Spontaneous bilateral fracture of patella

Bilateral patellae fractures represent a rare entity, accounting for approximately 2.9% of all lesions interesting in this anatomical district. In most cases found in the published work, they are described as stress fractures or as complications of chronic diseases such as osteoporosis, renal failure and secondary hyperparathyroidism. Although many pathogenetic mechanisms have been supposed, none have been proved for certain. Insufficiency fractures of the patellae are rare events and no data has been published on their incidence. We present a case of bilateral fracture of the patellae due to an indirect trauma occurring in an 85-year-old patient affected by Parkinson's disease, osteoporosis and diffuse degenerative osteoarthritis. X-ray of the knees (anteroposterior and lateral) and magnetic resonance imaging evaluation confirmed the fractures. The patient was treated conservatively. She had a good result, returning to her previous autonomous ambulation. This case is unusual because there was no direct trauma to the knees because of bilaterality, but confirmed previous observations about insufficiency fractures of patellae in the presence of comorbidity. Insufficiency fractures of patellae can be an insidious condition in elderly people. Prepatellar pain, a common symptom in the relapse phase of degenerative arthritis of the knee, should not be underestimated, particularly in patients with diseases influencing metabolism of bone and with an elevated risk of fall. A periodical clinical and instrumental follow up should be done in these patient. Moreover, we underline the necessity of a multidisciplinary approach.     

Spontaneous fracture of atlas of cervical spine affected by rheumatoid arthritis

A case of spontaneous fracture of the atlas in a 67-year-old woman who had suffered from rheumatoid arthritis for more than 20 years is described. This fracture is unique and can present diagnostic problems. Lying in the coronar plane makes the atlas difficult to visualize radiographically. Computer-guided tomography is a helpful diagnostic technique. The brittleness of the cervical spine in long-term rheumatoid patients should also be kept in mind when performing endotracheal intubation.     

Spontaneous fracture of the sternum simulating myocardial infarction

Summary Spontaneous fractures of the sternum are rare but worth knowing as they may simulate acute cardiac and pulmonary emergencies. A case of an insufficiency sternal fracture mimicking myocardial infarction and subsequent anginal pain is presented. The risk factors of this condition, its clinical features and the diagnostic procedures are discussed. Spontaneous fractures of the sternum should be considered as a diagnostic possibility for unexplained chest pains in the elderly.     

Spontaneous displacement of a pacemaker electrode and its subsequent successful reimplantation

A case of what was assumed to be twiddler's syndrome was caused by spontaneous twisting and displacement of the electrode on the fortieth postoperative day. The pacemaker had not been manipulated by the patient, the pocket was tight, and the proximal electrode was well secured. The complication was managed successfully by reimplanting the same electrode after stiffening the lead near the generator with a portion of the stylet.     

膝、肘关节骨折及功能重建的两种治疗方法对比观察

为探讨膝、肘关节碎性骨折的两种不同疗法的应用价值。对手术治疗的54例膝、肘关节内骨折,随机分为改良AO张力带固定组(A组)和传统治疗方法组(B组)进行对比观察。A组内固术中测试、关节活动度正常,骨折块无移位为固定可靠;术后石膏固定者,平关节面横行折断石膏托,消除有害旋转应力,关节在轴位功能锻炼恢复。术后随访1～12个月,A组骨折愈合时间2～4个月,骨折愈合率95.8％;B组骨折愈合时间3～6个月,骨折愈合率83.3％。两组骨折愈合率及关节功能恢复情况具有显著性差异(P<0.01)。认为影响膝、肘关节功能的开放性粉碎性骨折,应清创同时解剖复位,采用改良AO张力带固定,术后强化功能锻炼能促进骨折愈合及关节功能的恢复。     

Spontaneous closure of paravalvular leak after mitral valve replacement.

Complications after prosthetic valve replacement may be multiple. In biologic valves, valve detachment and cusp perforation may occur. If this is of significant magnitude, reoperation may be required. This report describes recurrent mitral regurgitation after mitral valve replacement with a Hancock porcine xenograft. The regurgitation subsided spontaneously three months later. We felt that a paravalvular leak closed, with progressive fibrosis and tightening of the annulus. Functional results in this patient were excellent.     

Spontaneous displacement of a pacemaker electrode and its subsequent successful reimplantation.

A case of what was assumed to be twiddler's syndrome was caused by spontaneous twisting and displacement of the electrode on the fortieth postoperative day. The pacemaker had not been manipulated by the patient, the pocket was tight, and the proximal electrode was well secured. The complication was managed successfully by reimplanting the same electrode after stiffening the lead near the generator with a portion of the stylet.     

可吸收线结扎固定手术治疗儿童尺骨鹰嘴骨折36例临床效果探讨

目的探讨可吸收线结扎固定手术治疗儿童尺骨鹰嘴骨折的治疗效果。方法选取该院2008-03～2011-10收治的36例儿童尺骨鹰嘴骨折患者,均采用切开复位可吸收线结扎固定手术治疗。结果36例均获随访,平均随访时间13个月。骨折全部愈合,平均愈合时间1.2个月。按HSS2肘关节评分进行肘关节功能评定,优良率为94.4%。结论应用可吸收线结扎固定手术治疗儿童尺骨鹰嘴骨折具有固定效果可靠、治疗效果良好、费用低廉、操作简便等优点,是一种治疗儿童尺骨鹰嘴骨折切实可行的方法。     

Post-infarction myocardial rupture: a case of pericardial tamponade salvaged by auto-blood transfusion

Left ventricular free-wall rupture (LVFWR) is a serious and lethal complication of acute myocardial infarction. Although this complication is not common, the fatality rate is high due to haemodynamic collapse in the setting of cardiac tamponade. We report a case of LVFWR in a patient with a rare blood group, who survived because of an innovative technique for pericardiocentesis and simultaneous transfusion of the aspirated blood into the femoral sheath. A video of the patient's ventriculography is provided.     

高龄股骨颈骨折髋关节置换术的围术期治疗

目的总结髋关节置换术治疗高龄股骨颈骨折患者的围手术期治疗方法及其效果。方法 27例高龄股骨颈骨折患者采用全髋关节置换术12例,人工股骨头置换术15例。所有患者重视围手术期治疗,包括术前全面评估患者全身情况;术中严密监护、缩短手术时间;术后加强合并疾病的治疗等。结果术后出现各种并发症16例,发生率59.3%。其中1例麻醉后发生心肌梗死致死亡,1例术后心律失常,4例患侧下肢深静脉血栓,4例尿路感染,3例肺部感染,2例合并尿路感染和肺部感染,1例合并下肢深静脉血栓和肺部感染。经加强围手术期治疗,26例全部治愈出院,髋关节活动功能良好。结论重视高龄股骨颈骨折髋关节置换术的围手术期治疗是手术成功的关键。     

Recovery from prolonged abnormalities of canine myocardium salvaged from ischemic necrosis by coronary reperfusion.

The purpose of this study was to determine whether or not the biochemical, functional, and ultrastructural abnormalities produced by brief temporary coronary occlusions (unassociated with necrosis) ever resolve and, if so, when they do. Anesthetized open-chest dogs were subjected to 15 min of coronary artery occlusion followed by 72 hr, 7 days, or 14 days of reperfusion. Serial in vivo myocardial biopsies were performed for measurement of ATP and for ultrastructural analysis. Regional function was evaluated by sonomicrometry. Mean (+/- SEM) myocardial ATP concentration was 36.6 +/- 1.2 nmol/mg of cardiac protein in nonischemic subendocardium and 18.9 +/- 1.5 in ischemic subendocardium after 15 min of ischemia. ATP remainede performed for measurement of ATP and for ultrastructural analysis. Regional function was evaluated by sonomicrometry. Mean (+/- SEM) myocardial ATP concentration was 36.6 +/- 1.2 nmol/mg of cardiac protein in nonischemic subendocardium and 18.9 +/- 1.5 in ischemic subendocardium after 15 min of ischemia. ATP remainede performed for measurement of ATP and for ultrastructural analysis. Regional function was evaluated by sonomicrometry. Mean (+/- SEM) myocardial ATP concentration was 36.6 +/- 1.2 nmol/mg of cardiac protein in nonischemic subendocardium and 18.9 +/- 1.5 in ischemic subendocardium after 15 min of ischemia. ATP remained depressed in the reperfused previously ischemic subendocardium at both 90 min (68% of nonischemic value) and 72 hr (78% of nonischemic value) but returned to normal at 7 days. Regional systolic function and cardiac ultrastructural abnormalities required 7 days for full recovery. Histologic and histochemical analysis did not reveal necrosis at any time. Therefore, biochemical, functional, and ultrastructural abnormalities induced by brief periods of transient coronary occlusion not associated with necrosis do resolve completely but the recovery period is prolonged.     

Mechanism of adenylate cyclase activation through the beta-adrenergic receptor: catecholamine-induced displacement of bound GDP by GTP.

The fate of the guanyl nucleotide bound to the regulatory site of adenylate cyclase was studied on a preparation of turkey erythrocyte membranes that was incubated with [3H]GTP plus isoproterenol and subsequently washed to remove hormone and free guanyl nucleotide. Further incubation of this preparation in the presence of beta-adrenergic agonists resulted in the release from the membrane of tritiated nucleotide, identified as [3H]GDP. The catecholamine-induced release of [3H]GDP was increased 2 to 3 times in the presence of the unlabeled guanyl nucleotides GTP, guanosine 5'-(beta,gamma-imino)triphosphate [gpp(NH)p], GDP, and GMP, whereas adenine nucleotides had little effect. In the presence of Gpp(NH)p, isoproterenol induced the release of [3H]GDP and the activation of adenylate cyclase, both effects following similar time courses. The findings indicate that the inactive adenylate cyclase possesses tightly bound (GDP, produced by the hydrolysis of GTP at the regulatory site. The hormone stimulates adenylate cyclase activity by inducing an "opening" of the guanyl nucleotide site, resulting in dissociation of the bound GDP and binding of the activating guanosine triphosphate.     

Spontaneous rupture of the rectosigmoid with small-bowel evisceration through the anus

A patient with spontaneous rupture of the rectum and evisceration of small bowel through the anus is presented. To the authors' knowledge, this paper represents the third reported case of this type of spontaneous rectal rupture. A discussion of the pathogenesis and treatment of this rather unique complication is presented. It is suggested that rectal or rectosigmoid rupture be condidered a rare complication of rectal prolapse.     

Activation of Trp3 by inositol 1,4,5-trisphosphate receptors through displacement of inhibitory calmodulin from a common binding domain

Mammalian homologues of Drosophila Trp form plasma membrane channels that mediate Ca(2+) influx in response to activation of phospholipase C and internal Ca(2+) store depletion. Previous studies showed that human Trp3 is activated by inositol 1,4,5-trisphosphate (IP(3)) receptors (IP(3)Rs) and identified interacting domains, one on Trp and two on IP(3)R. We now find that Trp3 binds Ca(2+)-calmodulin (Ca(2+)/CaM) at a site that overlaps with the IP(3)R binding domain. Using patch-clamp recordings from inside-out patches, we further show that Trp3 has a high intrinsic activity that is suppressed by Ca(2+)/CaM under resting conditions, and that Trp3 is activated by the following: a Trp-binding peptide from IP(3)R that displaces CaM from Trp3, a myosin light chain kinase Ca(2+)/CaM binding peptide that prevents CaM from binding to Trp3, and calmidazolium, an inactivator of Ca(2+)/CaM. We conclude that inhibition of the inhibitory action of CaM is a key step of Trp3 channel activation by IP(3)Rs.