Correction of Lower Limb Deformities Using Ilizarov's Technique

Background

India accounts for approximately 10 million orthopaedically handicapped children and adults with limb deformity. Ilizarov ring fixator could treat most of these deformities.

Methods

Twenty cases of deformities of lower limb managed with Ilizarov technique during period between March 2001 and February 2003 were studied.

Results

55% were in the age group of 11-30 years. Out of the 20 cases studied, 6 were congenital talipes equino varus, 8 were fixed flexion deformity of knee, 4 were equines deformity of the ankle and 2 were malunited fracture shaft of tibia.4 patients who had recurrence were operated for fixed flexion deformity of the knee. The main complication encountered was pin tract infection, which was seen in 15(75%) cases. In 16(80%) cases, the results were excellent with no recurrence of deformity and patients were able to walk independently. In 4 (20%) cases, recurrence was mild to moderate (10 to 20) but all of them were able to ambulate idependently and carry out their routine activities.

Conclusion

Ilizarov ring fixator is a superior compared to conventional methods for correction of deformities of lower limb.Key Words: Ilizarov method, Ligamentotaxis, Distraction     

Complex Pediatric Elbow Injury: An Uncommon Case

Background  

There is paucity of literature describing complex elbow trauma in the pediatric population. We described a case of an uncommon pediatric elbow injury comprised of lateral condyle fracture associated with posterolateral dislocation of elbow.     

Association of plasmid-mediated quinolone resistance with extended-spectrum beta-lactamase VEB-1

Association of the plasmid-mediated quinolone resistance determinant QnrA and the bla(VEB-1) gene was identified in a single Enterobacter cloacae isolate from K.-Bicêtre, France, and in 11 out of 23 bla(VEB-1)-positive enterobacterial isolates from Bangkok, Thailand. This result may explain in part the association between quinolone and extended-spectrum beta-lactam resistance.     

Novel genetic structure associated with an extended-spectrum beta-lactamase blaVEB gene in a Providencia stuartii clinical isolate from Algeria

A ceftazidime-resistant Providencia stuartii isolate from Algeria harbored a ca. 160-kb conjugative plasmid that contained a truncated bla(VEB-1b) gene flanked by three 135-bp repeated elements. This work gives further evidence of the worldwide spread of bla(VEB) genes that are associated with genetic structures other than class 1 integrons.     

OXA-60, a chromosomal, inducible, and imipenem-hydrolyzing class D beta-lactamase from Ralstonia pickettii

A chromosomally encoded oxacillinase, OXA-22, had been characterized from Ralstonia pickettii PIC-1 that did not explain by itself the resistance profile of this strain to beta-lactams. Thus, further analysis of the genetic background of this species led to the identification of another oxacillinase, OXA-60, that was expressed only after beta-lactam induction. This chromosomally encoded oxacillinase shared 19% amino acid identity with OXA-22. It has a narrow-spectrum hydrolysis profile that includes imipenem. OXA-60-like enzymes were identified in several R. pickettii strains. Gene inactivation and induction studies of the bla(OXA-60) and bla(OXA-22) genes in R. pickettii identified the relative contribution of each oxacillinase to the resistance profile of R. pickettii to beta-lactams.     

Molecular and biochemical characterization of a carbapenem-hydrolysing beta-lactamase from Flavobacterium johnsoniae

Flavobacterium johnsoniae CIP100931 is resistant to most beta-lactam antibiotics and has a decreased susceptibility to carbapenems. A beta-lactamase gene was cloned and expressed in Escherichia coli DH10B. The purified beta-lactamase, JOHN-1, with a pI value of 9.0 and with a determined relative molecular mass of approximately 27 kDa was found to be a monomeric zinc-dependent enzyme that hydrolyses penicillins, narrow- and expanded-spectrum cephalosporins, carbapenems, but not monobactams. Sequence analysis revealed that JOHN-1 is a molecular class B beta-lactamase that is most closely related to BlaB from Chryseobacterium meningosepticum and IND-1 from Chryseobacterium indologenes (47% and 41% amino acid identity, respectively). JOHN-1 is a new member of the highly divergent subclass B1 lineage of metallo-enzymes. Although F. johnsoniae and Chryseobacterium spp. are phylogenetically related bacteria, this report further underlines the heterogeneity of class B beta-lactamases that are naturally produced by environmental Gram-negative aerobes and that are now recognized as the most important reservoir for these beta-lactamase genes.     

Human hereditary hepatic porphyrias

The human hereditary hepatic porphyrias are diseases due to marked deficiencies of enzymes in the heme biosynthetic pathway. Porphyrias can be classified as either hepatic or erythroid, depending on the major production site of porphyrins or their precursors. The pathogenesis of inherited hepatic porphyrias has now been defined at the molecular level. Some gene carriers are vulnerable to a range of exogenous and endogenous factors, which may trigger neuropsychiatric and/or cutaneous symptoms. Early diagnosis is of prime importance since it makes way for counselling. In this article we present an overview of recent advances on hepatic porphyrias: 5-aminolevulinic acid dehydratase deficiency porphyria, acute intermittent porphyria (AIP), porphyria cutanea tarda (PCT), hereditary coproporphyria (HC), and variegate porphyria (VP).     

Incidence and factors influencing glaucoma after penetrating keratoplasty

PURPOSE: To determine the incidence and factors influencing glaucoma following penetrating keratoplasty. MATERIAL AND METHOD: We prospectively studied 440 consecutive patients undergoing penetrating keratoplasty over a period of 5 years, with an average follow-up of 2 years. High intraocular pressure was defined as IOP over 20 mmHg measured by Goldmann applanation for at least 1 week or if a patient required topical treatment for at least 1 week. Before surgery, 18.7% of the patients presented with glaucoma or high intraocular pressure; 44.9% received a graft for a bullous keratopathy condition, 25.6% had keratoconus, 31.5% received an anterior chamber lens, and 48.5% were phakic. RESULTS: After surgery, 42.2% of the patients had ocular pressure at 20 mmHg or more and required treatment for high ocular pressure. The increase in intraocular pressure appeared after an average delay of 3.3 +/- 4.7 months. The frequency of the increase in intraocular pressure was 54.3% for the bullous keratopathy patients, 26.6% for the keratoconus patients (p<0.001). At the end of the second year, the graft survival was 82.1% in absence of glaucoma, whereas it was 71.5% in cases of glaucoma after keratoplasty. Between all parameters that we studied, high intraocular pressure before surgery, etiology, the status, and receiver age over 60 years were the main factors influencing high intraocular pressure after keratoplasty. Intraocular pressure was correlated with the decrease in endothelial cell density and was at the origin of graft failure. Intraocular pressure correlated with the Best Spectacle Corrected Visual Acuity (BSCVA) by its effect on endothelial cell density and optic nerve destruction. CONCLUSION: The increase in intraocular pressure is a real and serious complication of keratoplasty. Its physiopathology is very complex. Better knowledge of risk factors can be useful in controlling it.