Intramedullary hip screw fixation of reverse oblique and transverse trochanteric femur fractures

Introduction  Reverse oblique and transverse trochanteric femur fractures (31A3) are relatively rare. They are associated with a high failure rate, particularly in cases where extramedullary implants are used. This study investigated a second-generation intramedullary nail in this specific fracture type. Methods  Flinders Medical Centre is a level 1 trauma centre and the largest user of the Intramedullary Hip Screw (IMHS, Smith and Nephew, Memphis, USA) in the Southern Hemisphere. Two hundred and forty-eight IMHS cases completed between September 2003 and August 2005 were retrospectively analysed. All fractures were classified using the AO/ASIF system (Muller et al., The comprehensive classification of fractures of the long bones, Springer, Berlin, 1990) and 31A3.1, 2, 3 fractures were selected. The case notes and radiology were reviewed over a 1-year follow-up. Results  Twenty-six cases were classified as 31A3 fractures. Thirty-eight percent of the cases received a long stem IMHS. Mean patient age was 81.9 years with a 1-year mortality of 11.5%. Two of the 26 cases (7.7%) had surgical complications, including one cut-out (associated with a tip-apex distance of 40.9 mm) and one loss of reduction. Both cases required re-operation. There were no femoral shaft fractures or non-unions in this series. Conclusions  This second-generation intramedullary implant, the IMHS, performed well in this often difficult to fix fracture. The complication rate is considerably less than the rate published for extramedullary implants and is comparable to previous studies using a range of intramedullary techniques.     

Allergy to mitomycin C complicating topical administration for urothelial cancer

Three cases are presented in which eosinophilic cystitis developed when patients who were known to have superficial bladder cancer were treated with instillations of the alkylating agent Mitomycin C.     

Perinatal acquired immunodeficiency syndrome

To date in the United States, 41,366 cases of acquired immunodeficiency syndrome (AIDS) have been reported, constituting a major health disaster. As AIDS spreads to the heterosexual population, perinatal hospital areas are seeing increasing numbers of AIDS patients and their families. Many health care workers have had no formal training in caring for these patients, a dilemma now complicated by fear. It is the challenge and responsibility of health care workers today to educate themselves about this disease. Preparation, both philosophically and with a protocol for standard of care, is essential to avoid a crisis in the workplace and to be able to deliver high quality care and support to these patients and their families. This article contains a protocol of care for mothers and infants with AIDS. Recommendations are made for changes in the routine care of the general population, as many cases of AIDS pass through the perinatal areas undetected.     

Influence of lysozyme on aggregation of Staphylococcus aureus.

The conditions under which lysozyme aggregates Staphylococcus aureus were studied. Lysozyme was found to aggregate S. aureus at concentrations found in human tear secretions. Aggregate size depended upon lysozyme concentration, ionic strength, and bacterial concentration. There was a low level of adherence of S. aureus to corneal epithelial cells, and the adherence of a recent clinical isolate was not influenced by lysozyme concentrations found in human tear secretions. Lysozyme may enhance bacterial clearance from the corneal surface of the eye by promoting particle aggregation.     

The MiniCAP III CO2 Detector: assessment of a device to distinguish oesophageal from tracheal intubation.

A new portable infra-red CO2 detector was assessed in 50 intubated patients. This device was 100% accurate in distinguishing between tracheal and oesophageal intubation when used by nursing and paramedic personnel.     

The potentiation of "incomplete" mouse monoclonal anti-Lea agglutination with colloids

Mouse monoclonal anti-Lea produced in this center was found to agglutinate only Le(a+) red cells which had been modified with proteases. In order to provide a stable medium in which the monoclonal anti-Lea would directly agglutinate unmodified red cells, the potentiating effect of a variety of colloids was assessed. Satisfactory results were obtained when 10 percent (wt/vol) dextran and 2 percent (wt/vol) bovine serum albumin were added to the culture supernatant containing anti-Lea. It is suggested that direct hemagglutination mediated by these colloids resulted from a combination of increased antibody uptake by Le(a+) red cells and change in the shape of these red cells induced by dextran.