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Intra-articular administration of TXA is effective in reducing blood loss after TKA, without increasing the risk of VTE.

Lymphoedema is an unusual extra-articular feature of rheumatoid arthritis and has rarely been described in psoriatic arthritis. We report a 41-year-old man with psoriasis and psoriatic arthritis who developed bilateral lymphoedema of the upper extremities. Lymphoscintigraphy showed absent lymphatic drainage in the right arm and a subnormal increase in lymphatic flow under manual exertion in both arms. Colour Doppler ultrasound studies did not reveal venous or arterial abnormalities. Conservative management and therapy with cyclosporin (for worsening arthritis) resulted in partial resolution of the lymphoedema and improvement of flow parameters on the right side upon repeat lymphoscintigraphy.

Objectives: Transplant arteriosclerosis is a major obstacle for long-term allograft survival in heart transplant. The aim of this study was to investigate potential synergistic effects of combined treatment with mycophenolate mofetil and ganciclovir on the development of transplant arteriosclerosis, presence of regulatory T cells, and expression of donor specific alloantibodies. Materials and Methods: Donor aortas from C57BL/6 (H2b) mice that were fully mismatched to the major histocompatibility complex were transplanted into CBA (H2k) mouse recipients. Groups of mice received mycophenolate mofetil (100 or 300 mg/kg, oral), ganciclovir (10 or 72 mg/kg, intraperitoneal), or a mycophenolate mofetil and ganciclovir combination. Grafts were analyzed by histology and morphometry on day 30 after transplant. Numbers of regulatory T cells and donor-specific alloantibodies were examined by fluorescenceactivated cell sorting analysis of splenic tissue and peripheral blood. Results: Mycophenolate mofetil (100 mg/kg) and ganciclovir (10 mg/kg and 72 mg/kg) did not show effects on transplant arteriosclerosis formation or alloantibody production. However, groups treated with mycophenolate mofetil (300 mg/kg) or a lowor high-dose mycophenolate mofetil and ganciclovir combination had significantly reduced transplant arteriosclerosis and alloantibody levels. Expression of regulatory T cells within the spleen was similar between all experimental groups and untreated controls. Conclusions: The combination of mycophenolate mofetil and ganciclovir significantly reduced the development of transplant arteriosclerosis in a mouse abdominal aortic allograft model. This effect may be a result of decreased alloantibody production.

Introduction: Bladder perforation is a serious complication of transurethral resection of bladder tumour (TURBT). One of the risk factors is an "obturator jerk", caused by stimulation of the obturator nerve, causing powerful adduction of the leg. As almost half of all bladder tumours are located on the lateral wall and 55-100% of resections on the lateral wall can result in obturator jerk; this is not an insignificant risk. Patients: We have introduced regional anaesthetic nerve block of the anterior branch of the obturator nerve in patients with known lateral wall tumours undergoing TURBT. Methods: This procedure was performed by two consultant anaesthetists in our unit. Patients are positioned supine with the leg slightly abducted and laterally rotated. Ultrasound (US) is used to identify the anterior branch of the adductor longus, brevis and magnus muscles in the medial thigh, 2-3 cm inferior to the inguinal crease. The obturator nerve is situated in the plane between adductor longus and adductor brevis, medial to pectineus. An insulated needle is passed under US guidance and a nerve stimulator is used to elicit a twitch. Levobupivicaine is used to infiltrate the anterior branch of the obturator nerve to achieve motor block of the adductor brevis, adductor longus and gracillis muscles. TURBT is then performed. Results: This prospective pilot series includes 18 TURBT procedures. These were performed under spinal anaesthetic (n=16) or general anaesthetic without muscle relaxant (n=2). Tumours characteristics were; large flat areas of reresection (n=5), flat bladder lesions (n=1) or exophytic lesions (n=12). There were no incidences of obturator jerk observed during TURBT (0/18). There were no intra or post-operative complications. Conclusion: This simple technique can be easily applied to patients undergoing TURBT. Larger studies are required, but our series supports the use of this technique to reduce obturator jerk, which is an important risk factors for bladder perforation.