Management of bilateral complex fracture-dislocation of proximal ulna and radius: a case report

Complex fracture-dislocation of proximal ulna and radius (FDUR) are rare, representing only 2-5 % of elbow injuries. Monteggia-like lesions and transolecranon fractures include various patterns of complex FDUR, which are not well defined. The management of these injuries is considered extremely difficult, and clinical results are often poor. In this report, we present a case of a 66-year-old woman with bilateral complex FDUR. This pattern of injury is very rare and little information is available about its management. Diagnosis, surgical technique, rehabilitation programme and clinical results are reported. The bilaterality of the condition does not appear to influence the treatment and results.     

Measurement of lung volume with 81Krm in a dynamic scintigram

The meaning of 81Krm counts obtained in a dynamic series of gated lung ventilation scans was evaluated in terms of flow rate, lung volume, or the flow/volume ratio. Flow and volume signals were recorded together with scintigraphic events in 29 subjects breathing 81Krm and after its decay, 127Xe as a tracer of lung volume. Gated ventilation scans and respiratory signals were reconstructed. Statistical analyses were carried out for linear regressions between total normalized counts detected by the gamma camera and (1) flow rate, (2) lung volume and (3) flow/volume ratio. Inspiration and expiration were analysed separately. For both isotopes, the best correlation was obtained between counts and lung volume (r greater than 0.93). No correlation was obtained between counts and flow rate or flow/volume ratio. Thus, we conclude that 81Krm count variations in gated scans correlate well with tidal volume.     

Surface shield: device to reduce personnel radiation exposure

A simple device is described that can reduce personnel exposure from scatter radiation by up to 75%. The device consists of an oblong piece of shielding (0.75-mm lead equivalent) that is taped to the side of the patient during percutaneous renal stone removal and other interventional procedures. Contrary to other shields and barriers, this does not interfere with access to the patient. Scatter exposure data from phantom studies are presented and the rationale for surface shielding discussed.     

Fibrosing alveolitis: CT-pathologic correlation

Computed tomography (CT) was performed within 10 days of open lung biopsy in nine patients with fibrosing alveolitis. One-centimeter collimation contiguous scans through the chest were obtained in all patients. Additional 1.5-mm collimation scans were obtained in the area in which lung biopsy was later performed in six patients. In seven patients, CT demonstrated patchy involvement of the lung parenchyma, areas with a reticular pattern being intermingled with areas of normal lung. The reticular pattern was associated with cystic spaces 2-4 mm in diameter and was more severe in the lung periphery. Histologically, the reticular pattern corresponded to areas of irregular fibrosis. One patient had diffuse honeycombing (2-20-mm cysts), and one had honeycombing only in the lung periphery. In all patients, CT clearly defined the architectural changes seen on open lung biopsy. These changes were much better seen on the 1.5-mm than on the 10-mm collimation scans. CT may be helpful in determining the pattern and distribution of lung involvement in patients with fibrosing alveolitis and in guiding the surgeon to the most appropriate area(s) for biopsy.     

Urine-compatible polymer for long-term ureteral stenting

Internal double-J ureteral stents were designed from a urine-compatible polymer (C-Flex), and 35 stents were placed in patients. The overall patency rate for the stents was 80%, with most stent failures occurring before 2 months; the follow-up period ranged from 2 to 16 months, with a mean follow-up for all stents of 5.0 months. Stents were considered patent at last follow-up only if they had been in place for at least 2 months. No migration or fracture of the stents occurred. Physical properties of urine-exposed stents were compared with those of virgin tubing and tubing exposed for 1 year to shelf conditions. Stent patency was optimized by increasing urine flow by increasing the patient's voluntary oral intake, administering prophylactic oral antibiotics, and avoiding placement of stents into grossly bloody or infected collecting systems.     

Imaging and assessment of regional clearances of indium-111 labelled circulating immune complexes in humans

The in vivo function of the reticulo-endothelial system in humans is currently studied by the blood clearance of 51Cr labeled RBC sensitized with IgG anti-Rh. By replacing 51Cr by 111In we developed a method which allows imaging and assessment of clearances of circulating immune complexes (CIC) by individual organs. Nine normal subjects were studied successively with 51Cr labelled CIC and 111In-labelled CIC by blood sampling and sequential imaging. Time activity curves were obtained over spleen, liver, heart lungs and kidneys. The blood clearance values were similar with 111In (T1/2 +/- SD = 23.4 min +/- 6.4 min) and 51 Cr (T1/2 = 22.9 min +/- 5.8 min). The blood clearance derived from the time activity curve obtained over the cardiac area (T1/2 = 26.6 min +/- 8.4 min) was not significantly different from that obtained by blood sampling. Most of the CIC were taken up by the spleen with a T1/2 of 20.3 min +/- 4.1 min. Although hepatic uptake was observed in all subjects, it was lower than that of the spleen and CIC were subsequently released from the liver in five of the nine patients. The spleen/liver ratio increased with time, reaching a plateau averaging 24.0 +/- 5.8 within 80 min in all subjects. CIC imaging allows, by a non-invasive procedure, the computation of CIC blood clearance and the estimation of the respective role of spleen and liver in phagocytic function.     

Changes in the distribution of ventilation and perfusion associated with separation from mechanical ventilation in patients with obstructive pulmonary disease

A trial of separation from mechanical ventilation may induce an abnormal respiratory pattern and a maldistribution of ventilation-to-perfusion ratios (VA/Q), especially in patients with chronic obstructive pulmonary disease. This study was designed to assess the effects of three different modes of ventilation on the distribution of global and also regional VA/Q in eight patients with chronic obstructive pulmonary disease recovering from acute respiratory failure who remained dependent on mechanical ventilation after more than 5 days of attempted separation from the ventilator. VA/Q distribution was assessed using the multiple inert gas and isotopic scanning methods after 30 min each of controlled mechanical ventilation (CMV), 10 cmH2O inspiratory pressure support, and spontaneous breathing (SB). Controlled ventilation was provided at a respiratory rate ranging from 12 to 18 breaths per min and a tidal volume of 8 ml.kg-1. In comparison to CMV, SB resulted in a decrease in tidal volume (from 512 +/- 144 to 301 +/- 102 ml, P less than 0.01), and an increase in respiratory rate (from 15.5 +/- 3.2 to 27.3 +/- 15.0 breaths per min, P less than 0.05), which increased dead space (+7.1% of minute ventilation), cardiac output (+36%), and the perfusion to areas of low VA/Q (+8.9% of cardiac output) (P less than 0.05, P less than 0.001, and P less than 0.05, respectively). Isotopic scans revealed a horizontal craniocaudal difference of VA/Q in all modes, with the lowest VA/Q zones at the basal part of the lungs (mean basal VA/Q 0.58 in SB and 1.05 in CMV).(ABSTRACT TRUNCATED AT 250 WORDS)