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Deepening trochleoplasty is a technically demanding operation that is rarely required for most of the patients presenting with recurrent dislocation of the patella. However, in the presence of significant trochlear dysplasia, standard extensor mechanism realignment techniques can fail. A deepening trochleoplasty using a thick osteochondral flap technique is a logical solution for severe dysplasia and does not rely on the presence of normal articular cartilage in the trochlea. Satisfactory outcomes, including returning to sports for those who actively participate is usual. Theoretical complications such as chondrolysis and progression of patellofemoral osteoarthritis have not been found. This article describes the step-by-step operative technique with illustrations.

Background: Arthroscopic labral debridement in the hip can be an effective treatment for labral tears but has demonstrated inferior outcomes compared with labral repair. Thus, the role for labral debridement has become unclear. Hypothesis/Purpose: The purpose was to evaluate the outcomes of a selective debridement with labral preservation (SDLP) group with a minimum 5-year follow-up. It was hypothesized that, with narrow indications, SDLP would produce statistically improved patient-reported outcome (PRO) scores, comparable with those of a matched-pair labral repair control group. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all patients undergoing primary hip arthroscopic surgery between February 2008 and September 2011. Exclusion criteria were acetabular or femoral head Outerbridge grade 4 chondral damage, preoperative Tnnis grade ≥2, workers’ compensation claims, previous hip conditions, severe dysplasia (lateral center-edge angle 2, sex, and Seldes tear type. Results: One hundred twenty-five hips were eligible for inclusion, of which 101 (80.8%) hips had a minimum 5-year follow-up. All PRO scores were significantly improved ( P < .001) at latest follow-up (mHHS, 63.4 to 82.4; NAHS, 57.4 to 83.6; HOS-SSS, 44.2 to 74.5). The mean VAS score decreased from 5.8 to 2.3 ( P < .001). The mean patient satisfaction score was 8.1. Four (4.0%) patients underwent second-look arthroscopic surgery (mean, 18.5 months), and 14 (13.9%) patients converted to total hip arthroplasty (mean, 46.9 months). In the matched-pair comparison, 69 in the SDLP group were matched 1:1 with those undergoing labral repair. Outcomes at latest follow-up of the SDLP group were comparable with those of the control group, respectively: mHHS, 83.0 vs 86.1 ( P = .084); NAHS, 85.0 vs 85.4 ( P = .415); HOS-SSS, 74.8 vs 76.8 ( P = .219); VAS, 2.3 vs 2.0 ( P = .277); international Hip Outcome Tool–12 (iHOT-12), 73.8 vs 76.4 ( P = .136); Short Form Health Survey–12 (SF-12) mental, 57.4 vs 55.1 ( P = .031); SF-12 physical, 48.7 vs 48.9 ( P = .357); Veterans RAND Health Survey–12 (VR-12) mental, 61.6 vs 59.8 ( P = .160); VR-12 physical, 50.1 vs 50.2 ( P = .340); and patient satisfaction, 8.0 vs 8.3 ( P = .211). Conclusion: In select cases of stable labral tears, SDLP may allow the preservation of a functional labrum. At a minimum 5-year follow-up, SDLP using narrow indications produced favorable outcomes comparable with a matched-pair labral repair group.

To explore the relationship between the morphological characteristics and pathological diagnosis of vocal cords leukoplakia.A total of 1635 vocal cords were collected. The morphology were classified into three types (Type I, II, III): flat and smooth; bulge and smooth; bulge and rough. The pathological reports were classified into five groups: no dysplasia, mild dysplasia, moderate dysplasia, severe dysplasia and cancerization. The number of the patients or vocal cords in each type and group was counted and their ratio was compared.In Type I, the number of vocal cord in Group A group was 2.2 and 2.6 times of the one in Type II and Type III respectively. In Type II, the mild, moderate dysplasia ratio was higher than those in Type I. In Type III group the ratio of severe dysplasia was 2.6 and 5.5 times of the one in Type II and Type I respectively. The ratio of Group E in Type III was 2.7 and 7.9 times of the one of Type II and Type I. The result was significant (pearson Chi-square value was 517.6, p = .00).The pathological results of vocal cord leukoplakia can be evaluated by morphology in most cases.

A 41-year-old male patient, a white farmer, was referred to the stomatology clinic diagnosed as having actinic cheilitis. Clinically, atrophic and leukoplastic areas were observed throughout the lower lip, and loss of the border between the red lip skin and the cutaneous portion. An incisional biopsy was performed in the leukoplastic area, and histopathologic examination showed atrophic and atypical stratified orthokeratinized pavement epithelium with severe oral epithelial dysplasia. The therapeutic approach was the removal of all leukoplastic areas using the high-intensity diode laser for re-epithelialization of the affected mucosa. Proper follow-up is being performed every 3 months, and after 9 months, no signs of relapse were observed. Because of the potential for malignancy of actinic cheilitis and the presence of dysplastic epithelial alterations, an early approach is justified. The vaporization of the labial tissues with high-intensity diode laser was effective in superficial removal of affected tissues.

Background : Patellofemoral replacements are used to treat isolated patellofemoral arthritis in carefully selected patients. The Kinematch ® custom-designed implant is placed directly on subchondral bone, leading critics of the device to believe that this results in overstuffing and limitation of flexion in cases of trochlear dysplasia; the current study aims to evaluate this premise. Methods : A retrospective analysis of a consecutive series of 24 patients (32 knees) was conducted. Trochlear dysplasia was evaluated using pre-operative axial CT scans, and knees were categorized as having minimal or moderate/severe dysplasia (moderate = flat trochlea, severe = convex trochlea). The primary outcome was post-operative knee flexion. Results : There was no statistical or clinical difference in post-operative knee flexion between the minimal (120°+12) and the moderate/severe dysplasia (117°+9) groups (p=.34). Conclusions : Use of the Kinematch ® patient-specific custom trochlear component does not significantly limit flexion in cases of trochlear dysplasia, and although the surgeon has the ability to deepen the trochlea by way of the pre-operative model, this is not necessary. Keywords : Patellofemoral replacement; custom; flexion; trochlear dysplasia Level of Evidence : III, Case-control study

WOS: 000319232000008, PubMed: 23549316, Objective: The aim of this study was to determine the normal acetabular index values in children between 6 months and 8 years of age based on sex, age and side and to define the cutoff values for mild and severe acetabular dysplasia. Methods: The records collected from the data pool that was gathered to define the prevalence of untreated congenital hip dislocation in Turkish children between 6 months and 14 years of age was used. The acetabular index was measured on pelvic and abdominal radiographs of children between 6 months and 8 years of age, taken in 19 different cities for non-dysplasia related causes. The distribution of the index values based on age, sex and side. Results: Thirty-three hips of 21 children (0.75%) out of 2788 children were found to be subluxated or luxated. Acetabular index values of 5534 hips of 2767 children were measured. Acetabular index values of 723 (13%) hips of 493 children (17.8%) were found to be between 1 and 2 standard deviations. Acetabular index values of 147 hips (2.65%) of 118 children (4.3%) were calculated to be above 2 standard deviations. There was a negative correlation between the acetabular index and age. Conclusions: The study defines the normal acetabular index values in healthy Turkish children between 6 months and 8 years of age and the expected acetabular index values for mild and severe dysplasia.

Aim The purpose of this study was to analyse the extent of surgical correction and the early clinical results obtained using periacetabular osteotomy with allogenic bone grafting in patients with severe acetabular dysplasia. Methods 44 hips in 38 patients were confirmed to have severe acetabular dysplasia and underwent this procedure. The mean follow-up period was 4.2 (range 1.5-8.2) years. Severe acetabular dysplasia was defined as a centre-edge angle less than 0°, an acetabular-head index less than 50% and an acetabular roof obliquity greater than 30°. Periacetabular osteotomy was performed with transpositional osteotomy of the acetabulum. The patients were divided into 2 groups according to the radiographic appearance: 34 hips in the early stage group and 10 hips in the advanced stage group. Postoperatively, the hips were radiographically assessed for dysplasia correction. The clinical results and hip function were measured using the Harris Hip Score. Results The average pre-operative Harris Hip Score improved from 70 to 91 points at the latest follow-up. The average centre-edge angle, acetabular-head index and acetabular roof obliquity improved from −9° to 36°, 41% to 91% and 31° to 2°, respectively. Continuity of the Shenton line improved from 15 to 35 hips. No instances of nonunion or of transported segment collapse were encountered in this series; however, a grafted allogenic bone was absorbed in 1 case. Conclusions The usage of allogenic bone grafting combined with periacetabular osteotomy is an effective technique for treating severe acetabular dysplasia. In this series, the early clinical and radiographic results were excellent.

Objective: In this study, anticancer effects of mirtazapine on rats were investigated in an adenocarcinoma model induced by N-methyl-N-nitro-N-nitrosoguanidine (MNNG) and compared with those of cisplatin. Materials and Methods: For this purpose, 10 mg/kg doses of mirtazapine were administered orally to one group of rats, while 1 mg/kg doses of cisplatin were administered intraperitoneally to another group. At 1 hour after administration, 200 mg/kg doses of MNNG were given orally to both groups. MNNG administration was repeated once every 10 days through 3 months, after which period, gastric tissue was taken and pathologically evaluated. Results: Mirtazapine prevented adenocarcinoma induction by MNNG in rats to a greater extent than cisplatin. Some of the rats receiving cisplatin demonstrated severe dysplasia in gastric samples and others exhibited mild dysplasia. Rats given mirtazapine were not observed to suffer severe dysplasia, only mild dysplasia being observed. Conclusion: For adenocarcinoma induced by MNNG on rats, mirtazapine was determined more effective than cisplatin. In order to make statement about mechanism of anticancer activity of mirtazapine, wider studies are required.

Fourteen hips in 14 patients (all female; average age, 64 years) with severe bone defects due to developmental dysplasia of the hip or migration of the socket were treated with hydroxyapatite block with impacted morselized bone graft in conjunction with a cemented socket. All patients were followed clinically in a prospective fashion, and radiographs were analyzed retrospectively. One initial patient had 17-year follow-up, whereas the remaining 13 patients had follow-up between 4 and 6.5 years. No acetabular components were revised, including the socket of a 17-year postoperative case that remains rigidly fixed and supported by the graft and hydroxyapatite block with only mild polyethylene wear and minor osteolysis. Osteointegration and good clinical outcome were achieved in all cases by reconstruction with this technique in total hip arthroplasty.

Special attention was given to the appearance of nucleoli in the cytological samples of 21 cases of severe dysplasia, 25 cases of carcinoma in situ and 23 cases of microinvasive carcinoma. Studies showed that the lowest occurrence of nucleoli was in carcinoma in situ, and that when present they tended to be single rather than multiple. Further, the nucleoli of carcinoma in situ were usually larger than those of severe dysplasia, but smaller than those of microinvasive carcinoma. These findings suggest that it would be cytologically possible during the follow-up, by observing the nuclear appearance, to determine whether severe dysplasia would progress to carcinoma in situ and carcinoma in situ would progress to microinvasive carcinoma, or whether there would be regression.

Introduction Colorectal adenomas which are discovered simultaneously or 6 months after the diagnosis of primary adenoma or colorectal cancer (CRC) are called synchronous adenomas. The presence of synchronous adenomas increases the probability of adenomas with severe dysplasia as well as CRC. Objective The aim of the study is to show the characteristics of synchronous colorectal adenomas and to present the relation between the index rectal adenoma and the proximal synchronous tumours. Methods The research included 114 synchronous colorectal adenomas diagnosed in 58 patients. Total colonoscopy was performed on all patients. Results The largest number of patients had two adenomas (p

In a study of 41 surgically removed colorectal adenomas of unselected size, the dysplasia was graded as mild in 9, as moderate in 22, and severe in 10 cases. Twenty-four of the lesions were classified as tubular adenomas and 17 as tubulo-villous. The presence of O-acylated sialic mucin was for each of the adenomas assessed as normal (19 cases), intermediate (13 cases) or absent (9 cases). The absence of O-acylated mucin was in the present study found to be highly predictive for severe dysplasia (89%). The morphometric measurements of epithelial structures showed that nuclear shape factor and nuclear stratification index were most significantly related to the grades of dysplasia. In a multivariate analysis, the grading of O-cylated sialic mucin most significantly contributed to the grade of dysplasia, and to a lesser degree, nuclear shape factor and nuclear stratification index. The presence of villous elements and the size of the adenomas had no independent influence on the grade of dysplasia in this statistical analysis.

We report two cases of bilateral cementless total hip arthroplasty in two young women affected by Morquio-Brailsford syndrome. Morquio-Brailsford disease belongs to the mucopolysaccharidoses; it shows growth retardation with disproportional dwarfism. Usually patients are affected by a severe joint degeneration from their 2nd or 3rd decade. Young age, severe dysplasia, and joint size are the main technical problems for a total hip replacement. Accurate radiographic and CT planning allows the use of standard prostheses instead of custom-made ones.

BACKGROUND AND OBJECTIVE Complete removal of tumours of the ampulla (papilla) of Vater is generally recommended, because of the known adenoma-carcinoma sequence yet the uncertainty regarding diagnosis of dignity of such tumours. The aim of this study was tho analyse different treatment concepts on the basis of data from a personal series of cases. PATIENTS AND METHODS Clinical, laboratory and histological data as well as treatment and course in nine patients (three women, six men; mean age 62 [46-82] years) with ampulla of Vater adenoma, treated at one hospital, were analysed retrospectively. The patients had been followed for 6-36 months. RESULTS All tumours had been removed endoscopically. Partial duodenopancreatectomy had subsequently been performed in two patients because of severe dysplasia. One tumour with moderately severe dysplasia had recurred locally within two months of endoscopic removal and was resected transduodenally. There had been no further recurrences 3 to 36 months later. CONCLUSION If there is no evidence of malignity and frequent follow-up can be ensured, endoscopic removal of a tumour of the ampulla of Vater is justified. Otherwise transduodenal excision of the ampulla or partial duodenopancreatectomy should be undertaken.

Submitted by Maria da Luz Antunes (mluz.antunes@estesl.ipl.pt) on 2015-08-20T13:59:22Z No. of bitstreams: 1 Citologia da cúpula vaginal com suspeita de lesão intraepitelial de grau indeterminado.pdf: 612028 bytes, checksum: 64e6fda0689f17d51470391a001e6540 (MD5) Made available in DSpace on 2015-08-20T13:59:22Z (GMT). No. of bitstreams: 1 Citologia da cúpula vaginal com suspeita de lesão intraepitelial de grau indeterminado.pdf: 612028 bytes, checksum: 64e6fda0689f17d51470391a001e6540 (MD5) Previous issue date: 2015-04

No presente artigo é relatado um caso de uma paciente de 42 anos, diagnosticada em 2011 com Adenocarcinoma in situ e displasia grave do epitélio de revestimento pavimentoso, que foi tratada por traquelectomia. Em Novembro de 2013, a paciente realizou uma citologia da cúpula vaginal, onde se observaram achados citológicos compatíveis com lesão intraepitelial de baixo grau mas também a presença de células que favorecem o diagnóstico de lesão intraepitelial de alto grau. Não sendo possível classificar a lesão intraepitelial como sendo claramente baixo ou alto grau, atribuiu-se a interpretação de lesão intraepitelial de grau indeterminado. Para confirmação e esclarecimento do diagnóstico foi efetuada biopsia com resultado de displasia grave do epitélio de revestimento pavimentoso vaginal sem evidência de invasão do estroma. Por fim foi indicada a pesquisa e tipificação de vírus do papiloma humano, com resultado positivo para o tipo 16. Diagnósticos citológicos de lesão intraepitelial de grau indeterminado apresentam um follow-up histológico estatisticamente diferente das lesões intraepiteliais de alto e baixo grau, e estão na sua maioria associadas a infeção por vírus do papiloma humano de alto risco. Os achados citológicos do presente estudo apoiam a necessidade de se estabelecer esta lesão como categoria de diagnóstico no Sistema de Bethesda, com um follow-up definido. ABSTRACT - This article reports a case of a 42 year-old female patient diagnosed in 2011 with adenocarcinoma in situ and severe cervical intraepithelial neoplasia that was treated with trachelectomy. In November 2013 a vaginal vault cytology was performed, with cytological findings consistent with low-grade squamous intraepithelial lesion but also with the presence of cells that favour the diagnosis of high-grade intraepithelial lesion. Since it was not possible to grade the lesion as clearly low or high, it was attributed the result of squamous intraepithelial lesion of undetermined grade. In order to confirm and clarify the diagnosis, a biopsy was performed which showed results of severe squamous intraepithelial neoplasia without evidence of stromal invasion. Finally, the specimen was tested for human papillomavirus genotype, with a positive result for type 16. Cytologic diagnosis of intraepithelial lesions of undetermined grade present histologic outcomes that are statistically different from intraepithelial lesions of high and low grade, and are mostly associated with infection by high-risk human papillomavirus. This findings support retaining intraepithelial lesions of undetermined grade as a unique category in the Bethesda System, and define the management guidelines for this patients.

Instability of the patella occurs when it fails to track fully in the femoral groove during knee movement. The groove begins at the metaphysis of the distal femur and extends on its anterior surface inferiorly to the femoral notch. It is normally present at birth and the cartilaginous shape is similar to that of the adult. An abnormal trochlea may be shallow. In extreme cases it may be dome-shaped, where it is associated with recurrent subluxation or dislocation of the patella. In these cases it is logical to consider fashioning a groove as part of a realignment procedure. This study reports the operative technique and early clinical and radiological results of a consecutive case series of the first 15 patients (17 knees) who underwent a deepening trochleoplasty for severe dysplasia developed from that described by Dejour. The follow-up was for a minimum of 1 year (average 3 years, range 1 to 9 years). The boss height was reduced from an average of 7.5 mm (range 6 to 11 mm) to 0.7 mm (range -1 to 3 mm). Tracking became normal in 11 knees and had a slight J-shaped in six. Seven knees had mild residual apprehension. Seven patients were very satisfied, six were satisfied, and two were disappointed. The Kujala score improved from an average of 48 (range 13 to 75) to 75 (range 51 to 98) out of 100 (p

The operative procedures chosen to treat arthrosis in patients with severe acetabular dysplasia vary among orthopaedic surgeons, particularly in younger patients. We operated on 450 hips with acetabular dysplasia by using the rotational acetabular osteotomy (RAO) method of Ninomiya and Tagawa by Ninomiya (Clin Orthop 247:127-137, 1989). In this report, we describe our technique of performing RAO with hydroxyapatite tricalcium phosphate-composite (HAP-TCP) blocks to achieve good acetabular coverage and the results of this procedure in 16 hips with severe dysplasia, including nine with advanced arthrosis. Adequate coverage of the osteotomized acetabulum was maintained and symptoms, especially pain, showed marked improvement at the latest follow up.

Background/Purpose Because severe dysplasia and carcinoma in children with familial adenomatous polyposis (FAP) younger than 18 years is rare, earlier surgical intervention is not common. The purpose of this study is to report the prevalence of dysplasia and carcinoma among children with FAP in our institution. Methods From 1998 through 2004, children 18 years or younger with FAP that underwent total proctocolectomy at a large children's hospital were retrospectively reviewed. Results Eleven children underwent surgery for FAP. The mean age at surgery was 13 ± 3.2 years. Approximately half of the patients who underwent preoperative endoscopy had evidence of dysplasia. Nine (82%) patients had dysplasia on preoperative biopsy and/or operative specimen, and 3 (27%) of these patients had severe dysplasia or carcinoma in situ. Four of the 5 patients without symptoms had evidence of dysplasia. No patients had invasive carcinoma. Conclusion We observed a higher incidence of severe colonic dysplasia in young children with FAP compared with the current literature. A significant number of patients with dysplasia at surgery had no symptoms and no evidence of dysplasia on preoperative endoscopic biopsies. These data suggest that earlier intervention in children with FAP may be beneficial and should be investigated further.