Chopart Joint Injury: A Study of Outcome and Morbidity

Injuries involving the Chopart joint complex are relatively rare and frequently missed or misdiagnosed, often leading to a poor functional outcome. This study was performed to determine the outcome and morbidity in patients with Chopart joint injuries, and to increase awareness of this severe injury. Patients with a Chopart dislocation or fracture-dislocation, treated between January 2004 and January 2010, were identified using the appropriate diagnosis code and reviewing all radiographs of patients diagnosed with hindfoot or midfoot injuries treated at our institution. Data on patient characteristics, trauma mechanism, delay, and treatment were collected using patient files, operation reports, and by reviewing radiographs. Outcome was determined using the American Orthopaedic Foot & Ankle Society midfoot score and a visual analog scale satisfaction score, in patients with a minimum follow-up of 6 months. Nine patients (1.5 per year) were identified, including 6 women. The mean patient age was 41.6 ± 25.1 years. The trauma mechanism was sprain or sports injury in 5 (55.6%), motor vehicle accident in 3 (33.33%), and a fall from height in 1 (11.11%) case. Seven patients with an average follow-up of 31.3 ± 19.2 months reported a mean American Orthopaedic Foot & Ankle Society midfoot score of 72 (range, 32-100) points and a mean visual analog scale score of 7.1 (range, 5-10). Four (57.14%) patients still experienced pain or had limitations in daily activities at the time of the final follow-up. This study supports the conclusion of previous studies, which stated that a higher level of awareness is needed to prevent permanent disability.     

Carrier detection in X-linked ocular albinism of the Nettleship-Falls type by DNA analysis

X-linked ocular albinism (XOA) is characterized by anomalies of the eyes and hypopigmentation or absence of pigment in skin, hair and eyes due to a hereditary inborn error of metabolism affecting the pigment cells. The gene of XOA of the Nettleship-Falls type (OA1) has been mapped to Xp22.3, and several closely linked RFLP loci have been identified. Linkage analysis and deletion mapping have established the marker gene order Xpter-STS-DX237-(OA1,DXS143,DXS85)-DXS1 6-DXS43-Xcen. Although the position of OA1 has yet not been fully resolved, we report on the first carrier detections in OXA of the Nettleship-Falls type by DNA analysis using markers which unquestionably flank OA1.     

Bilayered biodegradable poly(ethylene glycol)/poly(butylene terephthalate) copolymer (Polyactive) as substrate for human fibroblasts and keratinocytes.

The purpose of this study was to find an optimal polymer matrix and to optimize the culture conditions for human keratinocytes and fibroblasts for the development of a human skin substitute. For this purpose porous, dense bilayers made of a block copolymer of poly(ethylene glycol terephthalate) (PEGT) and poly(butylene terephthalate) (PBT; Polyactivetrade mark) with a PEGT/PBT weight ratio of 55/45 and a PEG molecular weight (MW) of 300, 600, 1000, or 4000 Da were used. The best performance was achieved with PEGT/PBT copolymer with MW of PEG 300 D (300PEG55PBT45). When fibroblasts were seeded into the porous underlayer and cultured for 3 weeks in medium supplemented with 100 microg/mL ascorbic acid, all pores were filled with fibroblasts and with extracellular matrix, which was judged from the presence of collagen types I, III, and IV, and laminin. When seeded onto the dense top layer of the bilayered (cell free or fibroblast populated) copolymer matrix, human keratinocytes grew out into confluent sheets. After subsequent lifting to the air-liquid interface, a multilayered epithelium with a morphology corresponding to that of the native epidermis was formed. Some differences could still be observed: the expression and localization of some differentiation specific proteins was different and close to that seen in hyperproliferative epidermis; a basal lamina and anchoring zone were absent.     

Improved cardiovascular variables during acetate free biofiltration.

BACKGROUND AND AIM: Acetate free biofiltration (AFB) provides a well-tolerated and efficient renal replacement therapy. Replacement of most of the acetate by bicarbonate in standard hemodialysis has resulted in a decrease in intradialytic hypotensive episodes. This has been attributed to a decrease in the acetate-induced impairment of myocardial contractility. The aim of the present study was to investigate whether the total absence of acetate in AFB would further enhance dialysis stability and improve cardiovascular status. PATIENTS AND METHODS: In a long-term, randomized trial we included 11 patients on AFB and 9 patients on bicarbonate hemodialysis (HD) for one year. Patients were matched for age, sex and urea reduction rate, but not for the presence of hypertension or cardiovascular history. During each dialysis session blood pressure was measured automatically and the presence of significant hypotension was recorded. Antihypertensive medication was registered every three months. Before and at the end of the study M-mode echocardiography was performed and left ventricular mass index (LVMi) was calculated. Every six months serum lipids were measured. RESULTS: At baseline, mean arterial pressure (MAP) before and after dialysis, the percentage of hypotensive dialyses, LVMi and serum lipids did not differ between AFB and HD. Pre-dialysis MAP decreased in AFB (from 112.5 to 107 mmHg) and increased in HD (from 101.7 to 105.3 mmHg; p = 0.01, HD versus AFB). Postdialysis MAP remained stable in both groups (AFB 91.6 mmHg at 0 months and 90.6 mmHg at 12 months, for HD respectively 83.9 and 86.5 mmHg, NS). The percentage of hypotensive dialyses did not differ significantly between the groups during the study. LVMi decreased in AFB from 195.4 to 162.1 gr/m2 and increased in HD patients from 153.8 to 182.5 gr/m2 (p = 0.03 HD versus AFB). The number of antihypertensive medications per patient did not differ between groups. Serum lipids remained unchanged during the trial. CONCLUSION: In conclusion, AFB provided better control of pre-dialysis MAP compared to HD, and stable postdialysis MAP. The percentage of dialysis sessions with hypotension did not differ. LVMi decreased significantly in AFB, but rose in HD.     

Analysis of donor selection procedure in 139 living-related kidney donors and follow-up results for donors and recipients

In 1981 an active programme was started in our centre for living-relatedkidney donation (LRD). The structure of this LRD programme isdescribed in this paper. Retrospectively the results of this LRD programme were studied.Between 1981 and 1988 139 potential living donors were evaluated.Of all potential donors 47 (34%) actually donated a kidney,including 24 HLA non-identical combinations. Follow-up was obtained until 1990. An acceptable incidence ofmorbidity and mortality for donors and recipients was observed.A high number of potential donors was excluded during the selectionprocedure (66%). They were often refused for medical reasons(29%), with a high incidence of renal dysfunction (16%). Nolong-term adverse effects of nephrectomy regarding decreasedrenal function, hypertension, or proteinuria were seen. Of allactual donors 23% experienced minor complications after donation.Living-related kidney transplants showed better graft functionthan cadaveric grafts.     

Urothelkarzinom

Various study groups are working on the WHO classification of 2004 which eliminates the previous grades of differentiation G1, G2, and G3 and classifies non-muscle-invasive bladder cancer into genetically stable low-grade and genetically unstable high-grade urothelial carcinomas. In muscle-invasive bladder cancer, extended lymph node dissection as part of radical cystectomy should remain the standard procedure for now.