Fracture of the lesser trochanter as a sign of undiagnosed tumor disease in adults

Isolated avulsion fractures of the pelvic ring are rare and occur predominantly in adolescent athletes. Isolated fractures of the lesser trochanter are reported to be pathognomic for tumor diseases in adults. We present a case of a female patient with an isolated avulsion of the lesser trochanter after treatment by her chiropractor. After staging examination, we determine the diagnosis of a left-sided carcinoma of the mamma. Additional imaging shows multiple metastases in liver, spine and pelvis. Palliative therapy has started over the course of time. We suggest, on suspicion of a malignant metastatic process, further investigation.     

Modulation of Ca2+ currents in rat thalamocortical relay neurons by activity and phosphorylation

Rhythmic low and high frequency activity in thalamocortical networks depend critically on activation of low- and high-voltage-activated (LVA, HVA) Ca2+ currents. In order to test whether Ca2+ currents are modified during repetitive activation, acutely isolated thalamocortical relay neurons of rats, at postnatal days 12 (P12) to P20, were investigated using patch-clamp, Ca2+ imaging and Western blot techniques. High-voltage-activated, but not LVA Ca2+ currents were reduced significantly during 2 Hz stimulation. Ca2+ imaging experiments demonstrated a close correlation between the increase in intracellular Ca2+ levels and the decrease in HVA Ca2+ current amplitudes. Further examination of HVA Ca2+ currents revealed a 'U-shaped' inactivation curve and a time-dependent inactivation process that could be described by a two-exponential function. The 'U-shape' was significantly reduced, current amplitude was increased significantly and time-dependent inactivation revealed a one-exponential decline with Ba2+ as the charge carrier, following activation of the cAMP/PKA pathway, and following application of phosphatase inhibitors (ascomycin, calyculin A). Western blot analysis and the effect of ascomycin indicated an involvement of calcineurin in the inactivation process. Isolation of HVA Ca2+ current components by subtype-specific blockers revealed that changes in time-dependent inactivation, inactivation curve and current amplitude were carried mainly by L-type and N-type Ca2+ currents. Furthermore, Ca2+-dependent inactivation was operative during stimulation protocols mimicking tonic action potential firing. These data indicate a modulation of L- and N-type Ca2+ channels by phosphorylation, resulting jointly in an increased intracellular Ca2+ influx during activity of the ascending brainstem system, the latter occurring during states of wakefulness.     

An audit of the use of laser Doppler imaging (LDI) in the assessment of burns of intermediate depth

This is the first report of an evaluation of the use of a laser Doppler imager (LDI) scanner in the assessment of burn depth in patients. It is based on a 6-month, prospective audit of 76 burns of intermediate depth. Clinical and LDI assessments of burn wound depth were recorded at 48-72 h post-injury. Histological confirmation of depth was obtained from those burns requiring surgery. A healing time of less than 21 days was taken as confirmation of the injury being an superficial dermal burn. The accuracy of LDI in the assessment of burn depth was 97%, compared with 60-80% for established clinical methods. This audit confirms that LDI is a very accurate measurement tool for the assessment of burn wound depth. We recommend that all burns of intermediate depth should be analysed in this way in order to ensure appropriate management of the burn, to avoid unnecessary surgery and to reduce hospital stay and costs.     

Effect of open wedge high tibial osteotomy on the lateral tibiofemoral compartment in sheep. Part II: standard and overcorrection do not cause articular cartilage degeneration

Purpose

To evaluate whether medial open wedge high tibial osteotomy (HTO) results in structural changes in the articular cartilage in the lateral tibiofemoral compartment of adult sheep.

Methods

Three experimental groups received biplanar osteotomies of the right proximal tibiae: (a) closing wedge HTO (4.5° of tibial varus), (b) opening wedge HTO (4.5° tibial valgus; standard correction), and (c) opening wedge HTO (9.5° of valgus; overcorrection), each of which was compared to the contralateral knees that only received an arthrotomy. After 6 months, the macroscopic and microscopic characteristics of the articular cartilage of the lateral tibiofemoral compartment were assessed.

Results

The articular cartilage in the central region of the lateral tibial plateau in sheep had a higher safranin O staining intensity and was 4.6-fold thicker than in the periphery (covered by the lateral meniscus). No topographical variation in the type-II collagen immunoreactivity was seen. All lateral tibial plateaus showed osteoarthritic changes in regions not covered by the lateral meniscus. No osteoarthritis was seen in the peripheral submeniscal regions of the lateral tibial plateau and the lateral femoral condyle. Opening wedge HTO resulting in both standard and overcorrection was not associated with significant macroscopic and microscopic structural changes between groups in the articular cartilage of the lateral tibial plateau and femoral condyle after 6 months in vivo.

Conclusion

Opening wedge HTO resulting in both standard and overcorrection is a safe procedure for the articular cartilage in an intact lateral tibiofemoral compartment of adult sheep at 6 months postoperatively.     

Can a Modified Anterior External Fixator Provide Posterior Compression of AP Compression Type III Pelvic Injuries?

Background

Current anterior fixators can close a disrupted anterior pelvic ring. However, these anterior constructs cannot create posterior compressive forces across the sacroiliac joint. We explored whether a modified fixator could create such forces.

Questions/purposes

We determined whether (1) an anterior external fixator with a second anterior articulation (X-frame) would provide posterior pelvic compression and (2) full pin insertion would deliver higher posterior compressive forces than half pin insertion.

Methods

We simulated AP compression Type III instability with plastic pelvis models and tested the following conditions: (1) single-pin supraacetabular external fixator (SAEF) using half pin insertion (60 mm); (2) SAEF using full pin insertion (120 mm); (3) modified fixator with X-frame using half pin insertion; (4) modified fixator using full pin insertion; and (5) C-clamp. Standardized fracture compression in the anterior and posterior compartment was performed as in previous studies by Gardner. A force-sensitive sensor was placed in the symphysis and posterior pelvic ring before fracture reduction and the fractures were reduced. The symphyseal and sacroiliac compression loads of each application were measured.

Results

The SAEF exerted mean compressions of 13 N and 14 N to the posterior pelvic ring using half and full pin insertions, respectively. The modified fixator had mean posterior compressions of 174 N and 222 N with half and full pin insertions, respectively. C-clamp application exerted a mean posterior load of 407 N.

Conclusions

Posterior compression on the pelvis was improved using an X-frame as an anterior fixation device in a synthetic pelvic fracture model.

Clinical Relevance

This additive device may improve the initial anterior and posterior stability in the acute management of unstable and life-threatening pelvic ring injuries.     

Prothetik bei proximalen Humerusfrakturen

Background

The purpose of this present study was to review the functional and radiological results of patients with complex fractures of the proximal humerus who were treated with an anatomical shoulder prosthesis.

Patients and methods

Between 1999 and 2005 a total of 61 patients were treated with an anatomical trauma prosthesis after an acute fracture.

Results

Thirty-eight patients (31 women and 7 men) with a mean age of 72 (range, 31–85) years could be followed-up. The absolute Constant score averaged 57.7 of 100 (range, 32–86) points by a mean of 86 (range, 60–129) months. Postoperative active elevation averaged 105 (range, 50–180)° and active abduction averaged 96 (50–180)°. Tuberosity resorption was found in 52% (20/38) at final follow-up. The outcome was significantly better in patients with healing of the tuberosities (p?=?0.02).

Conclusion

With the use of an anatomical trauma prosthesis the reduction of the pain level is excellent while the gain in function is only slight. The bony union of the tuberosities in an anatomical position is essential to achieve good results.     

Long‐term mortality after tuberculosis treatment among persons living with HIV in Haiti

IntroductionLong‐term mortality among TB survivors appears to be higher than control populations without TB in many settings. However, data are limited among persons with HIV (PWH). We assessed the association between cured TB and long‐term mortality among persons with PWH in Haiti.MethodsA prospective cohort of PWH from the CIPRA HT‐001 trial was followed from study enrolment (August 2005 to July 2008) to study closure (December 2018) to compare mortality between participants with and without TB. The index date for the survival analysis was defined as 240 days after TB diagnosis or randomization date. Time to death was described using Kaplan–Meier curves, and log‐rank tests were used to compare time to death between the TB and no‐TB cohorts. The association between TB and long‐term mortality was estimated with multivariable Cox models.ResultsOf the 816 participants in the CIPRA HT‐001 trial, 77 were excluded for a history of TB prior to study enrolment and 31 were excluded due to death or attrition prior to the index date, leaving 574 in the no‐TB and 134 in the TB cohort. Twenty‐four (17.9%) participants in the TB and 48 (8.4%) in the no‐TB cohort died during follow‐up. Five and 10‐year mortality rates were 14.2% and 17.9% respectively, in the TB cohort, and 6.1% and 8.4% in the no‐TB cohort. In Kaplan–Meier analysis, participants in the TB cohort had a significantly shorter time to death (log‐rank p < 0.001). In multivariable analysis, TB treatment was the only predictor of mortality (HR: 2.78; 95% CI: 1.61, 4.79). Sensitivity analyses, which included only baseline TB cases, an index date of two years after TB diagnosis, and study enrolment and case‐control matching yielded results that were consistent with primary analyses.ConclusionsPWH who are successfully treated for TB have higher long‐term mortality than those who are never diagnosed with TB, even after accounting for acute TB‐related mortality. A better understanding of the underlying mechanisms associated with TB sequelae is critically needed to guide specific interventions. Until then, more aggressive measures for health promotion and disease prevention are essential to improve long‐term survival for PWH after TB treatment.     

Effective treatment of anemia in pediatric kidney transplant recipients with methoxy polyethylene glycol-epoetin beta

Wedekin M, Ehrich JHH, Pape L. Effective treatment of anemia in pediatric kidney transplant recipients with methoxy polyethylene glycol‐epoetin beta.
Pediatr Transplantation 2011: 15: 329–333. © 2011 John Wiley & Sons A/S. Abstract: MPG‐EPO is a continuous erythropoietin receptor activator with a longer half‐life than darbepoetin, hence requires less frequent injections. It has been successfully used in adults, but currently, there are no published data available for its use in children. This pilot study was performed to verify the effect of MPG‐EPO on Hb levels in children. Twelve patients (age 6.4–17.2 yr) were treated with MPG‐EPO as an individual “Heilversuch” according to German law after RTx. Five patients were switched from DA, and seven were naïve to erythropoietin. Over a period of six months, Hb levels were measured monthly. A median MPG‐EPO dose of 2.5 μg/kg was administered intravenously in a single dose every four wk. The median Hb value increased in naïve patients from 9.9 to 11.2 g/dL (median, p = 0.004) and from 10.3 to 11.6 g/dL (median, p = 0.39) in patients switched from DA to MPG‐EPO. No adverse events secondary to MPG‐EPO therapy were detected. Our results indicate that a once‐monthly injection of MPG‐EPO is an effective treatment of anemia in children after renal transplantation. Larger randomized trials will have to confirm our findings.