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Introduction: There has been an increased focus on fast-track (FT) programmes and the potential to convert unicompartmental knee replacement (UKR) from short-term admission to outpatient surgery. However, relatively few studies have been presented and with differences in selection criteria and completion rates. The purpose of this study was to describe patient selection and completion rates in a patient group undergoing UKR in two high-volume FT knee surgery clinics., Methods: All consecutive patients (n = 368) referred to and selected for UKR were screened for eligibility for outpatient surgery with discharge on the day of surgery (DOS). Reasons why the patients were not discharged were recorded in patients not completing the outpatient pathway, and readmissions and complications were recorded until three months post-operatively., Results: Among all referred and screened patients, 69% were considered eligible for outpatient surgery. DOS discharge occurred in 59% of the operated patients and in 37% of all referred and screened patients. Main reasons for why patients were not discharged were active wound drainage and lack of mobilisation due to pain, nausea and vomiting. Two patients were readmitted during the first 24 hours due to wound drainage. One patient had a lung embolus and one patient an acute myocardial infarction during the follow-up period., Conclusions: This study illustrates that not all patients in a consecutive patient group for UKR were feasible for outpatient surgery. Further studies should focus on optimising pain treatment and reducing post-operative nausea., Funding: none., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Background: Hydrophobins are a family of small secreted proteins with a characteristic pattern of eight cysteine residues found exclusively in filamentous fungi. They have originally been divided into two classes based on their physical properties and hydropathy patterns, and are involved in the attachment of hyphae to hydrophobic structures, the formation of aerial structures and appear to be involved in pathogenicity., Findings: Analysis of nine genome sequences from seven Aspergilli revealed fifty hydrophobins, where each species displayed between two to eight hydrophobins. Twenty of the identified hydrophobins have not previously been described from these species. Apart from the cysteines, very little amino acid sequence homology was observed. Twenty-three of the identified hydrophobins could be classified as class I hydrophobins based on their conserved cysteine spacing pattern and hydropathy pattern. However twenty-six of the identified hydrophobins were intermediate forms. Notably, a single hydrophobin, ATEG_04730, from Aspergillus terreus displayed class II cysteine spacing and had a class II hydropathy pattern., Conclusion: Fifty hydrophobins were identified in Aspergillus, all containing the characteristic eight cysteine pattern. Aspergillus terreus exhibited both class I and class II hydrophobins. This is the first report of an Aspergillus species with the potential to express both class I and class II hydrophobins. Many of the identified hydrophobins could not directly be allocated to either class I or class II.

Background: In biomedical sciences, ex vivo angiography is a practical mean to elucidate vascular structures three-dimensionally with simultaneous estimation of intravascular volume. The objectives of this study were to develop a magnetic resonance (MR) method for ex vivo angiography and to compare the findings with computed tomography (CT). To demonstrate the usefulness of this method, examples are provided from four different tissues and species: the human placenta, a rice field eel, a porcine heart and a turtle., Results: The optimal solution for ex vivo MR angiography (MRA) was a compound containing gelatine (0.05 g/mL), the CT contrast agent barium sulphate (0.43 mol/L) and the MR contrast agent gadoteric acid (2.5 mmol/L). It was possible to perform angiography on all specimens. We found that ex vivo MRA could only be performed on fresh tissue because formalin fixation makes the blood vessels permeable to the MR contrast agent., Conclusions: Ex vivo MRA provides high-resolution images of fresh tissue and delineates fine structures that we were unable to visualise by CT. We found that MRA provided detailed information similar to or better than conventional CTA in its ability to visualize vessel configuration while avoiding interfering signals from adjacent bones. Interestingly, we found that vascular tissue becomes leaky when formalin-fixed, leading to increased permeability and extravascular leakage of MR contrast agent.

Anterior knee pain subsequent to surgery or trauma is commonly caused by a lesion of the infrapatellary branch of the saphenus nerve. This lesion is suggested by demonstration of intense soreness on the nerve branch and sensory change in its innervated territory. The common presence of continuous neuropathic pain and functional deficiency demands that clinicians are able to recognize the condition, in particular because it can be managed by surgical treatment.

The effect of isocaloric (500 kcal) protein and carbohydrate ingestion was studied in a crossover study in nine healthy humans. Subjects were studied twice after overnight fasting, with an interval of 3 to 7 days. Blood was collected for 240 min after food ingestion. The initial reaction of growth hormone (GH) and thyroid stimulating hormone (TSH) to protein and carbohydrate was identical, with a reduction in both GH and TSH, and nadir occurring after 45-60 min and 120 min, respectively. During the next 120 min TSH returned to starting level after carbohydrate intake but was still reduced after protein intake (p less than 0.04). After both diets GH increased after the initial decline, the increase was greatest after protein intake and maximum was reached at 180 min (p less than 0.02). It has been reported that the 5'-deiodination of T4 is stimulated by insulin and inhibited by glucagon. The physiological increase in insulin after carbohydrate ingestion (p less than 0.05), and the physiological increase in glucagon after protein ingestion (p less than 0.05) was not associated with any changes in TT4, FT4, TT3, FT3, or rT3 that could indicate changes in the 5'-deiodinase activity.

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.

A regional prospective casualty department investigation of patients with eye injuries is compared with recent Danish investigations on the subject. The frequency, causes and the primary sites of treatment are reviewed and the pattern of referral is followed. The investigation reveals that great regional differences exist as regards the frequency and the sites of primary treatment and that injuries sustained during leisure activities resemble occupational injuries. The combination of standardized casualty department treatment and the possibility of referral to a specialist or special department appears to be a good therapeutic model for acute eye injuries.

In order to determine the value of coronal magnetic resonance (MR) in diagnosing thoracic abnormalities, the multisection coronal spin echo MR images were reviewed of 10 normal subjects and 20 patients with thoracic abnormalities. In the abnormal patients, coronal images were compared with transaxial MR images obtained with TR values of 0.5 and 2.0 sec. In general, coronal imaging was of value in several situations. It allowed structures oriented in the coronal plane to be imaged along their longitudinal axes, provided an additional perspective and increased the confidence of diagnosis, and helped clarify anatomic relationships difficult or impossible to resolve on transaxial images because of volume averaging. Specifically, coronal images were sometimes superior to transaxial images in evaluating the aorticopulmonary window and masses at the lung apex or base. Transaxial images were often superior in evaluating the pretracheal space, subcarinal space, and hili. Within the pulmonary hili, lateral hilar masses were better defined on coronal images than were anterior or posterior hilar masses. Coronal images obtained with a TR of 1.0 sec (10 sections) allow evaluation of most node-bearing mediastinal compartments and provide adequate mass/fat contrast.

To determine the value of sagittal magnetic resonance (MR) in diagnosing thoracic abnormality, we reviewed the multisection sagittal spin-echo MR images of 13 normal subjects and 23 patients with a variety of thoracic abnormalities. In the abnormal subjects sagittal images were compared with transaxial MR performed with repetition time values of both 0.5 and 2.0 s. Sagittal images were most helpful in the evaluation of structures lying in the sagittal plane such as the thoracic aorta. Mediastinal masses in most locations were better seen and evaluated in the transaxial plane. However, the relationship of subcarinal masses to the trachea, left atrium, and pulmonary artery was better appreciated in the sagittal plane. The relationship of hilar masses to hilar vessels, bronchi, and the mediastinum was usually better seen on transaxial images. Also, the relationship of paramediastinal masses to the mediastinum was difficult to evaluate with sagittal scans.

Multiple cartilaginous exostosis (MKE) is an autosomally dominant hereditary disease with great individual expression. The disease becomes apparent most frequently at the age of 2-5 years and approximately 80% of the cases have been diagnosed before the age of ten years. The exostoses continue to grow until shortly after puberty. The exostoses may give rise to severe deformation of the skeleton particularly around the knee, ankle and wrist joints. Reduction of joint mobility is frequently observed either on account of the size of the exostoses and their localization or on account of the joint deformity. Treatment of MKE is surgical and corrective surgery with removal of symptom-producing exostoses is the commonest intervention. Osteotomies or introduction of joint-prostheses may prove necessary in cases with the severest joint deformities. The exostoses may undergo malignant transformation, most frequently to chondrosarcomata which grow relatively slowly and metastasize late. Treatment of these must be undertaken in a tumour centre where limb-saving tumour surgery is available in cooperation between the orthopaedic surgeon and the oncologist. Families with MKE should be given patho-genetic advice.

Presented is a case of bilateral spontaneous fracture of the femoral neck in a 40-year-old woman who suffered from severe phosphate depletion due to excessive intake of antacids containing magnesium and aluminum. Attention is drawn to this rare cause of osteomalacia, which can be easily treated.