Treatment of nonunion around the olecranon fossa of the humerus by intramedullary locked nailing

Nonunion of fractures of the olecranon fossa of the humerus presents a difficult surgical problem. The distal fragment is usually small and osteoporotic and stable fixation is not easy to achieve. We describe a modification of the technique of locked nailing by which the distal aspect of the nail is placed in the subchondral region of the trochlea. Good results were obtained in seven out of eight patients with this technique.     

Poloxamer gel as vehicle for transdermal iontophoretic delivery of arginine vasopressin: evaluation of in vivo performance in rats

The present study describes the formulation and evaluation for pharmacokinetic and pharmacodynamic activity of arginine vasopressin (AVP), a nanopeptide with antidiuretic activity on being delivered by transdermal iontophoresis. Poloxamer 407 was used to form stable gels that did not reduce the release of AVP. The release rate from the gel followed Higuchi kinetics indicating that the dominant mechanism of release is diffusion. Iontophoresis alone and in combination with chemical enhancers was used to augment the transdermal permeation of AVP. The results of both pharmacokinetic and pharmacodynamic studies emphasize the dimension of 'rapid onset' achieved by iontophoresis. The correlation between pharmacokinetic data and pharmacodynamic activity was only qualitative. Histopathological studies revealed that skin toxicity caused by either iontophoresis or chemical enhancers when used alone could be reduced by using a combination of both the techniques in tandem.     

Effect of iontophoresis and fatty acids on permeation of Arginine Vasopressin through rat skin

The aim of this study was to assess the effects of fatty acids and iontophoretic mode of penetration enhancement on transdermal delivery of Arginine Vasopressin (AVP). Sprague-Dawley (SD) rat skin was pretreated with fatty acids (e.g. 5% w/v, lauric acid, oleic acid, and linoleic acid in ethanol:water (EtOH:W, 2:1 system) for 2h and iontophoresis in vitro, separately or together. The results indicate that all fatty acids studied increased (P<0.05) the flux of AVP in comparison to control (not pretreated with enhancer) and their effectiveness in flux enhancement was comparable. Further, oleic acid in combination with iontophoresis significantly increased the permeation of AVP both in comparison to pretreatment with fatty acids and iontophoresis alone. However, iontophoresis did not further increase the permeation of AVP through linoleic acid pretreated skin. Fourier transform infrared (FT-IR) spectroscopic studies revealed that EtOH:W (2:1) system is not effective in lipid extraction. The shift to higher wavenumbers of the symmetric and asymmetric stretching peaks at 2850 and 2920cm(-1) revealed that at the concentration used, oleic acid and linoleic acid caused fluidization of stratum corneum (SC) lipids. This study provides direct evidence that oleic acid in EtOH:W (2:1) system causes disruption of the SC lipid lamellae and that a combination of oleic acid with iontophoresis further enhances the effects of oleic acid in a synergistic manner.     

Chlorinated pesticides and heavy metals in human semen

The concentration of chlorinated pesticides and heavy metals (lead and cadmium) was measured using gas liquid chromatography and the graphite tube atomizer of atomic absorption spectrophotometer, respectively, in semen samples collected from men in the normal human population. Significant concentrations of lead and cadmium were detected. Significant amounts of hexachlorocyclohexane (HCH) and its isomers alpha, beta, gamma and delta, the dichlorodiphenyl trichloroethane (DDT) metabolite 1,1,1-trichloro-2,2-bis (p chlorophenyl ethane) (pp'-DDE) and low values of 1,1,2-dichloro-2, 2-bis(p chlorophenyl ethane) (pp'-DDD) aldrin or endosulfan were detected. The presence of these xenobiotics in human semen might be related to the extensive use of pesticides, emission of exhaust from motor vehicles, consumption of tobacco and industrial operations.     

Acute inhalation toxicity study of 2-fluoroacetamide in rats

One of the most potent rodenticides is 2-fluoroacetamide)2-FA).Toxicity of this chemical is well documented.However,its inhalation toxicity data is not available in the literature.Hence,acute inhalation toxicity study was carried out by exposing male and female rats to aerosols of 2-FA at different concentrations for 4h in a dynamically operated whole body inhalation exposure chamber.During and after the inhalation exposure the rats were less active,and showed mild tremors and convulsions.At higher concentrations the rats died after2-3 days.The estimated 4-h LC50 for male and female rats was 136.6 and 144.5mg.m^-3 respectively.Exposure to 0.7 LC50 for 4h duration showed an increase in the liver weight of male and female rats 7 days after exposure.Various haematological and biochemical variables determined were within the normal limits.Howerver,histological findings showed injured lung as indicated by desquamtion and necrosis of the epithelium of the respiratory tract.Marked hypertorphy of hepatocytes displaying strong acidophilic granulated cytoplasm was observed.Focal dilatation of renal proximal tubules in kidney with cytoplasmic vacuolation,and irregularly placed pyknotic nuclei were seen.The present study shows that 2-FA is a highly toxic chemical through the inhalation route based on the LC50 value.Consequently necessary precautions should be taken during its handling.     

Endoscopy in non-neoplastic cholestasis

The role of endoscopic treatment of cholestasis is well codified as an alternative or adjuvant therapy to surgery, particularly in those cases where non malignant cause has been identified. Non-neoplastic cholestasis therefore benefits very substantially from endoscopic treatment in a context where the traditional surgical approach presents limitations in terms of morbidity and mortality. It should be borne in mind, however, that the two approaches are strictly complementary for the correct management of these patients.     

Posterior approach in the treatment of sacrococcygeal chordoma: a rare, locally infiltrating, destructive and recurrent tumor. A case report and review of the literature

Based on personal observation of a case of recurrent chordoma in the sacrococcygeal region four years after the first excision with subtotal resection of the coccyx using a posterior approach, the authors describe the unique characteristics of this rare neoplasm and underline the simplicity of this method of treatment. The surgical technique used to treat the recurrent form also used a posterior approach, with complete resection of the neoplasm including the scar of the previous operation and the last remaining segment of the coccyx. No intra- or postoperative complications were reported. The authors examine the clinical and histological aspects of this neoplasm, concluding that the correct form of treatment must aim both to protect the adjacent anatomic structures and to achieve radical exeresis, as well as achieving a simpler surgical approach unhampered by complications. The authors believe that this approach is simpler than the abdominal-dorsal approach, although this is necessary in the event of intra-abdominal infiltrations.     

Jet stream related iatrogenic retinal breaks during vitreo-retinal surgery

Purpose:To evaluate the causes of jet stream injury (JSI)-related iatrogenic retinal breaks (IRBs) during vitreoretinal surgery (VRS).Methods:The precise surgical environment, which includes the indication and type of surgical procedure, retina status, details of instrumentation and fluidic parameters, and characteristics of the jet responsible for the IRB, was noted from case records. The nature of IRB and its healing and impact on anatomical and visual outcomes were analyzed.Results:Five eyes of five patients with complete documentation of both the JSI and the IRB were included. Two cases were operated for macular hole, and one each for vitreous hemorrhage, retinal detachment, and endophthalmitis. One case had infusion-fluid-related JSI, while four developed it because of injection of surgical adjuncts (drugs, PFCL, and dye). JSI developed in two cases when the vitreous cavity was filled with fluid, while it was air-filled in three cases. In four cases, the fluid migrated into subretinal space, necessitating further maneuvers following which the breaks healed, but were directly responsible for vision loss in two cases.Conclusion:JSI related IRBs are rare but may be directly responsible for vision loss if they impact the macula. The balance between jet stream velocity, its distance from the retinal surface, the intervening media (vitreous cavity), and retinal health play an important role. It can occur because of both infusion as well as injection jets. Precautions must be taken in cases vulnerable to complications with suggested modifications in the surgical technique.