Flexible intramedullary nailing of displaced diaphyseal forearm fractures in children

INTRODUCTION: This study analyses the results of 50 displaced diaphyseal forearm fractures in children treated with flexible intramedullary nailing. METHODS: Between 1999 and 2002 we treated 50 children aged between 5 and 15 years, with diaphyseal fractures of the forearm using Flexible intramedullary nailing (FIN). Both bones were fractures in 45 patients, radius only in 4 and ulna only in 1. The indications for fixation were instability (26), re-displacement (20), and open fractures (4). RESULTS: 24 patients were reduced closed, followed by nailing, while 26 fractures required open reduction of either one bone(16 cases) or both bones(10 cases) prior to nailing. Bony union of all fractures was achieved by an average of 7 weeks (range 6 weeks to 4 months) with one delayed union. Pronation was restricted by an average of 20 degrees in 9 patients. Two patients developed post operative compartment syndrome requiring fasciotomy. Three patients were lost to follow-up. INTERPRETATION: FIN led to early bony union with acceptable bony alignment in all 47 patients available at final follow-up. We therefore recommend FIN for the treatment of unstable diaphyseal forearm fractures in children.     

Pregabalin add-on treatment in patients with partial seizures: a novel evaluation of flexible-dose and fixed-dose treatment in a double-blind, placebo-controlled study

PURPOSE: To evaluate pregabalin as add-on therapy for patients with partial seizures administered as fixed dose or as flexible dose adjusted to optimal seizure reduction and tolerability. METHODS: Patients receiving antiepileptic drugs (98.8% between 1 and 3 AEDs; 1.2% on more than 3 AEDs) and experiencing > or =4 partial seizures during the 6-week baseline period and no 4-week seizure-free interval were randomized (1:2:2) to placebo (n = 73), pregabalin fixed dose (600 mg/day BID; n = 137), or pregabalin flexible dose (n = 131; 150 and 300 mg/day for 2 weeks each; 450 and 600 mg/day for 4 weeks each, BID) for 12 weeks. Dosage could be adjusted based on tolerability and maintained when a 4-week seizure-free period was achieved. Primary efficacy parameter was reduction in seizure frequency from baseline. RESULTS: Both pregabalin regimens significantly reduced seizure frequency compared with placebo, by 35.4%, for flexible dose (p = 0.0091) and 49.3% for fixed dose (p = 0.0001) versus 10.6% for placebo, and the fixed-dose group was superior to the flexible-dose group (p = 0.0337). Most adverse events were mild or moderate. Discontinuation rates due to adverse events were 6.8% (placebo), 12.2% (pregabalin flexible dose), and 32.8% (pregabalin fixed dose). Patients receiving pregabalin fixed dose discontinued due to adverse event earlier than other groups. CONCLUSIONS: Pregabalin administered twice daily, either as fixed (600 mg/day), or as flexible (150-600 mg/day) dose, was highly effective and generally well-tolerated as add-on therapy for partial seizures with or without secondary generalization. Lower incidence of adverse events and discontinuations were achieved in patients receiving pregabalin when dosing was individualized to optimize efficacy and tolerability.     

Kleinzehendeformitäten

Zusammenfassung Stellten in der Vergangenheit — in Analogie zur Behandlung des Hallux valgus — resezierende Operationsverfahren die Methode der Wahl auch zur Korrektur von Kleinzehendeformitätem dar, stehen heutzutage auch bei Fehlstellungen der Kleinzehen rekonstruktive, gelenkerhaltende Operationen im Vordergrund des Therapiespektrums.Aufbauend auf einer differenzierten Analyse der Pathobiomechanik der Fehlstellung unter dem Gesichtspunkt einer kontrakten oder flexiblen Deformität kann mittels Sehnentranspositionen oder Korrekturosteotomien eine Funktionseinschränkung häufig vermieden werden. Eine Resektionsarthroplastik sollte in der Anwendung auf kontrakte Fehlstellungen beschränkt bleiben, der Verlust des Metatarsaleköpfchens bei der Therapie degenerativer Deformitäten gänzlich vermieden werden.     

Efficacy of 10 different cleaning processes in a washer-disinfector for flexible endoscopes

Successful cleaning of medical devices, such as flexible endocopes, has been recognized to be of major importance for effective processing. Washer-disinfectors (WD) are considered to be an important step in this direction. The cleaning process in WD, however, has only been partially assessed regarding its effectiveness, and therefore to study this in more detail, tests were carried out, according prEN ISO 15883, using transparent teflon tubes as test pieces (length 2 m). For each experiment three test pieces were contaminated with the 'German test soil' containing Enterococcus faecium in blood, two for the test and one as a control (no automatic cleaning). Automatic cleaning was performed with a Wassenburg WD 440. Ten cleaning agents were used. In addition the process was carried out with water alone. After automated cleaning, test pieces were assessed visually (four categories, range: very poor to excellent visible cleanliness) and microbiologically [log(10) reduction factor (RF)]. Each experiment was repeated three times. Using the WD water gave excellent visible cleanliness with a mean RF of 1.1+/-0.6. The same excellent visible cleanliness was obtained with seven cleaning processes: deconex 23 Neutrazym, Helimatic Cleaner enzymatic, Korsolex-Endo-Cleaner, Labomat E, neodisher mediclean, Thermosept ER, and Thermoton NR. Worse visible cleanliness was found with three cleaning processes: Olympus ETD Cleaner and neodisher FE led to adequate visible cleanliness, and the cleaning process with neodisher medizym led to poor visible cleanliness. Six cleaning processes reduced the test organism by RF>or=3, i.e. the reduction was significantly higher than after cleaning with water alone. No significant difference between use of water alone and the cleaning process was found with three cleaning processes: Olympus ETD Cleaner, neodisher mediclean, and Thermosept ER (range RF: 0.8-1.8; P > 0.05). The cleaning process with neodisher medizym yielded a significantly lower mean RF (P = 0.039) in comparison with water treatment alone. Both visible cleanliness and mean RF, varied indicating that the choice of cleaning process had a major impact on the overall result.     

应用U-100激光腔内碎石术治疗输尿管及膀胱结石的临床观察

目的探讨输尿管镜下应用U-100激光治疗输尿管及膀胱结石的疗效。方法对25例输尿管结石和5例膀胱结石患者在输尿管镜下应用U-100激光进行碎石治疗。术中激光输出功率为120 m j,频率为3~5 Hz,输尿管结石患者术中均留置“双J”管引流,4周后拔除。结果23例输尿管结石及5例膀胱结石患者一次碎石成功,72 h内排尽结石。有2例输尿管上段结石患者1例术中结石移入肾盂,另1例激光碎石无效,术后均行ESWL治疗成功。U-100激光碎石成功率达93.3%。全部碎石成功的患者术后除出现血尿以外,无其他明显并发症出现。结论输尿管镜下应用U-100激光碎石是一种快速,高效,安全,微创的腔内碎石方式。     

A flexible system for recording activity of caged animals

A flexible, sensitive system for continuous recording of activity in caged animals is described. The system can be adapted for animals of different body size. The animal cage rests on a pneumatic system, comprised of four compressible rubber pads, coupled via vacuum tubing to an aluminum pan covered with a rubber diaphragm. Pressure changes in the pneumatic system due to movements of the animal displace the membrane and unbalance the Wheatstone bridge of a force displacement transducer. The output of the transducer is recorded by means of a direct writing oscillograph.     

Evaluation of indication-based use of transpedicular instrumentations with different rigidity for lumbar spinal fusion: a prospective pilot study with 3 years of follow-up

In a prospective cohort study in 94 patients with 3 years' follow-up the efficacy of rigid and semi-rigid transpedicular instrumentation for lumbar spine fusion was evaluated via three established scores. Patient groups were similar in respect of anthropometric data. The indication for using the semi-rigid technique was a fairly stable intraoperative situation; for the more common unstable situations, the rigid technique was chosen. Selecting implant rigidity on these criteria led to results with an improvement rate well within the upper success range reported in the literature. Among people in employment, a lengthy preoperative sick leave was an important predictor for unsatisfactory outcome.     

Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Racial disparities in CRC incidence and mortality have been well documented. In addition, lower rates of CRC screening among ethnic minorities have been reported. Therefore, we tested the effectiveness of a patient navigator (PN) in increasing compliance with CRC screening in a minority community health setting. Men and women aged 50 or older attending a primary care practice were enrolled if they had not had a fecal occult blood test within the past year, a sigmoidoscopy or barium enema within the past 3–5 years, or a colonoscopy within the past 10 years. Participants were randomly assigned either to receive navigator services (PN+) or not to receive navigator services (PN−). There were no demographic differences between the two groups. Within 6 months of physician recommendation, 15.8% in the PN+ group had complied with an endoscopic examination, compared with only 5% in the PN− group (P=.019). The PN+ groups also demonstrated higher rates of fecal occult blood test completion (42.1% vs. 25%, P=.086). Thus, a PN system successfully increases CRC screening rates among a predominantly minority population of low socioeconomic status.     

输尿管镜气压弹道碎石治疗输尿管结石50例疗效分析

采用经尿道输尿管镜气压弹道碎石治疗输尿管结石５０例，并根据影像学及术中内窥镜观察结石周围组织病变情况，将结石进行临床分类并判断疗效。结果：上段结石碎石治愈率８３％，中下段结石治愈率９６％，总治愈率达９０％。结论：该术式对中下段结石、结石较大、嵌顿时间长、肉芽组织或息肉包裹、肾功能差以及其它情况不宜用体外冲击波碎石治疗的结石是首选的治疗方式