The surgical treatment of fractures of the proximal end of the tibia: a review of cases as related to prognostic factors

It is the purpose of this retrospective study to analyze factors capable of influencing clinical-functional and radiographic results, such as type of fracture, age of the patients, type of trauma, delay in treatment, associated lesions. A total of 33 fractures treated by open reduction and internal stabilization for fractures of the proximal tibia classified according to the AO were re-evaluated. Clinical and radiographic evaluation were obtained by assessing arthrosis, axis, and sinking of the tibial plateau. The clinical and functional results were satisfactory in 72.2% of cases, and radiographic ones were satisfactory in 63.6% for gonarthrosis, in 81.6% for axis, and in 84.8% for sinking. In conclusion, factors capable of influencing the results, such as type of fracture, age of the patient, and type of trauma, in addition to variables that the surgeon must monitor, such as reconstruction of the joint, alignment, synthesis, treatment of meniscal lesions, were observed.     

Human pregnancy levels of estrogen and progesterone contribute to humoral immunity by activating TFH/B cell axis

Circulating T_FH (cT_FH) cells express CXCR5, PD-1, and, when activated, ICOS, and release IL-21. According to the production of IFN-γ, IL-4, and IL-17 and expression of FoxP3, these cells are also classified as cT_FH1, cT_FH2, cT_FH17, and cT_FR cells, respectively. This CD4⁺T-cell subset is pivotal to efficient humoral immunity, and pregnancy appears to favor IgG production. Here, not only pregnancy amplified the in vivo production of anti-HBsAg IgG in HBV immunized women, but the frequency of cT_FH cells was directly correlated with estradiol levels. In vitro, pregnancy-related dose of 17-β-estradiol (E2) directly increased the percentage of different cT_FH subsets. While E2 and progesterone (P4) increased the proportion of differentiated T_FH cells derived from naïve CD4⁺T-cells, only E2 amplified the release of IL-21 in those cell cultures. In addition, E2 and P4 increased the proportion of memory B cells and plasma cells, respectively. In SEB-activated B/T_FH cell co-cultures, E2, in the presence of P4, increased the production of total IgG. Finally, among the hormones, P4 was stronger in upregulating the percentage of IL-10⁺T_FR cells. Collectively, our findings suggested that E2 and P4 cooperate in the humoral immune response by favoring the expansion of different cT_FH and B cell subsets.     

Delayed diagnosis and treatment of Tillaux fracture--a case report

Subchondral hematomas have been found with arthroscopy in one third of patients with dislocated distal radial fractures. The aim of the present, prospective study was to determine whether these hematomas might cause radiographic osteoarthrosis. We studied 41 patients (age 20–57 years, 22 women) with a dislocated distal radial fracture. At the time of fracture, 12 patients had subchondral hematomas in a radiocarpal compartment without a fracture line, as defined by arthroscopy. The 1-year follow-up included clinical and radiographic examinations.

At follow-up, radiographic subchondral bone plate changes occurred in unfractured compartments in 8 patients, of whom 7 had had a previous arthroscopically diagnosed subchondral hematoma (p?=?0.02) in the same compartment. Of the 8 patients with radiographic changes, 4 had also developed joint space narrowing (osteoarthrosis (OA) grade 1) after 1 year and 6 after 3 years. All but 1 had had a hematoma in the same compartment. More importantly, 3 of the 16 patients with entirely extra-articular fractures had subchondral bone plate changes in a compartment corresponding to a previous subchondral hematoma (p?=?0.02). One of these had also developed joint space narrowing. The patients with radiographic changes had a worse outcome, as measured with the Gartland and Werley wrist score (p?=?0.06).

In conclusion, subchondral hematomas in distal radial fractures can lead to early onset of mild OA and worse outcome after 1 year.     

Percutaneous injection of calcium phosphate composite in pediatric unicameral bone cysts: a minimum 5-year follow-up study

Sport Sciences for Health - Unicameral bone cyst (UBC) is a common lesion in skeletally immature patients. Multiple treatments are proposed as curettage and autologous bone graft, percutaneous...     

Treatment of a second maxillary molar with six canals

Variations in the dental anatomy are found in all teeth. Knowledge of these variations, particularly concerning the location and treatment of all canals, is very important for the success of the endodontic therapy. The purpose of this study is to present a clinical case of a maxillary second molar with three palatal canals, two mesio-buccal and one disto-buccal canal. This report serves to remind clinicians that such anatomical variations should be taken into account during endodontic treatment of the maxillary molars.     

Axillary Lymph Node Echo-Guided Fine-Needle Aspiration Cytology Enables Breast Cancer Patients to Avoid a Sentinel Lymph Node Biopsy. Preliminary Experience and a Review of the Literature

Purpose For many years, the status of the axillary lymph nodes has been determined by an axillary lymphadenectomy. However, a sentinel lymph node biopsy has been shown to effectively replace the need for an axillary lymphadenectomy in order to determine the axillary staging. This study presents the preliminary results regarding the efficacy of fine-needle aspiration cytology (FNAC) to identify metastatic axillary lymph nodes in the pre-operative phase. Methods One hundred lymph nodes from 100 patients with histologically and cytologically confirmed breast cancer (cT1–2 cN0) underwent echo-guided FNAC. The diagnostic accuracy (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) for the axillary metastases was evaluated based on the histological findings of either a sentinel lymph node biopsy or an axillary lymphadenectomy as a reference standard. Results It was possible to avoid a sentinel lymph node biopsy in 30% of the cases; the sensitivity was 68%, specificity 100%, PPV 100%, and NPV 65%. Echo-guided FNAC of the axillary lymph nodes should thus be included among the regular diagnostic procedures of presurgical staging. Conclusion This simple, inexpensive, and minimally invasive technique makes it possible to avoid the additional cost of a sentinel lymph node biopsy while also sparing the patient the stress of undergoing a second surgery.