Bone drilling is common in orthopedic procedures and the heat produced during conventional experimental drilling often exceeds critical temperature of 47 °C and induces thermal osteonecrosis. The osteonecrosis may be the reason for impaired healing, early loosening and implant failure. This study was undertaken to control the temperature rise by interrupted cutting and reduced friction effects at the interface of drill tool and the bone surface. In this work, rotary ultrasonic drilling technique with diamond abrasive particles coated on the hollow drill tool without any internal or external cooling assistance was used. Experiments were performed at room temperature on the mid-diaphysis sections of fresh pig bones, which were harvested immediately after sacrifice of the animal. Both rotary ultrasonic drilling on bone and conventional surgical drilling on bone were performed in a five set of experiments on each process using identical constant process parameters. The maximum temperature of each trial was recorded by K-type thermocouple device. Ethylenediaminetetraacetic acid decalcification was done for microscopic examination of bone. In this comparative procedure, rotary ultrasonic drilling on bone produced much lower temperature, that is, 40.2 °C ± 0.4 °C and 40.3 °C ± 0.2 °C as compared to that of conventional surgical drilling on bone, that is, 74.9 °C ± 0.8 °C and 74.9 °C ± 0.6 °C with respect to thermocouples fixed at first and second position, respectively. The conventional surgical drilling on bone specimens revealed gross tissue burn, microscopic evidence of thermal osteonecrosis and tissue injury in the form of cracks due to the generated force during drilling. But our novel technique showed no such features. Rotary ultrasonic drilling on bone technique is robust and superior to other methods for drilling as it induces no thermal osteonecrosis and does not damage the bone by generating undue forces during drilling.

Purpose: Adipose tissue dysfunction is at the center of metabolic dysfunctions associated with obesity. Through studies in isolated adipocytes and mouse models, ATP-binding cassette transporter A1 (ABCA1) expression in the adipose tissue has been shown to regulate high-density lipoprotein (HDL) cholesterol levels in the circulation and insulin sensitivity at both adipose tissue and whole-body levels. We aimed to explore the possible link between ABCA1 expression in the adipose tissue and metabolic derangements associated with obesity in humans. Patients and methods: This exploratory study among individuals who were lean (body mass index [BMI]: 22.3±0.34 kg/m², n=28) and obese (BMI: 44.48±5.3 kg/m², n=34) compared the expression of ABCA1, adiponectin and GLUT4 (SLC2A4) in visceral and subcutaneous adipose tissue using quantitative real-time PCR and immunohistochemistry. Homeostatic model assessment for insulin resistance (HOMA-IR) and adipose tissue insulin resistance (adipo-IR) were used as insulin resistance markers. Results: Visceral adipose tissue from individuals who were obese had significantly lower ABCA1 (P=0.04 for mRNA and protein) and adiponectin (P=0.001 for mRNA) expression compared to that from lean individuals. Subcutaneous adipose tissue did not show any significant difference in the expression. When individuals were divided into insulin-sensitive (IS) and insulin-resistant (IR) groups based on HOMA-IR, IR individuals had lower ABCA1 (P=0.0001 for mRNA and P=0.009 for protein) expression compared to IS individuals in visceral adipose tissue, but not in subcutaneous adipose tissue. The difference was significant after adjusting for age, gender and BMI. ABCA1 mRNA expression in visceral adipose tissue correlated negatively with both HOMA-IR (r=–0.44, P=0.0003) and adipo-IR (r=–0.35, P=0.005) after adjusting for age, gender and BMI. ABCA1 expression in either visceral or subcutaneous adipose tissue did not have any significant correlation with HDL cholesterol levels or mean adipocyte area. Conclusion: Obesity and insulin resistance are associated with lower expression of ABCA1 in visceral adipose tissue in humans.

Efficacy and outcomes of osteosynthesis depend on various factors including types of injury and repair, host factors, characteristics of implant materials and type of implantation. One of the most important host factors appears to be the extent of bone damage due to the mechanical force and thermal injury which are produced at cutting site during bone drilling. The temperature above the critical temperature (47 °C) produces thermal osteonecrosis in the bones. In the present work, experimental investigations were performed to determine the effect of drilling parameters (rotational speed, feed rate and drill diameter) and techniques (conventional surgical bone drilling and rotary ultrasonic bone drilling) on cutting force and temperature generated during bone drilling. The drilling experiments were performed by a newly developed bone drilling machine on different types of human bones (femur, tibia and fibula) having different biological structure and mechanical behaviour. The bone samples were procured from male cadavers with the age of second to fourth decades. The results revealed that there was a significant difference ( p < 0.05) in cutting force and temperature rise for rotary ultrasonic bone drilling and conventional surgical bone drilling. The cutting force obtained in rotary ultrasonic bone drilling was 30%–40%, whereas temperature generated was 50%–55% lesser than conventional surgical bone drilling process for drilling in all types of bones. It was also found that the cutting force increased with increasing feed rate, drill diameter and decrease in rotational speed, whereas increasing rotational speed, drill diameter and feed rate resulted in higher heat generation during bone drilling. Both the techniques revealed that the axial cutting force and the temperature rise were significantly higher in femur and tibia compared with the fibula for all combinations of process parameters.

Unusual presentation of Erdheim-Chester disease in a child with acute lymphoblastic leukemia

Mycobacterium leprae infection causes bone lesions and osteoporosis, however, the effect of antileprosy drugs on the bone is unknown. We, therefore, set out to address it by investigating osteogenic differentiation from bone marrow (BM)-derived mesenchymal stem cells (MSCs). Out of 7 antileprosy drugs, only clofazimine (CFZ) reduced MSCs viability (IC50 ∼ 1 μM) and their osteogenic differentiation but increased adipogenic differentiation on a par with rosiglitazone, and this effect was blocked by a peroxisome proliferator-activated receptor gamma antagonist, GW9662. CFZ also decreased osteoblast viability and resulted in impaired bone regeneration in a rat femur osteotomy model at one-third human drug dose owing to increased callus adipogenesis as GW9662 prevented this effect. CFZ treatment decreased BM MSC population and homing of MSC to osteotomy site despite drug levels in BM being much less than its in vitro IC50 value. In adult rats, CFZ caused osteopenia in long bones marked by suppressed osteoblast function due to enhanced adipogenesis and increased osteoclast functions. A robust increase in marrow adipose tissue (MAT) by CFZ did not alter the hematologic parameters but likely reduced BM vascular bed leading to osteonecrosis (ON) characterized by empty osteocyte lacunae. However, CFZ had no effect on visceral fat content and was not associated with any metabolic and hematologic changes. Levels of unsaturated fatty acids in MAT were higher than saturated fatty acids and CFZ further increased the former. From these data, we conclude that CFZ has adverse skeletal effects and could be used for creating a rodent ON model devoid of extraskeletal effects.

Lymphoma of the female genital tract is a rare condition. Involvement of the ovary by non- Hodgkin lymphoma (NHL) is usually secondary to systemic disease and primary ovarian lymphomas are unusual. In most cases, the diagnosis is not suspected initially and is confirmed only after detailed histopathological evaluation. We describe two cases of primary ovarian NHL which were diagnosed on fine needle aspiration cytology (FNAC). One of the patients was a 40 years old female who presented with abdominal distension and lump. She was found to have bilateral adnexal masses on ultrasound and computed tomography (CT) scan. A USG guided fine needle aspiration of the ovarian masses was performed, following which a diagnosis of primary ovarian diffuse large B-cell lymphoma was established. The second patient was a 14 years old female who presented with pelvic lump, which was lobulated and mildly enhancing on contrast enhanced CT. A diagnosis of high grade NHL of ovaries was made on cytology. Subsequently, the lymphoma was characterized as Burkitt's on histopathological examination. Both the patients were started on R-CHOP chemotherapy regimen. FNAC serves as an extremely useful minimally invasive procedure for the diagnosis of ovarian lymphomas and early institution of appropriate chemotherapeutic regimens.