Patellofemoral joint arthroplasty: patient selection,surgical technique and outcomes

Isolated patellofemoral arthritis is an increasingly recognized entity, and is usually associated with previous patellofemoral dysplasia or instability. Patellofemoral arthroplasty (PFA) has evolved significantly in recent years, both in terms of implant design and importantly in the understanding of appropriate patient selection. This review outlines the indications and investigations for PFA, provides a brief history of the development of contemporary implants, and presents the clinical outcomes for the prostheses most commonly used in the UK. In addition, it provides a detailed surgical technique for implantation of an onlay implant, with tips on how to optimize patellofemoral biomechanics and thus achieve a consistently good outcome.     

Effects of a summer school-readiness programme on measures of literacy and behaviour growth: a pilot study

Young children enter kindergarten with varying levels of readiness and abilities to learn. One factor that contributes to lower levels of school readiness is poverty. One timely, cost-effective, and feasible strategy to boost school readiness, regardless of exposure to high-quality preschool is to leverage the summer months prior to kindergarten entry and provide comprehensive, evidence-based programming immediately before the school year begins. The current study implemented a community-based summer programme targeted at improving school readiness for 25 four- and five-year-old children in a low-income community. Across the 9-week study, children participated in two types of early literacy activities and the Incredible Years social/emotional learning curriculum. Results indicate that participants demonstrated significant growth across three early literacy skills and were rated as overall stable regarding their behaviour across the summer. These results are discussed along with implications and future directions in this line of research.     

Clinical evolution of cystic teratoma during treatment with combination chemotherapy

Progressive, cystic tumor enlargement in the abdomen developed in a patient with teratocarcinoma during treatment with systemic chemotherapy. Tumor markers were elevated in the cyst fluid and negative in serum. Further, the patient underwent a successful surgical debulking of large amounts of cystic teratoma.     

Immunocytochemical study of retinal diode laser photocoagulation in the rat.

AIM: To determine the nature of the cellular infiltrate, alterations in cell adhesion molecules, and MHC II antigen expression in the rat retina following diode laser retinal photocoagulation. METHOD: 20 normal Lister rats underwent diode laser photocoagulation of the retina. Frozen sections from eyes enucleated at 0, 1, 5, 13, and 33 days post laser were examined for T cells (R7.3), CD4 T cells (W3/25), activated CD4 T cells (OX-40), CD8 T cells (OX-8), B cells (OX-33), and macrophages (OX-42), MHC II antigen (OX-6), and E-Selectin-1, VCAM-1, and ICAM-1. RESULTS: Retinal diode laser photocoagulation stimulated a wound healing response in the outer retina and choroid. The cellular infiltrate included macrophages and activated CD4 T cells at 13 and 33 days post laser. Glial cells in the inner plexiform and inner nuclear layers expressed MHC II antigen at 24 hours only. ICAM-1 antigen was induced in RPE cells and in Muller cells in the inner retina at all time intervals post laser and intense staining for ICAM-1 was present around intraretinal migrated cells at 13 and 33 days post laser. VCAM-1 antigen expression was induced in the choroidal vascular endothelium and RPE at 13 and 33 days after laser as was E-Selectin-1 antigen expression which was also evident focally at the external limiting membrane in association with migrated cells adjacent to the burn. CONCLUSIONS: These results suggest that alterations in cell adhesion molecules may regulate the migration and activation of retinal pigment epithelium, macrophages and CD4 T cells at the outer blood-retinal barrier and choroid following diode laser photocoagulation of the normal Lister rat retina.     

Canadian Association of General Surgeons Evidence Based Reviews in Surgery. 10. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial.

Question: Is there a difference in cancer-related survival between laparoscopic assisted colectomy (LAC) and open colectomy (OC)? Design: Randomized controlled trial. Setting: Single-centre trial, Barcelona, Spain. Patients: Two hundred and nineteen of 442 eligible patients with adenocarcinoma of the colon were included. Patients were excluded if the tumour was below 15 cm from the anal verge or was in the transverse colon; if there were distant metastases, adjacent organ involvement or obstruction; or the patient had previous colonic surgery. One hundred and eleven were randomized to the LAC group and 108 to the OC. Interventions: Randomization was done the day before surgery. Patients were stratified into 2 groups according to tumour location (right or left side with respect to the splenic flexure) and assigned to the LAC or OC group by means of sealed opaque envelopes containing computer-generated random numbers. Patients in both groups had surgery by a single gastrointestinal surgical team. Pre- and postoperative care was standardized for bowel prep and perioperative antibiotics. Patients received either LAC or OC using a no-touch technique and initial vascular ligation. Main outcome measure: Overall survival. Results: The Cox model showed that LAC was independently associated with reduced risk of tumour relapse (hazard ratio 0.39, 95% CI 0.19 – 0.82), death from any cause (0.48, 0.23 –1.01) and death from a cancer-related cause (0.38, 0.16– 0.91) compared with OC. This superiority of LAC was due to differences in patients with stage III tumours (freedom from recurrence p = 0.04, overall survival p = 0.02, and cancer- related survival p = 0.006). Conclusion: LAC is more effective than OC for treatment in terms of morbidity, hospital stay, tumour recurrence and cancer-related survival.