is thought to represent excessive thermal injury and tissue necrosis. After open capsulorrhaphy, capsular deficiency can be associated with subscapularis tendon deficiency.(4,6-8,12,13) Capsular deficiency occurring after either open or arthroscopic surgery presents a difficult surgical challenge. The purpose of this case series is to evaluate our experience in the surgical management of recurrent glenohumeral instability after surgery initially performed for treatment of glenohumeral instability that failed and is associated with irreparable tears of the subscapularis and capsular deficiency. The primary objectives of this study are to describe the surgical technique for capsular reconstruction with ITB and to report the clinical results in 7 patients.