Use of external fixation for perilunate dislocations and fracture dislocations

The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations and fracture dislocations treated with external fixation and K-wire fixation. Twenty patients (18 males and two females) with a mean age of 38 years (range 18–59) who had an acute dorsal perilunate dislocation or fracture dislocation were treated with the use of wrist external fixator and K-wires. The injuries included 12 perilunate dislocations, seven trans-scaphoid perilunate fracture dislocations, and one trans-styloid perilunate fracture dislocation. The median time from trauma to operation was 8 h (2–12 h). Indirect reduction via ligamentotaxis was achieved in all perilunate dislocation, and provisional K-wire fixation was added. In five of seven trans-scaphoid perilunate fracture dislocations, indirect reduction was achieved; whereas in the other two as well as in the case of trans-styloid perilunate fracture dislocation, open reduction was required. External fixator was supplemented with K-wires for stabilization of the fractures and the intercarpal intervals. The interosseous and capsular ligaments were not repaired, even after open reduction of fracture dislocations. The mean follow-up was 39 months (range 18–68 months). Range of motion and grip strength were measured. Cooney’s scoring system was used for the assessment of clinical function. Radiographic evaluation included time to scaphoid union, measurement of radiographic parameters (scapholunate gap, scapholunate angle, lunotriquetral gap, and carpal height ratio) and any development of arthritis. The flexion-extension motion arc and grip strength of the injured wrist averaged 80 and 88%, respectively, of the corresponding values for the contralateral wrists. According to Cooney’s clinical scoring system, overall functional outcomes were rated as excellent in four patients, good in eight, fair in six, and poor in two. Eighteen patients returned to their former occupations. Two patients with a trans-scaphoid perilunate injury developed nonunion of the scaphoid; one of them required scaphoid excision and midcarpal fusion. Two patients had radiographic evidence of arthritis. The use of external fixation and provisional K-wire fixation for the treatment of acute perilunate dislocations is associated with satisfactory midterm functional and radiographic outcomes. This minimally invasive treatment option is simple, reliable, and minimally invasive method that provides proper restoration and stable fixation of carpal alignment.     

The EuroPrevall surveys on the prevalence of food allergies in children and adults: background and study methodology

Background:  The epidemiological surveys in children and adults of the EU-funded multidisciplinary Integrated Project EuroPrevall, launched in June 2005, were designed to estimate the currently unknown prevalence of food allergy and exposure to known or suspected risk factors for food allergy across Europe. We describe the protocol for the epidemiological surveys in children and adults. This protocol provides specific instructions on the sampling strategy, the use of questionnaires, and collection of blood samples for immunological analyses.
Methods:  The surveys were performed as multi-centre, cross-sectional studies in general populations. Case–control studies were nested within these surveys. The studies in children aged 7–10 years and adults aged 20–54 years were undertaken in eight centres representing different social and climatic regions in Europe.
Results:  After a community-based survey collecting basic information on adverse reactions to foods, all those stating they had experienced such reactions, as well as of a random sample of those stating 'no reactions' to foods, completed a detailed questionnaire on potential risks and exposures. Also a blood sample was taken to allow serological analysis to establish patterns of food and aeroallergen sensitization. We also included a questionnaire to schools on their preparedness for dealing with food allergy amongst pupils. Subjects reporting adverse reactions to foods and sensitized to the same food(s) were called in for a full clinical evaluation that included a double blind placebo controlled food challenge (DBPCFC), following a protocol which is described in detail elsewhere.
Conclusions:  The outcome of these studies will help to improve our understanding of several important aspects of food allergies in the European Community, providing for more well-informed policies and effective measures of disease prevention, diagnosis and management.     

Two‐ and three‐dimensional multinuclear stray‐field imaging of rotating samples with magic‐angle spinning (STRAFI‐MAS): From bio to inorganic materials

Purpose:

To revisit and illustrate the potential of a simple and effective multidimensional stray‐field imaging technique with magic‐angle spinning, known as STRAFI‐MAS.

Materials and Methods:

STRAFI‐MAS images are acquired with a standard NMR magnet and a traditional magic‐angle sample spinning (MAS) probe. The stray‐field gradients are achieved by placing the MAS probe, along the z‐direction, at a distance from the center of the magnet. No pulsed‐field gradients are applied. The multidimensional spatial encoding is carried out by synchronizing the radiofrequency pulses with the sample MAS rotation.

Results:

Two‐dimensional (2D) and 3D multinuclear images of various phantoms, including a tibia bone and silicon carbide, are recorded. Images of inorganic solids containing quadrupolar nuclei, ²³Na and ²⁷Al, are also explored for the first time by STRAFI‐MAS.

Conclusion:

We have demonstrated that STRAFI‐MAS is a simple and user‐friendly technique for multidimensional imaging without the need of imaging equipment. With the current advancements in NMR and MRI methodologies, STRAFI‐MAS is expected to be further developed and improved. We anticipate that STRAFI‐MAS can spark a wide spectrum of interest, from material to bio science, where can benefit from high‐resolution images. J. Magn. Reson. Imaging 2010;32:418–423. © 2010 Wiley‐Liss, Inc.     

Evaluation and standardisation of different matrices used for double‐blind placebo‐controlled food challenges to fish

Background: Fish allergens represent one of the most common causes of adverse reactions to food worldwide. Double‐blind placebo‐controlled food challenges (DBPCFC) are the gold standard for food allergy diagnosis. However, no standardised recipes are available for common food allergens such as fish, and a well trained dietitian is essential for creating and standardising them. The present study aimed to create and standardise recipes for use in DBPCFCs to fish. Methods: Three recipes were prepared. Employing a standardised procedure, a total of 35 panelists evaluated the different matrices using an evaluation form. A paired comparison test was used to estimate total evaluation’s outcome. Fish allergic patients were challenged with different fish species blinded with the selected matrix and evaluated the recipe using the same form. Results: From a base recipe and step‐by‐step modifications, a low fat recipe was selected among other recipes tested, which proved to be appropriate for fish blinding, in terms of taste, odour, appearance and blinding. Patients challenged with the final matrix found it acceptable, no matter which fish type was used. Conclusions: In this pilot study, a recipe with satisfactory organoleptic characteristics was developed and validated for DBPCFC to fish.     

The trauma team concept and its implementation in a district general hospital.

A trauma team approach to the initial assessment, investigation and treatment of potentially seriously injured patients has been implemented at a district general hospital. Team members are mobilised by an emergency paging system which is activated when a patient fulfils one or more of a predetermined list of historical, pathophysiological and anatomical criteria. Aspects of the function of the trauma team were assessed after 10 months of operation. The problems encountered and solutions implemented are discussed. As a result, the structure and function of the trauma team has been modified and improved. Although hospitals differ in workload and staffing, the trauma team concept is possible and achievable at no extra cost. Trauma teams maximise existing resources and constitute a valid approach to the early management of the irregular presentation of the severely injured patient to district general hospitals. The establishment of such teams with members who should be ATLS trained, should be a current priority in district general hospitals in the UK.     

Should we measure routinely oxidised and atherogenic dense low‐density lipoproteins in subjects with type 2 diabetes?

Beyond low‐density lipoprotein (LDL)‐cholesterol concentrations, in recent years, several clinical studies have shown that both oxidised and small, dense LDL have a strong predictive role for the presence of vascular atherosclerosis. These two lipid parameters seem to have a synergistic impact on cardiovascular risk, with a greater importance in patients at higher‐risk, such as those with type‐2 diabetes. Increased levels of oxidised and small, dense LDL levels are a feature of diabetic dyslipidaemia, and small, dense LDL have been shown to be a good predictor of future cardiovascular events, at both univariate and multivariate analyses. On the other hand, although the association of oxidised LDL with surrogate markers of atherosclerosis is consistent, the correlation with hard clinical end points seems to be smaller. Yet, measurement of these two lipid parameters has not been widely used in daily practice because of the limited availability of clinical data and methodological problems: lack of availability of easy, cheap and reproducible essays for measurement of oxidised and, particularly, small, dense LDL has reduced their assessment in large clinical end‐points trials. However, on the basis of available data, the therapeutic modulation of small, dense LDL is significantly associated with reduced cardiovascular risk, even after adjustment for confounding factors. In conclusion, the routine measurement of oxidised and small, dense LDL in patients with type‐2 diabetes cannot be recommended in daily clinical practice so far; yet, their measurement is strongly encouraged to better understand their role on the cardiovascular risk of patients with type‐2 diabetes.