Short segment pedicle screw instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine

The purpose of this study was to evaluate and compare the effect of short segment pedicle screw instrumentation and an intermediate screw (SSPI+IS) on the radiological outcome of type A thoracolumbar fractures, as judged by the load-sharing classification, percentage canal area reduction and remodelling.

We retrospectively evaluated 39 patients who had undergone hyperlordotic SSPI+IS for an AO-Magerl Type-A thoracolumbar fracture. Their mean age was 35.1 (16 to 60) and the mean follow-up was 22.9 months (12 to 36). There were 26 men and 13 women in the study group. In total, 18 patients had a load-sharing classification score of seven and 21 a score of six. All radiographs and CT scans were evaluated for sagittal index, anterior body height compression (%ABC), spinal canal area and encroachment. There were no significant differences between the low and high score groups with respect to age, duration of follow-up, pre-operative sagittal index or pre-operative anterior body height compression (p = 0.217, 0.104, 0.104, and 0.109 respectively). The mean pre-operative sagittal index was 19.6° (12° to 28°) which was corrected to -1.8° (-5° to 3°) post-operatively and 2.4° (0° to 8°) at final follow-up (p = 0.835 for sagittal deformity). No patient needed revision for loss of correction or failure of instrumentation.

Hyperlordotic reduction and short segment pedicle screw instrumentation and an intermediate screw is a safe and effective method of treating burst fractures of the thoracolumbar spine. It gives excellent radiological results with a very low rate of failure regardless of whether the fractures have a high or low load-sharing classification score.

Cite this article: Bone Joint J 2014;96-B:541–7.

The effects of gender difference on monocrotaline-induced pulmonary hypertension in rats

The present study aimed to compare the effect of gender difference on hemodynamic consequences in the development of monocrotaline (MCT)-induced pulmonary hypertension in rat. The effect of antioxidant enzyme systems on the development of pulmonary hypertension mediated by the phytotoxin MCT and the effect of gender on these antioxidant systems were also investigated. For this purpose, the right ventricular pressures (RVPs) and right ventricular/heart weight (HW) ratios were compared between groups and the glutathione (GSH) level and superoxide dismutase (SOD), catalase (CAT) and glutathione-S-transferase (GST) activities were determined in lung and liver tissue samples of rats. RVP and right ventricular/HW ratios significantly increased in the MCT group compared to the control group. In the MCT group, RVP was significantly higher in males than females. MCT-induced pulmonary hypertension resulted in decreased GSH level, decreased GST and SOD activities and increased CAT activity in lung and liver tissues of both male and female rats. In addition, the lung and liver GSH level and GST and SOD levels were higher in female control rats compared to male control rats. The results of the present study, that antioxidant enzyme activities were different between the groups, highlight the possible role of oxidative stress in the pathogenesis of MCT-induced pulmonary hypertension in rats. Moreover, the lower antioxidant defense capacity of male rats than female rats may be considered as a cause of more aggressive course of MCT-induced pulmonary hypertension in males compared to females.

The effects of gender difference on monocrotaline-induced pulmonary hypertension in rats

The present study aimed to compare the effect of gender difference on hemodynamic consequences in the development of monocrotaline (MCT)-induced pulmonary hypertension in rat. The effect of antioxidant enzyme systems on the development of pulmonary hypertension mediated by the phytotoxin MCT and the effect of gender on these antioxidant systems were also investigated. For this purpose, the right ventricular pressures (RVPs) and right ventricular/heart weight (HW) ratios were compared between groups and the glutathione (GSH) level and superoxide dismutase (SOD), catalase (CAT) and glutathione-S-transferase (GST) activities were determined in lung and liver tissue samples of rats. RVP and right ventricular/HW ratios significantly increased in the MCT group compared to the control group. In the MCT group, RVP was significantly higher in males than females. MCT-induced pulmonary hypertension resulted in decreased GSH level, decreased GST and SOD activities and increased CAT activity in lung and liver tissues of both male and female rats. In addition, the lung and liver GSH level and GST and SOD levels were higher in female control rats compared to male control rats. The results of the present study, that antioxidant enzyme activities were different between the groups, highlight the possible role of oxidative stress in the pathogenesis of MCT-induced pulmonary hypertension in rats. Moreover, the lower antioxidant defense capacity of male rats than female rats may be considered as a cause of more aggressive course of MCT-induced pulmonary hypertension in males compared to females.

What kinds of hand injuries are more likely to result in amputation? An analysis of 6549 hand injuries

We analysed 6549 hand injuries treated between 1992 and 2005 at a specialist hospital in Turkey to identify risk factors for amputations. There were 2899 (44%) hand amputations. Left-side injuries were more prone to amputation. The risk of amputation was higher in men, workers and those in the 15-24 and 45-54 year-old age groups. Compared to home, commercial areas were the places with highest risk, followed by farms and industrial/construction areas. The majority of amputations occurred in industrial/construction areas (87%). Among objects/substances producing injury, watercraft led to the highest risk of amputation and contact with machinery was the mechanism with highest risk. Press machines were the most frequent objects causing amputation both in men and women, followed almost equally by powered wood cutters in men. Doors were the most frequent objects of amputation in children, followed by powered wood cutters. Education, enforcement, and improved engineering are the keys to prevent amputations. Precluding illegal child labour is essential.

Unipedicled laterodigital transposition flap for covering dorsal longitudinal skin defects in multi-digit injuries

A variety of flaps have been described to treat longitudinal soft tissue defects located on the dorsal aspect of the fingers. We report 13 dorsal soft tissue defects in four patients in which unipedicle laterodigital transposition flaps were used for reconstruction. This flap is especially useful for the reconstruction of long and narrow defects located on the dorsal region of the fingers in multi-digit injuries.

Reconstruction of finger pulp defects using homodigital dorsal middle phalangeal neurovascular advancement flap

Eighteen finger pulp defects were reconstructed using a homodigital dorsal middle phalangeal neurovascular island flap procedure based on a single neurovascular pedicle preserving the length of the finger. All flaps survived and achieved adequate functional and cosmetic results. The mean follow-up time was 22 months. The mean value of static two-point discrimination test of the healed flaps was 7 mm and the mean value of moving two-point discrimination test was 5 mm. Range of motion was considered satisfactory in all reconstructed fingers except one, in which a 20 degree extension deficit at the proximal interphalangeal joint was observed. This flap represents a useful alternative for reconstruction of the fingers with large pulp defects.

Cases of influenza A(H1N1)v reported in Turkey, May-July 2009

Following the declaration by the World Health Organization (WHO) of human cases of infection with a new influenza A(H1N1)v virus of swine origin, the Turkish Ministry of Health launched a case-based reporting of influenza A(H1N1)v throughout the country on 27 April 2009. The index case was detected on 15 May 2009. As of 17 July 2009 the number of laboratory-confirmed cases of influenza A(H1N1)v totaled 128 of whom 38 were indigenous cases.

Cases of influenza A(H1N1)v reported in Turkey, May-July 2009

Following the declaration by the World Health Organization (WHO) of human cases of infection with a new influenza A(H1N1)v virus of swine origin, the Turkish Ministry of Health launched a case-based reporting of influenza A(H1N1)v throughout the country on 27 April 2009. The index case was detected on 15 May 2009. As of 17 July 2009 the number of laboratory-confirmed cases of influenza A(H1N1)v totaled 128 of whom 38 were indigenous cases.

Evaluation of peripheral nerves of the upper limb with ultrasonography: a comparison of ultrasonographic examination and the intra-operative findings

We prospectively studied 26 consecutive patients with clinically documented sensory or motor deficiency of a peripheral nerve due to trauma or entrapment using ultrasound, and in 19 cases surgical exploration of the nerves was undertaken. The ultrasonographic diagnoses were correlated with neurological examination and the surgical findings. Reliable visualisation of injured nerves on ultrasonography was achieved in all patients. Axonal swelling and hypoechogenity of the nerve was diagnosed in 15 cases, loss of continuity of a nerve bundle in 17, the formation of a neuroma of a stump in six, and partial laceration of a nerve with loss of the normal fascicular pattern in five. The ultrasonographic findings were confirmed at operation in those who had surgery. Ultrasound may be used for the evaluation of peripheral nerve injuries in the upper limb. High-resolution ultrasound can show the exact location, extent and type of lesion, yielding important information that might not be obtainable by other diagnostic aids.

Autosomal dominant anhidrotic ectodermal dysplasias at the EDARADD locus

Anhidrotic ectodermal dysplasia (EDA) is a disorder of ectodermal differentiation characterized by sparse hair, abnormal or missing teeth, and inability to sweat. X-linked EDA is the most common form, caused by mutations in the EDA gene, which encodes ectodysplasin, a member of the tumor necrosis factor (TNF) family. Autosomal dominant and recessive forms of EDA have been also described and are accounted for by two genes. Mutations in EDAR, encoding a TNF receptor (EDAR) cause both dominant and recessive forms. In addition, mutations in a recently identified gene, EDARADD, encoding EDAR-associated death domain (EDARADD) have been shown to cause autosomal recessive EDA. Here, we report a large Moroccan family with an autosomal dominant EDA. We mapped the disease gene to chromosome 1q42.2-q43, and identified a novel missense mutation in the EDARADD gene (c.335T>G, p.Leu112Arg). Thus, the EDARADD gene accounts for both recessive and dominant EDA. EDAR is activated by its ligand, ectodysplasin, and uses EDARADD to build an intracellular complex and activate nuclear factor kappa B (NF-kB). We compared the functional consequences of the dominant (p.Leu112Arg) and recessive mutation (p.Glu142Lys), which both occurred in the death domain (DD) of EDARADD. We demonstrated that the p.Leu112Arg mutation completely abrogated NF-kB activation, whereas the p.Glu142Lys retained the ability to significantly activate the NF-kB pathway. The p.Leu112Arg mutation is probably a dominant negative form as its cotransfection impaired the wild-type EDARADD's ability to activate NF-kB. Our results confirm that NF-kB activation is impaired in EDA and support the role of EDARADD DD as a downstream effector of EDAR signaling.

Ganglion cysts of the proximal tibiofibular joint review of literature with three case reports

Proximal tibiofibular ganglion is a rare disorder. It may settle down in the subcutaneous tissue or may develop along the peroneal muscles and nerve. Common clinical findings are various sizes of mass, pain and hypoesthesis due to compression neuropathy. We report three cases of proximal tibiofibular ganglion and review the literature about the diagnostic tools, recurrence rates and treatment modalities.

Long-term follow-up of coronary angioplasty in patients with diabetes compared with nondiabetics

BACKGROUND

Some reports have indicated that in patients with diabetes mellitus and multivessel disease, coronary artery bypass surgery is preferred over percutaneous coronary intervention (PCI). We retrospectively compared outcome PCI in diabetic and nondiabetic patients.

METHODS

Ninety-seven diabetics and 971 nondiabetics were included and randomised before PCI to aspirin alone or aspirin plus coumadin. Fifty diabetics and 481 nondiabetics underwent follow-up angiography. The primary endpoint comprised all-cause mortality, myocardial infarction or targetvessel revascularisation.

RESULTS

Baseline characteristics were similar between the groups except for significantly more males and smokers among the nondiabetics. The diabetics had significantly more previous strokes, more left anterior descending coronary artery disease as well as more restenotic lesions and multivessel disease. At 30 days, the primary endpoint had occurred in five diabetics (5.2%) and 47 nondiabetics (4.9%), (p=0.8) and at one year in 17 (17.5%) and in 165 (17.1%), respectively (p=0.9). Event-free survival remained comparable during long-term follow-up (four years). Multivariate analysis showed no differences for the occurrence of any event (p=0.9, 95% CI 0.6-1.7). At six months, the minimal luminal diameter was significantly smaller in the diabetics (1.55±0.76 mm vs. 1.78±0.66 mm, p=0.01). Diabetics also had more restenosis (41% vs. 23%, p=0.003).

CONCLUSION

Despite angiographical differences at six months between the diabetics and nondiabetics, both short-term and long-term clinical follow-up appeared to be similar.

Effect of coumarins started before coronary angioplasty on acute complications and long-term follow-up: a randomized trial

BACKGROUND

Coronary angioplasty frequently creates a thrombogenic surface, with subsequent mural thrombosis that may lead to acute complications and possibly stimulates the development of restenosis. Whether coumarins can prevent these complications is unclear. The objective of this open, randomized trial was to assess the clinical effect of coumarins started before coronary angioplasty and continued for 6 months.

METHODS AND RESULTS

Before coronary angioplasty, 530 patients were randomly assigned to aspirin plus coumarins and 528 patients to aspirin alone. At the start of the angioplasty, the mean international normalized ratio was 2.7+/-1.1; during follow-up, it was 3.0+/-1.1. At 30 days, the composite end point of death, myocardial infarction, target-lesion revascularization, and stroke was observed in 18 patients (3.4%) treated with aspirin plus coumarin compared with 34 patients (6.4%) treated with aspirin alone (relative risk, 0.53; 95% CI, 0.30 to 0.92). At 1 year, these figures were 14.3% and 20.3%, respectively (relative risk, 0.71; 95% CI, 0.54 to 0.93). The incidence of major bleeding and false aneurysm during hospitalization was 3.2% and 1.0%, respectively (relative risk, 3.39; 95% CI, 1.26 to 9.11). The benefit of coumarins was observed in both stented and nonstented patients.

CONCLUSIONS

Coumarins in addition to aspirin started before PTCA and continued for 6 months was more effective than aspirin alone in the prevention of acute and late complications after coronary angioplasty. This benefit was accompanied by a small but significant increase in bleeding complications.

Acute occlusion of the left main coronary artery following intracoronary ultrasound examination

Intracoronary ultrasound (ICUS) is generally considered as safe procedure, with a low complication rate. We describe a nearly fatal complication of a diagnostic ICUS study that was treated successfully with stent implantation in the left main coronary artery and discuss the indications and remaining risks of this procedure.

Ten-year follow-up of percutaneous transluminal coronary angioplasty for proximal left anterior descending coronary artery stenosis in 351 patients

OBJECTIVES

We sought to evaluate the short- and long-term results of balloon angioplasty for stenoses in the proximal left anterior descending coronary artery.

BACKGROUND

Both the supposedly high rate of acute complications and relatively poor long-term results of balloon angioplasty for stenoses in the proximal left anterior descending coronary artery have led to a search for alternative interventional techniques.

METHODS

We analyzed the success rates and long-term follow-up results in 351 consecutive patients who underwent balloon angioplasty for stenosis of the left anterior descending coronary artery proximal to its first side branch. The power of the study was >80% in detecting a difference of 9% in the proportion of patients who survived at 10 years, assuming an 80% survival rate in the control group.

RESULTS

There were 60 ostial and 291 nonostial stenoses. Follow-up lasted a median of 85 months (range 0 to 137) and was 100% complete. The angiographic success rate was 90.9%. The clinical success rate was 86.3%. Nine patients (2.6%) died, 17 (4.8%) needed emergency coronary artery bypass graft surgery, and 10 (2.8%) developed a myocardial infarction. Several patients had subsequent complications. The success and complication rates were not significantly different for patients with ostial and nonostial stenoses. Ten years after balloon angioplasty, freedom from mortality was 80%, freedom from cardiac death was 87%, freedom from myocardial infarction was 84%, freedom from vessel-related reinterventions was 66%, and freedom from angina pectoris was 33%. There were more reinterventions for ostial stenoses, with a 1-year relative risk of ostial versus nonostial stenoses for related reinterventions of 1.7 (95% confidence interval 1 to 2.8, p = 0.049).

CONCLUSIONS

More than 10 years ago, balloon angioplasty for stenoses in the proximal left anterior descending coronary artery, either ostial or nonostial, had a high success rate. Although the long-term results are satisfactory, ostial stenoses are associated with a higher early clinical restenosis rate requiring more reinterventions.

Long-term results after successful percutaneous transluminal coronary angioplasty in patients over 75 years of age

A prospective study comparing the long-term results of balloon angioplasty in patients over 75 years of age with those in a younger patient group is not available. A total of 192 consecutive patients aged > or = 75 years (group I) who underwent a balloon angioplasty were matched with 192 control patients aged 40 to 65 years (group II). The groups were matched for gender, angina pectoris class, left ventricular function, 1-, 2-, and 3-vessel coronary artery disease, and previous myocardial infarction. The mean follow-up was 40.4 months (range 0 to 110). Actuarial analysis (freedom from events) after 5 years yielded the following results for group I versus group II: free from death remained 77.1% versus 97.9% (p = 0.0001), from cardiac death 92.4% versus 97.9% (p = 0.049), and from angina pectoris 54.6% versus 75.1% (p = 0.03). The differences were not significant for those remaining free from myocardial infarction, repeat balloon angioplasty, or coronary artery bypass grafting. When elderly patients with complete revascularization (n = 127) were compared with a matched control group of 127 patients aged 40 to 65 years who underwent complete revascularization, there was only a significant difference in noncardiac death rates. We conclude that patients > 75 years of age have a significant higher cardiac and noncardiac death rate and a higher incidence of angina pectoris after successful balloon angioplasty. However, the incidence of reintervention and myocardial infarction is lower in the elderly. If complete revascularization is achieved in the elderly, then freedom from cardiac death and recurrence of angina pectoris would be comparable to that in younger patients.

A comparative histological study of non-porous and micro-porous (algae-derived) hydroxylapatite ceramics

Two different types of hydroxylapatite ceramics were examined histologically to assess their effects on the healing of standardized bone defects drilled in the mandibular bone of beagles. After 40 days both materials were totally enclosed by newly-formed bone, but only the defects filled with micro-porous hydroxylapatite were found to show bone incorporation which is a good indicator of implant stability. These results suggest that the physio-chemical similarities between the micro-porous hydroxylapatite and native bone may promote effective bone incorporation which can increase the stability of implants.

A possible factor in genetic instability of cancer cells: stress-induced secreted proteins lead to decrease in replication fidelity

Ultraviolet irradiation triggers a response in mammalian cells known as the UV response. Part of the UV response forms the enhanced synthesis of various extracellular proteins able to transmit the response to non-irradiated cells. Because several cancer-prone syndromes with enhanced genetic instability also have an enhanced synthesis of the same set of proteins without prior stimulation it is possible that induction of these stress responsive proteins may be involved in the process of carcinogenesis and genetic instability. To test this hypothesis mouse T lymphoma cells, GRSL13, were treated with the conditioned medium of UV-induced cells under various experimental conditions. Overall the mutation rate is enhanced 1.8-fold (P < 0.01). However, the degree of enhancement is strongly influenced by culture conditions. UV-induced factors only lead to an enhanced mutation rate when cells, both for the production and response to those factors, originate from a similar cell density. In addition, it was found that fresh medium interferes with this response. To eliminate the hindrance of these factors on the effect of the conditioned medium on the mutation rate, serum-starved cells at high density were treated with serum-free medium derived from high-density UV-irradiated cultures. Using these conditions a 2.8-fold (P < 0.002) enhancement of the mutation rate was found. Fluctuation analysis indicated that the enhancement is 10-fold during the first five generations after treatment. UV-induced factors have also been found to induce cell growth, and the degree of induction was linearly correlated with the enhancement in mutation rate. These experiments are in agreement with the hypothesis that induction of stress responses leads to genetic instability.

Too early for cardiac transplantation--the right decision?

In 109 out of 479 patients who were referred for cardiac transplantation it was considered to be too early to put them on the waiting list for a donor heart. The clinical course of these 109 patients was analysed in order to verify whether this decision had been right. The mean age of the patients was 43 years, half of them suffered from ischaemic heart disease. The systolic left ventricular function of the patients was severely depressed (mean left ventricular ejection fraction 21%) and the left ventricular cavity was markedly dilated (mean echocardiographic end diastolic dimension 73 mm). Functional capacity, measured by bicycle ergometry, was low: mean maximal workload 62% of the expected load for gender, height and age. The median follow-up duration was 31 months. The survival rate of the patients was better than that of 175 patients who were accepted for transplantation after referral, 92%, 87%, 81%, 71% and 73%, 73%, 71%, 68% after 1, 2, 3 and 4 years respectively. Re-assessment was necessary in 29% of the patients within 1 year and in 52% within 3 years. Twenty patients died: 12 patients died before re-assessment had been initiated (eight sudden deaths), six patients because of progressive heart failure before heart transplantation could be performed and two patients died after heart transplantation. Left ventricular ejection fraction, pulmonary capillary wedge pressure and transpulmonary gradient were not reliable predictors of the course of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of human leukocyte interferon on IgG on the replication of herpes simplex virus in nervous tissue in vitro

Herpes simplex virus type 1 (HSV-1) replicated productively in rabbit and guinea pig ganglia and nerve organ cultures when inoculated in high titres. Treatment with IgG 20 hr before and 48 hr after infection produced a delay of 4 to 7 days in the recovery of HSV-1 by the method of co-cultivation. The same result was obtained when IgG was combined with human leukocyte interferon. There was no difference in the period up to HSV recovery between the groups treated with interferon alone and the HSV control. Morphological evidence by light and electron microscopy of viral productive infection was obtained in all the cell types of nervous tissues infected in vitro.

Morphological alterations induced in organ cultures of human fetal trachea and bronchi by diethylnitrosamine (DEN)

Human fetal respiratory tract was exposed to the action of N-nitrosodiethyl-amine (DEN), a potent carcinogen for other species, in a organ culture system. The dose of 15 mul/ml DEN elicited an intensive proliferative response of the respiratory epithelium while higher doses were toxic.