Arthroscopic screw fixation of large anterior glenoid fractures

Ten patients after traumatic shoulder dislocation with resulting instability due to an acute anterior glenoid fracture involving at least 21 percent of the glenoid length were treated by arthroscopic screw fixation of the fragment. The average fragment size measured 26.2% of the glenoid length. Pre- and postoperative radiographic evaluations were performed with three-dimensional CT scans. A cannulated titanium screw system was used for fragment fixation. All ten patients were followed up radiographically and, by evaluation of the Rowe score, clinically after a minimum of 2 years. At follow-up the Rowe score averaged 94 points. According to the rating scale, seven patients had an excellent result, two patients a good result, and one, fair result. In all patients CT scan confirmed that the fracture had healed in an anatomical position. One patient had one episode of traumatic redislocation with a positive apprehension test at follow up. In one case, removal of the screw was necessary due to mechanical impingement. We recommend this arthroscopic technique allowing for closed reduction and internal screw fixation of large anterior glenoid fractures, ensuring anatomical fracture healing and gleno-humeral joint stability.     

Involvement of GABAB receptors in convulsant‐induced epileptiform activity in rat neocortex in vitro

The role of γ-aminobutyric acid B (GABA_B) receptors in the generation and maintenance of bicuculline-induced epileptiform activity in rat neocortical slices was studied using electrophysiological methods. A block of GABA_B receptors in the presence of functional GABA_A receptor-mediated inhibition was not sufficient to induce epileptiform activity. In the presence of the GABA_A receptor antagonist bicuculline (10 μm ) and at suprathreshold stimulation, the GABA_B receptor antagonist CGP 35348 (10–300 μm ) significantly potentiated epileptiform activity. With stimulation at threshold intensity, low concentrations of CGP 35348 (10–30 μm ) potentiated bicuculline-induced activity, whereas higher concentrations (100–300 μm ) invariably led to a reversible suppression of stimulus-evoked epileptiform discharges. CGP 35348 also enhanced picrotoxin-induced epileptiform activity, but at higher concentrations it was considerably less effective in suppressing such epileptiform discharges. The GABA uptake inhibitor nipecotic acid partially mimicked the actions of CGP 35348: with stimulation at threshold intensity, it reversibly suppressed bicuculline-induced epileptiform field potentials, but it did not influence epileptiform activity induced by picrotoxin. We conclude that a postsynaptic blockade of GABA_B receptors induces an amplification of epileptiform activity in neocortical slices disinhibited by GABA_A receptor antagonists. An additional blockade of presynaptic GABA_B receptors, especially under conditions of weak stimulation of the neurons, reduces the inhibitory auto-feedback control of GABA release, leading to a displacement of competitive antagonists from the postsynaptic GABA_A receptor and hence, to a suppression of epileptiform activity induced by competitive GABA_A receptor antagonists.     

Learning to nurse in the clinical setting

The findings reported in this paper are part of a larger study examining student socialization into nursing In analysing the data, it became evident that two major factors influenced the students' learning in the clinical setting the first was the clinical instructor, the second peer support Instructors who were organized, encouraging, outgoing, and who had good relationships with students, patients and nursing staff were seen as'good' role models When instructors were unable to establish rapport on a unit, negative feedback from nursing staff could be detrimental to student learning Peer support encompassed three dimensions facilitating learning, providing emotional support, and assisting with physical tasks There was evidence that practising faculty had a stronger influence in shaping students' attitudes towards nursing than classroom teachers     

MRI in Cockayne syndrome type I

Summary MRI findings are reported from two patients with Cockayne syndrome (CS) type I, aged 11 and 37 years. Changes were compatible with diffuse white matter hypomyelination. Basal ganglia calcification was present in both, marked cerebellar atrophy in the older patient. MRI may support the diagnosis of CS in the appropriate clinical context. The view that CS is a dysmyelinating disorder is further substantiated.     

Demonstration of heterogeneity in xeroderma pigmentosum

Summary Two cases of xeroderma pigmentosum were studied at the cytogenetic and molecular level. DNA repair impairment was revealed in case 1 by a nucleoid sedimentation technique whereas a half diminished rate of DNA repair could be demonstrated in case 2. This may be a further case of a xeroderma pigmentosum variant.     

Role of commensal bacteria in chronic experimental colitis: lessons from the HLA-B27 transgenic rat.

Rats on Lewis or Fischer background, transgenic for human HLA-B27 and beta(2)-microglobulin genes spontaneously develop colitis, gastritis, arthritis, dermatitis, orchitis, epididymitis, carditis, alopecia and nail changes. Disease susceptibility correlates with the gene copy number and is influenced by the genetic background. The pathomechanism in this model is still not completely understood. Cell transfer experiments indicate an essential role of HLA-B27 expression in bone marrow-derived cells. On Fischer background the onset of colitis occurs at 2 months of age, peaks at 3 months of age, and plateaus. Histologic findings include inflammatory cell infiltration, mostly limited to the mucosa, crypt hyperplasia, reduction of goblet cells, occasionally crypt abscesses and early ulcers. There is evidence that normal luminal bacteria play an essential role in initiating and perpetuating chronic colitis and gastritis in HLA-B27 transgenic rats: Transgenic rats raised under germ-free conditions do not develop gastrointestinal disease, whereas transgenic littermates exposed to specific pathogen-free bacteria develop colitis and gastritis within 2-4 weeks. Obligate anaerobic bacteria, especially Bacteroides spp., may play a predominant role since metronidazole prevents colitis and transgenic germ-free rats contaminated with a cocktail of six obligate and facultative anaerobic bacteria develop colitis and gastritis only in the presence of Bacteroides vulgatus. Luminal bacteria may also be involved in trafficking and homing of inflammatory cells into remote organs, since varying cecal bacterial composition does not only alter local inflammation but also influences gastritis. Lymphocyte transfer experiments indicate a specific response to luminal bacteria. In summary, this animal model is suitable for investigating the influence of normal luminal bacteria on the cellular immune mechanism in chronic intestinal inflammation.     

Public opinion regarding AIDS policy: fear of contagion and attitude toward homosexual relationships

This study examines public attitudes toward AIDS issues and tests the extent to which fear of contracting AIDS and attitude toward homosexuality influence opinions regarding the screening of potentially infected persons and the isolation of those already identified as infected. The data for this study are drawn from a 1989 survey of a representative sample of the adult residents of Edmonton, Alberta (n = 443). Stepwise regression analysis reveals that fear of contracting AIDS and attitude toward homosexual relationships independently predict support for AIDS screening and isolation policies. The implications for public health education are discussed.     

Tobacco,alcohol, and diet in the etiology of laryngeal cancer: a population-based case-control study

Cancer of the larynx constitutes an increasingly important problem in Polish males during the last 25 years. A population-based case-control study of laryngeal cancer among people under 65 years of age was conducted in Lower Silesia, a province in Southwest Poland, from 1986 to 1987, with 249 newly-diagnosed cancer cases and 965 controls. The estimated relative risk (RR) for smoking and alcohol are both very high: for smoking more than 30 cigarettes, RR=59.7 (95 percent confidence interval [CI]: 13.0–274); for drinking vodka regularly for more than 30 years, RR=10.4 (95 percent CI: 4.0–27.2). Exposures to alcohol and tobacco show a clear multiplicative effect in all categories of exposure. The risk was shown to be reduced by quitting smoking (RR=0.3, 95 percent CI: 0.14–0.64, after 10 years) or by having a history of intermittent smoking. Poor nutrition was also identified as a strong independent risk factor. However, data quality regarding this factor is not as high as for tobacco and alcohol. Smoking alone accounts in this study for an estimated 95.2 percent of all the cases of laryngeal cancer.This work was conducted within the framework of the PR-6 Cancer Control in Poland-National Cancer Program and was supported by the Humboldt Foundation.