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Biomedical subjects

M S Dhillon

Publications and source records attributed to M S Dhillon.

At least 19 recordsLinked to original sources

Intra-osseous pseudoaneurysm following curettage of an aneurysmal bone cyst.

BACKGROUND: Pseudoaneurysms secondary to bone tumours are rare and most of the reported cases are related to osteochondromas, either due to direct pressure or following surgery. Aneurysmal bone cysts are relatively common bony lesions usually treated by curettage. DISCUSSION: We describe an unusual case of pseudoaneurysm of the anterior tibial artery complicating curettage of an aneurysmal bone cyst which presented as a rapidly enlarging mass clinically thought to be rapid recurrence of the tumour. This was successfully treated by embolisation.

Aneurysm, False↗

Mammotome biopsy: impact on preoperative diagnosis rate.

AIM: To assess the impact of mammotome biopsy on preoperative diagnosis rate. METHODS: A prospective study was undertaken to examine the referral patterns, radiological abnormalities, sensitivity, specificity and outcome of the first 150 patients undergoing mammotome biopsy at our institution. Most of the referrals were from the NHS Breast Screening Programme (85/100). RESULTS: The commonest radiological abnormality was microcalcification (87%). The accuracy of this biopsy technique for the target lesion was over 99%. Post-biopsy, 11 patients needed to proceed to a diagnostic surgical biopsy (7%). Forty-two malignancies were identified at final histology; 41 were diagnosed preoperatively. The positive predictive of mammotome biopsy was 98% for the present study. The present results for mammotome biopsy with regard to predicting invasion were: sensitivity 71.4% (10/14); specificity 100% (0/0); positive predictive value 100% (10/10); and negative predictive value 87% (27/31). CONCLUSION: Prone mammotome biopsy has proven to be highly accurate, considerably improving the preoperative diagnosis within our unit, and obviating the majority of diagnostic excision biopsies.

Adult↗

Reducing unnecessary skull radiographs in children: a multidisciplinary audit.

AIM: To review guidelines on the indications for skull radiographs with a view to improving compliance and reducing unnecessary irradiation of children. METHODS: Three audits on the indications, compliance and effect on practice of differing sets of guidelines for skull radiographs following paediatric head trauma were performed. After each audit, alterations in clinical practice with modifications of the guidelines were implemented. The effect of these changes on radiological practice and patient care were recorded. Audits were performed for 3 months (February-April) in 1999, 2001 and 2003. RESULTS: The number of children with head injuries presenting was unchanged. The number of skull radiographs performed fell from 146 in 1999 to 95 in 2001 and 50 in 2003. Compliance with hospital guidelines increased from 85% in 1999 to 100% in 2003. No neurosurgical problems were missed. CONCLUSION: The implementation of guidelines that are acceptable to all specialties will improve compliance and reduce unnecessary radiographs being performed. The involvement of the radiography staff will help maintain compliance. The training of junior staff and maintaining good communication with involved departments will improve patient care.

Child↗

Posterior cruciate ligament avulsion from the tibia: fixation by a posteromedial approach.

The authors present their experience with a posteromedial approach for fixation of posterior cruciate ligament avulsion from the tibia. The approach is easy, safe and demands no great technical prowess or instruments. Some minor modifications and technical tips for a safer exposure and a better fixation are highlighted. This is a reproducible method for achieving good stability in these avulsion fractures, where early intervention prevents significant late disability. Even in cases delayed up to 3 months we advocate fixation after gradual intra-operative traction and multiple longitudinal stab incidisons, if the ligament with the attached bony fragment has retracted proximally. A single 4-mm screw gives sufficient initial stabilisation to allow supervised mobilisation. A high index of suspicion should be maintained in all dash-board injuries presenting with femoral shaft fractures, especially when the patella is also fractured. The diagnosis may be missed in the acute setting if the bony avulsion is not adequately appreciated; routine MRI in this situation is a good option.

Adolescent↗

Three-dimensional printing and porous metallic surfaces: a new orthopedic application.

As-cast, porous surfaced CoCr implants were tested for bone interfacial shear strength in a canine transcortical model. Three-dimensional printing (3DP) was used to create complex molds with a dimensional resolution of 175 microm. 3DP is a solid freeform fabrication technique that can generate ceramic pieces by printing binder onto a bed of ceramic powder. A printhead is rastered across the powder, building a monolithic mold, layer by layer. Using these 3DP molds, surfaces can be textured "as-cast," eliminating the need for additional processing as with commercially available sintered beads or wire mesh surfaces. Three experimental textures were fabricated, each consisting of a surface layer and deep layer with distinct individual porosities. The surface layer ranged from a porosity of 38% (Surface Y) to 67% (Surface Z), whereas the deep layer ranged from 39% (Surface Z) to 63% (Surface Y). An intermediate texture was fabricated that consisted of 43% porosity in both surface and deep layers (Surface X). Control surfaces were commercial sintered beaded coatings with a nominal porosity of 37%. A well-documented canine transcortical implant model was utilized to evaluate these experimental surfaces. In this model, five cylindrical implants were placed in transverse bicortical defects in each femur of purpose bred coonhounds. A Latin Square technique was used to randomize the experimental implants left to right and proximal to distal within a given animal and among animals. Each experimental site was paired with a porous coated control site located at the same level in the contralateral limb. Thus, for each of the three time periods (6, 12, and 26 weeks) five dogs were utilized, yielding a total of 24 experimental sites and 24 matched pair control sites. At each time period, mechanical push-out tests were used to evaluate interfacial shear strength. Other specimens were subjected to histomorphometric analysis. Macrotexture Z, with the highest surface porosity, failed at a significantly higher shear stress (p = 0.05) than the porous coated controls at 26 weeks. It is postulated that an increased volume of ingrown bone, resulting from a combination of high surface porosity and a high percentage of ingrowth, was responsible for the observed improvement in strength. Macrotextures X and Y also had significantly greater bone ingrowth than the controls (p = 0.05 at 26 weeks), and displayed, on average, greater interfacial shear strengths than controls, although they were not statistically significant.

Animals↗

Tuberculosis of the sternoclavicular joints.

From May 1991 to December 1997, we treated 9 patients with tubercular arthritis in 10 sternoclavicular joints. The patients presented with a painful swelling (7 joints), painless swelling (2 joints) and a painless (?) discharging sinus (1 joint) having a mean duration of symptoms of 13 (6-32) months. The diagnosis was made with fine-needle aspiration or open biopsy. In 1 patient debridement of the joint was combined with open biopsy. All patients were initially put on a 4-drug regimen of antitubercular therapy (ATT). 2 joints not responding to closed treatment were surgically debrided after 2-3 months of ATT. Total duration of ATT was 14-18 months. At final follow-up after average 4.5 (1.5-7.5) years, all lesions had healed. 3 patients had mild limitation of shoulder motion, with no pain, and 2 patients had a cosmetically ugly scar at the site of the sinus or biopsy.

Adolescent↗

Fractures in transfusion dependent beta thalassemia--an Indian study.

AIM OF STUDY: To analyse the incidence of fractures in beta thalassemia patients and to identify causative factors. METHODS: We examined all cases of transfusion dependent beta thalassemia (TDBT) seen at our institute over a two-year period. The transfusion records, incidence of fractures, cause of fracture and Hb levels were recorded. Radiographs of the involved parts were taken in cases with fractures only. RESULTS AND CONCLUSIONS: Amongst 105 cases of TDBT assessed, 14 sustained a total of 28 fractures. Seven patients sustained more than one fracture. Two thirds of these fractures were caused by trivial trauma. All fractures, except one, were of the closed type. Radiologically, fractures frequently showed minimal or no displacement. All fractures were successfully treated by closed modalities of treatment. Majority of the fractures healed within normal union time for a given bone. Permanent deformities and gross limb length discrepancies were uncommon. On reviewing the literature, we noted that the incidence of fractures in our series and in the latest reports was lesser than previously reported. We postulate that this is a result of better and earlier control of hemoglobin status by improved transfusion techniques, and earlier recognition of the disease. Difficulties arise due to inadequate blood transfusion facilities in developing countries.

Blood Transfusion↗

Tuberculosis of the clavicle presenting as an expansile lytic lesion: a case report.

An unusual case of skeletal tuberculosis, presenting as an expansile osteolytic lesion in the lateral end of the clavicle is presented. Diagnostic confusion delayed appropriate medical therapy, leading to development of a discharging sinus with secondary infection, which further confused the picture. With re-emergence of tuberculosis as an important infection worldwide, and the ability of this disease to mimic many skeletal pathologies, this has to be included in the differential diagnosis, especially at unusual sites.

Adult↗

Bilateral sternoclavicular joint tuberculosis.

A unique case of bilateral sternoclavicular tuberculosis is presented, with discussion of the possible mechanism of infection. Early diagnosis is mandatory for good results, and with a world-wide resurgence of this disease, a high index of suspicion is mandatory (especially in immunocompromised patients and migrant populations). Computed tomography and magnetic resonance imaging are helpful for defining the exact extent of the disease.

Adult↗

Fractures of the medial humeral condyle in adults.

BACKGROUND/AIM OF STUDY: Fractures of the medial condyle of humerus are uncommon in adults. The aims of this study were (i) to highlight the rarity of this injury, (ii) to focus on the problems in management of cases which present late, and (iii) to compare the results of surgical excision of medial condyle with those of internal fixation. METHODS: Seven adult medial humeral condyle fractures were seen over a 10-year period. Four cases were surgically fixed within three weeks of the injury; one case refused operation. Two cases which presented late, one with an isolated trochlear fracture, and another Milch type I fracture comminution and compounding, were treated by excision of the condyle and supervised post excision physiotherapy. RESULTS: All six operated cases regained good function. The two patients with excised condyle had no significant instability and had good range of movements. The results were comparable to those managed by open reduction and internal fixation. CONCLUSIONS: Medial condyle fractures presenting early (within 3 weeks), should be managed by accurate open reduction and rigid fixation: non operative management leads to relatively poor results. In late/neglected cases, or those with extensive comminution, open reduction and fixation may lead to stiff and painful elbow, whereas excision of the condylar fragment does not lead to instability.

Adult↗

Surgical options in the management of residual foot problems in poliomyelitis.

Although poliomyelitis is not encountered in the Western countries, it is still endemic in the underdeveloped world. Because the foot commonly is involved, an understanding of the causative factors and the available options of treatment is essential before surgical intervention. It is important to note that inadequate or improper surgical procedures potentially can lead to more disability; a well-planned approach to the foot problem, after considering the patient as a whole and understanding the principles involved, is the best option.

Child↗

Inferomedial (subsustentacular) dislocation of the navicular: a case report.

A unique case of subsustentacular dislocation of the navicular is presented. The authors propose that such a severe displacement cannot occur until there is complete instability across the whole midfoot. The mechanism of injury and the treatment options are discussed. In the present case, there was late collapse of the foot into abduction because the lateral column was not primarily stabilized. Avascular necrosis is a common complication which leads to navicular collapse. A midfoot arthrodesis gave a good result in our patient.

Arthrodesis↗

Total dislocations of the navicular: are they ever isolated injuries?

Isolated dislocations of the navicular are rare injuries; we present our experience of six cases in which the navicular was dislocated without fracture. All patients had complex injuries, with considerable disruption of the midfoot. Five patients had open reduction and stabilisation with Kirschner wires. One developed subluxation and deformity of the midfoot because of inadequate stabilisation of the lateral column, and there was one patient with ischaemic necrosis. We believe that the navicular cannot dislocate in isolation because of the rigid bony supports around it; there has to be significant disruption of both longitudinal columns of the foot. Most commonly, an abduction/pronation injury causes a midtarsal dislocation, and on spontaneous reduction the navicular may dislocate medially. This mechanism is similar to a perilunate dislocation. Stabilisation of both medial and lateral columns of the foot may sometimes be essential for isolated dislocations. In spite of our low incidence of ischaemic necrosis, there is always a likelihood of this complication.

Adult↗

Addition of intrathecal midazolam to bupivacaine produces better post-operative analgesia without prolonging recovery.

OBJECTIVE: The administration of midazolam by centroneuraxis route has been shown to produce segmental antinociception. This midazolam analgesia was found to enhance the effects of local anesthetics given in combination epidurally without any adverse effects. The present study was designed to evaluate the post-operative analgesic effect of intrathecal midazolam-bupivacaine mixture in patients undergoing knee arthroscopy. METHODS: Thirty healthy patients scheduled for knee arthroscopy were divided into two groups to receive either midazolam-bupivacaine mixture (group M; n = 15) or bupivacaine alone (group B; n = 15) intrathecally. Level of sensory block, sedation score, assessment of pain using visual analogue score were recorded in both groups at regular time intervals. Time to block regression, recovery to ambulation and ability to void were recorded and noted before discharge. RESULTS: A significantly higher VAS score was seen in group B patients as compared to the score observed in group M patients before discharge (p<0.05). All patients received rescue analgesia in group B at a mean duration of 258 +/-46.8 minutes whereas only one patient in group M required supplemental analgesia within this period. Time to regression of sensory analgesia to L5-S1 level was longer in group M (267+/-67.38) as compared to group B (229.8+/-41.4) (p<0.05). Blood pressure, heart rate, oxygen saturation and sedation score showed no differences between the groups. Neither motor block nor time to void were prolonged with the addition of midazolam to bupivacaine. CONCLUSION: The results suggest that addition of midazolam to bupivacaine intrathecally provided better post-operative analgesia without any adverse effects.

Adjuvants, Anesthesia↗

Does the piriformis compress the sciatic nerve during limb length equalization?

BACKGROUND: Correction of limb length inequality during reconstruction procedures at the hip has the inherent danger of sciatic nerve injury. Among others, we think that constriction by a tightened Piriformis tendon may be a significant cause during longitudinal traction at the time of surgery. PATIENTS: A specific protocol involving the use of staged surgical release at the time of intraoperative traction/limb length equalization gave only partial nerve compromise in one out of 11 cases; three other patients treated without this protocol developed sciatic nerve problems. CONCLUSION: The authors feel that prior to the application of longitudinal traction, routine sectioning of the contracted piriformis tendon is important to prevent this complication; it is suggested that further investigations like intra operative nerve conduction studies during traction may perhaps substantiate these findings.

Adolescent↗

Accuracy and diagnostic sensitivity of radiographic absorptiometry of the second metacarpal.

The accuracy of a radiographic absorptiometry (RA) technique called digital image processing (DIP), discriminative ability of RA for osteoporotic fracture, and the relationship between RA and dual X-ray absorptiometry (DXA) of the spine and forearm were evaluated. We measured 16 cadaver hands, 32 healthy non-black premenopausal women, 39 healthy non-black postmenopausal women, and 35 non-black osteoporotic postmenopausal females. The overall correlation between the ash weights of the entire metacarpal and the DIP values was excellent (r = 0.954, P < 0.001, SEE = 0.14, CV = 6.4%). Short-term precision error of DIP was 3.5%. Age-related bone loss determined by DIP is comparable to that of spinal and forearm DXA: annual BMD decreases were 0.46% for DIP, 0.45% for forearm, and 0.32% for the spine. DIP of the 2nd metacarpal shows a gradient of risk for spinal fracture only slightly below that of forearm DXA, but substantially below that of spinal DXA. Age-adjusted odds ratios were 1.81 for RA, 2.45 for spinal DXA, and 1.94 for forearm DXA.

Absorptiometry, Photon↗

Tuberculosis of the patella.

A rare case of tuberculosis of the patella is presented. Diagnostic features include an osteolytic lesion in the patella with flaky sequestrum, associated with typical clinical features. Treatment should be urgent and should include a regimen of surgical debridement along with four antitubercular drugs. Once the joint is involved, the end results become less satisfactory.

Adolescent↗