Outcome ofJudet＇s quadricepsplasty for knee contractures and the effect of local infiltration of epinephrine on reducing blood loss

Objective： To evaluate the effectiveness ofJudet＇s quadricepsplasty for treatment of knee contractures and to identify the effect of local infiltration of epinephrine on blood loss associated with this procedure. Methods： A retrospective cohort study was conducted in which all cases of knee contractures managed with Judet＇s quadricepsplasty from 1st January 2009 to 31st December 2013 were included and were divided into two groups. The epinephrine group included patients who were infiltrated with diluted epinephrine （1：400,000） along with xylocaine, around the operative field 15 min prior to the incision time, while the control group did not receive any infiltration. Judet＇s outcome, blood loss, drop in he- moglobin and required blood transfusion were noted for all patients and compared between both groups. Results： Most common preceding pathology identified for the development of knee contractures was periarticular fracture while ilizarov application was the most common etiology. Both groups were found similar in all preoperative characteristics except preoperative flexion contracture （p = 0.02）. All func- tional outcome measures including Judet＇s outcome were similar in both groups. In contrast, duration of surgery （p = 0.01）, blood loss （p = 0.02）, drop in hemoglobin （p = 0.01） and number of transfusions （p = 0.03） were significantly reduced in epinephrine group. Conclusion： Judet＇s quadricepsplasty is a useful procedure to increase the range of motion of rigid knees and local infiltration of epinephrine is effective in decreasing the amount of subsequent blood loss and transfusion requirements.

An unusual biconvex epidural lesion:acutely presenting extraosseous intracranial Ewing's sarcoma

Background:Ewing's sarcoma family of tumors consists of small round cell neoplasms,inclusive of primitive neuroectodermal tumor(PNET),Askin's tumor,and PNET of the bone.Extraosseous Ewing's sarcoma occurs commonly at bones of lower extremities and paravertebral region of the spine.It rarely presents as a primary intracranial lesion.When intracranial,it can be misdiagnosed as central PNET(e.g.,medulloblastoma,pinealoblastoma,or supratentorial PNET),other intracranial lesions,or even as an epidural hematoma.Case presentation:We report the case of a 20-year-old patient who presented to the emergency department with complaints of drowsiness,headache,and fever for 1 day.On initial computed tomography(CT)scan of the brain,a right temporal biconvex epidural lesion involving squamous-temporal bone with periosteal reaction was noted.The patient underwent urgent craniotomy,and a tumor was found and excised.Biopsy report confirmed Ewing's sarcoma.Conclusion:Ewing's sarcoma is a rare intracranial malignancy with only a few cases reported in literature.In a young patient with a biconvex epidural lesion,in the absence of trauma or ongoing infection,the possibility of Ewing's sarcoma should be considered as well.

Estimation of Burden of Kidney Dysfunction in HIV-Infected Pediatrics and Adolescents by Use of Urinary Neutrophil Gelatinase-Associated Lipocalin: A Single Center Experience in Kenya

Background:About 75%of patients infected with human immunodeficiency virus(HIV)live in sub-Saharan Africa.In Kenya,about 1.5 million Kenyans are living with HIV,of whom almost 100,000 are children and adolescents.Highly active antiretroviral therapy(HAART)has converted HIV infection to a chronic illness with its attendant complications.Kidney disease is a common complication of HIV infection and its treatment.Kidney disease in HIV-infected persons can be asymptomatic,insidious onset and may lack specific clinical features.It can only be detected on active screening.The urine albumin-to-creatinine ratio and estimated glomerular filtration rate(eGFR)using serum creatinine are not sensitive in identification of early kidney injury.Urinary neutrophil gelatinase-associated lipocalin(uNGAL)has been used as marker of early kidney injury.Methods:This cross-sectional study used uNGAL and serum creatinine to determine the prevalence of kidney dysfunction in HIVinfected children and adolescents with HAART at Gertrude’s Children’s Hospital,Nairobi,Kenya,from March 2016 to February 2017.Urine samples were assayed for uNGAL using the Bio Porto®enzyme-linked immunosorbent assay.Serum creatinine was assayed using the Jaffe reaction in the Cobas®6000 biochemistry analyzer and eGFR calculated using the Schwartz formula.Scatter plot of eGFR against log uNGAL levles was performed by Statistical Package for Social Sciences and Pearson correlation coefficeint between log uNGAL levles and eGFR was analyzed.Results:Ninety-three patients were recruited.Their mean age was 11.8±3.6 years and the median duration on HAART was 72.6 months.Males were 47(50.5%).The prevalence of kidney dysfunction using uNGAL was 15.1%(95%CI 7.6%–22.5%)and 5.4%(95%CI 1.8%–12.1%)by eGFR.The mean eGFR was 131±25mL·min1·1.73m2 and median uNGAL was 10 ng/mL.For every one ng/mL increase in uNGAL value above the normal value,eGFR decreases by 4.8mL·min1·1.73m2(P=0.038).Patients with elevated uNGAL were older when compared with those with normal uNGAL(13.5 vs.11.5 years).Conclusion:Urinary NGAL picked up to three times more patients with kidney dysfunction than eGFR derived from serum creatinine.All the patients were asymptomatic.Older children and adolescents were more likely to manifest with kidney dysfunction.Further studies are necessary to evaluate if uNGAL can be utilized routinely to evaluate for early kidney disease in HIV-infected patients.