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Horseshoe kidney is a rare congenital anomaly resulting from the fusion of the lower pole leading to medial and caudal deviation of kidneys that pose challenges to successful stone clearance. We evaluated the various patient- and treatment-related factors that can impact successful stone clearance. A total of 34 patients with 36 renal moieties with urolithiasis in horseshoe kidneys from 2015 to 2021 were included with a median age of 38 years (11–56 years). The mean calculus size was 39.27 mm (21–70 mm). Twenty-two patients had left, 10 had right, and 2 had bilateral disease. Twelve patients (33%) had previous interventions done. As per Guy stone score (GSS), 14 patients had grade IV, 16 patients had grade III, and 4 patients had grade II disease. Of these patients, 22 underwent unilateral percutaneous nephrolithotomy (PCNL), 2 underwent bilateral PCNL, 6 had pyelolithotomy, 2 had right nephrectomy, and 2 patients underwent shockwave lithotripsy (SWL). Six patients undergoing pyelolithotomy had complete clearance. In PCNL, infra-costal puncture was done uniformly. Complete clearance was seen in 12 out of 16 with superior calyceal access (75% stone-free rates, SFR), 2 out of 8 with middle calyceal puncture (25% SFR), and both the cases with inferior calyceal puncture (100% SFR). Factors affecting stone clearance are as follows: GSS, i.e., grade < IV vs ≥ IV (71.4 vs 50%, P = 0.42), STONE score < 12 vs ≥ 12 (83.3 vs 28.5%, P = 0.048), stone size < 40 vs ≥ 40 mm (50 vs 71.4%, P = 0.42). Our analysis showed that stone clearance was independent of mode of access, GSS, or stone size, although STONE score was a predictor of successful outcomes in PCNL. [ABSTRACT FROM AUTHOR]

Arterial involvement, although rare, accounts for significant mortality and morbidity in patients of Behçet's disease (BD). There is paucity of data on arterial BD. The objective of this 5-year retrospective cohort study was to examine the clinical presentation, pattern of arterial involvement, and treatment outcome in Indian arterial BD patients. Data on demography, clinical presentation, radiology, instituted therapy, vascular interventions and treatment outcomes were recorded and analyzed. Ten (16.9%) out of 59 patients with BD had arterial involvement in 13 vascular territories [mean age 30 (8) years, 9 (90%) males]. Pulmonary artery was most commonly involved (46%), followed by abdominal aorta (15%), femoral artery (15%), descending thoracic aorta (8%), common iliac (8%), and dorsalis pedis artery (8%). Two patients had multi-territory involvement. The median interval between disease onset and development of arterial aneurysms was 3 years (3 months–12 years). Concomitant deep vein thrombosis was seen in 60% cases. Prednisolone and cyclophosphamide were the most common immunosuppressive therapy used; one patient who relapsed on cyclophosphamide responded to infliximab. Five surgical or endovascular interventions were performed. Four patients (40%) died due to aneurysm rupture—all had a delayed diagnosis, and three had pulmonary artery involvement, with death due to massive hemoptysis. Based on the present study, we concluded that arterial involvement in BD is seen predominantly in males and has a high mortality. Early detection and aggressive treatment with immunosuppression and surgical or endovascular interventions are essential for good outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The Judet's technique of quadricepsplasty for an extension contracture of the knee joint offers the benefit of a sequential and controlled release of the intrinsic and extrinsic soft tissue constituents restricting the knee flexion. The main principle of our study was to analyze the clinical as well as functional outcome and to assess an extension lag following Judet's quadricepsplasty for the knee extension contracture deformity. Materials and Methods: This is a retrospective cohort study comprises of thirty three patients, operated for extension contracture with Judet's quadricepsplasty with the mean follow-up was 30 months. Knee range of motion of the operated knee was recorded preoperatively and at 6, 12 and 24 month follow-up after the surgery. Judet's criteria were used to evaluate the outcomes following the procedure. Results: 92.42° (range, 60°–110°) of knee flexion was achieved after an average follow-up of 24 months compared to preoperative knee flexion was 14.09° (range 5°–25°), reflecting a 74.69° average improvement in knee flexion. Twelve patients had excellent results, nineteen had good results as per Judet's criteria but there were no patients with extension lag. The two patients with fair results had superficial wound infection which healed without any further surgical intervention. Conclusions: Judet's quadricepsplasty offers sequential release without extension lag of the knee joint. Patients with the knee extension contractures deformity can be successfully managed with the Judet's quadricepsplasty to gain useful knee motion and function. [ABSTRACT FROM AUTHOR]

Aim: Habitual dislocation of patella is an uncommon pathological condition. Though numerous techniques have been described in the literature for the treatment of patellar dislocations, none of the single procedure is fully effective in the surgical treatment of habitual dislocation of patella. We described our experience with a two in one procedure for habitual dislocation of patella in ten children. Patients and method: Ten children having habitual dislocation were reviewed prospectively for twelve months following surgical procedure. The age ranged between 5 and 9 years. We performed graded lateral soft tissue release and patellar tendon transposition as described by Roux Goldthwait. Clinical results were evaluated using Kujala score, ability to do straight leg raise, knee range of motion and visual analogue scale. Result: There has been no recurrence of dislocation. The mean Kujala score before surgery was 48 which improved to 97.8 at 12 months follow-up after the surgical procedure. At 12 months follow-up all patients were able to do straight leg raise and had almost full range of motion. Conclusion: We conclude that extensive proximal lateral release along with Goldthwait Roux procedure helps in treating the habitual dislocation in patella in children. Decision for the extent of lateral release must be taken intra-operatively. Our method of treatment is simple, cost effective and reproducible with excellent functional outcome. [ABSTRACT FROM AUTHOR]

The article describes the case of a 33-year-old woman who presented with a three-month history of gradually progressive, symmetrical proximal muscle weakness with inflammatory polyarthritis. Topics covered include the findings of the physical examination and electromyography which led to the diagnosis of antisynthetase syndrome, patient outcome following treatment with prednisolone and methotrexate, and the appearance of mechanic's hand after the relapse of her myositis and arthritis.