Measuring tip-apex distance using a picture archiving and communication system (PACS)

BACKGROUND: The sliding hip screw is currently the most frequently used prosthesis used to fix trochanteric fractures of the hip. The 'tip-apex distance' (TAD) has been found to be predictive of hardware failure, with a larger TAD being associated with an increasing risk of 'cut-out'. Previous studies have either used 'hard-copy' radiographs and geometrical aids or a mixture of scanned hard-copy images and extra software to measure TAD. The current study describes a new method of tip-apex distance estimation using an entirely digital picture archiving and communication system (PACS). MATERIALS AND METHODS: Ten radiographs were measured for TAD by four surgeons of differing experience using the described measurement protocol, at two different time points (4 weeks apart). The results were then subjected to two-tailed t-tests to determine if they differed significantly. RESULTS: No tests attained significance (i.e. no statistical difference existed between the observers' measurements and no difference existed over time from a single observer's results). CONCLUSION: This study shows that TAD can be easily, accurately and, importantly, reproducibly measured using an entirely digitally based image capture and archiving system. The ease with which the measurements and calculations can be made will facilitate orthopaedic practitioners and trauma units in their auditing activities, and allows for quick TAD estimation in the 'X-ray meeting' environment.     

Colloid milium: a review and update

Colloid milium (CM) is a rare cutaneous deposition disease with at least 3 distinct subtypes. The exact histogenesis of the condition is still unresolved and awaits definitive elucidation. Electron microscopy and immunohistochemical analysis have allowed the distinction of CM from clinically similar conditions such as amyloidosis. Successful treatment has been achieved with dermabrasion and, more recently, with ablative and fractional laser resurfacing of affected skin.     

Methylene blue administration in severe systemic inflammatory response syndrome (SIRS) after thoracic surgery.

A 66-year-old male patient developed significant pleural effusion on the right side six years after coronary bypass grafting and mitral valve replacement. After pleurocentesis, hemo-pneumothorax developed and finally resulted in complete atelectasis of the right lung. Three weeks later, the patient was transferred to our department, and underwent a right lateral thoracotomy. The hematoma was removed and a complete decortication was performed. Four hours postoperatively the patient developed severe SIRS with beginning multiorgan failure. Even extremely high doses of norepinephrine could not raise the systemic vascular resistance. Single intravenous administration of methylene blue lead to significant and permanent improvement of the hemodynamic status.     

Relationship of serum adiponectin with blood lipids, HbA(1)c, and hs-CRP in type II diabetic postmenopausal women

Adipose tissue has been considered an important endocrine organ. Adiponectin secretes from adipose tissue and plays an important role in the regulation of glycemia, beta-oxidation in muscle, and decreased insulin resistance in the liver. The objectives of this study were to compare the levels of adiponectin, hs-C-reactive protein (CRP), HbA1c, and blood lipids among diabetic and healthy postmenopausal women, and to determine the relationship between circulating adiponectin and development of type II diabetes. This case-control study was performed on 28 diabetic and 42 age-matched healthy women. All participants were postmenopausal. Serum adiponectin concentrations, serum triglycerides (TG), cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) concentrations were determined. Blood HbA1c and serum hs-CRP were also measured. Adiponectin levels were significantly decreased (P<0.01) in the diabetic patients as compared to normal control subjects. Adiponectin levels were negatively associated with hs-CRP, LDL-C, HbA1c, TG, and total cholesterol (TC). A positive correlation was observed between adiponectin and HDL-C. The obtained data indicate that diabetic women have lower adiponectin levels compared to healthy women. HbA1c as an indicator of glycemic control has a negative correlation with serum adiponectin. Adiponectin may play an important role in the pathogenesis of diabetes, and may be an independent predictor of the development of diabetes in women.     

The kinases aurora B and mTOR regulate the G1-S cell cycle progression of T lymphocytes

CD28-deficient T cells arrest at the G1-S transition of the cell cycle. Here we show that this is controlled by the kinase aurora B, which exists in a complex with survivin and mammalian target of rapamycin (mTOR). Expression of aurora B in Cd28-/- T cells augmented phosphorylation of mTOR substrates, expression of cyclin A, hyperphosphorylation of retinoblastoma protein and activation of cyclin-dependent kinases 1 and 2 and promoted cell cycle progression. Interleukin 2 enhanced aurora B activity, and inactive aurora B prevented interleukin 2-induced proliferation. Moreover, expression of aurora B restored Cd28-/- T cell proliferation and promoted inflammation in vivo. These data identify aurora B, along with survivin and mTOR, as a regulator of the G1-S checkpoint in T cells.     

Topical Metronidazole can Reduce Pain after Surgery and Pain on Defecation in Postoperative Hemorrhoidectomy

Background Topical metronidazole (10 percent) has been previously demonstrated to decrease postoperative pain after hemorrhoidectomy. The aim of this study was to evaluate the effect of topical metronidazole (10 percent) in reducing postoperative and after-defecation pain of hemorrhoidectomy. Materials and Methods A double-blind, randomized trial was conducted to compare posthemorrhoidectomy pain with use of topical metronidazole (10 percent) vs. placebo carrier, applied to surgical site. Forty-seven patients were randomly allocated to receive metronidazole (n = 25) or placebo (n = 22). Pain was assessed using a visual analog scale preoperatively and on postoperative hours 6 and 12 and at days 1, 2, 7, and 14. The use of narcotic, additional analgesics, and complications were recorded. (Pain scores were calculated and compared with baseline values and control group (t test, SPSS ver.10). Results Patients in the topical metronidazole group had significantly less postoperative pain than those in the placebo group up to day 14 (P ≤ 0.04). There was no significant difference in narcotic analgesic requirements between groups, except on hour 12 (P < 0.05). In the metronidazole group, after-defecation pain was ranked significantly lower at day 2 (P = 0.016) and patients required fewer additional analgesics postoperatively on days 2 and 7 (P ≤ 0.04). Conclusion These finding indicate that topical 10 percent metronidazole significantly reduce posthemorrhoidectomy discomfort, and postoperative defecation pain is reduced compared with that of the placebo control group. Support: A grant of vice-chancellor for research of Mazandaran University of Medical Sciences     

Interleukin-4 Modulation of Platelet-Derived Growth Factor–Induced Smooth Muscle Cell Urokinase Plasminogen Activator

Platelet-derived growth factor (PDGF) stimulates smooth muscle cell (SMC) migration owing to stimulation of SMC tissue plasminogen activator (t-PA) production. In this study we examined the effects of the T-cell lymphokine interleukin-4 (IL-4) on PDGF induction of human aortic SMC antigen levels of urokinase-type plasminogen activator (u-PA) and those of plasminogen activator inhibitor-1 (PAI-1), the endogenous inhibitor of t-PA and u-PA, measured by enzyme-linked immunosorbent assays (ELISAs). u-PA antigen levels from human aortic SMC incubated with PDGF 100 ng/mL and IL-4 500 U/mL were significantly greater than those incubated with PDGF 100 ng/mL alone. Coincubation of PDGF with IL-4 did not significantly increase SMC u-PA antigen levels in cellular lysates. Coincubation with PDGF 100 ng/mL and IL-4 500 U/mL did not significantly affect SMC PAI-1 antigen levels in conditioned media or cellular lysates. Therefore, interleukin-4 modulates vascular SMC u-PA production induced by PDGF.