Current guidelines in the surgical management of hereditary colorectal cancers

Incidence of colorectal cancer (CRC) is on rise. While approximately 70% of all CRC cases are sporadic in nature, 20%-25% have familial aggregation and only < 5% is hereditary in origin. Identification of individuals with hereditary predilection for CRC is critical, as it has an impact on their overall surgical management including surgical timing, approach & technique and determines the role of prophylactic surgery and outcome. This review highlights the concept of hereditary CRC, provides insight into its molecular basis, possibility of its application into clinical practice and emphasizes the current treatment strategies with surgical management, based on the available international guidelines.     

Epithelioid sarcoma presenting as radial mononeuropathy: anatomical, magnetic resonance neurography and diffusion tensor imaging appearances

The authors report an unusual case of radial mononeuropathy caused by epithelioid sarcoma and describe the anatomical 3-Tesla MR neurography and the functional diffusion tensor imaging findings of the case, which were subsequently confirmed on surgical excision and histopathology.     

Disequilibrium in naturally occurring radioactive series in some phosphate ores

Eight phosphate ore samples from Egypt and Saudi Arabia were studied by atomic absorption spectrometry for the Bi, Pb, Th and Al concentrations in ppm or ppb or per cent. Also X-ray diffraction spectrometry was applied for determining the mineral and chemical composition of the phosphate ore samples. A gamma spectrometry system, based on HPGe crystal, was applied for determining the concentrations of the radioactive elements in (238)U, (226)Ra and (232)Th series as well as (40)K, in Bq/kg dry weight. Concentrations in ppm were found to be from <10.0 to 20.48, from <7.50 to 27.30 and from <1.0 to 50.0 for Bi, Pb and Th, respectively. Al ranged from <0.05 to 3.13%. Major, minor and trace chemical and mineral compositions were assigned for each sample by XRD spectrometry. Concentrations of the different elements in both radioactive series, (238)U, (226)Ra and (232)Th were compared. Disequilibrium was found in both series.     

Cementation of tibial inserts into nonmatching base plates in revision total knee arthroplasty

We describe the use of a novel technique for adapting nonmatching tibial inserts into tibial trays in revision total knee arthroplasty. From 1998 to 2003, the senior author performed 7 revision total knee arthroplasty procedures, during which a nonmatching tibial insert was cemented into a tibial tray to retain a well-fixed but incompatible opposite component. Bench tests were undertaken to confirm the stability of cement as a locking mechanism substitute. Three components completed 1 000 000 cycles of loading under simulated physiologic stresses with no evidence of fixation failure. There have been no clinical failures at 18 to 69 months in vivo follow-up (mean, 49 months). This technique provided durable fixation while avoiding host bone damage that might have occurred needlessly had the well-fixed implant been extracted. Level of evidence: level IV therapeutic study, case series.     

Effect of inhibin on ovulation and implantation in mice

Injection of antiserum to ovine FSH on the day of proestrus could inhibit ovulation in the next cycle. Inhibin preparation purified from sheep ovaries failed to affect ovulation in mice. Suppression of FSH by this preparation of inhibin during early pregnancy reversed the mitotic index. Administration of inhibin during the peri-implantation period terminated pregnancy in mice. The inhibin preparation decreases FSH in circulation which in turn may possibly reduce ovarian estrogens, thereby inhibiting pregnancy.     

Anterior cruciate ligament reconstruction: Magnetic resonance imaging and factors influencing outcome

Purpose

This study was conducted to determine the magnetic resonance imaging (MRI) findings in cases of complications following anterior cruciate ligament (ACL) reconstructive surgery, and to correlate these complications with their possible etiological factors based on clinical and radiological criteria.

Methods

The study included 48 symptomatic patients (40 males and 8 females) after arthroscopic ACL reconstruction in the period between 2006 and 2008. Clinical evaluation of the patients was performed using the International Knee Documentation Committee scoring system (IKDC). MRI was performed using 1.5 T dedicated system and a standard imaging protocol. The scans were then reviewed by two senior radiologists for the assessment of integrity of the reconstructed ligament and the presence of related complications. The findings were then analyzed and correlated with the clinical evaluation.

Results

Tunnel widening was the most common MRI finding seen, as it was present in 42 patients (87.5%). The detected post reconstructive complications encountered in our patients included graft tear in 34 patients (70.83%), impingement in 12 patients (25%), osteoarthritis in six patients (12.5%), cystic degeneration in two patients (4.16%), and Cyclops lesion in two patients (4.16%).

Conclusions

MRI is a valuable imaging modality for assessment of post ACL reconstructive complications, as it is useful in demonstrating tunnel positioning, graft integrity and other soft tissue structures of the knee. It also helps in identifying possible underlying causes and predisposing factors for ACL graft failure.