Successful treatment of a patient with chronic lymphocytic leukaemia (CLL) presenting with bony metastases with aggressive antibody and chemotherapy.

Osteolytic lesions are rare in chronic lymphocytic leukaemia (CLL) and thought to result from Richter's transformation or metastatic disease from nonlymphoid malignancies. We report a patient who presented with a large femoral metastatic lesion and hypercalcaemia caused by CLL itself. Complete remission of CLL with resolution of the osteolytic lesion was achieved with rituximab and cyclophosphamide, adriamycin, oncovin and prednisolone [CHOP (R-CHOP)] combination chemotherapy.

Changing the route of hysterectomy: the results of a policy of attempting the vaginal approach in all cases of dysfunctional uterine bleeding.

Objective: To assess the effectiveness of a policy of performing a vaginal hysterectomy for as many cases of dysfunctional uterine bleeding without uterine prolapse as possible between 1997 and 2003.

Study Design: The study was prospective, with retrospective analysis of data.

Setting: Warwick Hospital.

Thermal ablation performed in a primary care setting: the South Warwickshire Experience.

Objective: To assess the feasibility of performing outpatient thermal ablation in a primary care setting.

Design: Prospective study.

Setting: A small peripheral hospital in the UK used by local general practitioners and visiting hospital practitioners for its outpatient facilities.

Can the epicondylar axis be defined accurately in total knee arthroplasty?

As part of a study on rotational alignment of the femoral component in knee replacement, the surgical epicondylar axis was identified in 74 knees and marked with pins. An alternative technique was employed to achieve rotational alignment and in each case the distance between the pins and the cut surface of the posterior condyles was measured. The alignment of the femoral component was measured postoperatively by axial CT scans of the distal femur, allowing an assessment to be made of what would have been achieved if the epicondylar pins had been used for guidance.

Accuracy of implantation of components in the Oxford knee using the minimally invasive approach.

Screened postoperative X-rays of 224 Oxford knees implanted through the minimally invasive approach were analysed using 16 criteria. The technique was as recommended by the Oxford Group except that the femoral intramedullary rod was used only as a guide to flexion/extension of the femoral component. All femoral components were within the recommended range for varus/valgus and mediolateral position.

Prevention and management of ureteric injuries.

Ureteric injury is one of the most serious complications of gynaecological surgery with important medico-legal considerations. This review is aimed at understanding the anatomy of the ureter, sites of ureteric injuries, types and causes of injury, simple preventive measures and management.

Achieving ligament stability and correct rotational alignment of the femur in knee arthroplasty: a study using the Medial Pivot knee.

In a series of 90 Medial Pivot arthroplasties rotational alignment of the femur was achieved by provisionally reconstructing the lateral side of the joint and tensioning the medial side with feeler gauges. Axial CT scans were employed to measure the rotational alignment relative to surgical epicondylar axis. In valgus knees the cutting block was externally rotated to adjust for posterolateral bone loss.

Patellar instability-can the TT-TG distance be measured clinically?

The horizontal distance between the tibial tubercle and the centre of the groove (TT-TG) is an important determinant in the treatment of patellar instability. We set out investigate whether it could be measured in the outpatient setting using a length of string lined up between a proximal reference point, the centre of the patello-femoral groove and the tibial tubercle. The technique was employed in 24 knees of patients awaiting patellar realignment and the results compared with linked MRI slices through the trochlear and tibial tubercle.

The influence of the tibial sagittal cut on component position in the Oxford knee.

The alignment of the components of the Oxford knee replacement were analysed before and after modification of technique for performing the sagittal cut. In the 126 knees prior to the change, there was wide variation in the apparent femoral rotation on screened X-rays centred on the tibial component. In the 40 knees after the change, the variability was markedly reduced (traditional technique, mean femoral rotation 7.

Reversal of the decision for caesarean section in the second stage of labour on the basis of consultant vaginal assessment.

During a 5-year period there were 32 cases where the vaginal assessment performed by a specialist registrar in the second stage of labour was re-assessed within 15 minutes by a consultant obstetrician. The examination was prompted by a request for permission to perform a caesarean section in the second stage of labour. The results suggest a significant discrepancy between the consultants and the specialist registrar's findings, with 44% of the cases indicating a difference in the position of the head, and 81% a difference in the station of the head.

Pregnancy following endometrial ablation: a review article.

This review summarises the 70 pregnancies reported following endometrial ablation by various techniques, including a those in a case report from the authors' own experience. Thirty-one viable pregnancies resulted, with a high proportion of complications. These included a perinatal mortality rate of 12.

Accuracy of patellar resection in total knee replacement. A study using the medial pivot knee.

A series of 80 patellae were randomly allocated to osteotomy by sawing or milling while implanting the medial pivot knee. Three landmarks were used to control the plane of the cut in the coronal plane. The lateral edge of the patellar tendon distally, and both medial and lateral edges of the quadriceps tendon proximally.

Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila in elderly patients with stroke (C-PEPS, M-PEPS, L-PEPS): a case-control study on the infectious burden of atypical respiratory pathogens in elderly patients with acute cerebrovascular disease.

Background And Purpose: Multiple studies have suggested an association between Chlamydia pneumoniae and Mycoplasma pneumoniae infection and cardiovascular disease. We investigated whether the risk of cerebrovascular disease is associated with Legionella pneumophila infection and the aggregate number/infectious burden of these atypical respiratory pathogens.

Methods: One hundred patients aged >65 years admitted with acute stroke or transient ischemic attack (TIA) and 87 control patients admitted concurrently with acute noncardiopulmonary, noninfective conditions were recruited prospectively.

Total knee replacement and patellofemoral pain.

Background: The decision to resurface the patella or not during total knee replacement (TKR) is a controversial issue. During primary TKR some surgeons routinely resurface the patella, others operate a selective policy and a third group never resurfaces the patella.

Aim: This study attempts to investigate the relationship of patellofemoral knee pain and TKR.