Single-cut osteotomy for correction of a complex multiplanar deformity of the radius in a Shetland pony foal

OBJECTIVE

To describe the surgical correction of a multiplanar deformity of the radius in a pony using a single-cut osteotomy.

STUDY DESIGN

Case report.

ANIMALS

A 9-week-old male Shetland pony foal with a bodyweight of 47 kg.

METHODS

The foal presented with a complex multiplanar deformity of the right radius. A 3-dimensional model of the bone was created based on computed tomography (CT) imaging. To correct the deformity, the cutting plane for a single-cut osteotomy was calculated following the mathematical approach described by Sangeorzan et al. After osteotomy, the bone was realigned and stabilized with two 4.5 locking compression plates (LCPs).

RESULTS

Recovery from surgery was uneventful, and the foal remained comfortable. A CT exam 15 weeks after surgery revealed that diaphyseal deformities improved substantially in procurvatum (from 8° to 1°), varus (from 27° to 0°), and rotation (30° to 5°). The operated radius was 2.1 cm shorter than the left. Eighteen-month follow up confirmed a functionally and cosmetically acceptable outcome.

CONCLUSION

The single-cut osteotomy resulted in the successful correction of a multiplanar equine long-bone deformity with a favorable outcome in a Shetland pony.

CLINICAL SIGNIFICANCE

Single-cut osteotomy is an alternative surgical technique for the correction of complex diaphyseal long-bone equine deformities. Computed tomography data and the possibility of printing 3D models provides a significant advantage for rehearsing the procedure and for evaluating the correction that was achieved.

Improving outcomes for patients discharged early using a home assessment scheme

Background

With increased delayed discharges from acute NHS hospitals, especially for older patients, solutions like the 'Discharge to Assess' (D2A) scheme aim to facilitate quicker discharge and improve experiences for patients and carers.

Setting

This report examines the quality process from the patient perspective of the D2A scheme implemented in a London Northwest Healthcare NHS Trust (LNWHT). A retrospective audit was conducted using the first cohort of patients discharged through this pilot scheme from April to July 2017.

Question

A brief study to explore patient views of their experience of the D2A scheme.

Methods

An opportunistic audit comprised of brief telephone interviews with patients following discharge from hospital through the D2A scheme.

Results

30 patients who had been discharged with the D2A scheme, agreed to participate. Overall, patients were positive about their experience and valued the support and services provided. However, there were concerns on the issue of communication. The scheme effectiveness from the patient's perspective improved over the duration of the evaluation.

Discussion

Patients' views about their experiences changed over time, which included patients' perceptions of the discharge process, patients' expectations and the way in which they were able to access services.

Tirapazamine with cisplatin in patients with advanced non-small-cell lung cancer: a phase II study

PURPOSE

A phase II study was conducted to evaluate the safety and efficacy of tirapazamine combined with cisplatin for the treatment of patients with advanced non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Forty-four patients with stage IIIB/IV NSCLC were treated with a combination of tirapazamine and cisplatin. Patients received tirapazamine 260 mg/m2 administered intravenously over 2 hours, followed 1 hour later by cisplatin 75 mg/m2 administered over an additional hour, repeated every 21 days. The duration of therapy was meant to be limited to four cycles for nonresponders and eight cycles for responders.

RESULTS

Ten of 44 patients (23%) showed a partial response. The estimated median survival for all patients was 37 weeks. Toxicities were treatable and included grade 3 nausea or vomiting (25%), fatigue (27.3%), and muscle cramps (4.5%). No dose reductions were necessary.

CONCLUSION

The results show that tirapazamine can safely be added to cisplatin. Both the median survival and response rate observed strongly suggest that tirapazamine with cisplatin is more active than cisplatin alone.

Lhcb Transcription Is Coordinated with Cell Size and Chlorophyll Accumulation (Studies on Fluorescence-Activated, Cell-Sorter-Purified Single Cells from Wild-Type and immutans Arabidopsis thaliana)

To study the mechanisms that integrate pigment and chlorophyll a/b-binding apoprotein biosynthesis during light-harvesting complex II assembly, we have examined [beta]-glucuronidase (GUS) enzyme activities, chlorophyll contents, and cell sizes in fluorescence-activated, cell-sorting-separated single cells from transgenic Arabidopsis thaliana wild-type and immutans variegation mutant plants that express an Lhcb (photosystem II chlorophyll a/b-binding polypeptide gene)/GUS promoter fusion. We found that GUS activities are positively correlated with chlorophyll content and cell size in green cells from the control and immutans plants, indicating that Lhcb gene transcription is coordinated with cell size in this species. Compared with the control plants, however, chlorophyll production is enhanced in the green cells of immutans; this may represent part of a strategy to maximize photosynthesis in the green sectors to compensate for a lack of photosynthesis in the white sectors of the mutant. Lhcb transcription is significantly higher in pure-white cells of the transgenic immutans plants than in pure-white cells from norflurazon-treated, photooxidized A. thaliana leaves. This suggests that immutans partially uncouples Lhcb transcription from its normal dependence on chlorophyll accumulation and chloroplast development. We conclude that immutans may play a role in regulating Lhcb transcription, and may be a key component in the signal transduction pathways that control chloroplast biogenesis.

Phase II trial of all-trans retinoic acid in metastatic non-small cell lung cancer

The toxicity and marginal effectiveness of cytotoxic chemotherapy in metastatic non-small cell lung cancer (NSCLC) necessitates the search for new agents. Preliminary data in lung cancer and other malignant and premalignant disorders have identified retinoid compounds as potentially useful antitumor agents. Twenty-eight patients with metastatic NSCLC were treated with oral all-trans retinoic acid in a phase II trial. The study population consisted of patients with excellent performance status and minimal weight loss. Toxicities were generally mild and included cutaneous effects, headache, and myalgia. A significant number of patients developed elevations of hepatic transaminases or hyperlipidemia and 3 patients had treatment-related leukocytosis. Two patients (8%) achieved a partial response, and 1 had a mixed response. The duration of remission in the 2 responders was 7 and 13 months and the median survival of all patients 7 months. Therefore, all-trans retinoic acid has minimal activity as a single agent in NSCLC but warrants further study in combination with biological agents and chemotherapy.

A strategy to enhance skills. Developing intravenous therapy skills for community nursing

1. Information abounds on teaching clients, partners and relatives about home i.v. therapy, but there is a lack of training for community nurses in this area. 2. Training for IV therapy has been difficult to develop in community settings, but must involve managers, specialists, and practitioners. 3. Community-led IV therapy training requires resources across acute and community sectors, with skills development through contract learning and focusing skills to specific practice contexts. 4. Training and experience in managing central venous access developed by community nurses are transferable to all clients and to other colleagues.