Is methyl methacrylate fixator reliable for the treatment of gartland type IV supracondylar fractures?

Background

In childhood supracondylar fractures of the humerus, fixation with percutaneous Kirschner wire is the standard treatment. In the case of irreducible-unstable fractures, these can be defined as fractures in which reduction is not well-achieved or in which fixation cannot be achieved with the K-wire. Intraoperative management of these types of fractures may be difficult. Treatment with a methyl methacrylate fixator consisting of K-wire and methyl methacrylate cement, as defined by the senior author of the article, may be a good option for Gartland type IV supracondylar humeral fractures where the fracture is unstable in flexion and extension due to complete periosteal tearing.

Materials and Methods

The short-term and mid-term results of 27 patients between the ages of 4-12 with Gartland type IV supracondylar fracture of the humerus treated with methyl methacrylate fixation were reviewed. The patients were scored in terms of function and cosmetic satisfaction.

Results

A total of 19 of the 27 patients treated with the methyl methacrylate fixator had full elbow motion function and rated the outcome of the treatment as excellent, which was judged by orthopedic surgeons on the basis of Flynn's criteria. Six patients had nearly full elbow motion and evaluated their recovery outcome as good. Two patients reported nearly full range of motion (ROM) and evaluated the method as moderate in terms of treatment.

Discussion

Treatment with the methyl methacrylate fixation method is an inexpensive method that allows early joint mobilization, provides strong biomechanical stability, ensures good outcomes, and should be considered in the treatment of irreducible and unstable supracondylar fractures of the humerus.

Clinical comparison of hook plate fixation versus extension block pinning for bony mallet finger: a retrospective comparison study

The aim of this retrospective study was to determine whether traumatic mallet fractures had better outcomes when treated by hook plate fixation (13 patients) or extension block pinning (19 patients). We assessed outcomes using Crawford's criteria; distal interphalangeal joint range of motion; the DASH score; and a visual analogue scale score for pain. We measured radiological parameters. No significant differences were observed in functional and clinical outcomes and in complications. Whereas the operative time was longer in the hook plate group, intraoperative fluoroscopy use, time to bone union and time to return to work were greater in the extension block group. Although the hook plate method is more technically demanding, it provides good stable reduction, earlier mobilization and an earlier return to work. The extension block pinning technique is easier and as effective but it requires greater peri-operative fluoroscopy. Level of evidence: Level III.

A case of retinal detachment in retinitis pigmentosa

PURPOSE

To report case of retinitis pigmentosa in association with rhegmatogenous retinal detachment.

METHODS

An eight year old boy complained of a sudden visual loss. The patient had night blindness, bone spicule-like hyperpigmentation, pale optic disc in both eyes, and the retina was totally detached in the right eye.

RESULTS

He was initially treated with conventional scleral buckling surgery, then pars plana vitrectomy with silicone tamponade was performed and retinal reattachment was established. After the phacoemulsification combined with silicone oil removal the final visual acuity of counting fingers was obtained.

CONCLUSIONS

The association of retinitis pigmentosa and rhegmatogenous retinal detachment is uncommon in young patients.

The anticonvulsant hypersensitivity syndrome

BACKGROUND

The anticonvulsant hypersensitivity syndrome is a potentially fatal multisystemic reaction to anticonvulsant medications.

OBJECTIVES

The purpose of this study was to investigate the clinical characteristics of anticonvulsant hypersensitivity syndrome.

RESULTS

A total 32 subjects, aged from 6 to 72 years, diagnosed as having anticonvulsant hypersensitivity syndrome based on clinical and histopathological findings, were included in the study. In 22 of the 32 cases, the anticonvulsants had been administered prophylactically after craniotomy and in 10 cases for epilepsy. When the cases were assessed for skin lesions, maculopapular eruption was registered in 22, Stevens-Johnson syndrome in five, and toxic epidermal necrolysis (TEN) in five. Treatment included suspension of the offending drug and then, except for the cases with toxic epidermal necrolysis, administration of corticosteroids. The 22 cases that required anticonvulsant therapy were treated with valproic acid. In all cases, we observed rapid clinical improvement corroborated by laboratory findings.

CONCLUSIONS

It is essential that due importance be given to the development of an eruption in individuals to whom anticonvulsants are administered after craniotomy because anticonvulsant hypersensitivity syndrome is likely to be life-threatening.

The management of giant retinal tears with silicone oil

PURPOSE

To report the surgical success of vitrectomy with silicone oil tamponade in the treatment of retinal detachment associated with giant retinal tears due to various factors.

METHODS

We retrospectively evaluated 21 eyes of 21 patients with retinal tears 90 degrees or greater that underwent vitrectomy, with injection of perfluorocarbon liquids and silicone oil tamponade. Eight eyes (38.1%) had previous ocular surgery (4 aphakia-pseudophakia, 4 pars plana vitrectomy), 4 eyes (19.0%) had a history of trauma (blunt injuries in 2 and penetrating injury in 2), 3 (14.3%) had high myopia. Six eyes (28.6%) had no known condition predisposing to development of giant retinal tear.

RESULTS

Retinal attachment was obtained in 17 (80.5%) of 21 eyes, with a mean follow-up of 12.5 months. Visual acuity improved in 15 eyes (71.4%).

CONCLUSIONS

Pars plana vitrectomy with silicone oil tamponade proved highly effective in giant retinal tears in terms of anatomical and functional results.

A case of bacillary angiomatosis presenting as leg ulcers

We report a 32-year-old immunocompetent man who had multiple leg ulcers caused by bacillary angiomatosis without a history of direct contact with cats. Bacillary angiomatosis should be kept in mind in the differential diagnosis of leg ulcers in cases of unknown aetiology.

Surgical management of retinal detachment with choroidal coloboma

PURPOSE

To verify the functional and anatomical results of retinal detachments related to choroidal coloboma.

METHODS

Seven eyes with retinal detachment secondary to retinal breaks at the margin of or within a choroidal coloboma were analysed retrospectively.

RESULTS

Scleral buckling was performed in five of the seven eyes; two needed additional pars plana vitrectomy (PPV) with internal tamponade using silicone oil to reattach the retina. In two eyes PPV with internal tamponade using silicone oil or gas was used as a primary procedure. All seven eyes were reattached. Five eyes (71.4%) showed improvement or had visual acuity of 20/400 or better after surgery, but two remained unchanged.

CONCLUSIONS

Retinal detachment secondary to choroidal coloboma can be treated successfully by scleral buckling or PPV with internal tamponade.

Aqueous humor nitric oxide levels in patients with central retinal artery occlusion

BACKGROUND/PURPOSE

There is increasing evidence suggesting that nitric oxide (NO) is implicated in the pathogenic process of ischemic disease. The purpose of this study was to quantify the aqueous humor NO levels in patients with central retinal artery occlusion (CRAO) and in age-matched controls.

METHODS

Aqueous humor specimens were obtained from seven patients who had been diagnosed with CRAO; the sampling was done within 12 to 24 hours of diagnosis. All specimens were obtained by paracentesis, which was performed as a therapeutic intervention. Samples of aqueous humor were also collected from 15 age-matched healthy patients undergoing cataract surgery, to be used as controls. For each sample, we assayed the amount of nitrite, which is the stable metabolite of NO, using the spectrophotometric method based on the Griess reaction.

RESULTS

There were detectable levels of nitrite in the aqueous humor from five of seven patients with CRAO (mean level, 0.32 +/- 0.08 micromol/L). The levels in the control group were below the detection limit in all cases (<0.08 micromol/L). There was a statistically significant difference between the aqueous humor nitrite levels in the CRAO group and the controls (P = 0.0008).

CONCLUSIONS

Our study shows that patients with CRAO present with elevated levels of NO in the aqueous humor. These findings may provide insight into the role that NO plays in CRAO.

Role of the vitreous in age-related macular degeneration

PURPOSE

To investigate the relationship between posterior vitreous detachment (PVD) and age-related macular degeneration (AMD).

METHODS

The condition of the vitreous was examined by slit-lamp funduscopy and ultrasonography in 93 eyes of 50 patients with AMD (exudative or dry) and 100 eyes of 50 controls.

RESULTS

There was complete PVD in 31 of the 93 eyes (33.3%) of 50 patients with AMD and the posterior vitreous was attached in 62 of these eyes (66.6%). In the control group, in 50 eyes (50%) of 50 subjects there was posterior vitreous detachment. The prevalence of PVD in eyes with macular degeneration was significantly lower (P < .05). There was no statistically significant difference between the exudative and the nonexudative groups in respect to PVD.

CONCLUSIONS

PVD may have a protective role against the development of AMD. Chronic vitreomacular traction and/or continuous exposure to free radicals and cytokines may possibly be one of the causes of AMD in eyes with attached vitreous.

Cutaneous leishmaniasis: evaluation of 3,074 cases in the Cukurova region of Turkey

A total of 3,074 cases of cutaneous leishmaniasis was evaluated for demography, diagnosis, clinical characteristics and treatment. A peak in the number of cases was observed in 1991 and 1992, with a total of 1,550 cases. There were seasonal differences in frequency, the highest levels being recorded during the period October-December each year. The disease was more frequent in females (59%) and in the age group 10-19 years (41%). More than 80% of 4394 lesions were located on exposed body sites, and most patients (87%) had the acute form of the disease. Diagnosis was made by the smear method in 90% of cases. Treatment was by intralesional injection of antimony compounds in 76% of cases. Cryotherapy was used in most of the remaining cases, either alone or combined with intralesional injection of antimony compounds. The overall healing rate was over 90%.

Autosomal recessive nanophthalmos

Nanophthalmos is a rare congenital ocular malformation which is generally recognized at middle age when serious complications have already developed. In this report 7 early diagnosed nanophthalmic cases are presented and diagnostic criteria, complications, inheritance and various modalities of treatment are discussed.

Electron microscopy of psoriatic skin before and after psoralen/ultraviolet A treatment

Skin biopsy specimens of patients with psoriasis receiving psoralen/ultraviolet A treatment were examined. A decrease in tonofilaments and keratohyaline granules and enlarged intercellular spaces were common findings in all cases. Hyperchromatic nuclei in the horny cells and hyperactive keratinocytes in the malpighian layer were also observed. Treatment resulted in normalization of keratinocytes and stimulation of melanocytes. Our study revealed that psoralen/ultraviolet A is effective and important in the treatment of psoriasis, but patients should be evaluated for atypical changes.

Chronic granulomatous anterior uveitis associated with multiple sclerosis

A retrospective review is presented of the medical records of seven female patients with uveitis associated with definite multiple sclerosis. Six of the patients had severe bilateral chronic granulomatous anterior uveitis, which in four cases resulted in extensive posterior synechiae and scarring of the peripupillary iris. One patient had bilateral intermediate uveitis with unilateral posterior synechiae. Severe chronic granulomatous anterior uveitis associated with multiple sclerosis has a predilection for women, can precede neurological symptoms and can be controlled with topical steroids.