The anatomy of the anterior inferior tibiofibular ligament and its relationship with the Wagstaffe fracture

BackgroundOur aim in this study was to identify the fibular footprint of the Anterior Inferior Tibiofibular Ligament (AITFL) and its relation to Wagstaffe fracture fragment size.MethodsWe examined 25 cadaveric lower limbs which were carefully dissected to identify the lateral ankle ligaments. The AITFL anatomy was compared to 40 Wagstaffe fractures identified from our ankle fracture database.ResultsThe AITFL origin was from the anterior fibular tubercle with an average length of 21.61 mm (95% CI 20.22, 22.99). The average distance of the distal aspect of the AITFL footprint to the distal fibula margin was 11.60 mm (95% CI 10.49, 12.71). In the ankle fractures analyzed, the average length of the Wagstaffe fragment was 17.88 mm (95% CI 16.21, 19.54). The average distance from the distal tip of the fibula to the Wagstaffe fracture fragment was 21.40 mm (95% CI 19.78, 23.01).In total there were 22 syndesmosis injuries. There was no statistical difference in Wagstaffe fragment size between stable and unstable groups.ConclusionThe AITFL fibular origin was both larger and more distal than the Wagstaffe fracture fragments seen in our institution. Therefore, this suggests that a ligamentous failure will also have to occur to result in syndesmotic instability. The size of fracture fragment also did not confer to syndesmotic instability on testing.Level of Evidence - 3     

An immunocytochemical study of malignant melanoma and its differential diagnosis from other malignant tumours.

A series of 41 fresh and 36 routinely processed malignant melanomas were immunostained with a panel of 12 monoclonal antibodies reactive against a range of epithelial, lymphoid, and melanoma associated antigens. The aim of the study was to determine whether this panel of antibodies would be useful in diagnostically difficult cases for differentiating melanomas from other tumours, particularly carcinomas and lymphomas. The results confirmed that most unequivocal malignant melanomas can be identified by positivity for S100 protein and for the antigen recognised by antibody NK1/C3, and by negativity for epithelial and lymphoid antigens. The incidence of melanomas expressing cytokeratin antigens was higher, however, particularly in cryostat sections than has previously been reported. It is therefore suggested that a panel of antibodies with more than one marker in each category should be used for identifying melanomas in clinical practice.     

Automation of APAAP immunocytochemical technique.

A tissue processing instrument (the Histokinette) was modified by the addition of an electronic timing device which allows an immunocytochemical staining technique (the APAAP method) to be performed as a semiautomated procedure. After incubation with primary monoclonal antibodies (applied by hand) slides (up to 72 in a batch) are placed in racks and cycled through tanks of reagents, comprising anti-mouse Ig followed by APAAP complexes with intervening timed draining and washing stages. This semiautomated process gave consistent staining results and offered considerable savings in time compared with conventional methods. The same reagent baths were used over four months on an almost daily basis without deterioration in staining intensity, and consequently the calculated overall cost of the staining procedure was less than if the reagents had been applied by hand and then discarded. The machine is now into its eleventh month of operation; the reagents have been changed twice. It is suggested that this approach, because of savings in time and increased consistency, may be an attractive technique for the routine immunocytochemical staining of slides, and that the nature of the APAAP method is particularly suitable for automation as the necessary reagents can be produced at low cost.     

Prioritising waiting lists

The 'top 22' patient conditions on the general surgical waiting list at Guy's Hospital were rated independently by five general surgeons. Each surgeon estimated the peri-operative mortality rates associated with each treatment; the proportion of patients who failed to benefit; the effect of successful treatment on life expectancy and on the patients' quality of life. the mean values were used to estimate the expected net benefits (in terms of quality-adjusted life-years) from treatment one year earlier than might otherwise have been the case. These benefits were then related to the operating times and length of stay associated with each treatment; this identified which treatments offered the greatest benefit per unit of each constrained resource. Of all conditions examined anal fissures where shown to be the least resource intensive in relation to the benefits generated, whilst varicose veins and epigastric hernias proved otherwise. For the full potential of this approach to be realised it needs to be repeated in other places and in other specialties. It nevertheless offers a more rational basis for interpreting waiting list data than presently exists and by using the short-cut methods is a relatively cheap way of generating much useful data.     

Characterization of chimeric proteins constructed from human epidermal growth factor (EGF) and the Drosophila EGF-receptor antagonist argos

The Drosophila argos protein is a natural ligand antagonist of Drosophila EGF receptor (DER), but does not interact with the human EGF receptor (EGFR). With a view to generating a corresponding EGFR antagonist, we, have designed five chimeric proteins featuring selected characteristic parts of argos within the framework of the human EGF ligand. These chimeras were expressed in bacteria, purified, refolded and characterized. We tested their ability to bind to EC;FR, to effect receptor tyrosine phosphorylation and to inhibit EGF-induced EGFR phosphorylation.