Tuberculosis of upper dorsal spine causing respiratory distress due to tracheo-oesophageal compression: an unusual presentation

A cold abscess causing tracheo-oesophageal compression is quite unusual. A case of a 5-year-old boy with caries spine of D3-D4 vertebrea with respiratory distress due to mediastinal cold abscess pressing over trachea is being reported. Urgent costotransversectomy was done to decompress the cold abscess. There was immediate relief of airway compression which was evident from fall in airway pressure from 39 cm H2O to 29 cm H2O. The child was extubated on the 5th postoperative day and discharged on the 15th postoperative day in good condition.

Preliminary soft tissue distraction using external fixator in radial club hand

Preliminary soft tissue distraction using an external fixator before centralisation and tendon transfer of the flexor and extensor carpi ulnaris to the little finger metacarpal was used to treat Bayne's type III and IV deformities in 18 hands of 14 patients with radial club hands. Treatment with external fixator was started at a mean age of 8 (range 3-30) months. In 16 of 18 hands, the surgical treatment was completed before 10 months of age. Adequate soft tissue stretching was achieved before centralisation using fractional distraction with the external fixator in the majority of hands. After an average follow-up period of 31 months, there were seven good, eight satisfactory and one unsatisfactory result.

Effect of fly ash inhalation on biochemical and histomorphological changes in rat liver

The effect of fly ash inhalation (4h daily, 5 days a week) for 28 days on the deposition of metal ions and histopathological changes in the liver and serum clinical enzymes has been studied. The results showed an increase in the concentration of metals such as cadmium (Cd), chromium (Cr), copper (Cu), manganese (Mn), and lead (Pb) in the tissues of exposed rats. The level of metals varied from metal to metal and from organ to organ. Level of serum enzymes such as serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, and alkaline phosphatase were increased in fly ash exposed rats using whole body inhalation exposure as compared to sham controls. Histopathological studies of rat liver exposed to fly ash revealed infiltration of mononuclear cells in and around the portal triads, which seems to be laden with fly ash particles. Hepatocytes showed necrotic changes such as pyknotic nuclei, karyorrhexis, and karyolytic. These changes were more towards the centrolobular areas than the midzonal and periportal areas. These findings demonstrate that the toxic metals of inhaled fly ash in rats may get translocated into extrapulmonary organs, become deposited and hence may manifest their toxic effects on different tissues.

Small wire external fixation for high-energy tibial plateau fractures

PURPOSE

To assess results of small wire external fixation using a ligamentotaxis technique for high-energy tibial plateau fractures.

METHODS

Between April 2002 and May 2004, 38 consecutive patients aged 21 to 60 (mean, 32) years underwent small wire external fixation for high-energy tibial plateau fractures. 15 involved the right and 23 the left knee. 34 were closed and 4 were open injuries. Fractures were classified according to Schatzker's staging system. After a minimal of 2 years' follow-up (range, 24-42 months), each affected knee was evaluated using Rasmussen's (1) 30-point clinical grading system and (2) radiological evaluation.

RESULTS

There were 22 type-VI and 16 type-V Schatzker tibial plateau fractures. Complications consisted of: 2 superficial infections, 3 pin site infections, and 4 peroneal nerve palsies. No soft tissue necrosis or devitalisation occurred. The mean range of knee movement was 132 degrees. The mean Rasmussen radiological score was 14 (range, 10-18): excellent in 6, good in 26, and fair in 6. The mean Rasmusssen functional score was 26 (range, 17-30): excellent in 19 patients, good in 17, and fair in 2. Clinical results did not parallel the radiological results.

CONCLUSION

Small wire external fixation allows anatomical reconstruction of the articular surface, stable fixation of fracture fragments, early movement of the joint, and care of associated soft tissue injuries, without a high rate of complications.

Surgical management for late presentation of supracondylar humeral fracture in children

PURPOSE

To report the results of surgical management for late-presenting displaced supracondylar fractures of the humerus in children.

METHODS

Between February 2002 and June 2003, 40 children (mean age, 7 years) with late presentation (range, 2-12 days) of displaced supracondylar humeral fractures were prospectively recruited. Gentle closed manipulation under image intensification was attempted in all patients, except one with a compound open fracture. Manipulation was successful in 25 patients and percutaneous skeletal stabilisation with Kirschner wires was performed. The remaining 15 patients were treated with open reduction and Kirschner wire fixation, using a mediolateral approach.

RESULTS

The mean delay in presentation was approximately 4 days. No patients presenting more than 7 days after injury had the fracture reduced by closed manipulation. The mean hospital stay was 41 hours. At the final follow-up (mean, 18 months), 88% of the patients had a satisfactory result, according to Flynn's criteria.

CONCLUSION

Operative treatment for late presentation of supracondylar humeral fractures in children is effective. It minimises the risk of complications and the need for continuous traction or corrective osteotomy.

Acquired radial club hand with humero-ulnar dislocation: a rare sequel to infantile compartment syndrome following venous cannulation: a case report

Acquired radial club hand caused by infection has been reported occasionally. We report a rare case of acquired radial club hand with an associated septic dislocation of the elbow, primarily caused by compartment syndrome following venous cannulation. The deformity and instability were treated with distraction using an external fixator followed by a centralisation procedure. At the 2-year follow-up the appearance and functions of the left forearm had improved considerably and the wrist was stable. There was no deterioration in ulnar growth.

Embryo and fetotoxicity of hexavalent chromium: a long-term study

Ingestion of chromium(VI) (250, 500 or 750 ppm as potassium dichromate, K2Cr2O7) through drinking water by female rats for 3 months prior to gestation was toxic to embryo and fetus. There was a significant reduction in number of implantations and number of fetuses and an increase in number of resorptions and pre-implantation and post-implantation losses. No significant visceral abnormality was found. The increase in the number of subdermal hemorrhagic patches on the thorax and abdomen was significant. Skeletal abnormality in the form of reduced ossification in parietal, interparietal and caudal bones was observed in fetuses. Chromium levels in the blood of mothers, placenta and fetuses showed a significant increase. Duration of the estrous cycle was also increased significantly. The study revealed that long-term chromium exposure in rats did not cause embryo and fetotoxicity in a duration-dependent manner compared to short-term treatment as observed earlier. A possible explanation could be that, in the 90-day study, the female rats did not mate for three estrous cycles, thus giving time for clearance of a sizable amount of chromium from their bodies.

Chromium induced teratogenicity in female rat

Exposure to chromium (VI) (250, 500 and 750 ppm as potassium dichromate) via drinking water pregestationally in rats revealed embryo- and fetotoxic effects in the form of a significant reduction in the number of implantations and number of fetuses. An increase in the number of resorptions, pre-implantation and post-implantation loss in chromium (VI)-treated mothers was also observed. No significant visceral abnormality was found. A significant increase in sub-dermal hemorrhagic patches on thoracic and abdominal areas was found. Skeletal abnormality in the form of reduced ossification in parietal, interparietal and caudal bones was found in the fetuses of chromium (VI)-treated mothers. Chromium levels in blood, placenta and fetuses were found to be significantly increased in the 500 ppm and 750 ppm dosed groups. The duration of estrus cycle was significantly altered after chromium (VI) exposure. This study suggests that chromium exposure in rat causes a lower degree of toxicity than in mice as observed in our earlier studies.