Locked pubic symphysis—A case series

BackgroundLocked pubic symphysis is an unusual form of pelvic injury. In this the intact pubis gets trapped against contralateral pubis. Closed reduction can be attempted though often requires open reduction and internal fixation. This paper is presented for its rarity and probably first case series on locked pubic symphysis from single institute.Materials and methodsThree cases are presented from the Institute of Orthopaedics and Traumatology, Government General Hospital and Madras Medical College, Chennai from February 2007 to July 2009. Initially closed reduction was attempted but was not possible, so open reduction was planned. Open reduction was successful in all cases with some difficulty and fixed with symphysial plating. All patients were followed up for functional outcome for a mean follow-up of 15 months.DiscussionThis is the first time in the literature a case series of locked pubic symphysis is presented. In all cases it was found that anterior superior iliac spine on the affected side had moved closer to the midline compared to the opposite side. Though suprapubic cystostomy is a contraindication for pfannensteil incision, we have reduced three cases by this incision and done internal fixation with no postoperative wound infection. We were able to reduce the locked pubis with simple maneuvers and with no special distraction instruments. We did not require any osteotomy for the reduction which is a disadvantage as it may produce healing problems.ConclusionLocked pubic symphysis is a rare form of pelvic injury. Though conservative closed reduction maneuvers have been described open reduction is often required. Internal fixation helps not only in stabilizing the anterior rim of pelvis but also the posterior aspect by stabilizing the sacro iliac joint which improves pelvic stability and promotes recovery.     

Antiproliferative effect of exemestane in lung cancer cells

Background  

Recent evidence suggests that estrogen signaling may be involved in the pathogenesis of non-small cell lung cancer (NSCLC). Aromatase is an enzyme complex that catalyses the final step in estrogen synthesis and is present in several tissues, including the lung. In the current study we investigated the activity of the aromatase inhibitor exemestane in human NSCLC cell lines H23 and A549.     

Visual attention in children with migraine: a controlled comparative study

The aim of this study was to evaluate the visual attention of children with migraine and compare it with a control group. Thirty migrainous children and 30 controls without headache were subjected to a visual attention assessment with Trail Making Tests (TMT) A/B, Letter Cancellation Test, and the Brazilian computerized test Visual Attention Test, third edition. The migraine group was evaluated after 2 days without headache. The migraine group had an inferior performance compared with the control group on TMT A ( P  = 0.03) and B ( P  = 0.001), and more errors on tasks 1 ( P  = 0.032) and 2 ( P  = 0.015) of the Visual Attention Test, presenting difficulty with selective and alternate attention. Attention is a neurological function that depends on structures such as the brainstem, cerebral cortex and the limbic system and on neurotransmitters such as dopamine and noradrenaline. The neurochemical aspects involved in the physiopathology of migraine and attention mechanisms probably predispose these children to visual attention deficits.     

Comparison of phaconit rollable IOL with acrylic foldable IOL

Background: Phaconit or ultra micro incision phacoemulsification cataract surgery involves phacoemulsification through a 0.9 millimetre sleeveless phaco tip and irrigating chopper followed by implantation of a rollable intraocular lens. The procedure leads to negligible astigmatism and faster visual recovery as compared to phacoemulsification with a foldable intraocular lens.     

Preoperative embolization of hypervascular head and neck tumours

The embolization of vascular tumours of the head and neck has become an important adjunct to the surgical treatment of these tumours. A vascular tumour in the head and neck region in a surgically treatable patient may be a candidate for embolization. Palliative embolization may be the sole treatment for high risk patients. Reducing intraoperative bleeding may shorten surgery time thus decreasing morbidity and mortality. The purpose of this study is to assess the efficacy of embolization as an adjunct to surgery or as a curative measure in the management of hypervascular head and neck tumours. We retrospectively reviewed the records of 46 consecutive patients (27 men and 16 women; mean age, 37.8 years) with 48 hypervascular head and neck tumours that had undergone preoperative transarterial, direct puncture or combined mode of embolization. Diagnosis of tumours was made on the basis of findings of imaging studies. The 46 patients underwent embolization either through transarterial route, by direct puncture technique or both direct puncture and arterial route. The devascularization reached 90–95% with the use of NBCA. The amount of devascularization reached by transarterial particle embolization is a little lesser. One patient (carotid body tumour) developed mild unilateral seventh, ninth and 10th cranial nerve palsy after transarterial embolization, transient hemiparesis was seen in another patient (nasopharyngeal angiofibroma). Both patients improved completely with steroids and had no deficit on follow up. One patient developed delayed glue migration into the middle cerebral artery territory 6 h after the procedure with no reported increase in size of the lesion in the following 5 years. Preoperative embolization of hypervascular tumour of head and neck region appears to be safe and improves the chance of complete removal during surgery with minimal blood loss.     

Success with lifestyle monotherapy in youth with new-onset type 2 diabetes

BACKGROUND:

Evidence is lacking to support the efficacy of lifestyle modification as first-line therapy in the clinical management of type 2 diabetes mellitus (T2DM) in adolescents.

METHODS:

A retrospective chart review of youth diagnosed with T2DM between 1999 and 2008 was conducted. The authors describe the percentage of youth presenting with glycosylated hemoglobin (HbA_1c) of <9% who achieved/maintained target glycemic control (HbA_1c ≤7.0%) with lifestyle monotherapy during the year following diagnosis.

RESULTS:

Among the 275 youth with T2DM, 38% (n=104) presented with an HbA_1c <9% and were prescribed lifestyle monotherapy at diagnosis. Of the 80 youth who had sufficient follow-up data over 12 months, 54% successfully maintained target glycemic control solely with lifestyle management. The mean HbA_1c score at diagnosis was lower in youth who where successful on lifestlye monotherapy compared with those who were not successful.

CONCLUSIONS:

A significant proportion of youth newly diagnosed with T2DM presenting with an HbA_1c <9% effectively achieved/maintained target glycemic control with lifestyle recommendations alone for 12 months.     

Eyes wide shut - unusual two stage repair of pectus excavatum and annuloaortic ectasia in a 37 year old marfan patient: case report

We report about a 37 year old male patient with a pectus excavatum. The patient was in NYHA functional class III. After performed computed tomography the symptoms were thought to be related to the severity of chest deformation. A Ravitch-procedure had been accomplished in a district hospital in 2009. The crack of a metal bar led to a reevaluation 2010, in which surprisingly the presence of an annuloaortic ectasia (root 73 × 74 mm) in direct neighborhood of the formerly implanted metal-bars was diagnosed. Echocardiography revealed a severe aortic valve regurgitation, the left ventricle was massively dilated presenting a reduced ejection fraction of 45%. A marfan syndrome was suspected and the patient underwent a valve sparing aortic root replacement (David procedure) in our institution with an uneventful postoperative course. A review of the literature in combination with discussion of our case suggests the application of stronger recommendations towards preoperative cardiovascular assessment in patients with pectus excavatum.