Pub Date : 2025-07-01DOI: 10.1016/j.mjafi.2025.02.005
Sajitha K , Michelle Mathias
Central nervous system (CNS) involvement in multiple myeloma (MM) is rare and can be a challenge to diagnose due to the heterogenous symptoms and associated confounding neurological symptoms because of any other underlying condition. CNS - MM can occur either at the onset of the disease or during relapse when the myeloma is usually more aggressive and the patient would have already taken different types of treatments. CNS - MM has a grim prognosis inspite of the availability of newer modalities of pharmacologic treatment including immunomodulatory drugs and proteasome inhibitors. Here, we report a case of MM with CNS involvement at presentation which posed a diagnostic challenge. This case is being reported due to its rarity of occurrence and limited data available in literature.
{"title":"Multiple myeloma with an unusual presentation","authors":"Sajitha K , Michelle Mathias","doi":"10.1016/j.mjafi.2025.02.005","DOIUrl":"10.1016/j.mjafi.2025.02.005","url":null,"abstract":"<div><div>Central nervous system (CNS) involvement in multiple myeloma (MM) is rare and can be a challenge to diagnose due to the heterogenous symptoms and associated confounding neurological symptoms because of any other underlying condition. CNS - MM can occur either at the onset of the disease or during relapse when the myeloma is usually more aggressive and the patient would have already taken different types of treatments. CNS - MM has a grim prognosis inspite of the availability of newer modalities of pharmacologic treatment including immunomodulatory drugs and proteasome inhibitors. Here, we report a case of MM with CNS involvement at presentation which posed a diagnostic challenge. This case is being reported due to its rarity of occurrence and limited data available in literature.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 ","pages":"Pages S147-S150"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144780328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.mjafi.2024.03.008
Kalpana Ketan Kulkarni , Asha Kashinath Kubde
Background
Breast cancer is a heterogenous group of diseases with steroid hormone dependant carcinogenesis. Along with Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal growth factor Receptor 2 (HER2), androgen receptor (AR) is now emerging to play key role in disease progression of various molecular breast cancer subtypes especially triple negative breast cancers. Aim of this study was to find out prevalence of AR positivity in all breast cancers, correlation of ER, PR, HER2 and Ki67 index with AR positivity. To find out correlation of AR positivity with histological grade.
Methods
This was a descriptive cross-sectional study done on 55 primary breast carcinoma cases. Routine Hematoxylin and Eosin stain as well as immunohistochemical ER, PR, HER2/neu, Ki67 and AR stain were done. The outcome was assessed in the form of relationship between AR and ER, PR, HER2 status and Ki-67 index and histopathological grade.
Results
AR positivity was seen in 69% of all breast cancers. AR positivity was seen in 8% of triple negative breast cancers. High Ki67 index showed 55% AR positivity. Grade II breast cancers showed 42% AR positivity.
Conclusion
Cases with triple negative breast cancers have worst prognosis. Unlike targeted novel hormone therapy (tamoxifen) in luminal cancers and monoclonal antibody (trastuzumab) in her2 enriched cancers, AR is looked upon as a target to treat triple negative breast cancer. However, the existing controversies demand more AR related studies.
{"title":"The role of androgen receptors in breast cancer","authors":"Kalpana Ketan Kulkarni , Asha Kashinath Kubde","doi":"10.1016/j.mjafi.2024.03.008","DOIUrl":"10.1016/j.mjafi.2024.03.008","url":null,"abstract":"<div><h3>Background</h3><div><span>Breast cancer is a heterogenous group of diseases with steroid hormone<span> dependant carcinogenesis. Along with Estrogen Receptor<span><span><span> (ER), Progesterone Receptor (PR), Human </span>Epidermal growth factor Receptor 2 (HER2), </span>androgen receptor (AR) is now emerging to play key role in </span></span></span>disease progression<span><span> of various molecular breast cancer subtypes especially </span>triple negative breast cancers. Aim of this study was to find out prevalence of AR positivity in all breast cancers, correlation of ER, PR, HER2 and Ki67 index with AR positivity. To find out correlation of AR positivity with histological grade.</span></div></div><div><h3>Methods</h3><div><span><span>This was a descriptive cross-sectional study done on 55 primary breast carcinoma cases. Routine </span>Hematoxylin and </span>Eosin stain as well as immunohistochemical ER, PR, HER2/neu, Ki67 and AR stain were done. The outcome was assessed in the form of relationship between AR and ER, PR, HER2 status and Ki-67 index and histopathological grade.</div></div><div><h3>Results</h3><div>AR positivity was seen in 69% of all breast cancers. AR positivity was seen in 8% of triple negative breast cancers. High Ki67 index showed 55% AR positivity. Grade II breast cancers showed 42% AR positivity.</div></div><div><h3>Conclusion</h3><div>Cases with triple negative breast cancers have worst prognosis. Unlike targeted novel hormone therapy<span> (tamoxifen) in luminal cancers and monoclonal antibody (trastuzumab) in her2 enriched cancers, AR is looked upon as a target to treat triple negative breast cancer. However, the existing controversies demand more AR related studies.</span></div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 ","pages":"Pages S55-S60"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144780413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The four-hour voiding observation is an important non-invasive urodynamic test for infants and young children before toilet training. The study was performed to generate normative data for term Indian neonates.
Methods
The study was a descriptive study performed in the Department of Paediatrics of a secondary care hospital in South India with patients having nationwide representation from August 2018 to August 2020. Term neonates, appropriate for gestational age on days 4–14 of life were included. Neonates at risk of oliguria or abnormal bladder functions were excluded. Four-hour voiding observation was performed by direct observation of voids, pre- and post-void diaper weight and measurement of post-void residue (PVR) by ultrasonography using two formulae within five minutes of voiding.
Results
A total of 102 neonates (166 voids) were studied. Important results were (a) Eight neonates did not void; (b) median (fifth–95th percentile) of important test outcomes as follows: voided volume: 15 (7.5–33.5) ml, maximum voided volume (MVV) 16.5 (8.0–38.7) ml, PVR 3.2 (0.5–10.2) ml, PVR% 17.0 (2.9–46.4) % functional bladder capacity 19.7 (9.6–38.0) ml, and diuresis: 1.7 (0.0–5.1) ml/kg/hour; (c) four (4.3%) neonates had one interrupted void each; (d) linear regression yielded the following formulae: MVV (ml) = 8.1019 + 4.8702 ∗Diuresis (ml/kg/hr) and PVR % (max) = 14.2312 + 3.2682∗ Diuresis (ml/kg/hr).
Conclusion
Normative data on the four-hour voiding observation study for Indian term exclusively breast-fed neonates are reported.
{"title":"Four-hour voiding observation: Normative data from term Indian neonates","authors":"R.W. Thergaonkar , Vivek Bhat , Manisha Thakur , Ahmad Jamal , Shikha Awasthi","doi":"10.1016/j.mjafi.2023.07.004","DOIUrl":"10.1016/j.mjafi.2023.07.004","url":null,"abstract":"<div><h3>Background</h3><div><span>The four-hour voiding observation is an important non-invasive </span>urodynamic<span> test for infants and young children before toilet training. The study was performed to generate normative data for term Indian neonates.</span></div></div><div><h3>Methods</h3><div><span>The study was a descriptive study performed in the Department of Paediatrics<span> of a secondary care hospital in South India with patients having nationwide representation from August 2018 to August 2020. Term neonates, appropriate for gestational age on days 4–14 of life were included. Neonates at risk of oliguria<span> or abnormal bladder functions were excluded. Four-hour voiding observation was performed by direct observation of voids, pre- and post-void diaper weight and measurement of post-void residue (PVR) by </span></span></span>ultrasonography using two formulae within five minutes of voiding.</div></div><div><h3>Results</h3><div><span>A total of 102 neonates (166 voids) were studied. Important results were (a) Eight neonates did not void; (b) median (fifth–95th percentile) of important test outcomes as follows: voided volume: 15 (7.5–33.5) ml, maximum voided volume (MVV) 16.5 (8.0–38.7) ml, PVR 3.2 (0.5–10.2) ml, PVR% 17.0 (2.9–46.4) % functional bladder capacity<span> 19.7 (9.6–38.0) ml, and diuresis: 1.7 (0.0–5.1) ml/kg/hour; (c) four (4.3%) neonates had one interrupted void each; (d) </span></span>linear regression yielded the following formulae: MVV (ml) = 8.1019 + 4.8702 ∗Diuresis (ml/kg/hr) and PVR % (max) = 14.2312 + 3.2682∗ Diuresis (ml/kg/hr).</div></div><div><h3>Conclusion</h3><div>Normative data on the four-hour voiding observation study for Indian term exclusively breast-fed neonates are reported.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 4","pages":"Pages 404-409"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41918782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.mjafi.2024.06.001
Abdeali Ginwala, Ajit Tambolkar
{"title":"Screening for Von Hipple-Lindau gene mutation and management of cerebellar hemangioblastoma presenting as erythrocytosis","authors":"Abdeali Ginwala, Ajit Tambolkar","doi":"10.1016/j.mjafi.2024.06.001","DOIUrl":"10.1016/j.mjafi.2024.06.001","url":null,"abstract":"","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 ","pages":"Pages S153-S155"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141693515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.mjafi.2024.05.007
Aditya A. Jha , Amit Singh , Sandhya Nair , Manish Manrai , Atul A. Jha , Sandeep Thareja , Pankaj P. Rao , Atul K. Sood , Praveen K. Sharma , Rajat Shukla
Background
There is a widening gap between the patients requiring transplants in proportion to the availability of organs donated. After brain stem death (BSD), counselling for consent is mandatory and if successful, and viable organs are recovered. A low consent rate for donation results in failed donation in a number of potential donors. Many potential donors fail to make a donation due to various social and familial reasons resulting in a poor consent rate. The aim of this study was to identify the variables that lead to donation denials.
Methods
This retrospective study, carried out from Jan 2009 to Dec 2021 at a tertiary centre with an active transplant and donation programme, analysed BSDs and their counselling outcomes.
Results
A total of 10998 patients were admitted to the intensive care unit, with 2401 (21.8%) deaths. BSD was diagnosed in 8.5% of all deaths, with donor suitability seen in 77.1% (n = 158) cases. After counselling, 55.7% families consented for organ donation. Amongst the families declining consent, most had multiple reasons. The commonest reasons were a difference of opinion among the family members (70%) and unclarity of BSD concept (44.3%). Other reasons included fear of mutilation, religious beliefs, and hope of a miracle.
Conclusion
As most reasons of denial are social and related to public awareness, a meticulous transplant program with enthusiastic coordinators coupled with augmentation of public awareness, responsible media reporting, and improved doctor–patient–relative communication would result in enhanced rates of consent.
{"title":"Demography of brain stem death and factors leading to successful consent for organ donation","authors":"Aditya A. Jha , Amit Singh , Sandhya Nair , Manish Manrai , Atul A. Jha , Sandeep Thareja , Pankaj P. Rao , Atul K. Sood , Praveen K. Sharma , Rajat Shukla","doi":"10.1016/j.mjafi.2024.05.007","DOIUrl":"10.1016/j.mjafi.2024.05.007","url":null,"abstract":"<div><h3>Background</h3><div>There is a widening gap between the patients requiring transplants in proportion to the availability of organs donated. After brain stem death (BSD), counselling for consent is mandatory and if successful, and viable organs are recovered. A low consent rate for donation results in failed donation in a number of potential donors. Many potential donors fail to make a donation due to various social and familial reasons resulting in a poor consent rate. The aim of this study was to identify the variables that lead to donation denials.</div></div><div><h3>Methods</h3><div>This retrospective study, carried out from Jan 2009 to Dec 2021 at a tertiary centre with an active transplant and donation programme, analysed BSDs and their counselling outcomes.</div></div><div><h3>Results</h3><div>A total of 10998 patients were admitted to the intensive care unit, with 2401 (21.8%) deaths. BSD was diagnosed in 8.5% of all deaths, with donor suitability seen in 77.1% (n = 158) cases. After counselling, 55.7% families consented for organ donation. Amongst the families declining consent, most had multiple reasons. The commonest reasons were a difference of opinion among the family members (70%) and unclarity of BSD concept (44.3%). Other reasons included fear of mutilation, religious beliefs, and hope of a miracle.</div></div><div><h3>Conclusion</h3><div>As most reasons of denial are social and related to public awareness, a meticulous transplant program with enthusiastic coordinators coupled with augmentation of public awareness, responsible media reporting, and improved doctor–patient–relative communication would result in enhanced rates of consent.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 ","pages":"Pages S70-S75"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144780421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mastalgia can be incapacitating for some individuals, necessitating medical intervention. Only a limited number of drugs have demonstrated effectiveness in managing the symptoms. An emerging option is oral centchroman, purported to be effective in this condition. Clinical trials are necessary to determine its role in the treatment of mastalgia.
Methods
An evaluator-blinded randomized controlled trial was conducted at a tertiary care teaching hospital to compare the efficacy of tamoxifen 10 mg and centchroman 30 mg daily. The study aimed to investigate the effect of treatment on the Visual Analog Scale (VAS) score of pain and the number of painful days per menstrual cycle or month. Following appropriate exclusion and randomization procedures, 51 patients completed the treatment and follow-up.
Results
Centchroman was more effective in controlling pain in the first month (p =0.04). No significant difference in the VAS score of pain was observed at the third or sixth month. Both drugs were effective in reducing the number of painful days, with no statistically significant difference between them. The recurrence rate at the sixth month was also not different (P = 0.41). Overall, 32% of patients on centchroman and 38.4% of patients on tamoxifen either failed to achieve satisfactory pain relief or experienced recurrences.
Conclusion
Centchroman is a safe and effective substitute for tamoxifen, demonstrating superior early symptom control, albeit with a slightly increased occurrence of adverse effects. In the event that no symptomatic relief is observed within a one-month trial of either medication, discontinuation is recommended, as prolonged use is unlikely to yield additional relief.
{"title":"Centchroman and tamoxifen in mastalgia: A randomized controlled trial","authors":"Mithilesh Kumar Sinha , Biswa Mohan Padhy , Ankur Gogoi Cheleng , Al Ameen Asharaf","doi":"10.1016/j.mjafi.2024.08.009","DOIUrl":"10.1016/j.mjafi.2024.08.009","url":null,"abstract":"<div><h3>Background</h3><div>Mastalgia can be incapacitating for some individuals, necessitating medical intervention. Only a limited number of drugs have demonstrated effectiveness in managing the symptoms. An emerging option is oral centchroman, purported to be effective in this condition. Clinical trials are necessary to determine its role in the treatment of mastalgia.</div></div><div><h3>Methods</h3><div>An evaluator-blinded randomized controlled trial was conducted at a tertiary care teaching hospital to compare the efficacy of tamoxifen 10 mg and centchroman 30 mg daily. The study aimed to investigate the effect of treatment on the Visual Analog Scale (VAS) score of pain and the number of painful days per menstrual cycle or month. Following appropriate exclusion and randomization procedures, 51 patients completed the treatment and follow-up.</div></div><div><h3>Results</h3><div>Centchroman was more effective in controlling pain in the first month (<em>p =0.04</em>). No significant difference in the VAS score of pain was observed at the third or sixth month. Both drugs were effective in reducing the number of painful days, with no statistically significant difference between them. The recurrence rate at the sixth month was also not different (<em>P = 0.41</em>). Overall, 32% of patients on centchroman and 38.4% of patients on tamoxifen either failed to achieve satisfactory pain relief or experienced recurrences.</div></div><div><h3>Conclusion</h3><div>Centchroman is a safe and effective substitute for tamoxifen, demonstrating superior early symptom control, albeit with a slightly increased occurrence of adverse effects. In the event that no symptomatic relief is observed within a one-month trial of either medication, discontinuation is recommended, as prolonged use is unlikely to yield additional relief.</div><div><strong><em>CTRI registration no.-</em></strong> CTRI/2021/01/030206.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 ","pages":"Pages S109-S114"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144780422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.mjafi.2024.09.001
Amresh Ghai , M.A. Jafri , S. Vignesh
Background: Knee injuries are commonly encountered in active sports persons as well as nonathletes, with approximately 60% of patients having cartilage damage with or without associated ligament and meniscal injuries. In this study, we report on the functional outcome of autologous osteochondral grafting in localised cartilage lesions of the knee.
Methods
A longitudinal follow-up study was conducted on 50 patients aged between 18-55 years with symptomatic focal cartilage defect in the knee of size less than 2.0 cm2 after necessary inclusion/exclusion criteria. Management involved arthroscopic autologous osteochondral grafting. The donor cartilage was from the non–weight-bearing region of the ipsilateral knee. Other associated intra-articular injuries were addressed in the same sitting. The patients were followed up after 6 weeks, 3 months and 6 months and clinical status documented by the Lysholm Knee Function Scale (LKFS).
Results
Most patients were young active males. Clinical presentation involved pain in all participants, followed by joint line tenderness. There was at least one associated injury to other intra-articular structures in 52% of the patients. The commonest associated injury was anterior cruciate ligament (ACL) tear followed by meniscus tear. The mean size of the focal cartilage defect was 1.013 cm2, ranging from 0.8 cm2 to 1.6 cm2. The mean preoperative LKFS was 56.97 ± 1.38 (standard error). There was a statistically (p < 0.001) as well as clinically significant (clinically important difference >13.0 and patient acceptable symptomatic state >70.0) improvement in the mean Lysholm score, which was 70 ± 1.32, 81.3 ± 1.12 and 92.1 ± 1.11 at the end of 6 weeks, 3 months and 6 months respectively. Eighty-four percent of the patients showed excellent functional outcome at 6 months (LKFS >90), whereas 8% and 4% had good and fair outcomes, respectively, at 6 months (LKFS: 70–90). Two patients (4%) who had failed ACL reconstruction had poor outcome (LKFS <70)at 6 months.
Conclusion
Mosaicplasty is an excellent procedure for managing cartilage defects of small to medium sizes, less than 2.0 cm2. The short-term results are satisfying and can accelerate rehabilitation of sports injuries. It is noteworthy that instability is a contra-indication for the procedure to succeed.
{"title":"Functional outcome after arthroscopic mosaicplasty for localised osteochondral defects in the knee","authors":"Amresh Ghai , M.A. Jafri , S. Vignesh","doi":"10.1016/j.mjafi.2024.09.001","DOIUrl":"10.1016/j.mjafi.2024.09.001","url":null,"abstract":"<div><div><em>Background:</em> Knee injuries are commonly encountered in active sports persons as well as nonathletes, with approximately 60% of patients having cartilage damage with or without associated ligament and meniscal injuries. In this study, we report on the functional outcome of autologous osteochondral grafting in localised cartilage lesions of the knee.</div></div><div><h3>Methods</h3><div>A longitudinal follow-up study was conducted on 50 patients aged between 18-55 years with symptomatic focal cartilage defect in the knee of size less than 2.0 cm<sup>2</sup> after necessary inclusion/exclusion criteria. Management involved arthroscopic autologous osteochondral grafting. The donor cartilage was from the non–weight-bearing region of the ipsilateral knee. Other associated intra-articular injuries were addressed in the same sitting. The patients were followed up after 6 weeks, 3 months and 6 months and clinical status documented by the Lysholm Knee Function Scale (LKFS).</div></div><div><h3>Results</h3><div>Most patients were young active males. Clinical presentation involved pain in all participants, followed by joint line tenderness. There was at least one associated injury to other intra-articular structures in 52% of the patients. The commonest associated injury was anterior cruciate ligament (ACL) tear followed by meniscus tear. The mean size of the focal cartilage defect was 1.013 cm<sup>2</sup>, ranging from 0.8 cm<sup>2</sup> to 1.6 cm<sup>2</sup>. The mean preoperative LKFS was 56.97 ± 1.38 (standard error). There was a statistically (p < 0.001) as well as clinically significant (clinically important difference >13.0 and patient acceptable symptomatic state >70.0) improvement in the mean Lysholm score, which was 70 ± 1.32, 81.3 ± 1.12 and 92.1 ± 1.11 at the end of 6 weeks, 3 months and 6 months respectively. Eighty-four percent of the patients showed excellent functional outcome at 6 months (LKFS >90), whereas 8% and 4% had good and fair outcomes, respectively, at 6 months (LKFS: 70–90). Two patients (4%) who had failed ACL reconstruction had poor outcome (LKFS <70)at 6 months.</div></div><div><h3>Conclusion</h3><div>Mosaicplasty is an excellent procedure for managing cartilage defects of small to medium sizes, less than 2.0 cm<sub>2</sub>. The short-term results are satisfying and can accelerate rehabilitation of sports injuries. It is noteworthy that instability is a contra-indication for the procedure to succeed.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 ","pages":"Pages S46-S54"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144780419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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