Basal fractures of the femoral neck: intra- or extra-capsular

The method of treatment and outcome for 83 patients presenting with a basal fracture of the femoral neck were determined. This represented 2.3% of all hip fractures admitted to one institution. The mean age of patients was 80 years, 25% were male. Seventy-one fractures were treated with a sliding hip screw, one of which cut-out. No other failures of fixation occurred or re-operations were required. Two fractures were fixed with cancellous screws, one healed in varus and the other fixation failed requiring re-operation. Six were managed with an arthroplasty and four treated conservatively. At 1-year from injury 29% of patients had died. For the survivors 87% were able to return home and only 6% had significant residual pain.     

Repeated intracerebral microinjections: efficacy in studying brain functions

Injection of chemicals into the brain has been considered as an important technique to study various functions of the brain. In these studies, as a rule, only one bilateral injection is given in one animal. This study was undertaken to evaluate the quality of the body temperature data obtained after first and second injections of methoxamine and artificial cerebrospinal fluid into the medial preoptic area. Though there was quantitative decrease in the effects produced after the second injection of the drug, there was no significant change in the effects produced by the second injections of artificial cerebrospinal fluid, which was used as a vehicle. Results of this study support the earlier recommendation to perform only one injection in any of the brain sites for evaluating the effect of any drug. But the vehicle can be administered as a second injection, without compromising on the quality of data.     

A prospective randomised controlled trial of capnography vs. bronchoscopy for Blue Rhino percutaneous tracheostomy

A crucial step for successful percutaneous tracheostomy is the introduction of the needle and guide wire into the trachea. Capnography has recently been proposed as one way to confirm tracheal needle placement. In this randomised controlled study, we used capnography in 26 patients and bronchoscopy in 29 patients to confirm needle placement for percutaneous tracheostomy using Blue Rhino kit. The operating times and the incidence of peri-operative complications were similar for both groups. Capnography proved to be as effective as bronchoscopy in confirming correct needle placement.     

Disorders of the lymph circulation: their relevance to anaesthesia and intensive care

The lymphatic system is known to perform three major functionsin the body: drainage of excess interstitial fluid and proteinsback to the systemic circulation; regulation of immune responsesby both cellular and humoral mechanisms; and absorption of lipidsfrom the intestine. Lymphatic disorders are seen following malignancy,congenital malformations, thoracic and abdominal surgery, trauma,and infectious diseases. They can occasionally cause mortality,and frequently morbidity and cosmetic disfiguration. Many lymphaticdisorders are encountered in the operating theatre and criticalcare settings. Disorders of the lymphatic circulation relevantto anaesthesia and intensive care medicine are discussed inthis review. Br J Anaesth 2003; 91: 265–72     

Diagnosis of disease in renal allografts: correlation between ultrasound and histology

Ultrasound was compared with histology in 66 cases to assess the accuracy of sonography in demonstrating abnormality in renal allografts. Patients with suspected acute, chronic or acute and chronic rejection, acute tubular necrosis and glomerulonephritis in the transplant kidney were included in the study. It was noted in this trial that ultrasound is less accurate at demonstrating abnormality in the grafted kidney than has been suggested previously in the literature. It was concluded that, where doubt exists, even when ultrasound examination is normal, biopsy should be considered.     

Use of unconventional therapies by children with cancer at an urban medical center

PURPOSE: The aim of this study was to determine the prevalence, modalities, and determinants of use of unconventional therapies among children with cancer receiving conventional treatment at an urban academic medical center in the United States. PATIENTS AND METHODS: We interviewed the parents of patients and/or patients who were receiving or had received conventional therapy for treatment of childhood cancer. Of 78 patients/ parents asked, 75 consented to the interview, which included demographic factors, life events, and use of unconventional therapies. All participants also consented to the abstraction of chart data for this study. RESULTS: Overall, 84% of respondents reported the use of one or more unconventional therapies. The most commonly used modalities were changes in diet, nutritional and herbal agents, and mind/body treatments. Most users had tried more than one unconventional modality. No difference in use was seen by cancer diagnosis, race/ethnicity, socio-economic status, or educational attainment of the respondent. Of the therapies used, 50% were not reported to the physicians. Of patients reporting use of an unconventional approach, 85% were concurrently enrolled on clinical trials for primary treatment of their cancer. CONCLUSIONS: The use of unconventional therapies is highly prevalent among children with cancer and is not associated with demographic or clinical factors or participation in clinical trials. The possibility that an unconventional treatment may interact with a protocol treatment underscores the need for more information about the use of such therapies among all patients.     

Dissolution behaviour of nalidixic acid solid dispersions using water soluble dispersion carriers

The oral bioavailability of nalidixic acid (NA) is low due to its poor solubility and slow dissolution. Solid dispersions of NA containing varying concentrations of polyvinylpyrrolidone (PVP), beta-cyclodextrin (BCD) and sodium starch glycolate (SSG) were prepared by solvent evaporation technique in an attempt to improve dissolution rate of NA. Physical characterization of NA, physical mixtures (PM) and solid dispersions were investigated by a variety of analytical methods including scanning electron microscopy (SEM), infrared (IR) spectroscopy and powder X-ray diffraction (XRD). SEM was useful in the verification of possible nalidixic acid inclusion in the dispersion system by studying its surface and shape characteristics of different samples. IR analysis demonstrated no strong interaction between the drug and the carrier exists in the solid dispersions. The degree of crystallinity of nalidixic acid decreased and also differed with the dispersion systems of different carriers. Disolution studies indicated that the dissolution rate and percent dissolution efficiency (DE) were significantly increased in the solid dispersions compared with drug alone. The relative potency of the carriers to enhance the dissolution rate of nalidixic acid was in the order: BCD > PVP > SSG. The dissolution rate of the drug in the solid dispersions was faster when the ration of the drug to carrier was smaller. F-test suggests that first order model may be used for explaining the kinetics of drug release from all the solid dispersion systems.     

Formation of physically stable amorphous phase of ibuprofen by solid state milling with kaolin.

Ibuprofen was milled in the solid state with kaolin (hydrated aluminium silicate) in different ratio to examine the extent of transformation from crystalline to amorphous state. The physical stability of the resultant drug was also investigated. X-ray powder diffractometry (XRD) and birefringence by Scanning Electron Microscopy (SEM) studies indicated almost complete amorphization of the drug on ball milling with kaolin at 1:2 ratio. Fourier transform infrared spectroscopy (FTIR) data showed a reduction in the absorbance of the free and the hydrogen-bonded acid carbonyl peak of carboxylic acid group accompanied by a corresponding increase in the absorbance of the carboxylate peak, indicating an acid-base reaction between the carboxylic acid containing ibuprofen and kaolin on milling. The extent of amorphization and reduction in the carbonyl peak and increase in carboxylate peak was a function of kaolin concentration in the milled powder. On storage of milled powder (at 40 degrees C and 75% RH for 10 weeks), XRD and birefringence of SEM study showed the absence of reversion to the crystalline state and FTIR data revealed continued reduction of carbonyl peak, whereas, ibuprofen converted from its crystalline acid form to amorphous salt form on milling with kaolin. Kaolin-bound state of ibuprofen was physically stable during storage. In-vitro dissolution studies revealed that percent release of ibuprofen from the kaolin co-milled powder is in the order: 1:2>1:1>1:0.5>1:0.1>milled alone ibuprofen>crystalline ibuprofen.