General short-term indomethacin prophylaxis to prevent heterotopic ossification in total hip arthroplasty

This prospective study evaluated heterotopic ossification prophylaxis with indomethacin for 14 days in 201 consecutive patients undergoing total hip arthroplasty. Ranitidine was administered concurrently to alleviate gastrointestinal side effects. None of the patients with mild gastrointestinal side effects (12%) had to suspend the prophylaxis, and no major postoperative bleeding or gastrointestinal ulcers were observed. After 12 months of follow-up, 67% of patients had no evidence of heterotopic ossification, 32% percent had grades I and 1% had grade III without clinical significance, and 0% had grade IV ossification according to Brooker's classification. These results indicate that short-term indomethacin prophylaxis is an effective, inexpensive, and easily administrated alternative to single-dose radiotherapy for nearly all patients undergoing THA.     

A community outbreak of Legionnaires' disease linked to hospital cooling towers: an epidemiological method to calculate dose of exposure.

BACKGROUND: From July to September 1994, 29 cases of community-acquired Legionnaires' disease (LD) were reported in Delaware. The authors conducted an investigation to a) identify the source of the outbreak and risk factors for developing Legionella pneumophila serogroup 1 (Lp-1) pneumonia and b) evaluate the risk associated with the components of cumulative exposure to the source (i.e. distance from the source, frequency of exposure, and duration of exposure). METHODS: A case-control study matched 21 patients to three controls per case by known risk factors for acquiring LD. Controls were selected from patients who attended the same clinic as the respective case-patients. Water samples taken at the hospital, from eight nearby cooling towers, and from four of the patient's homes were cultured for Legionella. Isolates were subtyped using monoclonal antibody (Mab) analysis and arbitrarily primed polymerase chain reaction (AP-PCR). RESULTS: Eleven (52%) of 21 case-patients worked at or visited the hospital compared with 17 (27%) of 63 controls (OR 5.0, 95% CI : 1.1-29). For those who lived, worked, or visited within 4 square miles of the hospital, the risk of illness decreased by 20% for each 0.10 mile from the hospital; it increased by 80% for each visit to the hospital; and it increased by 8% for each hour spent within 0.125 miles of the hospital. Lp-1 was isolated from three patients and both hospital cooling towers. Based on laboratory results no other samples contained Lp-1. The clinical and main-tower isolates all demonstrated Mab pattern 1,2,5,6. AP-PCR matched the main-tower samples with those from two case-patients. CONCLUSION: The results of our investigation suggested that the hospital cooling towers were the source of a community outbreak of LD. Increasing proximity to and frequency of exposure to the towers increased the risk of LD. New guidelines for cooling tower maintenance are needed. Knowing the location of cooling towers could facilitate maintenance inspections and outbreak investigations.     

Rundown of somatodendritic N-methyl-D-aspartate (NMDA) receptor channels in rat hippocampal neurones: evidence for a role of the small GTPase RhoA.

Actin filament (F-actin) depolymerization leads to the use-dependent rundown of N-methyl-D-aspartate (NMDA) receptor activity in rat hippocampal neurones. Depolymerization is promoted by Ca2+ which enters the cells via NMDA receptor channels. The ras homologue (Rho) GTPases (RhoA, Rac1 and Cdc42) promote actin polymerization and thus control the actin cytoskeleton. We have investigated, by means of the whole-cell patch clamp technique, whether the actin fibres which interact with NMDA receptors are controlled by Rho GTPases. In the presence of intracellular ATP which attenuates rundown, the C3 toxin from Clostridium (C.) botulinum was used to inactivate RhoA. Indeed, it enhanced the use-dependent rundown of NMDA-evoked inward currents to a level similar to that obtained in the absence of ATP. Lethal toxin from Clostridium sordellii which inactivates Rac1 and Cdc42 lacked this effect. We suggest that the function of somatodendritic NMDA receptor channels in rat hippocampal neurones can be modulated by RhoA via its action on F-actin.     

Light-dependent delay in the falling phase of the retinal rod photoresponse.

Using suction electrodes, photocurrent responses to 100-ms saturating flashes were recorded from isolated retinal rods of the larval-stage tiger salamander (Ambystoma tigrinum). The delay period (Tc) that preceded recovery of the dark current by a criterion amount (3 pA) was analyzed in relation to the flash intensity (If), and to the corresponding fractional bleach (R*0/Rtot) of the visual pigment; R*0/Rtot was compared with R*s/Rtot, the fractional bleach at which the peak level of activated transducin approaches saturation. Over an approximately 8 ln unit range of I(f) that included the predicted value of R*s/Rtot, Tc increased linearly with ln I(f). Within the linear range, the slope of the function yielded an apparent exponential time constant (tau c) of 1.7 +/- 0.2 s (mean +/- S.D.). Background light reduced the value of Tc measured at a given flash intensity but preserved a range over which Tc increased linearly with ln I(f); the linear-range slope was similar to that measured in the absence of background light. The intensity dependence of Tc resembles that of a delay (Td) seen in light-scattering experiments on bovine retinas, which describes the period of essentially complete activation of transducin following a bright flash; the slope of the function relating Td and ln flash intensity is thought to reflect the lifetime of photoactivated visual pigment (R*) (Pepperberg et al., 1988; Kahlert et al., 1990). The present data suggest that the electrophysiological delay has a similar basis in the deactivation kinetics of R*, and that tau c represents TR*, the lifetime of R* in the phototransduction process. The results furthermore suggest a preservation of the "dark-adapted" value of TR* within the investigated range of background intensity.     

Do arachnoid cysts grow?

Summary The volumes of intracranial arachnoit cysts were measured in 136 CT scans of 86 patients. Absolute and relative cyst size was calculated. Left hemisphere and middle cranial fossa location prevailed. A slight negative correlation of relative cyst size with age (r=–0.21, NS) disappeared when analysis was restricted to the adult age group (20 years). After the sample was divided into two groups according to relative cyst size (cysts less than mean volume vs cysts greater than mean volume), small AC showed no correlation with age, while large AC correlated positively with age (r=0.79,P<0.05). A subgroup of large AC appears to expand with time, while the majority of small AC remain unchanged.     

Possibilities of application of the fixateur externe at the femur - indications, results (author's transl)

Besides the methods of screwing of plates and medullary nailing, the fixateur externe (F.E.) is another method which can be considered for treating bone fractures at the femur, F.E. being an exceptional indication. In fresh fractures of the femur, open fractures of the second and third grade as well as debris and multiple-plane fractures are typical indications for F.E. Over and above, F.E. is almost always indicated as an emergency measure in case of initial inoperability (polytrauma, shock, loss of blood, craniocerebral trauma) or continuing general inoperability. F.E. has been found useful to an even greater extent especially in old fractures, refractures, pseudarthroses and infected pseudarthroses. Combined treatment of the infected pseudarthroses with F.E. and Septopal balls has proved particularly effective. The special advantages of F.E. application at the femur are blood-saving surgery requiring relatively little time and technical equipment, avoidance of surgically conditioned infection risk in the fractured region, avoidance of additional denudation of free fracture fragments, long-term applicability, good external stabilization with selective possibility between compression, distraction and neutral positioning of the fractured area, postoperative treatment without dressing, and free access to the fractured area without interfering with the F.E.; furthermore, exchangeability of the F.E., possibility of correcting the position and axis without surgical intervention, non-fixation of the adjacent joints and maintenance of physiotherapeutic treatment possibilities. F.E. is "panacea" and should not be applied without exact knowledge of the static and mechanical and biomechanical conditions and effects. Before resorting to F.E. this must be carefully weighed against the use of internal osteosynthesis methods. It is not a rival method to plate screwing and medullary nailing but rather an auxiliary system whenever these methods are inapplicable or would entail disadvantages.     

Vergleich der Bromcyanbruchstücke von Glaskörperkollagen und Typ II Kollagen

Zusammenfassung Aus Rinderglaskörper wurde pepsin-lösliches Kollagen isoliert, das bei der Untersuchung mit der Disk-Elektrophorese eine -Komponente zeigte, die im 1-Bereich wanderte. Auffallend sind mehrere Farblinien zwischen der - und der -Komponente. Bei der Disk-Elektrophorese der Bromcyan-Peptide von pepsin-löslichem Glaskörperkollagen kann festgestellt werden, daß das Peptidmuster nicht mit dem identisch ist, das aus pepsin-löslichem Typ II Kollagen erhalten werden kann.

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Comparison of the cyanogen bromide peptides of vitreous body collagen and type II collagen

Summary Pepsin-soluble collagen was isolated from bovine vitreous humor. This collagen showed only one -chain in disc electrophoresis, migrating in the 1-chain position and between the - and -components some colored bands were visible. The disc electrophoretic patterns of the cyanogen bromide peptides of pepsinsoluble vitreous body collagen and pepsin-soluble type II collagen revealed no identity.

     

Selective neuronal survival and upregulation of PCNA in the rat inner retina following transient ischemia

In this study we investigated the extent and time course of neuronal cell death and the regulation of the proliferating cell nuclear antigen (PCNA) in the different retinal cell layers following ischemia-reperfusion injury. Retinal ischemia was induced by controlled elevation of the intraocular pressure for a duration of 60 min. Changes in thickness and cell numbers in the retinal cell layers were analyzed at various time points (1 h to 4 weeks) after reperfusion. In parallel, apoptotic cell death was determined by the TUNEL method and the expression of PCNA analyzed by immunocytochemistry. In addition, we tested whether PCNA is expressed in neurons by double immunocytochemistry. The reduction in thickness was found to be less pronounced in the inner nuclear layer (INL). Correspondingly, cell numbers decreased by only 33% in the inner retina, but by more than 80% in the outer nuclear layer (ONL). Alterations in glial cell numbers did not contribute significantly to postischemic changes in the INL and ONL as assessed by using immunocytochemical markers for microglial and Müller cells. The time course of cell death determined by the TUNEL technique also differed markedly in the retinal layers being rapid and transient in the inner retina but delayed and prolonged in the ONL. PCNA immunoreactivity was undetectable in the normal retina, but was specifically induced in neurons of the inner retina within 1 h after reperfusion and was sustained for at least 4 weeks. We conclude that in contrast to photoreceptors in the ONL, a significant proportion of inner retinal neurons is resistant to ischemic insult induced by transiently increased intraocular pressure and that PCNA may possibly play a role in the selective postischemic survival of these cells.