Wrist injuries in children and adolescent athletes: macrotrauma and overuse

Young children and adolescents are becoming increasingly involved in recreational and professional sports. This inevitably leads to an increase in the number of sports-related injuries involving the hand and the wrist. Hence, physicians should have a good insight into macro- and microtraumas affecting the hand and the wrist. Prevention of injuries, correction of muscle-tendon imbalances, and maintenance of strength and flexibility are important issues for the prevention of disabilities in this age group.     

Renal transplant recipients over aged 60 have diminished immune activity and a low risk of rejection

Strict consideration of the renal transplant candidates chronologic age is generally supplanted by more subjective reflection on his (her) physiologic state. In the US, patients over 64 years old represented 9.0% of renal transplant recipients in the year 2000, yet little prior experience is available with which to guide the management of geriatric patients. Two hundred and forty six consecutive recipients of primary kidney transplants at the Yale–New Haven Organ Transplant Center between 1990 and 1995 were included in an outcome analysis. Age at transplantation ranged from 2 to 68 years; the study group consisted of the 16 (6.5%) over age 60. The immunosuppressive protocol was uniform for all patients. There was a disproportionately high use of cadaveric organs by older patients; only 1/16 (6.3%) received a living donor kidney. The overall rate of rejection within the first 90 days was 6.7% of cadaveric recipients over 60 versus 37.6% of younger recipients, P=0.001. Actual patient survival rates at 6 years were 100% of patients younger than 11 years versus 69% (11/16) of those older than 60 years. Death censored 5 year graft survival was 100% in older patients versus 85% among the younger patients. The older and younger patients received quantitatively equivalent immunosuppression, but acute rejection was uncommon in the former (6%) versus the younger cohort (34%). It seems logical to consider whether older renal transplant recipients may benefit from a less aggressive immunosuppression strategy.     

Mechanisms involved in contractile differences among cremaster muscles according to localization of testis

BACKGROUND/PURPOSE:Evidence suggests differences in contractility in cremaster muscles (CM) associated with undescended testis caused by alterations of autonomic innervation. Contractile responses of CM to various pharmacologic agents were evaluated and compared according to the localization of testis. METHODS: Samples of CM from boys with undescended testis or inguinal hernia were obtained. Twitch and tetanic contractions were recorded isometrically at 37 degrees C. Effects of verapamil, isoprenaline, calcitonin gene-related peptide (CGRP), substance P (SP) and N(omega)-nitro-L-arginine (L-NNA) were investigated. Results were compared through 2-way analysis of variance, and P values less than.05 were considered to be different. RESULTS: Verapamil alone significantly (P <.05) decreased contraction amplitudes in CM from both sources; the decrease was more pronounced in CM from boys with inguinal hernia (P <.05). Although isoprenaline increased contraction amplitudes in CM associated with undescended testis (P <.05), CGRP and SP increased contraction amplitudes in CM associated with descended testis (P <.05). L-NNA increased contraction amplitudes in both groups (P <.05). The decrease of contraction amplitudes after verapamil displayed a similar pattern after isoprenaline, SP, and L-NNA. Verapamil-induced contractility decrease was more pronounced after CGRP in both groups (P <.05). CONCLUSIONS: Sensitivity of CM to verapamil differs according to localization of testis. Isoprenaline enhances contractility by stimulating Na(+)-K(+)ATPase in undescended testis without altering voltage-sensitive channel sensitivity to verapamil. CGRP and SP increase contractility in inguinal hernia, and CGRP increases the sensitivity of voltage-sensitive Ca(2+) channels to verapamil in CM from both groups. Nitric Oxide (NO) exerts inhibitory action on CM contractility, and it is less pronounced in undescended testis. These differences may contribute to pathophysiology of undescended testis.     

High incidence of noninfectious esophagitis in orthotopic liver transplant (OLT) recipients

Incidence of esophagitis among cirrhotics is similar to the general population; post-OLT course of this entity is not well known. The aim of this study was to assess the incidence of non-infectious esophagitis among OLT recipients. Patients with chronic liver disease who have been considered for transplantation have undergone esophagogastroduodenoscopy (EGD) for examination of the upper gastrointestinal tract. Following transplantation, some of these patients have required EGD for various reasons. EGD findings following transplantation were compared to that individual's pre-transplant findings. There were 173 patients and the median age was 49. The incidence of pre-transplant esophagitis was 7.5%, which increased to 22% after OLT (p > 0.0001). None had specific etiology. Etiology of this increase needs to be further investigated and the effects of immunosuppressive drugs on lower esophageal sprinter and gastric motility should be clarified. Use of acid suppressing drugs during the early post-transplant period should be considered.     

A comparison of matrix resolution method, ratio spectra derivative spectrophotometry and HPLC method for the determination of thiamine HCl and pyridoxine HCl in pharmaceutical preparation

A comparison of two spectrophotometric methods and a HPLC method were described in this work for the analysis of pyridoxine hydrochloride and thiamine hydrochloride in a vitamin combination. In the first method, A₁¹ (1%, 1 cm) values of these two compounds were calculated using absorbances measured at 246.8 and 290.5 nm in zero-order spectra. The matrix was written for A₁¹ (1%, l cm) values and the concentration of both compounds were determined using ‘Matlab’ software. In the second method, the measurements in the derivative of the ratio spectra were made at 297.8 and 309.5 nm for pyridoxine hydrochloride and at 245.6 and 257.7 nm for thiamine hydrochloride. The calibration graphs were established in the range 8–40 μg/ml of both vitamins. In the HPLC method, the separation of these compounds was realized on a Nucleosil 100-5 C₁₈ column with 0.1 M (NH₄)₂C0₃–water–methanol (5:15:80 v/v) as the mobile phase. Results of spectrophotometric and HPLC procedures were compared.     

Tramadol encapsulated into polyhydroxybutyrate microspheres: in vitro release and epidural analgesic effect in rats

BACKGROUND: Controlled release techniques are used to increase the duration of action and decrease the toxicity of drugs. Any controlled release form of tramadol in spinal or epidural blocks has not been studied previously. Tramadol was encapsulated into polyhydroxybutyrate (PHB) microspheres and release kinetics was studied. The epidural analgesic effect of this solution in rats was also compared with free tramadol. METHODS: Controlled release of tramadol from PHB microspheres into 10 ml of phosphate buffer solution at pH 7.4 and 37 degrees C was studied in vitro. In vivo studies were performed in 40 rats. Epidural catheters were placed during general anaesthesia. Rats were randomly allocated into one of the four study groups to receive normal saline, 4 mg of tramadol, PHB microspheres without tramadol, or 4 mg of tramadol encapsulated into PHB microspheres. Analgesia was evaluated with tail flick tests performed at 52.5 +/- 0.5 degrees C before injection and at intervals up to 30 h after injection. Catalepsy and loss of corneal reflexes were considered as signs of supraspinal toxicity. RESULTS: In vitro drug release was observed for more than 6 days. Epidural analgesic effects of tramadol released from PHB microspheres were observed for 21 h, whereas an equal dose of free tramadol was effective for less than 5 h. No signs of toxicity were observed. CONCLUSION: Controlled release of tramadol from PHB microspheres is possible, and pain relief during epidural analgesia is prolonged by this drug formulation compared with free tramadol.     

Mediation of nitric oxide from photosensitive stores in the photorelaxation of the rabbit corpus cavernosum

Isolated rabbit corpus cavernosum relaxed in response to ultraviolet (UV) light (365 nm). The UV light-induced relaxation (photorelaxation) was diminished on repeated UV irradiation from 30.5+/-4.0% (the first photorelaxation) to 15.5+/-2.7% (the last photorelaxation). Hydroxocobolamine of 100 microM and hemoglobin (Hb) of 10 microM, which are nitric oxide (NO) scavengers, and 10 microM 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ), a soluble guanylyl cyclase inhibitor, markedly reduced photorelaxation. However, 300 microM 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl 3-oxide (carboxy-PTIO) failed to inhibit photorelaxation. NaNO(2) and N(G)-nitro-L-arginine (L-NA) but not 3-nitro-L-tyrosine (3-NT) were found to be photosensitive in that these compounds are photolysed to release NO, as demonstrated by use of an amperometric NO probe; NO signals produced by 500 microM NaNO(2), and 500 microM L-NA were 133.3+/-28.9 and 54.4+/-10.4 pA, respectively. Not 3-NT but the other compounds (all 200 microM) also enhanced photorelaxation of the cavernosal tissue. Based on these findings, the substance, which mediates photorelaxation, could be NO released from putative stores in the rabbit corpus cavernosum, and L-NA as well as NaNO(2) but not 3-NT produce NO under the influence of UV light.     

Atherogenic profile in preeclampsia

Atherosis is accepted to underlie the pathogenesis of preeclampsia, therefore we aimed to determine malonyldialdehyde (MDA) levels as a marker of lipid peroxidation, and lipoprotein(a) (Lp(a)), apolipoprotein A-1 (Apo A-1) and apolipoprotein B (Apo B) levels as a marker of atherogenic profile in preeclamptic and normal pregnant women. Twenty preeclamptic and 20 gestational-age matched normal pregnant patients were enrolled in the study, mean gestational ages for the preeclamptic and the control group were 33.9+/-1.4 and 35.5+/-0.7 weeks, respectively. Blood was withdrawn from the patients soon after diagnosis, and from the controls at their routine prenatal visits. MDA levels was significantly higher in preeclamptic patients (P=0.0003), but no difference was observed in Apo A-1 and Apo B and Lp(a) levels between the 2 groups. We consider that higher MDA was due to oxidative stress seen in preeclampsia, and similar Apo A-1 and Apo B and Lp(a) levels were due to lack of systemic atherosis.     

Slow Coronary Flow: Correlations with Myocardial Perfusion Tomography and Coronary Arteriography

A reduction in velocity in coronary artery contrast filling during coronary arteriography that is called slow coronary flow is one of the reasons of myocardial ischemia. Ischemia mechanism hasn't been understood. We evaluated coronary arteriographic and scintigraphic properties in patients with a slow flow pattern (SFP). The study included 60 patients who revealed SFP in their coronary arteriograms. The control group consisted of 50 patients with normal myocardial perfusion and normal coronary arteries in their coronary arteriograms. The Thrombolysis in Myocardial Infarction (TIMI) flow count method was used for the assessment of slow coronary flow. Single day rest-stress Technetium-99m hexakis-2-methoxy-isobutyl isonitrile (Tc-99m MIBI) myocardial perfusion tomography was performed to all study patients. Patients with SFP revealed both higher frame counts in native coronary arteries and higher average frame counts. In control patients, the average frame count was 26.4 ± 3.5 (LAD: 35.4 ± 3.3, LCx: 22.5 ± 4.5, RCA: 21.5 ± 2.8). In patients with SFP the average frame count was 64.40 ± 16.64 (LAD: 85.75 ± 24.39, LCx: 57.21 ± 15.25, RCA: 53 75 ± 17.81) (p < 0.001). Myocardial perfusion tomography showed ischemia in 17 patients (Group 1), while 43 patients in Group 2 revealed no perfusion defect. There were no statistically significant differences between Groups 1 and 2 in frame counts. In conclusion, no correlation was observed between the time needed to fill a native coronary artery and ischemia even if there is SFP.