BackgroundInflammation-induced endothelial precursor cell recruitment and angiogenesis are thought to be associated with CXCL16-CXCR6 pair activity. This study’s main purpose was to determine plasma CXCL16 levels after minimally invasive colorectal resection (MICR) for colorectal cancer (CRC); an adjunct study assessed wound fluid (WF) and plasma CXCL16 levels in a separate group of CRC patients.MethodsCRC patients who had MICR and for whom plasma was available in a tissue bank were eligible. Plasma samples were collected preoperatively from all patients. Samples were also collected on postoperative days (POD) 1 and 3 and at various late postoperative time points (POD 7–34). In a separate study, blood and intra-abdominal wound fluid (WF) samples were collected from CRC MICR patients (pts). Samples were stored at − 80 °C. CXCL16 levels were determined via ELISA. The Wilcoxon signed-rank and Mann and Whitney tests were used for analysis.ResultsMain study: 86 CRC pts. were included. The mean preoperative plasma CXCL16 level was 2.36 ± 0.57 ng/ml. Elevated mean plasma levels (p <  0.0001 × first 4 time points) were noted on POD 1 (2.82 ± 0.81, n = 86), POD 3 (3.12 ± 0.77, n = 82), POD 7–13 (3.28 ± 0.88, n = 64), POD 14–20 (3.03 ± 0.62, n = 24), POD 21–27 (3.06 ± 0.67, n = 20, p = 0.0003), and POD 28–34 (3.17 ± 0.43, n = 11, p = 0.001) vs. preop levels. WF study: In the adjunct study, plasma and WF CXCL16 levels were determined for 23 CRC MICR pts. WF levels at all time points were significantly elevated over plasma levels.ConclusionPlasma CXCL16 levels were elevated for 4 weeks after minimally invasive colorectal resection for cancer. Also, WF CXCL16 levels were 3–10 times greater than the corresponding plasma concentrations. The source of the late plasma elevations may be the healing wound. Increased plasma CXCL16 levels may promote tumor angiogenesis in the first month after MICR.

ObjectiveClosed reduction of Schatzker type 4, 5, and 6 fractures of the tibial plateau, internal fixation by lag screws inserted through a mini-incision, and stabilization with Ilizarov external ring fixator. IndicationsFractures of the tibial plateau of Schatzker type 4, 5, and 6. ContraindicationsOpen infected tibial plateau fractures. Relative contraindications are Schatzker type 1, 2, and 3 fractures of the tibial plateau which can be treated by simpler methods. Surgical TechniqueReduction of fracture by longitudinal traction on a fracture table. Percutaneous insertion of two or three 6.5-mm lag screws to compress the major fragments. Stabilization of the fracture with a three-ring construction of the Ilizarov frame. Further compression of fragments with olive wires, used also to reduce and compress posterolateral and/or posteromedial fragments. The frame is extended to the femur in instances of subluxation of the knee joint, ligamentous injuries, and associated femoral condylar fractures. ResultsBetween 1991-1997, 56 patients were operated on. Average follow-up: 3 years. Union occurred in all. Six patients showed a varus deformity of 5-10° and one a varus deformity of 15°; four patients had an extension lag between 5-10°. A minor pin tract infection was observed 20 times and a major pin tract infection three times necessitating pin removal. One patient who suffered a compound fracture complicated by aseptic arthritis eventually required an arthrodesis. Applying the score of the American Knee Society, an excellent result was obtained 20 times, a good result 28 times, a fair one four times, and a poor one four times.

Introduction: Pain management in total knee arthroplasty is aimed to minimize postoperative pain and improve functional outcomes in patients. Although there are many methods used for controlling the pain there has been no consensus on most appropriate or the best protocol. Adductor canal block (ACB) has the unique advantage of providing localized analgesia but it doesn't provide pain relief to the posterior capsule, it has been postulated that IPACK (interspace between the popliteal artery and the capsule of the knee) combined with ACB will provide better pain relief than ACB alone. Materials and Methods: 60 Patients were studied in two groups. Group A had those patients with ACB+ ipack and Group B had ACB. Group A -Patient were subjected to combined ACB block with IPACK. Group B -Patient in this group were given ACB. Patient were studied for pain score VAS on Day 0 and Day 1 morning and evening, range of movement at postoperative Day 1 and distance walked on Day 1. Results: Group B had better outcome as compared to Group A. The mean VAS score for the ACB+IPACK group was less than for ACB alone at end of Day 0 and Day 1 in morning and evening. The ROM for the ACB+IPACK group was better than ACB alone and number of steps walked by patients were more in ACB+IPACK as compared to ACB alone. The statistical difference was significant when Adductor +IPACK group was compared to Adductor group for VAS, ROM and number of steps walked. Conclusion: ACB+IPACK is better mode than ACB for control of postoperative pain in patient undergoing Total knee replacement. IPACK is relatively safe and combined with adductor canal block decreases posterior pain in TKR patients.

Acute pancreatitis as a cause of thrombotic microangiopathy is very rare. We report a case of 40-year-old woman with idiopathic recurrent pancreatitis, who presented with acute pancreatitis complicated by thrombotic microangiopathy. Although thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) has been reported as causing acute pancreatitis, the induction of TTP/HUS by pancreatitis is rare. As far as we are aware this is the first reported case of TTP/HUS in association with pancreatitis in India. Our patient had a complete recovery of her thrombotic microangiopathy following plasma exchange therapy.

Palatal expansion has a unique role in dentofacial therapy. The rapid Maxillary expansion which is a type of skeletal expansion involves the opening of the mid-palatal suture and movement of the palatal shelves away from each other. Selection of appropriate appliance should be made by preparing a list of criteria depending on the biomechanical requirements of RME. Rapid expansion affects the maxillary complex, palatal vaults, maxillary teeth, adjacent periodontal structures to get desired expansion in the maxillary arch. Maxillary transverse deficiency in adults is a malocclusion of relatively high prevalence in orthodontics. The rapid maxillary expansion (RME) surgically assisted is considered the preferred procedure to correction of this alteration in patients skeletally mature. This review discusses the types of palatal expansion and skeletal and soft tissue effects of palatal expansion.