Radiofrequency ablation for osteoid osteoma – Recurrence rates and predictive factors

Background and purpose

Osteoid osteoma is an infrequent but debilitating benign bone lesion which can be successfully managed by percutaneous radiofrequency ablation (RFA). There are few studies investigating the efficacy and follow-up of this treatment. An arbitrary upper limit of 15 mm has been used to differentiate between osteoid osteoma and osteoblastoma with surgery used for lesions above this limit.We aimed to analyse the cases identified from our prospectively maintained database over a ten year period since adoption of this technique in our unit. The primary objectives were to investigate factors which influenced recurrence and the time period at which patients are at risk of this.

Wanda Ossowska (1912-2001) and Stanisława Leszczyńska (1896-1974): Polish nurses working under Nazi occupation

Poland was invaded by Nazi Germany on 1 September 1939 and World War II began on 3 September. Polish nurses have their place in this difficult history. In the first months of occupation, nurses focused on caring for wounded soldiers. In order to protect them from prisoner-of-war camps and execution, nurses sought safe havens for the wounded in private homes and transported them there. After their regular jobs, the nurses visited them, changed their dressings and provided them with civilian clothes so that soldiers could eventually escape. This paper describes the work of two of these nurses, Wanda Ossowska and Stanis?awa Leszczyńska. The first three authors (BD, SH, AJS) were nurses in Poland at that time and they present some of the information in this paper as primary source data.     

Sacral nerve stimulation for faecal incontinence: response rate,satisfaction and the value of preoperative investigation in patient selection

Objective Before undergoing sacral nerve stimulation (SNS) for faecal incontinence (FI), patients are investigated with morphologic, dynamic and electrophysiologic tests. The purpose of our study was to evaluate their value in the selection of patients who may benefit most from neuromodulation. Method If temporary stimulation resulted in a good objective response, a permanent neuromodulator was implanted. Patients were reviewed at 3 months and then at 6 monthly intervals. Asked by telephone, patient’s satisfaction was described as good, satisfactory or poor. Results Forty‐five consecutive patients (41 females, median age 59 years) with FI (Wexner 16.1 ± 2.9) underwent SNS. Temporary stimulation was successful in 32 (71)% patients. At a median follow‐up of 33 months, the neuromodulator remained in place in 25 (55%) patients, two do whom switched it off, leaving 23 (51%) with a functioning neuromodulator. There was no statistically significant difference between the characteristics (including manometry, ultrasound and electrophysiology) of patients undergoing implantation (n = 32) or not (n = 13) and those with or without a functioning stimulator (n = 23: n = 13). In the 23 patients with a functioning stimulator the result was good in 12, satisfactory in five and poor in six. There was no statistically significant difference in the patient characteristics between those with a good result (n = 12) and the remainder (n = 32). Conclusion The findings suggest that investigation for FI does not facilitate patient selection for SNS and cannot be used to predict outcome.     

Guideline for the management of hip fractures 2020

We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.     

A biomechanical analysis of exercise in standing, supine, and seated positions: Implications for individuals with spinal cord injury

Context/objective

The distal femur is the primary fracture site in patients with osteoporosis after spinal cord injury (SCI).

Objective

To mathematically compare the compression and shear forces at the distal femur during quadriceps stimulation in the standing, supine, and seated positions. A force analysis across these positions may be a consideration for people with SCI during neuromuscular electrical stimulation of the quadriceps.

Design

A biomechanical model.

Setting

Research laboratory.

Outcome measures

Compression and shear forces from the standing, supine, and seated biomechanical models at the distal femur during constant loads generated by the quadriceps muscles.

Results

The standing model estimated the highest compressive force at 240% body weight and the lowest shear force of 24% body weight at the distal femur compared with the supine and seated models. The supine model yielded a compressive force of 191% body weight with a shear force of 62% body weight at the distal femur. The seated model yielded the lowest compressive force of 139% body weight and the highest shear force of 215% body weight.

Conclusions

When inducing a range of forces in the quadriceps muscles, the seated position yields the highest shear forces and lowest compressive forces when compared with the supine and standing positions. Standing with isometric contractions generates the highest compressive loads and lowest shear forces. Early active resistive standing may provide the most effective means to prevent bone loss after SCI.     

Modified enucleation via lateral orbitotomy for choroidal melanoma with orbital extension: a report of two cases.

We report two cases of choroidal melanoma with massive orbital extension that were managed by modified enucleation by way of a lateral orbitotomy. In both cases, the orbital component of the tumor was removed intact along with the globe. This approach allows placement of an orbital implant and avoids the long healing process associated with orbital exenteration.     

Massive orbital extension of posterior uveal melanomas.

Among 2,135 consecutive patients with posterior uveal melanoma who were evaluated clinically in the Ocular Oncology Service of Wills Eye Hospital between February 1974 and December 1986, 123 (5.8%) were found to have some degree of extrascleral extension of the tumor. Ten of the 2,135 patients (0.5%) had massive orbital extension we defined as extrascleral tumor having an estimated volume exceeding 1,000 mm3. Three of these patients were characterized by orbital recurrence sometime after enucleation, whereas seven had massive orbital extension as the initial manifestation of the neoplasm with no prior history of enucleation. These cases of advanced orbital extension are presented in detail with emphasis on clinical features, diagnostic problems, pathologic findings, and follow-up observation. Based on our observations, suggestions are made regarding the diagnosis and management of advanced orbital extension of posterior uveal melanoma.     

Genetic epidemiology of complex phenotypes

A theory is given for complex phenotypes represented by an ordered polychotomy separately for affected (as severity) and for normals (as diathesis), with consideration of history, ascertainment, sampling frames, and phenotype systems. Nonrandom selection of probands by severity is permitted. Both probit and logistic models are developed in a form compatible with segregation and/or linkage analysis. Probabilities are set out in detail in the Appendix. This approach avoids problems that have been encountered with quantitative traits and correlated phenotypes, although using this information.