The effects of angular and rotational deformities of both bones of the forearm. An in vitro study

In intact fresh cadaver specimens, we experimentally studied angular and rotatory deformities at the distal and middle levels of the forearm. The remaining pronation and supination motions were measured. When both bones of the forearm were angulated with a combined deformity (radio-ulnar or dorsovolar, or both) of 10 degrees, a loss of pronation-supination of 12.5 +/- 4.5 per cent occurred in the forearms with a distal-third fracture; in the forearms with a middle-third fracture the average loss was 16.0 +/- 5.7 per cent. Pronation losses were similar for both distal and middle-third deformities. However, supination losses were much less affected (p less than 0.01) in forearms with deformities at the distal-third level while the losses were considered drastic for middle-third deformities. Rotatory deformities produced losses of pronation-supination that were equal to the degree of deformity. Clinical Relevance: Study of the artificially created deformities in cadavera indicated that angular and rotatory deformities of the forearm of 10 degrees or less result in minimum limitation of pronation-supination. These degrees of limitation of motion in clinical practice are easily compensated for and are cosmetically acceptable. The fact that the perfect anatomical restoration of fracture alignment that often is obtained with internal fixation does not always result in complete restoration of motion suggests that: (1) this residual impairment of function is due to soft-tissue scarring, and (2) the mild angular and rotatory deformities resulting from nonsurgical treatment of fractures of the forearm may produce limitations of motion of an equally acceptable degree.(ABSTRACT TRUNCATED AT 250 WORDS)     

An in vitro analysis of wrist motion: the effect of limited intercarpal arthrodesis and the contributions of the radiocarpal and midcarpal joints

Radiocarpal and intercarpal arthrodeses were simulated in 12 fresh cadaver wrists by means of external fixation. Range-of-motion measurements were made before and after simulated arthrodesis and used to calculate the contribution of the midcarpal and radiocarpal joints to wrist motion, as well as the residual wrist motion after limited intercarpal arthrodeses. Relative contributions to wrist motion were as follows: wrist flexion: radiocarpal (RC) joint 63%, midcarpal (MC) joint 36%; wrist extension: RC joint 53%, MC joint 46%. The wrist motion remaining after simulated arthrodeses was as follows: capitate-hamate: flexion (Flx) 98%, extension (Ext) 92%, ulnar deviation (UD) 96%, radial deviation (RD) 90%; scaphoid-lunate: Flx 97%, Ext 91%, UD 90%, RD 91%; scaphoid-trapezium-trapezoid: Flx 86%, Ext 88%, UD 67%, RD 69%; scaphoid-lunate-triquetrum: Flx 91%, Ext 82%, UD 86%, RD 70%; capitate-lunate: Flx 70%, Ext 59%, UD 89%, RD 79%; capitate-hamate-triquetrum: Flx 88%, Ext 79%, UD 88%, RD 81%; hamate-triquetrum: Flx 90%, Ext 85%, UD 89%, RD 94%; scaphoid-trapezium-trapezoid-capitate: Flx 85%, Ext 77%, UD 64%, RD 57%.     

Bypass induced liver disease: an experimental study of the effect of post-operative protein supplementation and metronidazole therapy in an animal model

An animal model of jejuno-ileal bypass (JIB) with post-operative weight loss and liver dysfunction was established in the rat. The role of a protein supplemented diet and post-operative metronidazole was investigated using this model. The use of a protein supplemented diet alone markedly reduced the detrimental effects of JIB. Although a beneficial effect was also noted with post-operative metronidazole, it was less marked and there appeared to be no additive benefit when both were used together. The results of this study would support the routine use of a protein enriched diet post-operatively in patients undergoing JIB.     

Biodistribution of liposome-entrapped human gamma-globulin

The present study was aimed at the preparation and performance evaluation of Intacglobin-loaded liposomes for selective drug presentation to the lungs. Egg phosphatidylcholine- and cholesterol-based liposomes (1:1 and 1:0.25 mol/mol) were prepared by a dehydration-rehydration procedure. A tissue distribution study after single intranasal administration of 0.5 microCi 125I-Intacglobin-loaded liposomes was conducted in Balb/c mice. The efficiencies of drug entrapment (30%) and the average diameters did not differ significantly between the two liposome formulations. However, liposomes composed of an increased cholesterol amount showed a lower in vitro drug release rate. The airway penetration efficiency of the liposomal formulation was determined by the cumulative percentage of the dose reaching the lungs (AUC) and its sojourn time therein, and were 1.7- and 2.2-times higher compared with the plain 125I- Intacglobin solution-based formulation, respectively. A significantly greater (p<0.001) drug localization index after 24 h was found at the lungs in comparison with the other tissues (p<0.01), although similar values were detected between groups following administration of either liposomes or control solutions, despite the formulations attributes. In conclusion, it is suggested that longer Intacglobin exposure at the pulmonary region is observed after administration of the liposomal formulation. The results open future perspectives in assessing local passive immunization for the treatment of respiratory infectious diseases.     

Impaired anti-pneumococcal polysaccharide antibody production and invasive pneumococcal infection following heart transplantation

An increased risk of invasive pneumococcal infection has been described among adult heart transplant (HT) recipients. Vaccination has been recommended before HT but the appropriate time for revaccination is not known. In a preliminary analysis of a prospective study involving a cohort of 32 HT recipients receiving daclizumab and triple immunosuppresion therapy, a progressive decline in pneumococcal polysaccharide antibody (anti-PPS) levels was observed during the first year after HT. One of the patients who was found to have a decrease in the levels of anti-PPS developed severe pneumococcal meningitis 20 months after HT. Before HT he had received non-conjugated 23-valent pneumococcal vaccine and showed a normal post-immunization anti-PPS production. The data suggest that long-term immunologic monitoring might be useful to recognize impairment of antibody responses under immunosuppressive therapy in HT.     

A radiographic review of 135 total hip Charnley arthroplasties followed between 15 and 35 years

The long-term radiologically interpreted results of low-friction Charnley hip arthroplasties have been previously suggested to be influenced by surgical details, such as orientation of the femoral component, degree of coverage of the plastic acetabulum and other features. We carefully analyzed the radiographs of 135 Charnley arthroplasties that had remained functional, had not been revised and had follow-ups between 15 and 35 years. Several common denominators were identified amongst these radiographs: 93.5% arthroplasties had 100% coverage of the acetabular component; 88% had acetabular inclination between 40-45 degrees ; 84.5% had a proximal/medial column of cement between 3 and 5 millimeters at the level of femoral head resection; 81% had a femoral canal/stem ratio more than 50%; and 84% had a column of cement that extended below the tip of the prosthesis. This study supports the importance of technical surgical details that enhance the chances of long-term survival of cemented total hip arthroplasties.