Catapult splint: A foot dorsiflexion assist splint

Background

Loss of dorsiflexion is a common problem in cases where an external fixator or Ilizarov assembly is applied. It results in functional impairment of the foot by affecting the swing phase of gait cycle. We devised a simple dynamic dorsiflexion assist splint for prevention, correction of equinus/cavus deformity and maintenance of normal dorsiflexion of foot.

Methods

This prospective study used a rubber splint styled in the shape of a catapult, made of discarded car rubber tubes attached to the frame of fixator in 50 patients.

Results

In 17 patients there was varying amount of loss of dorsiflexion at the time of application of splint while in 22 patients it was applied soon after the application of the fixator. In the rest of patients it was applied for cavus deformity. Out of 17 patients 10 had complete recovery of dorsiflexion. 22 patients in whom it was applied at the outset had normal range of movement at ankle. Correction was achieved in all 6 cases of cavus deformity and prevented its occurrence in the rest of 5 cases.

Conclusion

Catapult splint is a low cost foot dorsiflexion assist splint.     

Safety and efficacy of ultrasonography as an adjunct to fluoroscopy for renal access in percutaneous nephrolithotomy (PCNL)

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

? To evaluate the safety and efficacy of ultrasonography (US)‐guided renal access in percutaneous nephrolithotomy (PCNL), as compared with conventional fluoroscopy‐guided renal access in a prospective randomized trial.

PATIENTS AND METHODS

? From January 2008 to October 2009, 224 patients with renal calculi undergoing PCNL were randomized into two groups. ? Group 1 (112 patients) underwent PCNL using only fluoroscopy‐guided renal access; while in group 2 (112 patients), US guidance for puncture was used in addition to fluoroscopy. ? The inclusion criteria were: normal renal functions, American Society of Anesthesiology scores 1 or 2, absence of congenital abnormalities, aged 15–70 years, and anticipated single‐tract procedure. The patients in both groups were matched for age, sex, and stone characteristics. ? The Student t‐test was used for statistical analysis with an allowable error of 5%.

RESULTS

? The mean time to successful puncture was 3.2 min and 1.8 min in group 1 and group 2, respectively (P < 0.01). ? The mean duration of radiation exposure to successful puncture was 28.6 s in group 1 and 14.4 s in group 2 (P < 0.01). ? The mean numbers of attempts for successful puncture in the desired calyx was 3.3 in group 1 as compared with 1.5 in group 2 (P < 0.01). ? The meantime taken for tract formation in group 1 was 7.4 min with radiation exposure of 82 s, while in group 2 it took 4.8 min with radiation exposure of 58 s (P < 0.01). ? Successful access was achieved in all patients. All patients were stone‐free at the end of the operation. The hospital stay (2–3 days) was same in both groups. There was no incidence of significant bleeding requiring transfusion during or after surgery. All the patients were followed‐up for a ≥6 months.

CONCLUSION

? US‐guided puncture in PCNL helps in increasing accuracy of puncture and decreasing radiation exposure for the surgical team and the patients.     

Unusual cause of failure of end-to-end anastomotic urethroplasty for traumatic obliterative bulbar urethral stricture

End-to-end anastomotic urethroplasty (EEA) for traumatic bulbar urethral stricture has excellent long-term success rate. We encountered a patient with obliterative bulbar stricture and persistent phlegmon in perineum resulting from straddle injury. Phlegmon-excision and EEA was performed, which ended up in recurrence. Thorough excision of recurrent nodules & scar with stage-I urethroplasty was performed using 'scrotal shutter flap'. Histopathology of phlegmon of first surgery and nodules & urethral margins of second revealed amyloidosis. Stage-II urethroplasty was performed 3-months later after which he is well at 24 months follow-up. This is the first case of perineal-urethral amyloid associated with trauma. Etiology is elusive.     

Effect of noncontact normothermic wound therapy on the healing of neuropathic (diabetic) foot ulcers: An interim analysis of 20 patients

This is the interim analysis of a prospective, randomized, controlled study comparing diabetic foot ulcer healing in patients being treated with either noncontact normothermic wound therapy (Warm-UP; Augustine Medical Inc. Eden Prairie, MN) applied for 1 hour 3 times daily until healing or 12 weeks, or standard care (saline-moistened gauze applied once a day). Surgical debridement and adequate foot off-loading was provided to both groups. Evaluations were performed weekly and consisted of acetate tracings, wound assessment, and serial photography. Twenty patients have completed the trial and both treatment groups were distributed evenly (N = 10). Ulcers treated with noncontact normothermic wound therapy had a greater mean percent wound closure than control-treated ulcers at each evaluation point (weeks 1-12). After 12 weeks, 70% of the wounds treated with noncontact normothermic wound therapy were healed compared with 40% for the control group. In this subset of patients there have been no adverse events associated with noncontact normothermic wound therapy.     

Differential usage of transcriptional repressor Zeb2 enhancers distinguishes adult and embryonic hematopoiesis

1. Download : Download high-res image (170KB)
2. Download : Download full-size image

     

Managed care, deficit financing, and aggregate health care expenditure in the United States: A cointegration analysis

We applied a battery of cointegration tests comprising those of Johansen and Juselius [19], Phillips and Hansen [35], and Engle and Granger [6], to model aggregate health care expenditure using 1960–96 US data. The existence of a stable long-run economic relationship or cointegration is confirmed, in the United States, between aggregate health care expenditure and real GDP, population age distribution, managed care enrollment, number of practicing physicians, and government deficits. The evidence of cointegration among these variables, chosen on the theoretical basis of prior studies, implies that while they are individually non-stationary in levels, together they are highly correlated and move, in the long run to form an economic equilibrium relationship of US aggregate health care expenditure. More specifically, and for the first time in this line of inquiry, (i) managed care enrollment is found to be negatively associated with the level of health care spending, (ii) supply disinduced demand effects of physicians tend to moderate health expenditure, and (iii) government deficit financing is positively related to health care spending. The observed sign and magnitude of the income coefficient are consistent with health care being a luxury good. This revised version was published online in July 2006 with corrections to the Cover Date.     

The pharmacodynamics of lansoprazole administered via gastrostomy as intact, non-encapsulated granules

Background:

Because of its acid-labile nature, lansoprazole is usually administered as encapsulated enteric-coated granules. The gelatin capsule and acid-resistant coating of the granules have been considered essential for effective drug absorption and optimal bioavailability. Lansoprazole may attain effective plasma levels when given as non-encapsulated intact granules, but effects on intragastric acidity are unknown.

Aim:

To test the effectiveness of non-encapsulated, intact lansoprazole granules in suppressing intragastric acidity when administered through a gastrostomy.

Methods:

Eight men, each with an established gastrostomy, underwent baseline 24 h intragastric pH monitoring while off any acid-suppressing medication. Via the gastrostomy, they then received 7 days of once-daily dosing with 30 mg lansoprazole as intact granules in 3 fl. oz. of orange juice. Intragastric pH monitoring was repeated on day 7.

Results:

Mean intragastric pH pre-dosing was 1.96 ± 0.5 (s.d.). This increased to 4.7 ± 0.6 on day 7 (P < 0.0001). Median intragastric pH rose from 1.5 to 5.2 (P < 0.0001). Before lansoprazole, the proportions of time when intragastric pH was above 3, 4 and 5 were 23.2, 13.5 and 7.5%, respectively. Corresponding values after 7 days of lansoprazole were 81.1, 70.2 and 52.3% (P < 0.0001 for each comparison).

Conclusion:

Lansoprazole can effectively suppress intragastric acidity when given through a gastrostomy as intact, non-encapsulated granules in orange juice.