Is it possible to achieve multiplanar correction of complex deformities around the knee in children and adolescents using a monolateral external fixator?

PURPOSE

To present the technique of correction of multiplanar deformities around the knee in children and adolescents using the monolateral external fixator. Also, to evaluate the results of the technique regarding radiological correction, time to union, and possible complications.

METHODS

A total of 29 patients (47 limbs) were prospectively included in the study (14 males and 15 females). Their median age was 13 years (range, 7-17). All patients had at least a 2-plane deformity around the knee which was corrected using a monolateral external fixator. The primary outcome measure was deformity correction (correction of mechanical axis deviation (MAD) in both the coronal and sagittal planes with correction of rotational deformities). The secondary outcome measures included bony union, radiographic, and functional results (assessed by using the Association for the Study and Application of the Method of Ilizarov (ASAMI) score).

RESULTS

The median pre-operative MAD improved from 6.3 to 0.4 cm post-operatively. According to the ASAMI scoring system, the radiographic scoring was excellent in all cases (100%), and the functional scoring was excellent in 22 cases (89.7%) and good in three cases (10.3%).

CONCLUSION

The simple monolateral fixator can be an effective tool for multiplanar correction of complex deformities around the knee without limb length discrepancy.

Fusidic Acid/Tea-Tree Oil Nanoemulsions: A Potentially Safe and Effective Anti MRSA/MSSA Topical Agent for Chronic Wound Healing

Fusidic acid (FA) is clinically used as an antibacterial agent for the treatment of Gram-positive bacterial infections. It interferes with bacterial protein synthesis, specifically by preventing the translocation of the elongation factor G on the ribosome. In the present work, oil-in-water nanoemulsion (NE) was developed as a carrier for the transdermal delivery of FA. Different oils, surfactants and co-surfactants were screened. The solubility of FA, the emulsifying capacity of the surfactants and phase diagrams for each oil and surfactant mix were constructed. From the analysis, eight stable NE formulations were chosen, and their physicochemical properties were further evaluated. The antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) were also evaluated, and cytotoxicity was conducted on HS-27 cell line to determine the safety of the formula. It was found that the NE produced from tea tree oil has the most optimal stability with promising antibacterial activity against MRSA as compared to a commercially available product. The safety profile of the NE was also comparable to the commercial product; thus, the formulated FA-NE is promising for clinical use.

Determination of hormoligosis of organophosphate insecticides against Phenacoccus solenopsis

Abstract Cotton mealybug is a highly invasive pest of agricultural crops worldwide. Major agriculturists most rely on the use of insecticides for the control of pesticides. So, the indiscriminate use of insecticides leads to resistance development in recent years. For this purpose, an experiment was conducted using different concentrations of the three insecticides (profenfos chlorpyrifos and triazophos) to check the hormoligosis effects against cotton mealybug (CMB) in laboratory conditions. Investigation of variations for % mortality of adults of CMB after three days revealed that all treatments had statistically significant (P ˂ 0.05). The highest mortality was observed at the highest concentrations of profenofos 2.4% (38.55%). After 7 days, all the treatments were significant with difference in means (P ˂ 0.05). The highest mortality was recorded at the highest dilution of pesticide profenofos 2.4% (77.11%). The values of fecundity and longevity exposed a valid difference among treatments (P ˂ 0.05). Maximum fecundity was observed at the concentration 2.4% (181.41%) and longevity showed (38.46%). The highest mortality was observed at a concentration of triazophos 4% (27.98%). For chlorpyriphos the highest mortality was examined at concentration 4% (24.79%). The fecundity showed a statistically significant difference for different concentrations of triazophos and chlorpyriphos (P ˂ 0.05). The results of the recent study provide valuable information regarding the selection of insecticides and hormoligosis effects. The study can be helpful in the implications of integrated pest management of P. solenopsis.

Retrograde femoral nails for emergency stabilization in multiply injured patients with haemodynamic instability

Introduction

The purpose of this study is to retrospectively evaluate the immediate effect of retrograde intramedullary femoral nail (RIMFN) fixation technique on patient's hemodynamic status as documented by vital signs (blood pressure and pulse) intraoperatively in all patients with femoral shaft fractures with multiple injuries and hemodynamic instability who were treated with RIMFN at our institution on emergency basis as part of damage control orthopaedics.

Patients and methods

A retrospective review of intra operative vital signs obtained from patient records was completed at a Level 1 trauma center in a university hospital.

In all, 11 multiply injured patients with (14) femur fractures with hemodynamic instability were identified. Of those, 3 had bilateral femur fractures. Closed reduction and retrograde femoral nailing without proximal locking was performed to achieve immediate skeletal and haemodynamic stability. Pulse rate and BP measurements were noted for all patients starting from the time patient would enter the operating room till the patient was shifted back to the recovery ward.

Results

The average cohort age was 28 years (20–36 years). The average Injury Severity Score was 28 (16–50). Statistically significant improvement in pulse rate and blood pressure was noted following femoral fracture fixation with intramedullary nail. No cases of infection or symptomatic fat or pulmonary embolism were encountered. One patient required exchange nailing for non-union and one femur underwent later lengthening.

Conclusions

Retrograde Intramedullary femoral nail can be an effective alternative to external fixator as damage control device and is associated with immediate improvement in vital signs (pulse and blood pressure) intra operatively.

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Reversal of shock is important determinant of outcome in multiply injured patients.

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Retrograde femoral nailing achieves immediate haemodynamic stability.

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Retrograde nailing as damage control device has low morbidity and mortality.

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Retrograde nailing without proximal locking is rapid, safe, effective procedure.

Prevalence of Helicobacter pylori, gastric myoelectrical activity, gastric mucosal changes and dyspeptic symptoms before and after laparoscopic cholecystectomy

BACKGROUND/AIMS

Cholecystectomy may lead to anatomic and functional alterations which eventually induce reflux of duodenal contents with its sequlae. The aim of this study is to evaluate the prevalence of Helicobacter pylori (H. pylori), gastric myoelectrical activities and gastric mucosal changes before and after laparoscopic cholecystectomy.

METHODOLOGY

This prospective study has been carried out on 46 patients (20 M & 26 F) with mean age 41.7+/-0.2 years for whom laparoscopic cholecystectomy for gallstones was carried out. Prior to the operation and 1 year after, all patients were subjected to clinical assessment, upper gastrointestinal endoscopy, histopathology of antral mucosa, reflux gastritis score, detection of H. pylori and electrogastrography.

RESULTS

There was an increase in the postoperative suggestive symptoms of reflux gastritis compared to the preoperative: epigastric pain increased from 8 (17.4%) to 11 (23.39%) patients, nausea increased from 6 (13%) to 12 (26.1%) and bilious vomiting increased from 3 (6.5%) to 11 (23.9%) patients. Mild antral gastritis was detected endoscopically before laparoscopic cholecystectomy in 20 patients (43.5%) and increased to 27 patients (58.7%) after surgery. Meanwhile, severe antral gastritis and erosions were only detected after the operation in 10 (21.7%) patients, respectively. The histological results showed an increase of the histopathologic score of reflux gastritis after cholecystectomy from 4.28 (+/-1.56) to 9.28 (+/-1.99) (p<0.001). Active chronic superficial gastritis decreased from 23 (50%) to 13 (28.2%) patients while the inactive form increased from 15 (32.6%) to 23 (50%) patients. Also, chronic atrophic gastritis, intestinal metaplasia and dysplasia were detected postoperatively in 4 (8.6%) patients. The incidence of H. pylori infection was decreased from 32 (69.6%) to 19 (41.3%) patients (p<0.0001). Electrogastrography abnormal frequency decreased in fasting from 26.1% to 8.7% (p<0.001), and postprandial from 16.9% to 4.4% recording (p<0.002). On the other hand, there was an increase in the number of patients with decreased electrogastrography amplitude after a meal from 4.3% to 28.3% (p<0.0001).

CONCLUSIONS

Our study shows that dyspeptic symptoms, endoscopic and histologic gastric changes as well as electrogastrography abnormalities are present before and increase after cholecystectomy; meanwhile H. pylori colonization in gastric mucosa is decreased after cholecystectomy.

Does cholecystectomy affect antral mucosa? Endoscopic, histopathologic and DNA flow cytometric study

BACKGROUND/AIMS

Although cholecystectomy is still the "gold standard" for treatment of gallstones, this operation may be followed by gastric disorders. The aim of this study is to detect the effects of cholecystectomy on gastric antral mucosa.

METHODOLOGY

This prospective study has been carried out on 46 patients (20 M & 26 F) with mean age 41.7 +/- 0.2 years for whom simple cholecystectomy for gallstones was decided. Prior to the operation and 1 year after, patients were subjected to the following: clinical assessment, upper gastrointestinal endoscopy, histopathology of antral mucosa, detection of H. pylori and DNA flow cytometry.

RESULTS

There was an increase in the number of patients presenting suggestive symptoms of reflux gastritis: patients experiencing epigastric pain increased from 8 (17.4%) to 11 (23.39%) patients, nausea increased from 6 (13%) to 12 (26.1%) patients and bilious vomiting increased from 3 (6.5%) to 11 (23.9%) patients. Mild antral gastritis increased from 20 (43.5%) to 27 (58.7%) patients. Antral gastritis and antral erosions were detected only after the operation in 8 (17.4%) and 2 (4.3%) patients, respectively. The incidence of active chronic superficial gastritis decreased from 23 (50%) to 13 (28.2%) patients while the inactive form increased from 15 (32.6%) to 23 (50%) patients. Chronic atrophic gastritis, intestinal metaplasia and dysplasia were only detected postoperatively in 2 (4.3%) patients each. There was a decrease in the incidence of H. pylori infection from 32 (69.6) to 19 (41.3%) patients. DNA aneuploid pattern increased from 1 (2.2%) to 4 (8.7%) patients and there was a significant increase of DNA index from 1.01 (+/- 0.03) to 1.03 (+/- 0.05) (P < 0.005).

CONCLUSIONS

Changes in clinical, endoscopic and histopathologic findings suggest that cholecystectomy may affect gastric antral mucosa due to duodenogastric reflux. Flow cytometry may be used as an objective method for detection and evaluation of postcholecystectomy reflux gastritis.

Effect of dynorphin on insulin and somatostatin secretion, calcium uptake, and c-AMP levels in isolated rat islets of Langerhans

Dynorphin-[1-13], at concentrations of 5.8 X 10(-12) to 5.8 X 10(-9) M, stimulated insulin secretion from isolated islets of Langerhans of the rat, in medium containing 6 mM glucose. Higher concentrations of dynorphin had no significant effect on secretion. Dynorphin (5.8 X 10(-9) M) was unable to initiate insulin release from islets in the presence of 2 mM glucose, or to increase insulin secretion further in the presence of 20 mM glucose or 6 and 12 mM glyceraldehyde. Dynorphin-induced insulin secretion from islets was blocked by verapamil (5 microM) or by chlorpropamide (72 microM), but not by a mu opiate receptor antagonist, naloxone (0.11 microM), or by ICI 154129, a specific antagonist for the delta receptor (0.25 microM). Dynorphin had no effect on islet somatostatin secretion, under conditions in which insulin secretion was greatly stimulated. Glucose (20 mM) and glyceraldehyde (6 and 12 mM) significantly increased both insulin and somatostatin secretion. Dynorphin (5.8 X 10(-9) M) increased 45Ca2+ uptake into islets, and also increased intracellular islet c-AMP levels. These changes persisted when higher concentrations of dynorphin were used. These results suggest that (1) dynorphin is a very potent stimulus for insulin secretion; (2) dynorphin does not affect somatostatin secretion in static incubations of islets, in the same way as does glucose and glyceraldehyde; (3) dynorphin's effects may involve increased calcium ion movement and can be blocked by verapamil; (4) dynorphin can also increase islet c-AMP, and could thereby modulate the responsiveness of other secretagogues; (5) the actions of dynorphin on insulin secretion are not mediated by delta or mu opiate receptors in islets.