Patellar Denervation Reduces Postoperative Anterior Knee Pain After Patellar Resurfacing Total Knee Arthroplasty: A Randomized Controlled Trial

BackgroundThe benefit of patellar denervation (PD) in patellar resurfacing total knee arthroplasty (TKA) is still debatable. This prospective, randomized controlled trial investigated whether circumferential PD should be performed in patellar resurfacing TKA.MethodsA total of 241 patients who underwent unilateral TKA were randomized into PD or non-PD groups. Incidence, intensity, and presentation time of anterior knee pain (AKP) and clinical outcomes were evaluated at 3, 6, 9, 12, 18, and 24 months postoperatively.ResultsThe incidence of AKP was significantly lower in the PD group (6.4% vs 16.2%, P = .032). The intensity of AKP and patient satisfaction scores were significantly better in the PD group at 3 months but not after 3 months. The presentation time of AKP mostly occurs at 3 months after surgery. The Knee Society score, range of motion, Oxford score, patellar score, activity of daily living score, and visual analog scale of overall knee pain were not significantly different between the two groups during the follow-up period.ConclusionGiven that PD can improve AKP and patient satisfaction at an early period postoperatively without jeopardizing clinical outcomes at no additional cost, this inexpensive procedure readily available in nearly every operation room is strongly recommended during primary TKA with patellar resurfacing.     

Connective tissue diseases in the hospital outpatient service in Lomé (Togo)

PURPOSE: There have been few studies of connective tissue diseases in Africa. METHODS: A retrospective study was conducted in order to describe the various connective tissue diseases and their semiological profile in patients attending the dermatology and rheumatology units at Lomé hospital. RESULTS: Clinical examinations showed that eighty-four (0.2%) out of the 34,169 patients were suffering from connective tissue diseases. Diseases that were encountered were the following: scleroderma (18 cases), systemic lupus erythematosus (four cases), discoid lupus erythematosus (15 cases), rheumatoid arthritis (29 cases), polymyositis and dermatomyositis (16 cases), juvenile rheumatoid arthritis (one case), giant cell arteritis (one case). Raynaud's syndrome was present in six out of the 18 patients suffering from scleroderma. Nephrotic syndrome was observed in a patient suffering from systemic lupus erythematosus. A septicemia caused this patient's death. Two patients suffering from polymyositis had cancer. No etiology was found in the 14 other patients. Hip involvement was present in two patients suffering from rheumatoid arthritis. Patients with rheumatoid arthritis had no systemic involvement (nodulitis, vasculitis). CONCLUSION: Our results are in agreement with those of previous studies on connective tissue diseases in Africa. However, further studies are required to better understand the epidemiological and semiological profiles of connective tissue diseases in Africa.     

An HIV-Infected Woman with Choriocarcinoma Presenting with a Nasal Mass

Gestational choriocarcinoma metastasized to the nasal mucosa is extremely rare. An HIV-infected woman with choriocarcinoma presenting with a nasal mass is reported. The clinical findings are compared with a previous reported case. She responded to multiagent chemotherapy and has obtained complete remission. The role of HIV infection is also discussed.     

Preevacuation Serum CA 125 in Complete Hydatidiform Mole

Studies on CA 125 in hydatidiform mole are limited. The objective of this study was to measure the preevacuation serum CA 125 level in patients with complete hydatidiform mole and to determine whether it could predict the later development of persistent trophoblastic disease. Preevacuation serum CA 125 levels were immunoradiometrically measured in 69 patients with histologically confirmed complete hydatidiform mole. The mean (range) serum CA 125 level was 63.7 (10.5–404.7) U/ml. Using 35 U/ml as the cutoff point, the elevated CA 125 levels were observed in 53.6% (37/69) of the patients. The mean serum CA 125 level of patients who later developed persistent trophoblastic disease was not significantly higher than that of those who had benign course (78.9 vs 52.6 U/ml,P> 0.05). In conclusion, the preevacuation serum CA 125 level was elevated in about half of patients with complete hydatidiform mole and it could not be used to predict the subsequent development of persistent trophoblastic disease.