Osteoarthritis (OA) is becoming a significant problem worldwide. Pain and loss of joint function have a major impact on an individual's quality of life and through loss of time at work and increasing health care costs has a significant economic burden on society. OA is a complex disease with a number of known risk factors. There is variable involvement of the synovial joints in populations as a result of both environmental and genetic factors. Recent candidate gene studies and genome-wide association studies are beginning to identify known and previously unsuspected genes to be associated with the development of OA. These studies raise the exciting prospect of future stratification of patients into genetically identified sub-groups that may have specific targetable pathways for disease management.

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In the present work, we report a case of Taiwanese male who developed flu-like seroconversion illness initially. Then early-onset human immunodeficiency virus-related mania was found 4 weeks later. In the case, sepsis-induced delirium complicated the treatment course. Quetiapine and topiramate were used for short-term stabilization and long-term treatment. Mild neurocognitive disorder, the hint of worse prognosis, was proved by intact psycho-cognitive evaluation.

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Systemic lupus erythematosus (SLE) up-raises the surgical risk due to its unpredictable perioperative disease activity. Lupus flare represents an important issue because of its potential threat in organ damage and drug toxicity after adjusting the dosage of immune-modulating agents. A 34-year-old female was referred for trabeculectomy surgery for her poor-controlled steroid-related glaucoma with a 5-year history of SLE under systemic steroids control. Remission status was confirmed with normal serum complement levels. However, lupus flare with clinical ocular findings as hypotony maculopathy presented 1-week after uneventful surgery. Early and effective treatment with pulse corticosteroid therapy was conducted, and this patient recovered her ocular performance 1-month later except preexisting glaucomatous visual field deficits. SLE flare may be seen in any form of postoperative complications, even masked with consecutive hypotony maculopathy. This case reminds early detection of systemic lupus flare and different therapeutic plan is prompt in postoperative follow-up.

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Chest wall tumors can arise from a wide variety of benign and malignant etiologies, and therefore it can be challenging for clinicians to diagnose and manage them. Isolated metastatic squamous cell carcinoma from cervical cancer is extremely rare. We report a metastatic chest wall tumor from cervical cancer arising after 19 years of disease-free survival. Wide resection of the metastatic chest wall tumor, followed by a polypropylene mesh and free flap reconstruction with adequate coverage was successful. The patient continues to be a disease-free at 2 years.

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Ventriculoperitoneal (VP) shunt is an established method of diverting cerebrospinal fluid for the management of hydrocephalus. The procedure is associated with various complications. Bowel perforation caused by migration of VP shunt is rare but serious complication. Because most of the patients are asymptomatic, and the occurrence of such complication is fatal due to ascending meningitis, early diagnosis, and rapid treatment is important in these patients. The diagnosis of such complication is based on direct visual of the protruding tube from the anus or abdominal computed tomography. Colon perforation due to shunt catheter migration may initially but not essentially present as meningitis after shunt infection, abdominal symptoms, seizure, and fever. However, colon perforation may rarely resemble the symptoms of acute gastroenteritis (abdominal pain, vomiting and/or diarrhea) before the prolapse of shunt catheter from the rectum. Here, we report a 75-year-old man underwent VP shunt for hydrocephalus presented with "watery diarrhea" masqueraded as acute gastroenteritis and further diagnosed as migration of VP shunt from the colon, via digital examination and further disclosed by computed tomography.

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We report a rare case of a 62-year-old male who presented to surgical emergency department with the complaints of sudden onset pain and swelled in the right inguinal region with nausea, vomiting and abdominal distension. There was a history of a reducible swelling in the right inguino-scrotal region for the last 1 year. Based on history, clinical examination and investigations a provisional diagnosis of right-sided strangulated inguinal hernia was made and patient was planned for an emergency surgery. On the exploration, the hernial sac revealed a gangrenous vermiform appendix and the diagnosis of Amyand's hernia was made. Appendectomy was performed through the same incision, and hernial repair was done using a polypropylene mesh.

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This paper describes the use of CyberKnife radiosurgery in the treatment of accidentally found cervical spinal arteriovenous malformation (AVM). We present the case of a patient with cervical spinal AVM, who developed progressive neck pain, gait disturbance, urine and stool incontinence 2 weeks after the fell down accident. The patient underwent CyberKnife radiosurgery. After CyberKnife radiosurgery for 2 years, the patient's neck pain diminished and was able to keep the walk without any assistance. The management of cervical spinal AVM varies. This patient demonstrated a successful treatment of cervical spinal AVM with CyberKnife radiosurgery.

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Background: Enterobacteriaceae, common pathogens responsible for urinary tract infections are known to be susceptible to aminoglycosides. The emergence of resistant pathogens complicates antimicrobial regimen and becomes a challenge for clinicians. The aim of this study was to evaluate the susceptibility of clinically isolated Enterobacteriaceae to isepamicin and amikacin using disc diffusion method. Materials and Methods: A total of 234 Enterobacteriaceae isolates was collected and examined. Antimicrobial susceptibilities to gentamicin, amikacin, and isepamicin were assessed using disc diffusion method. The production of extended-spectrum β-lactamase (ESBL) or AmpC β-lactamase was also tested. The susceptibilities of the pathogens to isepamicin and amikacin were evaluated. Results: Two hundred and thirty-four Enterobacteriaceae isolates were found to be more susceptible to amikacin and isepamicin than to gentamicin. Of the isolates, 39 (16.7%) produced ESBL and 41 (17.5%) harbored AmpC β-lactamase. The results revealed that amikacin and isepamicin exerted excellent antibacterial activity (94% vs. 93.6%) against all tested isolates. Isepamicin was effective against 89.7% ESBL-producing isolates and 92.7% of AmpC-producing isolates. The susceptibility to amikacin and isepamicin established by the disc diffusion method was mostly consistent with the overall agreement estimated 99.6%. Conclusions: Isepamicin showed excellent activities against infections caused by Enterobacteriaceae, including strains harboring ESBL or AmpC beta-lactamase. The susceptibility of tested isolated to isepamicin measured by disc diffusion method is comparable to that of amikacin.

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Background: The surgical treatment of humeral fractures is controversial, and conservative therapy of pathologic fractures is not recommended. Materials and Methods: We performed a retrospective study of eight patients who had pathological humeral shaft fractures. All fractures were stabilized with ante-grade intramedullary nailing and wide resection of the tumor. Bone defects were filled with polymethylmethacrylate cement augmentation. Results: The mean operative time for the procedure was 160 min (range, 120-190 min), and the mean duration of hospitalization was 10.5 days (range, 5-15 days). Relief of pain was rated as good to excellent. There were no wound problems, deep infections, nerve palsies, or implant failures observed. X-ray studies demonstrated the improved stability of the humerus. Conclusion: Interlocking intramedullary nailing for pathological humeral shaft fractures provides immediate stability and can be accomplished with wide resection of tumor and bone defect augmentation with cement. Early return of functional status and pain relief greatly improved the patient's quality of life.

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