The measurement of the effect of knee binding on patients with symphyseal separation

Knee binding enhances pelvic reduction in patients with unstable pelvic fractures. The aim of this study was to measure the effect of knee binding on patients with certain pelvic fractures. 13 consecutive patients who underwent open reduction and internal fixation of pubic symphysis diastasis ± sacroiliac joint fixation were recruited prospectively. These patients were transferred to this National level 1 trauma centre for definitive pelvic fracture management in an elective setting. All patients had sustained anteroposterior compression type pelvic injuries. In theatre, a centred anteroposterior radiograph of the pelvis was taken both with and without binding of the knees. Measurements of symphysis pubis widening were made of the digital images taken in theatre. With knee binding, the average percentage closure of the pubic symphysis as compared to the pre-operative, pre-reduction, position was 50%. When compared to the anatomically reduced position after internal fixation, there was a 69% closure of the symphysis pubis, with knee binding. This manoeuvre is rarely employed in patients in the field but is useful both as a simple resuscitation type tool and during definitive reconstruction in the operating theatre. Just over two-thirds of the reduction can be achieved prior to commencement of the operation.     

Can cervical spine computed tomography assist in detecting occult pneumothoraces?

IntroductionScreening CT often detects posttraumatic pneumothoraces that were not diagnosed on a preceding supine anteroposterior chest radiograph (occult pneumothoraces (OPTXs)). Because abdominal CT imaging misses OPTXs in the upper thorax, the objective of this study was to evaluate the utility of cervical spine (C-spine) CT screening for diagnosing OPTXs.MethodsA dual-institution (Foothills Medical Centre and Grady Memorial Hospital) retrospective review of consecutive OPTXs was performed. The accuracy of various CT screening protocols in detecting OPTXs was compared.ResultsOPTXs were detected in 75 patients. Patient demographics and injury characteristics were similar between centres (65% male; 97% blunt mechanism; 29% hemodynamically unstable; mean ISS = 27; mean length of stay = 22 days; mortality = 9%)(p > 0.05). Patients received either abdominal (41%) or thoraco-abdominal (59%) CT imaging. Most patients (89%) also underwent C-spine CT imaging. OPTXs were evident on thoracic CT in 100% (44/44), abdominal CT in 83% (62/75), and C-spine CT in 82% (55/67) of cases. All patients with OPTXs identified solely on thoracic CT (i.e. not abdominal) who also underwent imaging of their C-spine could have had their OTPXs diagnosed by using the pulmonary windows setting of their C-spine CT series. Combining C-spine and abdominal CT screening diagnosed all OPTXs (67/67) detected on thoracic CT, for patients who also underwent these investigations.ConclusionsOPTXs were evident on thoracic (and not abdominal) CT in 17% of severely injured patients. For patients who also underwent C-spine imaging, all OPTXs isolated to thoracic CT could be diagnosed by using the pulmonary windows setting of their C-spine CT imaging protocol. All OPTXs, regardless of intra-thoracic location, could also be detected by combining C-spine and abdominal CT screening.     

Functional improvement and social participation through sports activity for children with mental retardation: a field study from a developing nation

Background: While the positive effect of sports and exercise on physical and psychological well being is well documented within the general population, the effects of sports on the functional ability of a child with mental retardation are limited. Objectives: To determine if sports activities have been detrimental in improving functional ability in sample of children with mental retardation based in Kolkata, a metropolis in India. Study Design: Field level study. Methods: Six sports associations registered under the Sports Authority of India for training children with mental retardation were shortlisted on the basis of four criteria. From the register, every third name (gender irrespective) belonging to the second (12-15 years) and third (15-21 years) subclasses (out of the four categories laid down in the Special Olympics participation rules) against a constraint of at least two years active attendance in the sports facility for the child was selected. A sample of 31 children was drawn and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version was administered to the caregiver-teacher-coach team of the sample. Relative changes in scores between the point when the survey was conducted and the point when the child joined the sports facility was used as the dependent variable for regression analysis. The number of years in active sports, in school age of the respondent and base score of the children when they joined school were the independent variables. Results: For seven of the WHODAS 2.0 12-item attributes, the number of years in sports activities was found to have a statistically significant effect (p < 0.01) on the functional well being of children with mild to moderate mental retardation. The number of years in school was also another statistically significant factor (p < 0.01) responsible for this improvement. The children, however, perceived of being not welcome in community activities, but participated in activities meant exclusively for them. Conclusions: This small study showed that the proposition that number of years in sports activities was a significant factor responsible for improving the functioning of children with mild to moderate mental retardation. Clinical relevance WHODAS 2.0 12-item version has been a useful tool to monitor the effect of intervention (sports activity in this case) on the functional abilities of children with mild to moderate mental retardation. From a developing nation perspective with people with disabilities having very limited access to rehabilitation, this study would find its clinical relevance in the use of sports as an inexpensive and indigenous rehabilitative measure to promote the health and well being of people with disabilities as proposed in community-based rehabilitation guidelines (2010).     

Phosphate functionalized and lactic acid containing graft copolymer: synthesis and evaluation as biomaterial for bone tissue engineering applications

Polyvinyl alcohol (PVA) and polylactic acids (PLA) are biocompatible materials possessing some inherent contrasting limitations which have reduced the scope of their individual applicability. Specifically, overcoming strong hydrophobicity and introducing chemical groups for biofunctionalization are unmet challenges for PLA whilst chemical endeavors to render adequate aqueous stability and cell adhesion properties to PVA have not produced completely intended results. Objective of the present work is to explore synthesis of a graft polymer as an approach towards coupling biofunctional groups with PLA materials. In a two-step reaction, PPVA (phosphorylated polyvinyl alcohol or PVA pre-functionalized with phosphate) is esterified with lactic acid followed by polymerization into PLA in presence of stannous chloride as catalyst to obtain phosphorylated polyvinyl alcohol-graft-polylactic acid (PPVA-g-LA) copolymer. Product is characterized by nuclear magnetic resonance, X-ray diffraction, and thermogravimetric analysis. PPVA-g-LA shows an increase in uniaxial elongation compared to parent PPVA under condition of tensile loading. The graft copolymer also exhibits higher water contact angles compared to PPVA, but a more hydrophilic surface compared to PLA. Culture of MG-63 cells on solvent cast films of polymers demonstrates that PPVA-g-LA as a cell substrate can significantly (p?<?0.05) improve proliferation and differentiation of cells compared to PPVA substrate whereas in comparison to PLA can significantly ameliorate osteoblast function of cultured cells. Overall, results illustrate the feasibility of PVA to act as a carrier for biofunctional agents to be coupled to lactic acid-based biomaterials with subsequent improvement in cell response on the polymers. In this attempt, it also affords materials with tunable surface or bulk properties of relevance for tissue engineering applications.     

Selbstlimitierende fokale Epilepsien aus dem Parietal- und Okzipitallappen im Kindesalter

Clinical Epileptology - Den selbstlimitierenden fokalen Epilepsien im Kindesalter, eine heterogene Gruppe von Epilepsiesyndromen, sind fokale epileptische Anfälle ohne strukturelle Ursache,...     

Chronic intestinal pseudo-obstruction: systematic histopathological approach can clinch vital clues

The histopathological approach of chronic intestinal pseudo-obstruction (CIP) is critical, and the findings are often missed by the histopathologists for lack of awareness and nonavailability of standard criteria. We aimed to describe a detailed histopathological approach for working-up cases of CIP by citing our experience. Eight suspected cases of CIP were included in the study to determine and describe an approach for reaching the histopathological diagnosis collected over a period of the last 1.5 years. The Hirschsprung’s disease was put apart from the scope of this study. A detailed light microscopic analysis was performed along with special and immunohistochemical stains. Transmission electron microscopy was carried out on tissue retrieved from paraffin embedded tissue blocks. Among the eight cases, three were neonates, one in the pediatric age group, two adolescent, and two adults. After following the described critical approach, we achieved the histological diagnoses in all the cases. The causes of CIP noted were primary intestinal neuronal dysplasia (IND) type B (in 4), mesenchymopathy (in 2), lymphocytic myenteric ganglionitis (in 1), and duplication of myenteric plexus with leiomyopathy (in 1). Desmosis was noted in all of them along with other primary pathologies. One of the IND patients also had visceral myopathy, type IV. Histopathologists need to follow a systematic approach comprising of diligent histological examination and use of immunohistochemistry, immunocytochemistry, and electron microscopy in CIP workup. Therapy and prognosis vary depending on lesions identified by pathologists. These lesions can be seen in isolation or in combinations.