Performance of a self-expanding silicone stent in palliation of benign airway conditions

INTRODUCTION: The Polyflex stent (Boston Scientific; Boston, MA) is a self-expanding, thin-walled, silicone stent. Its use has been described in the management of patients with malignant airway obstruction, yet reports of its use for treatment of benign airway conditions are rare. Study: We report a retrospective review of our experience with the Polyflex stent in the management of benign airway conditions. RESULTS: A total of 16 stents were deployed in 12 patients. The indications for the stent placement included the following: anastomotic stenosis following lung transplantation (LTR) [four patients]; tracheal stenosis (three patients); tracheobronchomalacia (two patients); tracheobronchopathiaosteochondroplastica (one patient); relapsing polychondritis (one patient); and bronchopleural fistula (one patient). Even though immediate palliation was established in most cases (90%), the incidence of complications was 75%. Stent migration was the most common consequence, with time to the event ranging from < 24 h to 7 months. One stent was expectorated within < 24 h. One patient coughed up a portion of the inner lining of the stent 7 months after its placement. Emergent bronchoscopy was required in four patients for mucous impaction. The complication rate was 100% in patients with LTR-related anastomotic stenosis. CONCLUSION: The use of the Polyflex stent for the treatment of benign airway conditions is associated with a high complication rate. We have abandoned its use under such conditions in our practice.     

Restless leg syndrome, periodic limb movements, febrile seizures and Attention deficit hyperactivity disorder in an Indian family

Restless leg syndrome (RLS) is a common neurological disorder which can affect individuals of all age groups and incidence increasing with age. It can cause severe sleep disruption and negatively impact quality of life of an individual. Its diagnosis is clinical, based on essential criteria of International RLS Study Group. It can be idiopathic or associated with various medical and other neurological disorders. Idiopathic RLS can be sporadic or may have a familial inheritance, with several genetic loci been reported till date. RLS has a strong association with periodic limb movements, both sleep and awake. Very few studies of familial RLS/Periodic limb movements in sleep and their associations have been reported. We report an Indian family with autosomal dominant RLS/PLMS, with RLS and PLMS as well as psychiatric disorders, febrile seizures and Attention Deficit Hyperactivity Disorder in different family members, over three generations.     

Classical response of antidromic atriofascicular tachycardia to premature atrial extrastimulus delivered during septal refractoriness

A 23‐year‐old gentleman presented with a history of palpitations. The 12‐lead electrocardiogram showed no manifest ventricular pre‐excitation. Echocardiogram was within normal limits. A retrograde study showed concentric activation of the atrium with decremental conduction. Atrial pacing from right atrial free wall showed progressive pre‐excitation. No anterograde nodal duality was documented.     

Study of clinical utility of antibodies to phosphatidylserine/prothrombin complex in Asian-Indian patients with suspected APS

Clinical Rheumatology - Antiphospholipid syndrome (APS) is the most common acquired pro-thrombotic disorder, also associated with obstetric complications. Phosphatidylserine/Prothrombin complex...     

Locking versus non-locking plating system in the treatment of mandibular fractures: A randomized comparative study

To evaluate fracture stability and complications such as infections, need for hardware removal, malunion, and nonunion when using 2.0-mm locking plating system in fixation of mandible fractures and to compare these to those associated with the 2.0-mm non-locking plating system.A prospective clinical study was conducted in a cohort of mandible fracture patients who were randomly assigned to two groups. Patients in the non-locking group were treated with 2.0-mm non-locking plating system, and those in locking group were treated with 2.0-mm locking plating system. Fracture stability, need for maxillomandibular fixation (MMF) and postoperative complications were assessed and compared.A total of 60 patients (30 in each group) were recruited. Significant differences were found between the two groups with respect to postoperative fracture stability (P = 0.001) and need for MMF (P = 0.005). Multivariate analysis revealed that type of fixation was not the only dependent variable which affected fracture stability. There were no significant differences in postoperative complications between the two groups.The 2.0-mm locking plating system provides greater stability and early functional restoration than the 2.0-mm non-locking plating system, with similar rates of postoperative complications. Thus, it can be used as a reliable and effective treatment modality for treating mandibular fractures.     

What is the Responsiveness and Respondent Burden of the New Knee Society Score?

Background

Although the new Knee Society score (NKSS) has been validated by a task force, a longitudinal study of the same cohort of patients to evaluate the score’s responsiveness and respondent burden has not been reported, to our knowledge.

Questions/Purposes

We analyzed the NKSS for (1) responsiveness; (2) respondent burden; and (3) convergent validity in 148 patients studied longitudinally during more than 1 year.

Methods

During an 8-month period, 165 patients underwent TKA by the same surgeon at our institution, of whom 148 (90%) completed this study; the others were excluded because of distance to travel or loss to followup at the specified time. The NKSS, WOMAC, and SF-12 were completed by each patient 1 day before surgery and at 3 and 12 months postoperatively. At the same times, the original KSS (OKSS) which is designed as an observer’s assessment, was completed by the same orthopaedic fellow for all patients. Responsiveness of the NKSS was assessed by determining effect size, standardized response mean (SRM), and ceiling and floor effects. Respondent burden was assessed through time to completion recorded in minutes and ease of completion which was measured objectively on a Likert scale of 1 to 5 by the patients. Convergent validity was assessed by correlating the NKSS with the WOMAC, SF-12, and OKSS (current, widely used scales) by Pearson’s correlation coefficient.

Results

Effect size was largest (2.83 and 3.38) and SRM was highest (2.29 and 2.68) for the NKSS at 3 and 12 months respectively, indicating the NKSS to be the most-responsive score followed by the OKSS, WOMAC, and SF-12. The NKSS exhibited no ceiling and floor effects. The NKSS took a longer time to complete (5.49 ± 3.56 minutes) compared with the WOMAC (4.64 ± 3.19 minutes) and SF-12 (4.35 ± 3.27 minutes). The mean difference in time taken for the NKSS versus the WOMAC was 0.85 minutes (95% CI, 0.54–1.17 minutes; p < 0.001) and the mean difference for the NKSS versus the SF-12 was 1.14 minutes (95% CI, 0.76–1.15 minutes; p < 0.001). Its ease of completion generally was comparable to that of the WOMAC and SF-12. Convergent validity showed a strong correlation (r > 0.6; p < 0.001) of the NKSS with the WOMAC at all times and moderate to strong correlation (r = 0.4–0.6; p < 0.001) with the SF-12 and OKSS at the first two assessments, which became strong (r > 0.6; p < 0.001) at 12 months.

Conclusions

The NKSS exhibited greater responsiveness than the WOMAC, SF-12, and OKSS scales and showed no ceiling effect, indicating adequate potential for recording future improvement. The NKSS also showed reliable convergent validity when correlated with these other scores. However, it posed a greater respondent burden in terms of time to completion.

Clinical Relevance

As independent nondevelopers of the NKSS, we found it to be a responsive tool for assessment of TKA outcomes. We have confirmed that the NKSS can be used interchangeably for this purpose with the WOMAC scale and that it correlates positively with other established scales of the SF-12 and OKSS. Further study of the short-form version will establish whether it also can be used effectively while reducing the respondent burden.

     

Are Stems Redundant in Times of Metaphyseal Sleeve Fixation?

BackgroundVarious options exist for implant fixation in revision total knee arthroplasty. One of it is direct cementless metaphyseal sleeve fixation with stems, which has shown excellent short-term and midterm results. Stemless fixation of sleeves is another fixation option for the treatment of specific bone defects; however, so far no data in larger series exist. The objective of this study was, therefore, to analyze the midterm (3-6.5 years) results of stemless sleeve fixation in a larger revision total knee arthroplasty series.MethodsIn this prospective study, 85 patients with 109 stemless sleeves have been assessed with a mean follow-up of 58.2 (36-78) months. An exclusion criterion was uncontained type II and type III defects. Analysis included clinical and radiographic assessment.ResultsThe results showed a survival rate of sleeves in 96% of the tibia (27/28) and 100% of the femur (81/81). This results in an overall survival rate of sleeves of 99% (108/109). So far, 10 patients (11.8%) underwent rerevision during the follow-up period. The main reason for failure was infection (4/85; 4.7%). Range of motion, Oxford Knee Score, Knee Society Score, and Functional Score improved significantly. Mechanical leg alignment was within the 3° corridor in all patients.ConclusionsIn cases with type I and contained type II defects, sleeves without stems are a promising option, with a survival rate of sleeves of 99% after 5 years. Also, the clinical improvement and reconstruction of leg alignment showed excellent results. In uncontained defects and type III defects, however, we do recommend using stems for additional fixation in the diaphysis. Although the midterm results are very promising, long-term data are needed.     

Y RNA derived small RNAs in Sjögren's syndrome: Candidate biomarkers?

Anti‐Ro and anti‐La antibodies are important in pathogenesis and diagnosis of Sjögren's syndrome (SS). Ro60, Ro52 and La are RNA binding proteins of Y RNA, which were discovered more than three decades ago. Significance of Y RNA is not appreciated as much as Ro and La in SS. It can be hypothesised that 5′‐YsRNA, short fragment derived from Y RNA may be recognized by TLR7 in pDC, which induces type I interferon signature in SS. New genomics tools, namely RNA seq, enables assay of 5′‐YsRNA in blood. 5′‐YsRNA has the potential to be a novel biomarker of SS.     

Outcome of patients with seronegative spondyloarthritis continuing sulphasalazine and methotrexate after a short course of infliximab therapy—experience from a tertiary care teaching hospital in South India

The objective of the study is to evaluate the outcome of patients with seronegative spondyloarthritis continuing on sulphasalazine (SSZ) and methotrexate (MTX) after a short course of infliximab. Patients with seronegative spondyloarthritis on MTX and SSZ were given short course of infliximab therapy at 0, 2, 6 and 14 weeks. Outcome of these patients while continuing on MTX and SSZ was assessed. Clinical features, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were noted at baseline (pre-infliximab), 1 month, 3 months and last follow-up after last dose of infliximab infusion. Twenty-four patients were included in this study. The mean duration of follow-up was 9.1 months. Statistically significant reduction in tender and swollen joint count was noted at all the three visits as compared to baseline. Fall in ESR and CRP was statistically significant at 1 and 3 months, but not at last follow-up. Mean reduction in BASDAI at 1 month ,3 month and last follow-up after last infliximab dose were 3.907 (95% CI 2.98–4.83; p < 0.001), 4.53 (95% CI 3.56–5.49; p < 0.001) and 2.48 (95% CI 1.12–3.84; p = 0.002), respectively. Mean reduction in BASFI at 1 month, 3 months and last follow-up after last infliximab dose were 4.13 (95% CI 3.23–5.04; p < 0.001), 4.34 (95% CI 2.8–5.88; p < 0.001) and 2.38 (95% CI 0.86–3.90; p = 0.005), respectively. Continuing SSZ and MTX after short course of infliximab results in sustained improvement in our patients with seronegative spondyloarthritis in India.