Fractures in the Maxillofacial Region: A Four Year Retrospective Study

Introduction

The incidence of maxillofacial injuries is on the rise due to motor vehicle accidents and increased incidence of violence in recent times. The aim of this retrospective study was to determine the incidence, aetiology, the pattern of fractures, their management with open reduction and internal fixation (ORIF) and complications, if any.

Methods

A retrospective analysis of 621 fractures in 361 patients managed by ORIF over a four year period was carried out.

Result

The average age of patients was 24.3 years with a male to female ratio of 21.2:1. Panfacial fractures comprised 4.7%, frontal bone fractures 8.9%, orbital fractures 0.7%, naso-orbito-ethmoid complex (NOE) fractures 0.7%, zygomatic complex fractures 23.5%, fracture maxilla 11.5% and mandibular fractures 52.2% of all facial fractures. All the cases were successfully managed by ORIF under general anaesthesia (GA). Complications were noticed in 6.8% of cases in the form of reactive implants in 3.6%, deranged occlusion in 1% and infection at operated site in 1% cases which were managed satisfactorily.

Conclusion

The findings of this study reveal sharp annual increase in the number of cases of maxillofacial trauma. Road traffic accidents (RTA) were the commonest cause and the age group most affected was between 20-25 years. ORIF of these fractures was chosen for its obvious advantages of direct anatomical reduction, early return to function and minimal complications.Key Words: Road traffic accidents (RTA), Inter maxillary fixation (IMF), Open reduction and internal fixation (ORIF)     

Early predictors of success of non-invasive positive pressure ventilation in hypercapnic respiratory failure

Background

Non-invasive positive pressure ventilation (NIPPV) has emerged as a significant advancement in the management of acute hypercapnic respiratory failure.

Method

Patients with hypercapnic respiratory failure requiring ventilation therapy (respiratory rate [RR] of > 30 breaths per minutes, PaCO2 > 55 mmHg and arterial pH < 7.35) were included in the study. Baseline clinical parameters and arterial blood gas (ABG) were recorded before initiating NIPPV. Clinical parameters including heart rate (HR), RR, oxygen saturation and ABG were revaluated at 1, 4, and 24 hours after initiation of NIPPV. Change in these parameters and need for intubation was evaluated.

Results

Of the 100 patients, 76 (76%) showed improvement in clinical parameters and ABG. There was improvement in HR and RR, pH, and PCO2 within the first hour in the success group and these parameters continued to improve even after four and 24 hours of NIPPV treatment. Out of 24 (24%) patients who failed to respond, 13 (54%) needed endotracheal intubation within one hour. The failure group had higher baseline HR than the success group.

Conclusion

Improvement in HR, RR, pH, and PCO2 one hour after putting the patient on NIPPV predicts success of non-invasive positive pressure ventilation in hypercapnic respiratory failure.     

Article not available electronically: Neurocognitive impairment in alcohol-dependence syndrome cases and its response to treatment

Background

A sizeable portion of psychiatric ward beds in military hospitals is occupied by patients with psychoactive substance abuse and especially by alcohol-dependence syndrome (ADS) cases. Though there have been significant advances in the diagnosis and management of these cases, not much of work has been done in our set up for the evaluation of their cognitive impairment and its response to treatment.

Methods

Neuropsychological evaluation of 100 cases of freshly diagnosed ADS was done by using postgraduate battery of brain dysfunction (PGI-BBD). The findings were compared with controls. They were detoxified, treated and after four weeks were re-evaluated and the findings were analysed.

Results

There was significant impairment in all parameters of cognition. All of them showed improvement with treatment but after four weeks, the impairment persisted to significant level in some parameters.

Conclusion

Alcohol-dependence syndrome cases have significant cognitive impairment but improve with detoxification, multivitamin supplement and abstinence. This aspect has to be kept in mind while deploying them in sensitive appointments.     

The case for the development of novel analgesic agents targeting both fatty acid amide hydrolase and either cyclooxygenase or TRPV1

Although the dominant approach to drug development is the design of compounds selective for a given target, compounds targeting more than one biological process may have superior efficacy, or alternatively a better safety profile than standard selective compounds. Here, this possibility has been explored with respect to the endocannabinoid system and pain. Compounds inhibiting the enzyme fatty acid amide hydrolase (FAAH), by increasing local endocannabinoid tone, produce potentially useful effects in models of inflammatory and possibly neuropathic pain. Local increases in levels of the endocannabinoid anandamide potentiate the actions of cyclooxygenase inhibitors, raising the possibility that compounds inhibiting both FAAH and cyclooxygenase can be as effective as non-steroidal anti-inflammatory drugs but with a reduced cyclooxygenase inhibitory ‘load’. An ibuprofen analogue active in models of visceral pain and with FAAH and cyclooxygenase inhibitory properties has been identified. Another approach, built in to the experimental analgesic compound N-arachidonoylserotonin, is the combination of FAAH inhibitory and transient receptor potential vanilloid type 1 antagonist properties. Although finding the right balance of actions upon the two targets is a key to success, it is hoped that dual-action compounds of the types illustrated in this review will prove to be useful analgesic drugs.     

Monosegmental fixation for the treatment of fractures of the thoracolumbar spine

Background:

A short vertebral arthrodesis has been one of the objectives of the surgical treatment of fractures of the thoracolumbar spine. We present here clinical, functional and radiographic outcome obtained after monosegmental fixation (single posterior or combined anterior and posterior) of specific types of unstable thoracolumbar fractures.

Materials and Methods:

Twenty four patients with fractures of the thoracolumbar spine submitted to monosegmental surgical treatment (Group I - 18 single posterior monosegmental fixations and Group II - 6 combined anterior and posterior fixations) were retrospectively evaluated according to clinical, radiographic and functional parameters. The indication for surgery was instability or neurological deficit. All the procedures were indicated and performed by the senior surgeon (Helton LA Defino).

Results:

The patients from group I were followed-up from 2 to 12 years (mean: 6.65±2.96). The clinical, functional and radiographic results show that a single posterior monosegmental fixation is adequate and a satisfactory procedure to be used in specific types of thoracolumbar spine fractures, The patients from group II were followed-up from 9 to 15 years (mean: 13 ± 2,09 years). On group II the results of clinical evaluation showed moderate indices of residual pain and of satisfaction with the final result. The values obtained by functional evaluation showed that 66.6% of the patients were unable to return to their previous job and presented a moderate disability index (Oswestry = 16.6) and a significant reduction of quality of life based on the SF-36 questionnaire. Radiographic evaluation showed increased kyphosis of the fixed vertebral segment during the late postoperative period, accompanied by a reduction of the height of the intervertebral disk.

Conclusion:

It is possible to stabilize the fractures which have an anterior good load-bearing capacity by a standalone posterior monosegmental fixation. However this procedure, even with an anterior support is not suitable for fracture involving the vertebral body.     

肝泡型包虫病临床分期与sIL-2R、TNF-α和IFN-γ含量的关系

为探讨肝泡型包虫病（Alveolar echinococcosis AE)临床分期与sIL-2R,TNF-α和IFN－γ含量的关系和意义,将经B超和血清学方法证实的23例AE病人和对照组12人采血后,用ELISA双抗体夹心法,做sIL-2R,TNF-α和IFN－γ含量的测定。按B超肝脏扫描的声像损害情况,将AE分期（组）,对照相应细胞因子的含量,经方差分析和Q检验,讨论细胞因子在AE发育增殖中的可能作用和临床意义。结果P2组、P3组、P4组和对照组sIL-2R每mL含量均值分别为96.57u、226.44u、193.81u、110.89u;TNF－α含量均值分别为P2组1．12μg/L,P3组3＝67μg/L,P4组1．30μg/L,对照组则为0．40μg/L;IFN－γ含量均值分别为P2组360ng/L,P3组486ng/L,P4组259ng/L,对照组则为15.63ng/L;各组经方差分析和Q检验,证实AE病人病理的三个不同时期,其sIL-2R,TNF-α和IFN－γ的含量均有显著性差异（P＜0．01）。sIL-2R含量均值除P2与对照组无差异外（P＞0．05）,其余各组与P2组和对照组均有显著性差异（P＜0．05）;TNF－α含量在P3组最高（P＜0．01）;AE各组病人的IFN－γ含量明显高于对照组（P＜0．01）,而AE病人组间却并无差异（P＞0．05）。低水平的sIL-2R可视为AE早期病变或疾病稳定的指标;反之则表示属AE的进展期;高水平的TNF－α可能是造成AE肝组织损伤的因素之一;单一的IFN－γ对AE的免疫防御作用有限,并不能有效地阻止AE的病理进展。     

Two-year follow-up after catheter-based radiotherapy to inhibit coronary restenosis

BACKGROUND: Although early trials indicate the treatment of restenosis with radiation therapy is safe and effective, the long-term impact of this new technology has been questioned. The possibility of late untoward consequences, such as aneurysm formation, perforation, and accelerated vascular disease, is of significant concern. Furthermore, it is not known whether the beneficial effects of radiation therapy will be durable or whether radiation will only delay restenosis. METHODS AND RESULTS: A double-blind, randomized trial was undertaken to compare 192Ir with placebo sources in patients with previous restenosis after coronary angioplasty. Patients were randomly assigned to receive a 0.76-mm (0. 03-in) ribbon containing sealed sources of either 192Ir or placebo. All patients underwent repeat coronary angiography at 6 months. All living patients were contacted 24 months after their index study procedure. Patients were assessed with respect to the need for target-lesion revascularization or nontarget-lesion revascularization, occurrence of myocardial infarction, or death. Over a 9-month period, 55 patients were enrolled; 26 were randomized to 192Ir and 29 to placebo. Follow-up was obtained in 100% of living patients at a minimum of 24 months. Target-lesion revascularization was significantly lower in the 192Ir group (15.4% versus 44.8%; P<0. 01). Nontarget-lesion revascularization was similar in 192Ir and placebo patients (19.2% versus 20.7%; P=NS). There were 2 deaths in each group. The composite end point of death, myocardial infarction, or target-lesion revascularization was significantly lower in 192Ir-treated versus placebo-treated patients (23.1% versus 51.7%; P=0.03). No patient in the 192Ir group sustained a target-lesion revascularization later than 10 months. CONCLUSIONS: At 2-year clinical follow-up, treatment with 192Ir demonstrates significant clinical benefit. Although further follow-up (including late angiography) will be necessary, no clinical events have occurred to date in the 192Ir group to suggest major untoward effects of vascular radiotherapy. At the intermediate follow-up time point, vascular radiotherapy continues to be a promising new treatment for restenosis.     

均一扩增和荧光杂交探针用于基因型检测

过去 5年中 ,在人类基因组测序和确定有临床意义的基因方面取得了巨大进展。具有临床意义的基因在疾病的诊断和预后估计以及疾病治疗中具有重要价值。通过直接测序将首先确定由种系和体细胞ＤＮＡ改变引起的未知基因突变 ,随后应用其他一些检测特别突变的方法。最近出现了采用ＰＣＲ和荧光杂交探针相结合的均一扩增技术用于基因型测定的设备和方法 ,并可在 1ｈ内完成产物分析。基因ＤＮＡ通过快速循环ＰＣＲ扩增 ,在反应开始时加入全部所需的试剂 ,15～ 2 0ｍｉｎ后完成ＰＣＲ ,仪器自动描记出一个熔解曲线。随着反应逐渐加热 ,进行连续荧光…