Acetabular fractures in the elderly. Results of a sophisticated treatment concept

Acetabular fractures in elderly patients are rare injuries, but their incidence is increasing. Poor bone quality due to osteoporosis and an increased operative risk due to concomitant disease are factors complicating surgical therapy. Literature does not provide generally accepted treatment protocols.In a 4-year period, 27 patients who were 65 years or older and who had an acute displaced fracture of the acetabulum were admitted to our department. Four minimally displaced and stable fractures were managed conservatively. Internal fixation was performed in 16 cases. According to the Merle d'Aubigné score, in 15 out of 18 surviving patients excellent or good results were found.Treatment strategy should be planned individually for each fracture, taking into account the patients biological age and general condition, fracture type, bone quality and associated injuries. Primary endoprosthetic replacement should only be considered when the acetabular bone stock allows stable cup fixation. Osteosynthesis in combination with early endoprosthetic replacement should be considered in acetabular fractures with associated femoral head or neck fractures or when significant articular steps and/or bone defects remain after open reduction and internal fixation.     

Myocardial infarction in a neonate with hereditary antithrombin III deficiency

We report the case of a newborn girl with antithrombin III deficiency type 1. The clinical features of a hypercoagulable condition that lead to this rare diagnosis differed from the reports in the literature, since the primary thromboembolic incident resulted in neonatal myocardial infarction, which is in itself a rare condition during the first days of life.     

Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors

OBJECTIVE: The purpose of this study was to analyze the factors that influence local recurrence after radiofrequency coagulation of liver tumors. SUMMARY BACKGROUND DATA: Local recurrence rate varies widely between 2% and 60%. Apart from tumor size as an important risk factor for local recurrence, little is known about the impact of other factors. METHODS: An exhaustive literature search was carried out for the period from January 1, 1990 to January 1, 2004. Only series with a minimal follow-up of 6 months and/or mean follow-up of 12 months were included. Univariate and multivariate meta-analyses were carried out. RESULTS: Ninety-five independent series were included, allowing the analysis of the local recurrence rate of 5224 treated liver tumors. In a univariate analysis, tumor-dependent factors with significantly less local recurrences were: smaller size, neuroendocrine metastases, nonsubcapsular location, and location away from large vessels. Physician-dependent favorable factors were: surgical (open or laparoscopic) approach, vascular occlusion, general anesthesia, a 1-cm intentional margin, and a greater physician experience. In a multivariate analysis, significantly less local recurrences were observed for small size (P < 0.001) and a surgical (versus percutaneous) approach (P < 0.001). CONCLUSIONS: Radiofrequency coagulation by laparoscopy or laparotomy results in superior local control, independent of tumor size. The percutaneous route should mainly be reserved for patients who cannot tolerate a laparoscopy or laparotomy. The short-term benefits of less invasiveness for the percutaneous route do not outweigh the longer-term higher risk of local recurrence.     

Adolescents' food habits: results of the Health Behaviour in School-aged Children survey

The present study describes food habits in adolescents in thirty-five countries and regions (European countries/regions, Israel, Canada and the USA), based on the food-frequency questions from the cross-sectional Health Behaviour in School-aged Children survey of the year 2001-2. A total of 162,305 pupils of 11, 13 or 15 years of age completed an anonymous standardised questionnaire on health and lifestyle factors during one school hour. Large differences in food habits between countries were found: the consumption frequency of fruit varied from on average 2.8 to 5 d/week, the consumption of vegetables varied from on average 2.4 to 5.5 d/week, the consumption of soft drinks varied from 2.1 to 5 d/week and sweet consumption from 2.6 to 5 d/week. Methodological problems in comparing between countries are discussed. Nonetheless, the results indicate a need for national and international health promotion programmes to improve adolescents' food habits.     

Attention and information processing in survivors of childhood acute lymphoblastic leukemia treated with chemotherapy only

BACKGROUND: Omitting radiotherapy for central nervous system (CNS) prophylaxis has improved the overall quality of life for long-term survivors of childhood acute lymphoblastic leukemia (ALL). However, recent reports suggest minor cognitive impairment in survivors who received chemotherapy only. PROCEDURE: This study focused on attentional functioning and speed of information processing in 23 children previously treated for ALL according to EORTC 58881 and EORTC 58951 protocol. Patients received intrathecal methotrexate combined with high doses intravenous methotrexate as CNS prophylaxis. Cognitive functioning was assessed with the Amsterdam Neuropsychological Tasks, a computerized attention assessment program. Variables of both speed and accuracy of the patients were compared with those obtained from 23 age- and sex-matched control children. RESULTS: Patients were equal to control children concerning baseline speed, sustained attention, response inhibition, and response organization. However, they were significantly slower than controls in three tasks: encoding, memory search letters, and focused attention 4-letters. Interactions with the difficulty of the task were found. There were no differences in number or type of errors between groups on all tasks. CONCLUSIONS: ALL survivors treated with chemotherapy have specific information processing difficulties. They process information slower than control children, especially when more information has to be processed or when attention has to be focused precisely. In spite of being slower, patients are equally accurate compared to control children.     

Virosome-based active immunization targets soluble amyloid species rather than plaques in a transgenic mouse model of Alzheimer’s disease

Active vaccination with amyloid peptides shows promise for the treatment and prevention of Alzheimer's disease (AD). Several studies in transgenic mouse models of AD have revealed the potency of vaccination to prevent or even clear amyloid plaques from mouse brain. However, the idea that soluble oligomeric species of beta-amyloid (Abeta), rather than plaques, trigger the disease has gained momentum, and current active vaccination strategies affect the levels of total or soluble brain Abeta little or not at all. We describe an active vaccination method based on Abeta1-16 presented on the surface of virosomes, which triggered a dramatic decrease in both soluble Abeta40 (75% reduction; p=0.01) and soluble Abeta42 (62% reduction; p=0.03) in a double transgenic mouse model of AD. Whereas Abeta40 and Abeta42 levels in the insoluble fraction tended to be reduced (by 30% and 27%, respectively), the number of thioflavine-S-positive amyloid plaques was not affected. The high specific antibody responses, obtained without eliciting T-cell reactivity, demonstrate that immunostimulating reconstituted influenza virosomes are a promising antigen carrier system against the neuropathology of AD.     

Sonography of a rupture of the tendon of the extensor pollicis longus muscle: initial clinical experience and correlation with findings at cadaveric dissection

OBJECTIVE: The objectives of our study were to report our initial clinical experience with sonography of the wrist for diagnosing a proximal rupture of the tendon of the extensor pollicis longus (EPL) muscle and to perform sonographic-anatomic correlation of the EPL tendon. MATERIALS AND METHODS: Clinical and imaging files of five patients who underwent sonography and subsequent open wrist surgery were reviewed retrospectively. Imaging was performed by four radiologists experienced in musculoskeletal sonography. Tendon retraction was evaluated on sonography and at surgery. In cadavers, sonography was performed in concert by two musculoskeletal radiologists during progressive stages of dissection of four embalmed specimens. One specimen was sliced in the transverse plane. RESULTS: In cadavers, the EPL tendon was located on or adjacent to Lister's tubercle and extended to the base of the thumb. The EPL tendon crossed over the extensor carpi radialis tendons where it exhibited a flattened aspect. In the five patients in the study, a tubular-shaped hypoechoic area was evident at the position of the ruptured EPL tendon on sonograms. At surgery, this area corresponded to fluid, hemorrhage, and scar tissue in the EPL tendon sheath. The assessment of tendon retraction on sonography correlated with findings at surgery. CONCLUSION: Sonography may aid in diagnosing a rupture of the EPL tendon and in the preoperative assessment of gap size and position of the retracted tendon ends. A characteristic tubular hypoechoic area may be seen crossing over the extensor carpi radialis tendons.     

Speech recognition with a cochlear implant using triphasic charge-balanced pulses

OBJECTIVE: Typically, symmetrical charge-balanced biphasic current pulses are used in cochlear implants to ensure biological safety. Theoretically, monophasic pulses are more effective, but potentially noxious, stimuli. In this study we charge-balanced such monophasic pulses during selected non-stimulated intervals, effectively leading to triphasic pulses with a 4:1 amplitude ratio between the cathodic and anodic phases. Apart from ensuring safety, this is also expected to reduce power consumption and channel interaction. MATERIAL AND METHODS: Seven experienced Clarion CII cochlear implant users with a multichannel (12-16 channels) monopolar continuous interleaved sampling (CIS) strategy participated in the study. Three different CIS strategies were fitted using the Clarion Research Interface (CRI-2). The reference was an implementation of each subject's own CIS program. The two strategies tested used triphasic pulses on the same channels, one with half-wave rectification (TP-HWR) and one without rectification (TP-NoR) at the input. Directly after fitting (i.e. without any training), speech perception (phoneme score on consonant-vowel-consonant words) was measured in silence (sound-only) and in speech-shaped background noise with signal:noise ratios (SNRs) of +5 and 0 dB. RESULTS: Speech perception with the reference via the CRI-2 was equal to that of the free-field condition with the subjects' own speech processor. With the TP-NoR strategy, speech perception improved significantly (from 89% to 93%) in silence and in the 0-dB SNR condition (from 43% to 49%). With a SNR of +5 dB, performance was stable at approximately 66%. With the TP-HWR strategy, performance increased significantly in the 0- and +5-dB SNR conditions, to 55% and 74%, respectively. Power consumption was reduced in both strategies, to 30% and 36% for TP-HWR and TP-NoR, respectively. CONCLUSION: The new triphasic strategies are most promising, with respect to both their improved speech perception and reduced power requirements. The optimal parameters will have to be identified following long-term use.     

Treatment of a metastasis of a rectal carcinoma in the greater trochanter with the AO/ASIF Proximal Femoral Nail. A case report

A 48-year-old patient was referred to our department because of a solitary metastasis of a rectal carcinoma, localized in the left greater trochanter. Since the risk of pathological fracture was higher than acceptable for radiation therapy alone and because of the young age of the patient, radical debulking and reconstruction using the AO/ASIF Proximal Femoral Nail and cement augmentation was performed. Solitary bone metastases of colorectal adenocarcinomata are rare, as discussed. The prognosis of a primary colorectal carcinoma in the presence of a bone metastasis, even a solitary one, is poor. In patients with these metastases with poor overall prognosis, the treatment objectives, which we could define as 'safe, short and simple' are stringent, although there most certainly remains an indication for palliative surgery.