Percutaneous suturing of the ruptured Achilles tendon under local anesthesia.

A prospective study of modified percutaneous Achilles tendon repair performed from 1991 to 1997 under local anesthesia with a minimum 2-year follow-up is presented. There were 134 procedures in 124 men and 8 women (mean age, 37 years) treated within 7 days after acute total rupture. Postoperative care consisted of wearing a cast or soft-cast immobilization for 6 weeks. The procedure was well tolerated in all patients. There was 1 (0.7%) complete and 4 (3%) partial reruptures. Six patients (4.5%) developed transient sural neuritis that spontaneously resolved in 3 to 10 months. One case of deep venous thrombosis was successfully treated. There were no cases of increased postoperative dorsiflexion, deep infection, or necrosis. Eighteen patients (14%) had a slightly decreased range of ankle motion; 129 (98%) patients, including all high-caliber athletes, resumed all their previous activities, 22 of them (17%) with some minor complaints. The mean American Orthopedic Foot and Ankle Society's ankle-hindfoot score was 96 points. The proposed method offers a reasonable treatment option for acute total Achilles tendon ruptures, with a low number of complications and a low risk of sural nerve injury. The rerupture rate and return to preinjury activities is comparable to open procedures.     

Rotaviral RNA found on various surfaces in a hospital laundry

The aim of this investigative study was to determine the presence of rotaviral RNA at various control points (CP) of a hospital laundry. One of the possible sources of hospital infections is inappropriately laundered and disinfected hospital textiles. RT-PCR and nested PCR for gene amplification using specific primers following RNA isolation were used to determine the presence of rotaviral RNA on swabs. In addition, rotavirus suspensions were inoculated on marked surfaces as positive controls for different surfaces (cotton textiles, folding table and industrial dryer). Rotaviral RNA was found on various laundry surfaces: technical equipment, storage shelves, transport vehicles, personnel's hands, damp textiles, and folded laundry. Rotaviral RNA was also detected at all positive controls on tested surfaces after 24h. Based on the results, it is very important to take into consideration the proper handling of textiles after washing as one of the precautions against hospital-acquired infections. This paper reports the presence of rotaviral RNA for the first time on surfaces in laundries and equipment, as well as textiles.     

Intraneuronal amyloid beta and reduced brain volume in a novel APP T714I mouse model for Alzheimer's disease

Transgenic mouse models of Alzheimer's disease (AD) expressing high levels of amyloid precursor protein (APP) with familial AD (FAD) mutations have proven to be extremely useful in understanding pathogenic processes of AD especially those that involve amyloidogenesis. We earlier described Austrian APP T714I pathology that leads to one of the earliest AD age-at-onsets with abundant intracellular and extracellular amyloid deposits in brain. The latter strikingly was non-fibrillar diffuse amyloid, composed of N-truncated A beta 42 in absence of A beta 40. In vitro, this mutation leads to one of the highest A beta 42/A beta 40 ratios among all FAD mutations. We generated an APP T714I transgenic mouse model that despite having 10 times lower transgene than endogenous murine APP deposited intraneuronal A beta in brain by 6 months of age. Accumulations increased with age, and this was paralleled by decreased brain sizes on volumetric MRI, compared to age-matched and similar transgene-expressing APP wild-type mice, although, with these levels of transgenic expression we did not detect neuronal loss or significant memory impairment. Immunohistochemical studies revealed that the majority of the intraneuronal A beta deposits colocalized with late endosomal markers, although some A beta inclusions were also positive for lysosomal and Golgi markers. These data support earlier observations of A beta accumulation in the endosomal-lysosomal pathway and the hypothesis that intraneuronal accumulation of A beta could be an important factor in the AD pathogenesis.     

Central venous to arterial pCO2 difference in cardiogenic shock

In normal circumstances central venous to arterial pCO(2) difference is approximately 1?kPa (7.5?mmHg). In shock states it is usually increased. We sought to evaluate the agreement between admission central venous to arterial pCO(2) difference and mortality in patients with acute myocardial infarction and cardiogenic shock. We hypothesized that patients with higher central venous to arterial pCO(2) difference on admission would have higher mortality. We retrospectively included 30 patients with acute myocardial infarction and cardiogenic shock (mean age 67?±?10 years, 73?% men), of which 20 (67?%) died. Nonsignificant differences between survivors and nonsurvivors were observed in age, gender, admission mean blood pressure, heart rate, lactate, hemoglobin, peak troponin I, cardiopulmonary resuscitation, use of therapeutic hypothermia, vasopressors, inotropes, intraaortic balloon pump, and mechanical ventilation. A significant difference between survivors and nonsurvivors was observed in admission central venous to arterial pCO(2) difference (1.35?±?0.49?kPa vs. 0.83?±?0.36?kPa, p?=?0.003). In patients with admission central venous oxygen saturation over 70?%, we observed a significant difference in central venous to arterial pCO(2) difference between survivors and nonsurvivors (1.33?±?0.51?kPa vs. 0.7?±?0.3?kPa, p?=?0.003) and a nonsignificant difference between survivors and nonsurvivors in patients with admission central venous oxygen saturation under 70?% (1.38?±?0.53?kPa vs. 1.25?±?0.33?kPa, p?=?0.37). Patients with decreased central venous to arterial pCO(2) difference on admission seem to be at increased risk of dying even with admission central venous oxygen saturation over 70?%.     

Computer tomographic evaluation of talar edge configuration for osteochondral graft transplantation

To successfully surgically reconstruct osteochondral lesions of the talus, the exact three-dimensional (3D) configuration of the upper articular surface of the talus has to be respected. We assessed the talar geometry by measuring the coronal and sagittal talar edge radius and the frontal talar profile in multiplanar reconstructions of computer tomographic (CT) studies of 79 patients (83 feet) with a healthy ankle joint. An image visualization software designated for coordinate measurement was used to perform the measurement. In the coronal plane, the mean lateral talar edge radius was 4.0 mm and the medial 4.5 mm. In the sagittal planes the mean lateral talar edge radius was 20.3 mm, the radius of the sulcus 20.7 mm and the medial talar edge radius 20.4 mm. The talus showed a concave shape in coronal cuts. These results show a significant difference between medial and lateral talar edge configuration in coronal planes. The measurements of the lateral and medial sagittal radius and the mid-sagittal radius in the sulcus tali show no statistically significant difference. The depth of the talar sulcus shows no correlation to age or sex. Different sizes of custom-made tissue-engineered grafts according to the location of the osteochondral lesion at the talus are needed for exact surgical reconstruction of the anatomy. Osteochondral lesions are three dimensional; therefore, a 3D preoperative planning tool by CT scan or MRI is mandatory.