Unusual ankle fracture: A case report and literature review

Fractures of the talus are uncommon, and talar body fractures in the sagittal plane are still rarer. The aim of its treatment is urgent anatomic reduction to restore congruency of the ankle and to reduce the risk of avascular necrosis by preserving any remaining blood supply. We report the case of a body talar fracture in sagittal plane associated with fracture of the medial malleolus in a young adult; the mechanism of the fracture was plantar hyperflexion, internal rotation and axial compression. We perform an open reduction and stabilization with two screws for the talus and screw the medial malleolus. At 14 months following the injury patient had good range of movement with little pain. The mechanism is discussed along with a literature review.     

Impact of epidermal growth factor receptor and transforming growth factor–α on hepatitis C virus‐induced hepatocarcinogenesis

Epidermal growth factor receptor system plays a central hepato‐protective and pro‐regenerative role in liver. Transforming growth factor‐α (TGF‐α) is an important autocrine growth regulator of hepatocytes that plays a role in development of hepatocellular carcinoma (HCC) among patients with chronic hepatitis C (CHC). This study was done on 40 core liver biopsies from patients with CHC, 20 liver specimens from HCC cases on top of CHC as well as five normal controls. All were immunohistochemically stained with epidermal growth factor receptor (EGFR) and TGF‐α antibodies. Some selected HCC cases were submitted for FISH technique to detect EGFR gene alteration. By immunohistochemistry EGFR and TGF‐α were overexpressed in HCC and cirrhotic cases compared to CHC cases without cirrhosis. Also, their expression was stronger in CHC cases with higher grades of activity and stages of fibrosis compared to lower ones. FISH positive results for EGFR were detected in 33.3% of the examined HCC cases. EGFR and TGF‐α can be used as predictive markers for activity, fibrosis, and carcinogenesis in CHC patients. Overexpression of EGFR in HCC patients can be promising in selecting those who can get benefit from anti‐EGFR target therapy.     

Amplification of P1 and 16S rRNA genes by nested PCR for detection of Mycoplasma pneumoniae in paediatric patients

Mycoplasma (M.) pneumoniae is the most frequent atypical pathogen responsible for community-acquired respiratory infection in children and adults. The etiologic diagnosis of these infections still remains difficult. This is mainly due to the absence of characteristic clinical findings, and to the available detection methods (serology and culture) which are time consuming, insensitive and non-specific. To improve the detection of this infectious agent, nested polymerase chain reaction (PCR) analysis was developed. A total of 46 nasal aspirates, from children hospitalised with severe lower respiratory tract infection and in whom M. pneumoniae was suspected, were analysed for the presence of M. pneumoniae DNA by PCR. Routine microbiological investigations revealed no virus in these 46 samples. Using nested PCR, two targets were amplified: the sequences of 16S ribosomal (r) RNA gene (rDNA) and P1 adhesin gene. Evidence of M. pneumoniae infection was identified in four paediatric patients. The amplification of 16S rDNA was found to be more sensitive for the detection of M. pneumoniae. Our results suggest that amplification of the 16S rDNA by nested PCR and detection of the amplification products by visual inspection of the polyacrylamide gel should allow the rapid diagnosis of M. pneumoniae in respiratory tract infection in paediatric patients.     

Immunohistochemical identification of the pacemaker cajal cells in the normal human vagina

Objectives: It is claimed that the electric waves recorded from the gut and urinary system are generated from specialized cells called interstitial cells of Cajal (ICCs). As the vagina exhibits electric activity, we investigated the hypothesis that ICCs could be detected in its wall. Methods: Vaginal specimens were obtained from 28 female cadavers (mean age 34.8±10.8 SD years) and fixed sections were prepared for immunohistochemical investigations using the specific ICC marker c-kit. Controls for antisera specificity consisted of tissue incubated with normal rabbit serum substituted for the primary antiserum. Results: Branching, c-kit-positive ICC-like cells were found in the muscular layer of the vagina. They were clearly distinguishable from the smooth muscle cells which were c-kit negative and not branched and from the c-kit positive non-branched mast cells. Immunoreactivity was absent in the negative controls. Conclusions: We have, for the first time, identified in the vagina ICCs that may be responsible for initiating the slow waves recorded from the vaginal smooth muscle cells.     

Oviduct contractile response to vaginal distension: identification of vagino-tubal reflex

Objective The effect of vaginal distension on the oviduct contractile activity during penile thrusting at coitus could not be traced in the literature. We investigated the hypothesis that vaginal distension effects oviduct contraction, which assists in ovum transport along the oviduct.Methods Oviduct pressure was measured upon vaginal condom distension in 16 women (mean age 32.2±1.2 years) scheduled for abdominal hernia repair and oviduct ligation for sterilization. The test was repeated after individual anesthetization of the vagina and oviduct.Results Ten milliliters vaginal distension effected pressure elevation of the ampullary (AO) and isthmic (IO) parts of the oviduct (p<0.01, p<0.01 respectively) and a decrease in intramural oviduct (IMO; p<0.01). Twenty milliliters distension further increased the pressure in the AO and the IO (p<0.001, p<0.001) and decreased it in IMO (p<0.001). Vaginal distension with greater volumes produced an oviduct pressure response similar to that with 20 ml distension (p>0.05). Vaginal distension of anesthetized vagina or oviduct did not evoke the oviduct pressure response, but saline infusion did.Conclusions Vaginal distension seems to produce oviduct motile activity as evidenced by oviduct pressure changes, which appear to assist in sperm–ovum transport and fertilization. These oviduct changes are suggested to occur reflexly through the vagino-tubal reflex. Pathologic changes of the oviduct presumably interfere with this reflex action, a point that needs to be investigated.     

Surgical anatomy of the perineal muscles and their role in perineal disorders

The anterior perineum contains the perineal body and muscles. It is the site of functional and pathological disorders, many of which have not yet been related to a precise cause. In the present study, we investigated the anatomy of the perineal muscles with the aim of elucidating their function in light of their anatomic structure. Knowledge of their functional-structural relationship is deemed necessary for the understanding of the disorders that affect this part of the perineum. The perineal muscles of 28 cadaveric specimens were studied by direct dissection, as well as histologically. Fifteen male and 13 female specimens were collected from 18 adult (mean (+/- SD) age 31.6 +/- 9.8 years) and 10 neonate cadavers. Histological sections were stained with hematoxylin and eosin and Masson's trichrome stain. The fibers of the superficial transverse perineal muscle proceeded medially to decussate in a criss-cross pattern with the muscle fibers of the contralateral muscle; a few muscle fibers passed directly without decussation. Similarly, the fibers of the deep transverse perineal muscle decussated with their fellows on the opposite side. The two decussation raphes constituted the main bulk of the perineal body. A 'digastric' pattern could be identified for each of the superficial transverse perineal muscle and deep transverse perineal muscle. This pattern allows simultaneous contraction of the muscles on both sides as a single unit. The perineal muscles, forming the floor of the anterior perineum, are apparently subjected to variations in intra-abdominal pressure, which, if exceeding normal physiological limits, may lead to weakening, subluxation and sagging of the perineal muscles and, eventually, to perineocele. Further studies to investigate the role of the perineal muscles in the functional disorders of the perineum are needed.     

Assessment of endometrial receptivity using Doppler ultrasonography in infertile women undergoing intrauterine insemination

Objective: The aim of this study was assessment of subendometrial blood flow with Doppler ultrasonography as an indicator of endometrial receptivity in stimulated cycles for intrauterine insemination (IUI).

Patients and methods: This prospective study enrolled 90 women scheduled for IUI after ovarian stimulation randomly assigned to one of the three equal groups; group (C) received Clomiphene citrate, group (H) received HMG and group (CH) received Clomiphene citrate in addition to HMG. All participants had ultrasound folliculometry starting on day 9, followed by transvaginal Doppler study of the subendometrial blood flow and perifollicular blood flow on the day of detecting at least one follicle >18?mm. Resistivity index (RI) and pulsatility index (PI) of subendometrial and perifollicular flow were measured. Endometrial thickness was measured on day of hCG injection.

Results: Group (H) showed significantly higher frequency of subendometrial flow (80%) compared to the other two groups (p?=?0.009). In cases of positive subendometrial flow, the RI and PI were significantly lower in group (H) compared to the other two groups (p?=?0.007 and 0.012, respectively). Endometrial thickness was significantly lower in group (C) compared to group (H) (p?p?p?=?0.372). Subendometrial indices and perifollicular RI were significantly lower in cases of successful implantation, while endometrium was significantly thicker in these cases (p?Conclusion: The presence of subendometrial flow is associated with successful IUI in women under stimulated cycles undergoing IUI. HMG seems a superior option for induction of ovulation regarding success of implantation.