MIPPO and intramedullary nailing are effective treatment options in the management of distal tibial extra particular fractures, with comparable functional outcomes.
Introduction: Low back ache is the most common problem seen in orthopedic clinic. Low backache with lumbosacral radiculopathy remains the most challenging musculoskeletal problem for its therapeutic management. In around 90% patients, the cause of low back with radiculopathy is a prolapsed disc. Epidural steroid injections are used in the management of patients with subacute or chronic low backache with radiculopathy, not responding to conservative treatment. The aim of study was to check the efficacy of epidural steroid injection in patients of subacute or chronic low backache with radiculopathy due to herniated disc. Material and Methods: The study was conducted over 100 patients reporting to our OPD with chief complaints of LBA with radiculopathy, not responding to conservative treatment. Maximum of three epidural steroid injections were given with two weeks of interval in between. The patients were assessed before and after the procedure and assessment was done using VAS scoring system. Results: In our study, 80% patients got a significant improvement in symptoms according to VAS scoring system. Out of them, 70% improved with only a single dose of ESI, 20% with the second dose and the remaining 10% after third dose. Also the procedure was found to be more effective in treating patients of subacute low backache with radiculopathy rather than the chronic one. Conclusion: ESI is a safe, cost effective and minimally invasive method of treating patients of subacute or chronic LBA with radiculopathy due to herniated disc. The procedure decreases analgesic use and allows early return to work.
Fifty percent of joint dislocations reported to the emergency department are of shoulder joint. Various techniques are used to reduce the shoulder and Spaso technique is the least known to the orthopaedic residents which is a simple one-man vertical traction method of shoulder reduction. We evaluated the effectiveness of vertical traction method for anterior shoulder dislocation by orthopaedic residents. Sixty consecutive patients of anterior glenohumeral dislocation attending the emergency department of our hospital were taken up for the study. The reduction was done using Spaso technique. Right shoulder was dislocated in 40 patients and 31 patients had recurrent shoulder dislocation. In 55 patients, shoulder was reduced without the use of any anaesthesia. In patients where no anaesthesia was used, the time of traction ranged from 45 seconds to 5 minutes, while under anaesthesia the time of traction ranged from 1 to 4 minutes. Twenty-one patients had associated greater tuberosity fracture which did not affect the method of reduction and all of them were reducible. No complication was reported, and all the patients were satisfied with the method. In conclusion vertical traction method is a good technique for reducing anterior shoulder dislocation with an easy learning curve among the residents and no complication has been reported so far.
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Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER University of MinnesotaMinneapolis, MN 55455 SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR'S ACRONYM(S)U.S.Army Medical Research and Material Command Fort Detrick, Maryland, SPONSOR/MONITOR'S REPORTMD, 21702-5012 DISTRIBUTION / AVAILABILITY STATEMENTApproved for public release; Distribution Unlimited SUPPLEMENTARY NOTES14. ABSTRACT: We proposed to investigate the role of BMI1 (a member of polycomb gene family) in human prostate cancer (CaP) development. Here, we present the work accomplished during the last 5 months (after submitting the 1 st annual report ) of the project. In 1 st annual report we showed that BMI1 protein levels are highly elevated in human CaP patients and we investigated the mechanistic basis of the role of BMI1 in human CaP. We showed that BMI1-silenced CaP cells exhibit decreased proliferative and clonogenic potential. On the contrary, BMI1-overexpressing CaP cells exhibited the reverse. Based on the outcome of micro-array and PCR array analysis, we showed that silencing of BMI1 caused a decrease in the cyclin D1 (Wnt target) and Bcl-2 (Sonic Hedgehog-SHH target), however an increase in p16 was observed. Conversely, overexpression of BMI1 exhibited the reverse effects. In the current report we provide novel findings about the transcriptional activation of Bcl-2 in CaP cells. We provide evidence that BMI1 induces the Bcl-2 expression in CaP cells suggesting the involvement of other pathway too in the regulation of Bcl-2 transcriptional activation. Another important finding of our report is that we identified those Bcl-2 acts as a novel Wnt target in CaP cells. We found that BMI1 regulates (i) activity of TCF4 transcriptional factor and (ii) binding of TCF4 to the promoter region of anti-apoptotic BCL2 gene. Notably, an increased TCF4 occupancy on BCL2 gene was observed in prostatic tissues exhibiting high BMI1 levels. Using tumor cells other than CaP, we also showed that regulation of TCF4-mediated BCL2 by BMI1 is universal. It is noteworthy that forced expression of BMI1 was observed to drive normal cells to hyperproliferative mode. We show that targeting BMI1 improves the outcome of docetaxel therapy in animal models bearing chemoresistant prostatic tumors. Finally, by employing BlueGen/L Super computer modeling, we identified small molecule inhibitors of BMI1. We suggest that BMI1 could be exploited as a potential molecular target for therapeutics to treat chemoresistant tumors.
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