Evaluation of the posterior cruciate ligament in long standing cruciate retaining total knee arthroplasty

We evaluated the status of the posterior cruciate ligament in 52 knees with a cruciate retaining total knee arthroplasty 11 years after the index surgery. The evaluation consisted of the Knee Society scores, clinical examination of antero-posterior laxity using the Lachmann test and posterior drawer test. We also used the KT 1000 device, stress radiographs and MRI scan to corroborate this. Three knees were found to be lax clinically and had a posterior tibial shift on radiographs. The MRI scans were able to delineate the posterior cruciate ligament in 86% of the knees. Eleven years after surgery, clinical, radiological and MRI scans when assessed in combination demonstrated the presence of a stable posterior cruciate ligament in 94%.     

New insights into the pharmacology and cytotoxicity of gemcitabine and 2',2'-difluorodeoxyuridine

In a clinical study with oral gemcitabine (2',2'-difluorodeoxycytidine, dFdC), 2',2'-difluorodeoxyuridine (dFdU) was extensively formed and accumulated after multiple oral dosing. Here, we have investigated the in vitro cytotoxicity, cellular uptake, efflux, biotransformation, and nucleic acid incorporation of dFdC and dFdU. Short-term and long-term cytotoxicity assays were used to assess the cytotoxicity of dFdC and dFdU in human hepatocellular carcinoma HepG2, human lung carcinoma A549, and Madin-Darby canine kidney cell lines transfected with the human concentrative or equilibrative nucleoside transporter 1 (hCNT1 or hENT1), or empty vector. Radiolabeled dFdC and dFdU were used to determine cellular uptake, efflux, biotransformation, and incorporation into DNA and RNA. The compounds dFdC, dFdU, and their phosphorylated metabolites were quantified by high-performance liquid chromatography with UV and radioisotope detection. dFdU monophosphate, diphosphate, and triphosphate (dFdU-TP) were formed from dFdC and dFdU. dFdU-TP was incorporated into DNA and RNA. The area under the intracellular concentration-time curve of dFdC-TP and dFdU-TP and their extent of incorporation into DNA and RNA inversely correlated with the IC(50) of dFdC and dFdU, respectively. The cellular uptake and cytotoxicity of dFdU were significantly enhanced by hCNT1. dFdU inhibited cell cycle progression and its cytotoxicity significantly increased with longer duration of exposure. dFdU is taken up into cells with high affinity by hCNT1 and phosphorylated to its dFdU-TP metabolite. dFdU-TP is incorporated into DNA and RNA, which correlated with dFdU cytotoxicity. These data provide strong evidence that dFdU can significantly contribute to the cytotoxicity of dFdC.     

Assessment of nostril symmetry after primary cleft rhinoplasty in patients with complete unilateral cleft lip and palate

The aim of this study was to assess the nostril symmetry following primary cleft rhinoplasty done with either a dorsal onlay or columellar strut graft in patients with non-syndromic complete unilateral cleft lip and palate. In this retrospective study 30 consecutive patients treated with autogenous or alloplastic dorsal onlay grafts and 30 consecutive patients treated with autogenous or alloplastic columellar strut grafts for complete unilateral cleft nose reconstruction were analyzed for nasal symmetry. The autogenous grafts used were costo-chondral or septal cartilage and the alloplastic graft used was high density polyethylene (Medpore^®). Assessment of the nostril symmetry was done using a two-dimensional nasal analysis 24–30 months postoperatively. Ratios between cleft and noncleft side nostril for three parameters were used to assess symmetry namely nostril width, nostril height and nostril gap area. None of the three parameters showed statistically significant changes. A satisfactory, though not statistically significant, difference in symmetrical outcome could be achieved in both the groups with the exception of nostril width symmetry in group treated with dorsal onlay graft.     

Vertebral osteomyelitis following transrectal ultrasound-guided biopsy of the prostate

Transrectal ultrasound-guided needle biopsy of the prostate (TRUS) is a well-tolerated and standardized procedure for the diagnosis of prostate cancer. Complications associated with TRUS requiring emergency room visits or hospital admissions are relatively low and include complications, such as a 1% risk of urinary retention and less than 1% chance of bacterial sepsis. Vertebral osteomyelitis is a rare complication of TRUS; there are 3 reported cases. Vertebral osteomyelitis has an insidious onset and usually resolves following medical intervention. We present an extremely rare case of vertebral osteomyelitis following TRUS, its clinical outcome and management.     

慢性创面微循环障碍的作用及评估

Chronic wounds pose a clinical challenge.Such wounds may present all over the body although the majority appear on the lower extremities.In the main,wounds are caused by hypertension(venous or arterial...     

Acromegaly: a rare manifestation of bronchial carcinoid

Bronchial carcinoids usually present with pulmonary symptoms. Neurohumoral manifestations in the form of acromegaly and Cushing's syndrome are rarely encountered. We report a case of bronchial carcinoid with features of acromegaly due to ectopic production of growth hormone-releasing hormone. Surgical resection of the lung lesion resulted in regression of acromegalic features, normalization of growth hormone secretory dynamics, and remarkable diminution of pituitary size seen on magnetic resonance imaging.