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3C 396 is a composite supernova remnant (SNR), consisting of a central pulsar wind nebula (PWN) and a bright shell in the west, which is known to be interacting with molecular clouds (MCs). We present a study of X-ray emission from the shell and the PWN of the SNR 3C 396 using archival Suzaku data. The spectrum of the SNR shell is clearly thermal, without a signature of a non-thermal component. The abundances of Al and Ca from the shell are slightly enhanced, which indicates the presence of metal-enriched supernova ejecta. The PWN spectra are well described by a power-law model with a photon index of ∼1.97 and a thermal component with an electron temperature of ∼0.93 keV. The analysis of about 11 yr of Fermi data revealed an 18σ detection of gamma-ray emission from the location overlapping with the position of 3C 396 / 4FGL J1903.8+0531. The spectrum of 3C 396 / 4FGL J1903.8+0531 is best fitted with a log-parabola function with parameters of α = 2.66 and β = 0.16 in the energy range of 0.2–300 GeV. The luminosity of 3C 396 / 4FGL J1903.8+0531 was found to be >1035 erg s−1 at 6.2 kpc, which rules out the inverse Compton emission model. Possible scenarios of gamma-ray emission are hadronic emission and bremsstrahlung processes, due to the fact that the SNR is expanding into dense MCs in the western and northern regions of the SNR. [ABSTRACT FROM AUTHOR]

Bone tunnel enlargement associated with anterior cruciate ligament (ACL) reconstruction has recently become a topic of interest in the literature. This association was examined, along with the effect of femoral and tibial tunnel enlargement on the clinical results of ACL reconstruction performed with either bone-patellar tendon-bone (BPTB) or hamstring (HST) autografts. Forty-six patients underwent arthroscopic ACL reconstruction (23 receiving BPTB autograft and 23 HST) between March 1999 and July 2001. Thirty patients (13 receiving BPTB autograft and 17 HST) completed the last clinical and radiologic evaluations and were included in the study. The mean age of patients in the HST group was 29.8 years (range 18-39) and that in the BPTB group was 27.6 years (range 20-37). The mean follow-up period was 24.6 months (range 12-36) in HST group and 18.5 months (range 12-40) in BPTB group. The effect of tunnel enlargement on the clinical results was evaluated by comparing preoperative and postoperative Lysholm, Tegner, and International Knee Documentation Committee scores and ligament laxity measurements between and within the groups. Postoperative femoral and tibial tunnel diameters in both groups were significantly larger than their corresponding preoperative tunnel diameters. In an intergroup evaluation, the enlargement of the tibial tunnel was similar in both groups (P=.556), but the femoral tunnel diameter was significantly larger in the HST group than in the BPTB group (P>.001). Preoperative laxity of the knees significantly improved after the operations in both groups, but no difference between the groups was evident at the final follow-up visit. No correlation between tunnel widening and the clinical results of the BPTB and HST procedures was observed. [ABSTRACT FROM AUTHOR]

Depression is one of the most important reasons for psychiatric referrals in elderly patients. Geriatric depression can be chronic and is associated with an increased risk of dementia. We aimed to determine the prognosis of major depression patients and associated risk factors regarding persistence of depression. Patients who were admitted to the tertiary geriatric psychiatric outpatient unit of Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul between January and December 2018 and were diagnosed with major depression according to DSM-5 diagnostic criteria were included in the study. A structured telephone interview was conducted with between February-April 2022. For detailed clinical evaluation, Turkish version of Structured Clinical Interview for DSM-5-Disorders/Clinician Version (SCID-5/CV-TR), Telephone Cognitive Screen (T-cogS-TR), Geriatric Depression Scale (GDS), Clinical Dementia Rating Scale (CDR), Lawton-Brody Instrumental Activities of Daily Living Scale (IADL) and Beck Anxiety Inventory (BAI) were used. Of the 123 patients interviewed, 40.9% were diagnosed with major depression and 14.6% with minor depression. 43.4% showed significant anxiety and depression symptoms. Dementia developed in 14.6% of the patients. Only 29.5% of the patients recovered completely. Hypertension, orthopedic disease or arthritis, cancer, and absence of prior work experience were found to be predictors of current depression diagnosis. Geriatric depression has an unfavorable prognosis despite continued antidepressant treatment and may even serve as a prodrome for future dementia. Timely management of co-morbid medical conditions such as hypertension can potentially improve the prognosis of geriatric depression., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The existence of predisposing effects of latent Toxoplasma gondii ( T. gondii ) infection in bipolar disorder (BD), major depression (MD), and even suicide attempt (SA) has long been debatable. This conjecture remains unclear because there is a lack of evidence regarding how T. gondii manipulates the brain and behavior., Methods: We investigated the influence of T. gondii infection on BD and MD patients with or without SA compared to age-, sex-, and province-matched healthy controls (HCs) concurrently with serology and molecular-based evaluations. We prospectively assessed 147 volunteers with BD, 161 with MD, and 310 HCs., Results: T. gondii seropositivity rates were 57.1% for BD, 29.2% for MD, 64.8% for SA, and 21.3% for HC. Binary logistic regression analyses revealed that T. gondii positive Immunoglobulin G (IgG) status may be a prominent tendentious agent for BD (OR = 3.52; 95% CI [2.19-5.80]; p < 0.001) and SA (OR = 17.17; 95% CI [8.12-36.28]; p < 0.001), but not for MD (OR = 1.21; 95% CI [0.74-1.99]; p = 0.45). Nevertheless, the T. gondii DNA ratios determined by polymerase chain reaction (PCR) were linked to BD and MD., Conclusion: Our findings strongly support the burgeoning interest in the possibility that latent T. gondii infection may be relevant to the etiology of BD and SA, although this connection remains ambiguous.

Objective: The Papanicolaou (Pap) smear test is a standard screening test that detects cervical lesions and cancers. In this multicentric study, we performed a retrospective analysis of cytological results associated with atypical glandular cells, not otherwise specified (AGC-NOS)., Methods: We retrospectively reviewed Pap smear tests that resulted as AGC-NOS. A total of 254 women who underwent colposcopy due to a Pap smear result of AGC-NOS were included the study between 2003 and 2021. The ages, Pap smear results, HPV results if any, colposcopic biopsy results, endocervical and endometrial pathology results, and management of these patients were analysed., Results: Two hundred fifty-four patients with AGC-NOS Pap smear results were included in the study. A total of 70 (27.6%) patients had cervical and endometrial premalignant or malignant lesions. Malignancy was observed in 17 (6.7%) patients (endometrium, n = 11 [4.3%]; cervix, n = 6 [2.4%]). Isolated premalignant or malignant lesions of the cervix and endometrium were detected in 57 (22.4%) and 12 (4.7%) patients, respectively., Conclusions: Patients diagnosed with AGC-NOS should undergo a careful evaluation with all clinicopathological features. Because cancer of the cervix and endometrium is not rare in patients diagnosed with AGC-NOS, colposcopic examination with endocervical sampling should be a priority based on a cervicovaginal smear. Endometrial sampling is also required according to the patient's clinic, age, and examination characteristics., (© 2022 John Wiley & Sons Ltd.)

Hemagglutinin is the surface protein of the influenza virus that mediates both binding and penetration of the virus into host cells. We here report on the synthesis and structure-activity relationship of some novel N-(1-thia-4-azaspiro[4.5]decan-4-yl)-carboxamide compounds carrying the 5-chloro-2-methoxybenzamide structure, designed as influenza virus fusion inhibitors. The carboxamides (1a-h, 2a-h) have a similar backbone structure as the fusion inhibitors that we reported on previously. Compounds 2b and 2d displayed inhibitory activity against influenza A/H3N2 virus replication (average antiviral EC 50 : 2.1 µM for 2b and 3.4 µM for 2d). Data obtained in the hemolysis inhibition assay supported that these compounds act as inhibitors of the influenza virus hemagglutinin-mediated fusion process., (© 2019 Deutsche Pharmazeutische Gesellschaft.)

A series of 1-thia-4-azaspiro[4.5]decan-3-ones bearing an amide group at C-4 and various substitutions at C-2 and C-8 were synthesized and evaluated against human coronavirus and influenza virus. Compounds 7m, 7n, 8k, 8l, 8m, 8n, and 8p were found to inhibit human coronavirus 229E replication. The most active compound was N-(2-methyl-8-tert-butyl-3-oxo-1-thia-4-azaspiro[4.5]decan-4-yl)-3-phenylpropanamide (8n), with an EC 50 value of 5.5 µM, comparable to the known coronavirus inhibitor, (Z)-N-[3-[4-(4-bromophenyl)-4-hydroxypiperidin-1-yl]-3-oxo-1-phenylprop-1-en-2-yl]benzamide (K22). Compound 8n and structural analogs were devoid of anti-influenza virus activity, although their scaffold is shared with a previously discovered class of H3 hemagglutinin-specific influenza virus fusion inhibitors. These findings point to the 1-thia-4-azaspiro[4.5]decan-3-one scaffold as a versatile chemical structure with high relevance for antiviral drug development., (© 2019 Deutsche Pharmazeutische Gesellschaft.)

Nasal type natural killer/T-cell lymphoma is a rare type of extranodal non-Hodgkin lymphoma which originates from nasal cavity and paranasal sinuses. Exact diagnosis of nasal natural killer/T-cell lymphoma, which is a rapidly progressive clinical condition, may be established by immunohistochemical analysis on biopsy material after clinical suspicion. In this article, we report four cases of nasal natural killer/T-cell lymphoma who were followed-up in our clinic and discuss the diagnosis and treatment of the disease in light of the literature data.

Elastofibroma is a benign and slow-growing soft tissue tumor that classically presents as an ill-defined solitary mass at the inferior pole of the scapula in the fifth and sixth decades of life for women. This tumor can be rarely seen in childhood, but it has not been reported in the infantile age group to date. To our knowledge, this case represents the first report of elastofibroma in the infantile age group. The aim of this report is to present a paravertebral elastofibroma in a 14-month-old patient and discuss the clinical features and treatment modalities., (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Solitary plasmacytoma comprises 2%-10% of all plasma cell diseases. Cranial localization of plasmacytoma is quite rare. They may emerge after years without systemic involvement and symptoms. They may be confused with other tumors as they are not remembered primarily in radiological diagnosis. The definite diagnosis is made upon histopathological examination. Surgical resection followed by radiotherapy is the first choice of therapy. Chemotherapy may be administered for secretory tumors. In this paper, we discussed a patient who underwent surgery with the prediagnosis of meningioma and histopathologically diagnosed with plasmacytoma.

A microwave-assisted three-component one-pot cyclocondensation method was applied for the synthesis of novel N-(1-thia-4-azaspiro[4.5]decan-4-yl)carboxamide compounds carrying an adamantyl moiety. The structures of the compounds were confirmed by spectral and elemental analysis. All compounds were evaluated for antiviral activity against influenza A (H1N1 and H3N2) and influenza B virus in MDCK cell cultures. The compounds displayed a confined structure-activity relationship. The N-(2,8-dimethyl-3-oxo-1-thia-4-azaspiro[4.5]dec-4-yl)adamantane-1-carboxamide 3b was the most potent inhibitor [antiviral EC(50): 1.4 μM against influenza A/H3N2 virus]. Its strong inhibitory effect in a virus hemolysis assay supports that 3b acts as an influenza virus fusion inhibitor by preventing the conformational change of the influenza virus hemagglutinin at low pH., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Thyroid gland is among the many organs that could be infiltrated in systemic amyloidosis. However, diffuse infiltration of the thyroid gland secondary to systemic amyloidosis associated with Familial Mediterranean fever (FMF) is rare. Here, we present a 49-year-old woman diagnosed with FMF and systemic amyloidosis, who had a large goiter and multiple nodules that developed slowly through the years and was complicated by tracheal compression symptoms and a mild thyroid dysfunction. Multiple fine needle aspiration biopsies of the nodules and the thyroid parenchyma revealed amyloid deposits. We would like to point out that amyloidosis may have a significant impact on the thyroid gland and fine needle aspiration biopsy is a valuable tool for diagnosis.

Objective: The purpose of this study was to analyze the relation between tendon integrity and functional results following the arthroscopic treatment of small- and medium-sized rotator cuff tears., Methods: Arthroscopic repair was performed on 26 consecutive patients (21 women, 5 men;mean age: 55.9 years; range: 33-72 years) with small- and medium-sized tears of the supraspinatus tendon. Patients were postoperatively evaluated at 12 and 24 months using the Constant and UCLA functional outcome scores and ultrasound examinations., Results: The supraspinatus tendon did not heal in nine patients (34.6%) and was partially healed in three (11%), 12 months after surgery. Mean postoperative Constant and UCLA scores of these patients were 73.1 and 27.8, respectively, which were not significantly different from those with an intact tendon on the final follow-up (Constant: 78 and UCLA: 30; p=0.107 and p=0.164). Both rating systems reflected significant improvement with treatment (p<0.01). The mean age of patients with a re-tear was 66.8 years, which was significantly higher than those with an intact repair (54 years; p<0.01)., Conclusion: The arthroscopic repair of small and medium-sized supraspinatus tendon tears yields good long-term results independent of tendon integrity. Healing potential may be decreased with increased age.

In the title compound, C(19)H(24)N(4)O(2)S(2), inversion-related mol-ecules are linked together to form a dimer by N-H⋯O and C-H⋯O hydrogen bonds, generating two R(2) (1)(6) rings and one R(2) (2)(10) ring motif. An inter-molecular C-H⋯O hydrogen bond connects the dimers to each other. An intra-molecular C-H⋯O inter-action occurs. In the pyrrolidine ring, the two C atoms of the ring not bonded to the N atom displays positional disorder with site-occupation factors of 0.630 (18) and 0.370 (18).

A series of new 1-[(2,8-dimethylimidazo[1,2-a]pyridine-3-yl)carbonyl]-4-alkyl/arylthiosemicarbazides, 2-[(2,8-dimethylimidazo[1,2-a]pyridine-3-yl)carbonyl]hydrazono-3-alkyl thiazolidin-4-ones, 2-(2,8-dimethylimidazo[1,2-a]pyridine-3-yl)-5-arylamino-1,3,4-oxadiazoles and 4-alkyl/aryl-2,4-dihydro-5-(2,8-dimethylimidazo[1,2-a]pyridine-3-yl)-3H-1,2,4-triazole-3-thiones were synthesized. The structures of the compounds have been elucidated by IR, 1H NMR, EI mass spectra and elemental analysis. Antibacterial, antifungal and antimycobacterial activities of compounds were evaluated against various microorganisms and some of them were found to be active in varying degrees against Staphylococcus aureus, Staphylococcus epidermidis or Mycobacterium tuberculosis H37Rv.

A new class of N-(1-thia-4-azaspiro[4.5]decan-4-yl)carboxamide inhibitors of influenza virus hemagglutinin (HA)-mediated membrane fusion that has a narrow and defined structure-activity relationship was identified. In Madin-Darby canine kidney (MDCK) cells infected with different strains of human influenza virus A/H3N2, the lead compound, 4c, displayed a 50% effective concentration of 3 to 23 muM and an antiviral selectivity index of 10. No activity was observed for A/H1N1, A/H5N1, A/H7N2, and B viruses. The activity of 4c was reduced considerably when added 30 min or later postinfection, indicating that 4c inhibits an early step in virus replication. 4c and its congeners inhibited influenza A/H3N2 virus-induced erythrocyte hemolysis at low pH. 4c-resistant virus mutants, selected in MDCK cells, contained either a single D112N change in the HA2 subunit of the viral HA or a combination of three substitutions, i.e., R220S (in HA1) and E57K (in HA2) and an A-T substitution at position 43 or 96 of HA2. The mutants showed efficiency for receptor binding and replication similar to that of wild-type virus yet displayed an increased pH of erythrocyte hemolysis. In polykaryon assays with cells expressing single-mutant HA proteins, the E57K, A96T, and D112N mutations resulted in 4c resistance, and the HA proteins containing R220S, A96T, and D112N mutations displayed an increased fusion pH. Molecular modeling identified a binding cavity for 4c involving arginine-54 and glutamic acid-57 in the HA2 subunit. Our studies with the new fusion inhibitor 4c confirm the importance of this HA region in the development of influenza virus fusion inhibitors.

Objectives: The aim of this study is to evaluate both the technical problems of surgery and the clinical and radiologic outcomes of patients treated with unicondylar knee arthroplasty., Patients and Methods: Forty-one unicondylar knee prosthesis were performed in 40 patients (3 males, 37 females; mean age 58.2 years; range 44 to 76 years) diagnosed with unicompartmental knee osteoarthritis. Technical problems encountered during surgery were noted. For evaluation of clinical outcomes, the Hospital for Special Surgery (HSS) knee score and WOMAC score were used. Radiologic evaluations were performed using the Oxford Knee Group criteria., Results: The radiologic evaluation determined there was more than 10 degrees varus-valgus malposition in eight patients, more than 2 mm medial tibial overhang in seven patients, the insertion of a femoral component in extension in one patient, and joint distraction in one patient. The patient with joint distraction underwent a total knee replacement after six months because of progressive pain. The mean HSS knee score improved 21 points; perfect results were obtained in 33 patients and good results in seven patients. The mean postoperative WOMAC score was reduced by 18 points, with perfect results in 33 patients, good results in six patients and a moderate result in one patient. The mean follow-up was 19 months (range 9-42)., Conclusion: Unicondylar knee arthroplasty is a surgical treatment method with a long-term recovery and high frequency of technical faults. Minor errors diagnosed on radiographs do not have an effect on early clinical results. Unicondylar knee arthroplasty is a good alternative surgical technique for appropriately selected patients with medial unicompartmental knee osteoarthritis.

Introduction: Biphasic calcium phosphate (BCP) has proved to be an effective bone substitute, but it's effectiveness and remodeling potential in open wedge high tibial osteotomy (OWHTO) has not been analyzed yet. This study sought to evaluate the bone healing and remodeling potentials of BCP granules using a radiographic rating system in biplanar OWHTO., Materials and Methods: Fifteen patients (15 knees) underwent biplanar OWHTO. Bone gaps were filled with BCP granules. For radiographic evaluation, remodeling was divided into four phases. Phase 1 was accepted as rounded osteotomy sites, with clear distinction between BCP and bone, phase 2 was accepted as whitened osteotomy sites, with distinction between BCP and bone still visible, phase 3 was accepted as distinction between BCP and bone not visible and cloudy bone formation and phase 4 was accepted as full reformation of BCP granules (4A-BCP visible, 4B-disappearence of BCP) with no sign of osteotomy. Bone union was confirmed with clinical (full weight bearing without pain) and radiographic evaluation (cortical bridging callus on radiographs and phase 3 or greater remodeling). The time to full remodeling and the starting point of the consolidation on anteroposterior radiographs were noted. Complications were also noted at each clinical follow-up., Results: Mean follow-up was 27.2 months. The mean age was 55.8 years. At clinical follow-up, there were no wound healing problems, no loss of corrections, no infections, and no complications. All osteotomies successfully healed. According to the radiologic classification system, at the 6th week, 73.3% (11/15) of patients were in phase 1 and the remaining 26.7% (4/15) were in phase 2. At 12-month follow-up, 46.7 (7/15) of the patients were still in phase 3. After 2 years, all radiographs showed to be in phase 4A. Radiographic union was noted to progress from lateral to medial and finally central., Conclusions: BCP can be successfully used as a bone substitute. The radiographic remodeling and consolidation process of BCP was found to be different from that of beta-tricalcium phosphate. In our patients with more than 2 years of follow-up, BCP granules did not completely remodel. As a result, this clinical study demonstrated that calcium phosphate granules containing hydroxyapatite had a long period of "creeping substitution" that lasts longer than 2 years.

Allograft has been shown to be highly successful for managing large osseous defects in total knee arthroplasty. We report a 68-year-old woman in whom a bone allograft had been used during total knee arthroplasty owing to a massive segmental medial tibia plateau defect 4 years earlier. Eighteen months after surgery, a 10x10 cm knee synovial cyst was detected by computed tomography scanning on the anteromedial side of the tibial plateau, and an en-bloc surgical excision was performed. At 36-month follow-up, a 16x12 cm cyst was found. Excision was again performed with removal of the allograft and application of an autologous iliac graft. After allograft removal, clinically and radiologically satisfactory results were achieved at the final follow-up.

Objectives: We investigated the effects of anatomic and non-anatomic tunnel fixations on femoral tunnel widening and clinical results in anterior cruciate ligament (ACL) reconstructions., Methods: We retrospectively evaluated 35 patients who underwent arthroscopic ACL reconstruction with quadrupled hamstring tendon graft. Fixation was performed in the tunnel using the transcondylar RigidFix pin (group 1) in 18 patients (mean age 32 years), and from outside the tunnel using the EndoButton-CL device (group 2) in 17 patients (mean age 30 years). The patients were assessed using the IKDC (International Knee Documentation Committee) and Lysholm knee scores and tunnel widening was assessed by computed tomography. Ligament laxity was measured bilaterally using the Rolimeter knee tester. The mean follow-up was 24 months (range 21 to 38 months) in group 1, and 24.6 months (range 12 to 36 months) in group 2., Results: The two groups were similar with respect to age and sex distribution, operated side, the size of the tunnel created, and follow-up period (p>0.05). Postoperative knee scores did not show a significant difference (p>0.05). There was marked and excessive tunnel enlargement in 14 patients (77.8%) in group 1, and in 15 patients (88.2%) in group 2, with no significant difference between the two groups (p>0.05). Ligament laxity exceeded 3 mm in eight patients (44.4%) in group 1, and in three patients (17.7%) in group 2 (p<0.001). There was no relationship between tunnel widening and ligament laxity (p>0.05; r=0.175 and r=-0.01 for group 1 and group 2, respectively)., Conclusion: Our results suggest that differences in the localization of the tunnel fixation have no effect on tunnel enlargement and that joint laxity may be affected by biomechanical properties of fixation materials.

We investigated whether there is a correlation between coronal plane correction magnitude and tibial slope in patients treated with medial open wedge high tibial osteotomy (OWHTO) and also measured changes in patellar height. Thirty-four knees treated with for varus deformities were retrospectively reviewed and the follow-up period of the patients was averaged 24.1 months. Preoperative and postoperative measurements of the Hospital for Special Surgery (HSS) score, Insall-Salvati index, posterior tibial slope angle, mechanical axis deviation, proximal medial tibial angle (PMTA) was used to determine. All patients had a significant increase in their HSS score postoperatively (P < 0.0001). There was no significant correlation between the differences in patellar heights (P = 0.368). The mechanical axis deviation was altered by a mean of 25.5 +/- 10.9 mm and the difference was statistically significant (P < 0.05). The mean posterior tibial slope angle on preoperative radiographs was 9.0 +/- 5.1 degrees ; on postoperative radiographs it was 11.7 +/- 5.7 degrees and the difference was statistically significant (P < 0.007). Seventeen knees (50%) demonstrated postoperative posterior tibial slope angle increases; 7 knees (21%) had a decrease in this angle, while 10 knees (29%) showed no change. Statistical analyses revealed that the mechanical axis deviation was not correlated with change in tibial slope (P = 0.837). Although we could not find a correlation between tibial slope change and the amount of coronal correction, 50% of our patients demonstrated increased tibial slope.

The apoptotic bodies were observed aging in osteoarthritic cartilage and meniscus but there is still a lack of knowledge in the literature about the relationship between meniscal injury and apoptosis. The aim of this study is to investigate the apoptotic changes on meniscal tears caused by degeneration and trauma. Thirty-eight specimens of human meniscal tissues harvested from cadavers and patients were selected from groups below the age of 40. There were 14 normal meniscal tissues from cadavers in the control group. There were 24 meniscal tissues harvested from patients who had had arthroscopic operations for meniscal tear due to degeneration or trauma. The torn meniscal samples were divided into two groups according to their etiologies, either degenerative or traumatic. Apoptotic cells were investigated in each of the three groups in the histopathological examination. There was statistically significant difference among the groups according to apoptotic index (p < 0.01). The mean indexes of apoptosis in both groups of torn meniscus (group 2 = 0.497 and group 3 = 0.725) were significantly higher than that in the normal tissue (group 1 = 0.237) (p < 0.01) but the difference between groups 2 and 3 was not significant (p > 0.001). This study indicates that an increase in the amount of apoptosis appeared to have a close relationship with meniscal tear caused by either trauma or degenerative changes.

Introduction: Shortening the period of time for the external fixator after limb lengthening decreases the complication rate and increases the patient satisfaction., Material and Method: We describe the plating after lengthening (PAL) as a new technique on five patients with limb length discrepancy (1 femoral, 4 tibial) who had lengthening procedure with Ilizarov technique. The mean amount of lengthening was 50 mm. The mean lengthening period was 100 days (5-135 days). When the lengthening period ended, the locking compression plate was applied percutaneously by using the technique of minimal invasive plate osteosynthesis, and the Ilizarov external fixator was removed., Results: The fixator-free period was achieved at the beginning of the consolidation phase, except in two patients, which were delayed for plating because of pin-tract infection. No complication was encountered except in one patient who had limited flexion of knee joint. There was no need for blood transfusion., Discussion: The PAL, which shortened the period of time for the external fixator, was an easy and safe method for the fixation of the bone after limb lengthening.

The aim of this study was to compare the alteration of patellar tracking by time, which was performed through two different approaches: midvastus and medial parapatellar. Twenty-one patients undergoing simultaneous bilateral primary total knee replacements were randomized prospectively to perform the surgery via a medial parapatellar approach on one knee and midvastus approach on the other knee. All of the patellae were resurfaced. Preoperative, early and late postoperative (mean 22 month) skyline views of the patellae were taken. We found that preoperative 2.24 degrees lateral tilt of patella had not changed by time at the midvastus side (2.95 degrees and 2.57 degrees ). Moreover, preoperative 0.48% lateral subluxation of the patella for midvastus approach had not changed (1.48% and 1.67%). Although 2.19 degrees patellar lateral tilt had not significantly changed at the early postoperative period, which was performed via medial parapatellar approach, there had been a significant increase to 5.38 degrees by time (P=0.037) compared to the preoperative radiographs. Additionally, the preoperative lateral subluxation of the patella (0.57%) at the medial parapatellar side had increased to 5.43% at the early (P=0.009) and 5.62% at the late (P=0.012) postoperative measurements. Midvastus approach is superior to medial parapatellar approach concerning the late patellar tracking.

We report the case of a 41-year-old man with right ankle pain and swelling who had an intraosseous talar ganglion in the medial part of talar dome. A surgical procedure was performed using the 3-portal arthroscopic approach. The softened chondral surface was removed and the content of the cyst was discharged arthroscopically. The sclerotic rim was abraded until the bleeding spongious layer was seen. A grafting procedure was also performed arthroscopically. A trocar was introduced into the defect from the superomedial portal. Autografts were impacted using a cylindrical rod through the trocar into the defect. The clinical and radiologic results at the 1-year follow-up were satisfactory. We encountered no complications postoperatively. We conclude that arthroscopic debridement and grafting of an intraosseous ganglion adjacent to the articular surface may be a better option compared with open surgery.

Purpose: Most cases of knee locking and giving-way are caused by meniscal tears, loose bodies, or chondral lesions. Intra-articular benign tumors or tumor-like lesions can present with symptoms that resemble acute mechanical derangement. From a database of 2,200 arthroscopic interventions, 19 cases of intra-articular masses that presented with catching and locking symptoms in the knee were retrospectively analyzed., Type of Study: Case series., Methods: Our review revealed 33 patients with benign intra-articular masses in the knee joint. Nineteen of these individuals had sought medical attention for mechanical symptoms of catching or locking. The other 14 patients had a variety of symptoms including pain, swelling, and limitation of knee motion, but did not have mechanical symptoms. Age, sex, history of trauma, knee pain and effusion, medical illnesses, physical examination, arthroscopic findings, and pathologic findings were noted., Results: The average age of the 6 male and 13 female patients was 37.5 years (range, 18 to 58 years). Preoperative magnetic resonance imaging confirmed the diagnosis in 7 cases and 12 cases were diagnosed during knee arthroscopy. The mean follow-up time after surgery was 52.5 months (range, 6 to 120 months). Pathologic examination of the lesions revealed 15 cases of localized pigmented villonodular synovitis (79%), 1 lipoma arborescens (5%), 1 pseudocyst (5%), and 2 nonspecific synovial masses (11%). None of the lesions showed malignant transformation., Conclusions: Solitary benign intra-articular lesions should be considered a rare cause of mechanical knee symptoms. Localized pigmented villonodular synovitis originating from the extensor mechanism or fat pad is the most common solitary intra-articular mass lesion in the knee and usually arises in the patellofemoral compartment. Recurrence has not occurred in our series, which includes 14 of 19 patients with greater than 24 months follow-up., Level of Evidence: Level IV.