Complex pediatric elbow injury: an uncommon case

Background

There is paucity of literature describing complex elbow trauma in the pediatric population. We described a case of an uncommon pediatric elbow injury comprised of lateral condyle fracture associated with posterolateral dislocation of elbow.

Case presentation

A 12-year-old boy sustained a direct elbow trauma and presented with Milch type II lateral condyle fracture associated with posterolateral dislocation of elbow. Elbow dislocation was managed by closed reduction. The elbow stability was assessed under general anaesthesia, followed by open K-wiring for the lateral condylar fracture fixation. The patient had an uneventful recovery with an excellent outcome at 39 months follow-up.

Conclusion

Complex pediatric elbow injuries are quite unusual to encounter, the management of such fractures can be technically demanding. Concomitant elbow dislocation should be managed by closed reduction followed by open reduction and internal fixation (K-wires or cannulated screws) of the lateral condyle fracture.

Girdlestone resection arthroplasty following failed surgical procedures

We retrospectively reviewed 43 patients who had undergone Girdlestone resection arthroplasty of the hip after failed total hip replacement or failed operations for hip trauma between 1990 and 2002. The indications were peri-prosthetic infection, aseptic loosening, recurrent dislocation and failed internal fixation for femoral neck fractures. Twenty-five patients died with an overall mortality of 58%. Out of 18 survivors, four patients had a prosthesis re-implanted and were excluded from the study. In 14 surviving patients followed-up for a mean of 44.5 months, the average age was 76 years. Adequate pain relief was achieved in 12 patients and infection was controlled in all. They all needed walking aids. The overall patient satisfaction was 10/14. We observed that patients who had had resection arthroplasty following failed operations for hip trauma had a higher mortality than those for failed total hip arthroplasty. Girdlestone arthroplasty is still a viable option to salvage irretrievably failed hips presenting technical difficulties in medically compromised patients. Limb shortening and the inevitable need for a walking aid should be clearly explained to patients during the consenting process in order to avoid unrealistic expectations.

An unusual presentation in the emergency department with ‘hands up’ posture

A75-year-old right-hand dominant woman attended the emergency department with both arms locked in the erect position. She had fallen off a ladder and had landed vertically down on both outstretched hands. Her past medical history was unremarkable. She had had no previous shoulder trauma. On examination, both humeral heads were palpable in the axillae, lying against the lateral chest walls. On neurological assessment of the extremity, paraesthesia in the regimental badge area with deltoid weakness was noted, affecting the left shoulder. Bilateral inferior shoulder dislocations, with no associated bony injuries, were confirmed on a chest X-ray (Figure 1). A closed manipulation was successfully performed under sedation in the emergency department (Figures 2 and 3).

Health Service Delivery Through Private Pharmacies- A case study from Dhading and Siraha district

Abstract

Osteoarthritis: a review

A brief review of osteoarthritis including its clinical features, laboratory tests and management has been discussed with review of literature.

Laboratory study of biological retention for urban stormwater management

Urban stormwater runoff contains a broad range of pollutants that are transported to natural water systems. A practice known as biological retention (bioretention) has been suggested to manage stormwater runoff from small, developed areas. Bioretention facilities consist of porous soil, a topping layer of hardwood mulch, and a variety of different plant species. A detailed study of the characteristics and performance of bioretention systems for the removal of several heavy metals (copper, lead, and zinc) and nutrients (phosphorus, total Kjeldahl nitrogen [TKN], ammonium, and nitrate) from a synthetic urban stormwater runoff was completed using batch and column adsorption studies along with pilot-scale laboratory systems. The roles of the soil, mulch, and plants in the removal of heavy metals and nutrients were evaluated to estimate the treatment capacity of laboratory bioretention systems. Reductions in concentrations of all metals were excellent (> 90%) with specific metal removals of 15 to 145 mg/m2 per event. Moderate reductions of TKN, ammonium, and phosphorus levels were found (60 to 80%). Little nitrate was removed, and nitrate production was noted in several cases. The importance of the mulch layer in metal removal was identified. Overall results support the use of bioretention as a stormwater best management practice and indicate the need for further research and development.

Case report of substance dependence with buprenorphine and mephentermine

Here is reported an unusual case of substance dependence with buprenorphine, mephentermine, & promethazine. This combination taken through intramuscular route produced a relatively mild & delayed abstinence syndrome with features viz. increased sleep and appetite in the patients. The neurophysiological basis for use of this rare form of additive (mephentermine) with buprenorphine is speculated.

Characterization of wheatgrass-derived barley yellow dwarf virus resistance in a wheat alien chromosome substitution line

ABSTRACT Wheatgrass (Thinopyrum intermedium) possesses a high level of resistance to barley yellow dwarf virus (BYDV) subgroup I and subgroup II strains. A wheat line (P29), in which the 7D chromosome has been substituted with a group 7 chromosome from T. intermedium, was examined for the level of resistance to two subgroup I and two subgroup II BYDV strains. In P29 plants inoculated with the subgroup I PAV strains, the titer of virus in leaf and stem tissue was typically reduced 42 to 52% when compared with the BYDV-susceptible cv. Abe. P29 and 'Abe' had the same content of PAV in roots. These results and the absence of detectable virus in inoculated T. intermedium plants indicate that the complete resistance to subgroup I possessed by the wheatgrass has not been introgressed into P29. In contrast, P29 was completely resistant throughout the plant to the subgroup II strains, NY-RPV and NY-RMV, demonstrating that the complete resistance to subgroup II in T. intermedium was incorporated into P29. Further analysis of this resistance to NY-RPV showed that NY-RPV can replicate in mesophyll protoplasts of P29 and 'Abe', suggesting that this resistance is not operating at the single-cell level. Molecular marker analysis confirmed that the T. intermedium chromosome present in P29 is a different group 7 wheatgrass chromosome than that present in L1, a wheat line with BYDV resistance properties similar to those of P29.

Psychiatric morbidity among victims of bomb blast

Thirty one victims of bomb blast in a bus caused by terrorist activity in Dausa district, Rajasthan on 22.5.96, were evaluated for psychological reactions 3 days & 2 weeks after the incident. All hospitalized & non hospitalised bomb blast victims were assessed within 3 days of injury by objective predictors (percent of burnt area, facial disfigurement, limb amputations, fractures etc.) and subjective predictors (emotional distress and perceived social support). Detailed history, physical and mental state examination of all patients was carried out and for those having scores more then 17 on GHQ-60 (Hindi version), IPIS was administered. Diagnosis was made by 3 senior consultant psychiatrists of Psychiatric Centre, Jaipur, on the basis oflCD-10. At day 3 of 31 patients studied 11 (35.45%) had psychiatric morbidity. Out of which 6 (19.35%) had acute stress reaction, 3 (9.68%) had depression and 2 (6.45%) dissociative amnesia. Most commonly reported symptoms on IPIS were depersonalisation, derealisation, sleep disturbances specially generalised sleep loss, loss of appetite, nightmares, situational anxiety, depression, mental irritability, dulness of feelings, self blame, guilt, loss of interest, suicidal ideas, and worry about money, spouse, work and children. Most common physical injury was burns, followed by hearing disturbances, wounds received due to glass <& metal pieces and non specific pains and aches. Findings of follow up have been discussed and battery of tests for evaluation of victims of acute trauma has been suggested.

Election - a stressful life event

54 patients who sought consultation at this centre after developing psychiatric illness following local panchayat elections in Rajasthan were studied. The study aims to find out whether election is a stressful life event, relationship of socio-demographic characteristics, role of process of election, and nature of psychiatric illness as related to election stress. This group was compared to general psychiatric patients randomly selected from the same hospital, with or without other stressful life events (n=60). Socio-demographic variables, nature of their illness, ways of coping with the stress and relationship of predisposition to mental illness have been studied in both groups. Findings have been discussed and implications highlighted.

An investigation of the parameters influencing the bioadhesive properties of Myverol 18-99/water gels

An in vitro assessment was undertaken of the parameters influencing the bioadhesive strength of lyotropic liquid crystalline gels formed by the monoglyceride blend Myverol 18-99 and water. The gels were found to bind more strongly to a dry Perspex surface than to moist mucosal tissue and were shown to be weaker bioadhesives than Carbopol 934P and sodium alginate. The works of adhesion and forces of detachment were independent of contact time, were reduced by the presence of surface water and increased with an increase in the compression force, suggesting that interpenetration was not the mechanism of bioadhesion. The bioadhesion of Myverol 18-99/water gels appeared to be due to secondary chemical bonds, such as van der Waals forces, but was limited by their cohesive strength. An in vivo gel retention assessment by gamma scintigraphy showed that the gels were retained within the vaginal cavity for a period of at least 6 h.

Endothelial cell seeding kinetics under chronic flow in prosthetic grafts

Improved patency of endothelial cell seeded grafts relies on good initial adherence and cell retention when the circulation is restored. In this study human adult endothelial cells (HAECs) were used to evaluate the suitability of commercially available prostheses for seeding. Acutely seeded indium-111 oxine labeled HAECs were used to measure cell adherence to plain and fibronectin (FN)-coated expanded polytetrafluoroethylene (ePTFE), gelatin-impregnated Dacron (Gelseal), and collagen-impregnated Dacron (Hemashield) grafts. Cell loss from FN-coated prostheses, when exposed to a simulated human arterial blood flow of 200 ml/min in an artificial pulsatile circulation, was quantified from the loss of gamma activity from the graft over 24 hours, pressure in the circulation being reduced to 15 mm Hg to reduce fluid loss. Initial HAEC adherence (mean [SD]) to plain grafts was 3(1)%, 47(9)%, and 53(9)% for ePTFE, Gelseal, and Hemashield, respectively. This improved significantly with FN coating (78[6]%, 60[8]%, and 76[4]%). Cell retention after 24 hours of flow to FN-coated grafts was 16(10)%, 25(5)%, and 65(4)% and was confirmed qualitatively by scanning electron microscopy and environmental scanning electron microscopy. FN significantly improved initial cell adherence with Dacron grafts showing the better adherence. Cell retention after 24 hours of flow was better with FN-coated Dacron than with ePTFE but was best with Hemashield grafts.

Antidepressant-induced hyponatraemia in the aged. Avoidance and management strategies

Antidepressant-induced hyponatraemia, while relatively uncommon, is an important clinical problem with serious consequences. Most antidepressants have been associated with hyponatraemia. Although the exact mechanism by which abnormalities of serum sodium level are produced is not known, most of the patients described in case reports meet the accepted criteria for the syndrome of inappropriate antidiuretic hormone secretion. Symptoms of hyponatraemia can mimic depression or psychosis, so awareness of this syndrome and periodic monitoring of serum electrolytes are important for early recognition. Stopping the medication and assuring normal extracellular fluid volume are the mainstay of treatment; rarely, intravenous infusion of hypertonic saline is required. After correcting the metabolic abnormalities, options for treatment of depression include: rechallenging with the same medication or initiating another antidepressant while carefully monitoring serum sodium level, or considering electroconvulsive therapy, if warranted by the clinical condition.

Interleukin (IL) 15/IL-T production by the adult T-cell leukemia cell line HuT-102 is associated with a human T-cell lymphotrophic virus type I region /IL-15 fusion message that lacks many upstream AUGs that normally attenuates IL-15 mRNA translation

We reported previously that the human T-cell lymphotrophic virus type I (HTLV-I)-associated adult T-cell leukemia line HuT-102 produces a cytokine designated interleukin (IL) T that requires interleukin (IL) 2 receptor beta-subunit expression for its action. Using anti-cytokine antibodies, we demonstrated that IL-T is identical to the simultaneously described IL-15. When compared to activated monocytes, IL-15 mRNA expression was 6- to 10-fold greater in HuT-102 cells. The predominant IL-15 message from HuT-102 is a chimeric mRNA joining a segment of the R region of the long terminal repeat of HTLV-I and the 5'-untranslated region (UTR) of IL-15. Normally, by alternative splicing, this 118-nucleotide R element represents the most 5' region of several HTLV-I transcripts including tax, rex, and env. The introduction of the R element eliminated over 200 nucleotides of the IL-15 5'-UTR, including 8 of 10 upstream AUGs that are present in normal IL-15 messages. On analysis of the 5'-UTR of normal IL-15, we demonstrated that the presence of these 10 upstream AUGs interferes with IL-15 mRNA translation. Thus, IL-15 synthesis by the adult T-cell leukemia line HuT- 102 involves an increase in IL-15 mRNA transcription and translation secondary to the production of an HTLV-I R element fusion message that lacks many upstream AUGs.

Herpes associated erythema multiforme annularis concentricum

A young man had large, concentric plaques over the back and extensors of forearms for eight weeks. Past history suggested recurrent herpes labialis. Serum anti HSV-1 IgG titre was raised to 32 micrograms/l and histopathology of an active lesion suggested erythema multiforme. Symptomatic treatment and oral zinc therapy subsided EM lesions but concentric depigmentation developed after healing.

Molecular manifestations of cardiac hypertrophy in the spontaneously hypertensive rat effects of antihypertensive treatments

Antihypertensive treatments were given to young and adult SHRs, to prevent and reverse hypertension, respectively. Cardiac hypertrophy and the steady state level of the "fetal" genes, ANP, alpha-skeletal actin (alpha-skA), and beta myosin heavy chain (beta-MHC) mRNAs were assessed. Our findings show that the reduction of blood pressure does not consistently result in a similar regression of the "fetal gene program".

Chronic hydronephrosis: renographic drainage patterns and renal morphology in an animal model

OBJECTIVE

To develop an animal model of chronic progressive hydronephrosis; to establish patterns of diuretic renography during development of the condition; and to relate renographic abnormality to morphological change in the renal parenchyma.

MATERIALS AND METHODS

The cellophane sclerosis technique was used to produce a hydronephrosis in the left kidney of six rabbits. Post-operatively MAG3 diuretic renography was performed at weekly intervals. When a steady renographic trend was noted the rabbits were killed and the kidneys examined histologically.

RESULTS

Four rabbits had persistent type II renographic curves on the left for 12 weeks. The measured split renal function fell steadily to < 20% in this time. Morphologically there was hydronephrosis with marked structural changes in the parenchyma seen on histological examination. Two rabbits had stable type IIIa renographic drainage patterns on the left with preserved renal function. Morphologically there was hydronephrosis but histologically the kidneys were normal. There were no renographic or structural changes in a control rabbit after a sham laparotomy.

CONCLUSIONS

The cellophane sclerosis technique can be used to create a reproducible chronic progressive hydronephrosis. In this animal model hydronephrosis and a persistent type II curve are associated with renographic evidence of deteriorating renal function and disruption of renal architecture histologically. Hydronephrosis and a type IIIa curve are associated with preservation of normal renal function and histological structure.