Infections and neutrophils in the pathogenesis of bronchiolitis obliterans syndrome in children after allogeneic stem cell transplantation

It is plausible that infections post‐hematopoietic SCT play a role in the pathogenesis of BOS. A prospective study for children with history, questionnaire, examination, PFTs, and blood counts at one, three, six, nine, 12, 18, and 24 months post‐SCT was conducted. Between September 2009 and September 2011 (n = 39), six developed BOS at 200 days (range 94–282), three patients had probable clinical respiratory infection, and all six had higher neutrophil count compared to non‐BOS patients (4.7 vs. 2.4 at three months and 6.3 vs. 2.9 at six months ×10⁹/L, p = 0.03). Contribution of clinical and subclinical infection needs to be considered in the pathogenesis of BOS.     

Median nerve compression by a large cephalic vein aneurysm—a case report

The term aneurysm is derived from the Greek word aneurysma, meaning “a widening.” In current vascular surgery practice, an aneurysm is defined as a permanent localized dilatation of any vessel, having at least a 50 % increase in diameter compared with the expected normal diameter (Suggested standards for reporting on arterial aneurysms; Johnston et al., J Vasc Surg, 13: 452–458, 1991). Generally, this term is used for arteries as it is more common in them, but it can also be used for veins which are extremely rare presentation. In our case, a middle-aged female presented with complaints of swelling over the right mid-forearm flexor aspect with difficulty in flexing her wrist and paraesthesia over the right index finger and thumb. The patient was examined and diagnosed as a case of cephalic vein aneurysm compressing the median nerve. She underwent surgical resection of the involved segment of the cephalic vein. Venous aneurysm is a rare disorder and till date only few cases have been reported in English literature; however, its possibility should be kept when dealing with a subcutaneous mass in upper limb.     

Biomechanical analysis of tension band wiring (TBW) of transverse fractures of patella

Purpose: Tension band wiring is commonly used for fixation of simple transverse fractures. The popular configuration is parallel Kirschner wires (K-wires) and a stainless steel wire loop placed in a vertically oriented figure-of-8. Methods: We used a wooden model of a patella with a midway transverse fracture and compared four different types of fixation. The first construct had a vertical figure-of-8 with one twist of wire. The second contained a vertical figure-of-8 with two twists of wire. The third was a vertical figure-of-8 with two twists of wire placed at adjacent corners while the last one had a horizontal figure-of-8 with two twists of wire placed at adjacent corners. Interfragmentary compression at the point of wire breakage was measured for each construct as well as permanent displacement on cyclic loading. Results: Placement of the figure-of-eight in a horizontal orientation with two wire twists at the corner improved interfragmentary compression by 63% (p < 0.05, Tukey post hoc test). On cyclic loading, all the constructs with vertical figure-of-eight but none with a horizontal construct failed (p ¼ 0.01; Fisher''s exact test). Permanent fracture displacement after cyclic loading was 67% lower with horizontal figureof-eight constructs (p < 0.05; t test). Conclusion: Placing wire twists at the corner and a horizontal placement of figure-of-8 improves stability of the construct.