Deltoid ligament reconstruction with autologous gracilis tendon in chronic medial ankle instability after ankle fracture surgery: A case report

IntroductionThe repair of a deltoid ligament injury, following an ankle fracture with involvement of the syndesmosis, has no univocal consensus. Also the surgical strategies in case of a subsequent chronic instability are still under debate. In this work the result of a double bundle anatomic reconstruction of deltoid ligament with ipsilateral autologous gracilis muscle tendon is presented.Case reportA 50 year old active male patient came to our attention with a catastrophic medial ankle instability, a severe pronation of the hindfoot and disabling ankle pain. He reported a Weber type B fracture of the left ankle with a lesion of the syndesmosis treated with anatomic plate and screws and a transyndesmotic screw 8 months before. The imaging showed a complete deltoid ligament lesion. Due to the impossibility of a direct repair of the ligament, we performed the reconstruction of the medial ligamentous complex with an autologous gracilis tendon graft. 10 months after the medial ligamentous complex reconstruction, the patient showed an excellent recovery of walking ability, disappearance of pain under load and resumed an active lifestyle.DiscussionThe deltoid ligament has a key role in ankle joint stability and its integrity promotes the recovery after ankle fractures. However, its lesion is often left untreated in the acute setting. The result of a chronic untreated deltoid ligament injury could be extremely disabling and the ligament reconstruction, when an optimal native deltoid ligament repair is not achievable, is the choice to restore ankle function and stability.ConclusionIn the delayed treatment of a deltoid ligament rupture the described double bundle anatomic reconstruction with autologous tendon graft can be an effective and suitable option.     

中药蒲公英的质量标准研究

用ＨＰＬＣ法测定蒲公英中咖啡酸和绿原酸的含量。采用 ＨＰ Ｈｙｐｅｒｓｉｌ Ｃ_１８色谱柱,２００ ｍｍｘ ２． １ｍｍ,５μｍ,流动相：甲醇－磷酸盐缓冲溶液（ｐＨ＝４． ２） ２３： ７７,检测波长：３２３ ｎｍ,柱温：４０℃,流速：１．０ ｍＬ／ｍｉｎ。该法咖啡酸平均回收率 ９９．８０％,ＲＳＤ ２．１４％;绿原酸平均回收率９９．５４％,ＲＳＤ ２．６９％。本法稳定可靠,为药典建立蒲公英药材的质量标准提供了依据。     

Conversion factor for comparison of data from Humphrey and Medmont automated perimeters

Background : Clinical experience has shown that the sensitivity indices reported by the Humphrey Field Analyser (HFA) are generally higher than those given by the Medmont Automated Perimeter (M600). It is the purpose of this paper to determine a conversion factor for the two perimeters and to confirm this prediction using clinical data. Theory predicted that HFA_sensitivity ? 5 dB = M600_sensitivity. Methods : Sensitivity versus eccentricity profiles were measured over the central visual field on 10 young subjects using both perimeters. Results : Both the HFA and the M600 operate within the realms of the Weber law and measure similar Weber fractions. The sensitivity profiles had similar slopes (about ?0.2 dB/degree) and were separated by about six decibels with the HFA reporting higher sensitivity values. This result confirmed the theoretical prediction. Conclusion : The difference in threshold sensitivities between the two perimeters is a result of differences in scaling factors and instrument luminances. A suggested clinical conversion factor is to subtract 5 dB from the HFA data to approximate those of the M600.     

Rendu–Osler–Weber syndrome presenting with pulmonary arteriovenous fistula

A pulmonary arteriovenous fistula is an abnormal connection between pulmonary arteries and veins. Patients with Rendu–Osler–Weber syndrome may present with this vascular malformation, which is a typical finding of the disease. Approximately 5–15% of Rendu–Osler–Weber syndrome patients have pulmonary arteriovenous malformations (AVM) and there is usually a family history of AVM in these patients. The malformations are usually located in the lower lobes. In this paper, I describe a 49‐year‐old male patient with dyspnoea, cough, haemoptysis and epistaxis. Physical examination showed nasal telangiectasias, cyanosis of the lips and nails, and a systolic bruit over the left lung. Chest X‐ray revealed a 5‐cm mass in the left lower lobe and after magnetic resonance examination, together with 3‐D magnetic resonance angiography, it was demonstrated to be a pulmonary arteriovenous fistula. The history of a niece with a similiar history of suspected pulmonary arteriovenous fistula led me to consider the possibility of Rendu–Osler–Weber syndrome presenting with a pulmonary arteriovenous fistula.     

Outline of a typology of men’s use of anabolic androgenic steroids in fitness and strength training environments*

Recent research into the use of anabolic androgenic steroids (AAS) in fitness and strength training environments have revealed great variance in users’ approach to AAS use and more specifically their approach to health risks and desired objectives. However, there have only been few attempts to develop theoretical frameworks directed at conceptualising the variance in AAS use. In this paper, we propose a unified framework in the form of a typology, which concerns men’s general approach to AAS use. The typology is based on sociologist Max Weber’s method on the ideal typology. The work comes out of the authors’ own qualitative empirical research on male AAS users in fitness and strength training environments, but is also related to and draws on the international literature on the subject. The suggested typology consists of four ideal types: the Expert type, the Well-being type, the YOLO type and the Athlete type. The four types are developed around two overarching categories, namely users’ approach to risk and effectiveness. The typology outlines distinct and characteristic approaches to AAS use and can, thus, be employed by researchers as well as health professionals as a heuristic tool for investigation and explanation.     

Surgical vs non-surgical management of Weber B fractures: A systematic review

BackgroundThe aim of this systematic review was to compare surgical and non-surgical management of Weber B ankle fractures.MethodsA systematic computer-based search was conducted using the MEDLINE (via OvidSP), EMBASE (via OvidSP) and Central databases. Data were extracted regarding functional outcome, radiological union, range of motion (RoM), infection rate and quality of life (QoL).ResultsThere were no significant differences identified between surgical and non-surgical management of Weber B fractures with respect to functional outcome. There is a higher rate of complication following surgical management, including infection, reoperation, thromboembolic events and death. With respect to QoL and ankle RoM, this review identified no differences between surgical and non-surgical management.ConclusionsThere is a need for further published literature evaluating the most efficacious management as there is a poverty of high-level research available. Currently, the available literature does not overwhelmingly favour a particular approach to Weber B ankle fractures.     

Unusual presentation of Sturge-Weber syndrome: Progressive megalencephaly with bilateral cutaneous and cortical involvement

The Sturge Weber syndrome is characterized by developmental delay, seizures in infancy, unilateral cutaneous lesions with ipsilateral leptomeningeal enhancement. We report an unusual presentation of Sturge Weber syndrome with bilateral port wine nevus on the trunk and face along with bilateral cortical involvement in a developmentally normal child with progressive megalencephaly.     

Lamotrigine for intractable migraine-like headaches in Sturge–Weber syndrome

We herein report that naratriptan remarkably improved intractable migraine-like headaches in a patient with Sturge–Weber syndrome (SWS) despite his past history of cerebral infarction. In addition, lamotrigine had a prophylactic effect on his visual aura and headaches. An 18-year-old male patient with SWS had intractable migraine-like headaches every several months from the age of 3 years. His migraine-like headaches were characterized by pulsating attacks preceded by left homonymous hemianopsia, which persisted after headache disappearance. In addition, after 14 years of age, the pulsating headaches were preceded by photophobia without homonymous hemianopsia and occurred almost daily. Headache pains were not improved by acetaminophen or loxoprofen sodium hydrate. Furthermore, various prophylactic drugs were ineffective. After obtaining informed consent, naratriptan was administered. The pain severity was reduced and the duration of headache with homonymous hemianopsia was shortened from several days to several hours. Interestingly, naratriptan also shortened the duration of homonymous hemianopsia to several hours. We confirmed that his headache attacks were not epileptic seizures by ictal electroencephalography. However, 25 mg/day of lamotrigine had a prophylactic effect on the frequency of headache. Moreover, lamotrigine led to complete remission of his headache without homonymous hemianopsia. Lamotrigine may have an advantage in terms of reducing the risk of cerebrovascular disease caused by migraine-like headaches and the use of triptans. The most effective management for migraine-like headaches in patients with SWS has not been established. Lamotrigine is a potentially effective option for patients with SWS with migraine-like headaches.     

Sturge-Weber综合征继发青光眼的手术治疗

Objective To evaluate the efficacy and complications of anti-glaucoma surgery in child-hood with Sturge Weber syndrome (SWS) and secondary glaucoma. Methods We have performed glaucoma filtering surgery in 6 patients (10 eyes) with SWS and secondary glaucoma. Results The mean intraocular pressure (IOP) was 34.3mmHg (25.81～50.62 mmHg) preoperatively. ARe, surgery, the mean lOP in all cases was 22.22mmHg ( 14.75～30.82 mmHg) and in the end of follow-up,IOP of 5 patients were controlled to nor-real. We have not observed any intraopemtive or postoperative complications. Conclusion The better safety and efficacy of glaucoma filtering surgery could be obtained in patients with SWS.