Fracture and lateral dislocation of the T12-L1 vertebrae without neurological deficit--case report

A 21-year-old man suffered T12-L1 vertebrae fracture and lateral dislocation without neurological deficit. Computed tomography and magnetic resonance imaging demonstrated the fracture and lateral dislocation of the thoracolumbar spine. The injured spine was realigned with rods and screws, and bony fusion of the affected vertebrae was performed. Patients with thoracolumbar fracture-dislocation without neurological deficit may suffer unintended neurological injury secondary to maneuvers that cause further dislocation of the spine. Severe spinal injury without neurological deficit should be evaluated in detail, especially with spinal computed tomography. Internal fixation and reduction are recommended if the patient's condition is suitable for surgery.     

Gadolinium-enhanced magnetic resonance angiography for detection of acute pulmonary embolism: an in-depth review

STUDY OBJECTIVE: To review the published experience with gadolinium-enhanced magnetic resonance angiography (MRA) for the detection of acute pulmonary embolism (PE) in order to test the hypothesis that gadolinium-enhanced MRA may be potentially sensitive and specific enough to include it among diagnostic alternatives in the evaluation of patients with suspected PE. METHODS: Studies were identified by searching MEDLINE for trials that used gadolinium-enhanced MRA to diagnose acute PE based on the visualization of an intraluminal filling defect or a cutoff vessel, using pulmonary angiography as a reference standard. RESULTS: Twenty-eight investigations were identified in which MRA was used to diagnose PE. Only three studies, however, met the criteria for inclusion in the analysis. In these three case series, the sensitivity of gadolinium-enhanced MRA ranged from 77 to 100%, and the specificity ranged from 95 to 98%. CONCLUSION: Gadolinium-enhanced MRA may be a useful diagnostic alternative in some patients with suspected acute PE, particularly if they have an elevated creatinine level, have an allergy to radiographic contrast material, or should, if possible, avoid exposure to ionizing radiation.     

Lower gastrointestinal bleeding secondary to Dieulafoy-like lesion of the rectum

Two cases of gastrointestinal hemorrhage resulting from Dieulafoy-like lesion of the rectum are presented. Both patients developed acute episodes of massive lower gastrointestinal hemorrhage requiring transfusions. Colonoscopy was performed in both instances and lesions were localized. The patients were successfully treated by alcohol and epinephrine injection. Colonoscopy assisted in earlier diagnosis and added therapeutic options to the treatment regimen for this lesion.     

Low back pain due to spinal chronic subdural hematoma mimicking intradural tumor in the lumbar area: a case report and literature review.

Although magnetic resonance imaging has dramatically enhanced the ability to diagnose spinal mass lesions, some lesions remain difficult to diagnose. We report a spinal chronic subdural hematoma that comprised the cauda equina ventrally in the lumbar area in a 51-year-old man who was under anticoagulant therapy. Low back pain was the only symptom of the patient after sports activity. Surgical treatment was performed 2 months after the onset of symptoms. Intraoperative view showed chronic subdural hematoma with abnormal enlarged dural vascularization. The patient had no preoperative and postoperative neurologic deficit. Low back pain with sudden onset after minor trauma refractory to medical treatment must be investigated with magnetic resonance imaging in patients under anticoagulant therapy for spinal hematoma because of the possibility of spinal chronic subdural hematoma.     

Effect of alpha-lipoic acid supplementation on trace element levels in serum and in postmitotic tissue in aged rats

Redistribution of redox-active divalent metal ions (e.g. copper, zinc, and iron) in postmitotic tissues of lipoic acid supplemented aging rats has been proposed to contribute to metal-catalyzed protein oxidation. DL-alpha lipoic acid (LA) (100 mg/kg body wt/day) was administered intraperitoneally to the Sprague-Dawley rats for 14 days. Serum copper levels lowered in the aged rats with LA supplementation compared to the rats without LA supplementation. On the other hand, serum zinc and iron levels increased in the aged rats with LA supplementation compared to the rats without LA supplementation. Copper levels of the postmitotic tissues were not changed in the aged rats with LA supplementation compared to the controls. The heart zinc levels detected in LA supplemented rats were significantly lower than controls. Similarly, the iron levels of the heart were found to be significantly lower in LA supplemented rats when compared to control rats. LA supplementation did not affect brain and muscle iron levels. The brain and muscle zinc levels remained the same in both group of rats. Based on the findings of our study, we have concluded that LA may exhibit prooxidant effect depending on the altered trace element homeostasis. Therefore, our results emphasize the importance of monitoring the dose of LA supplementation, duration of treatment and its potential harmful effects in the postmitotic tissues of aged rats.     

Ipsilateral combination of Galeazzi and Monteggia fractures in a ten-year-old patient: a case report

Galeazzi fractures represent approximately 3 to 6 percent of forearm fractures, whereas Monteggia fractures represent 1 to 2 percent. The combination of these injuries in the same extremity is an exceedingly rare occurrence. We report a case of ipsilateral combination of Galeazzi and Monteggia fractures in a ten-year-old patient. The patient was treated with closed reduction and internal fixation with Kirschner pins. The distal radioulnar and radiocapitellar joint relationships were restored and the fractures healed. The patient proceeded to obtain a satisfactory functional result three years later. Internal fixation is a safe method for such complex forearm fractures in older children and allows post-operative rehabilitation with the advantage of early mobilization.     

Arthroscopically assisted percutaneous osteosynthesis of lateral tibial plateau fractures

Background

The aim of our study was to evaluate the results of lateral tibial plateau fractures treated with arthroscopically assisted percutaneous osteosynthesis (AAPO).

Methods

Twenty-one patients (14 men and 7 women) with a mean age of 41 years underwent AAPO to repair low-energy Schatzker I–III tibial plateau fractures. Under pneumatic tourniquet, we reduced and fixed the fracture with 1 or 2 subchondral cannulated screws. Accompanying lesions included 10 meniscus tears, which we partially excised in 9 patients and repaired in 1 patient. On the second postoperative day, patients began range-of-motion exercises. We encouraged partial and full weight-bearing by the sixth and tenth weeks, respectively. The mean follow-up period was 38 (range 12–96) months, and we evaluated the patients using Rasmussen''s clinical and radiologic criteria. We used a t test for statistical analysis.

Results

There were 13 excellent (62%), 6 good (28%) and 2 fair (10%) clinical results, and 11 excellent (52%), 7 good (33%) and 3 fair (14%) radiologic results. We observed mild or moderate arthritic changes in 5 patients (24%). There were no infection or wound problems, but we removed hardware in 4 patients.

Conclusion

Arthroscopically assisted treatment of lateral tibial plateau fractures yields satisfactory results and can be accepted as an alternative and effective method for the treatment of low-energy tibial plateau fractures.     

FGFR3 is a negative regulator of the expansion of pancreatic epithelial cells

Fibroblast growth factors (FGFs) and their receptors (FGFRs) are key signaling molecules for pancreas development. Although FGFR3 is a crucial developmental gene, acting as a negative regulator of bone formation, its participation remains unexplored in pancreatic organogenesis. We found that FGFR3 was expressed in the epithelia in both mouse embryonic and adult regenerating pancreata but was absent in normal adult islets. In FGFR3 knockout mice, we observed an increase in the proliferation of epithelial cells in neonates, leading to a marked increase in islet areas in adults. In vitro studies showed that FGF9 is a very potent ligand for FGFR3 and activates extracellular signal-related kinases (ERKs) in pancreatic cell lines. Moreover, FGFR3 blockade or FGFR3 deficiency led to increased proliferation of pancreatic epithelial cells in vivo. This was accompanied by an increase in the proportion of potential islet progenitor cells. Thus, our results show that FGFR3 signaling inhibits the expansion of the immature pancreatic epithelium. Consequently, this study suggests that FGFR3 participates in regulating pancreatic growth during the emergence of mature islet cells.     

Simultaneous bilateral quadriceps tendon rupture in a patient on chronic haemodialysis. (Short-term results of treatment with transpatellar sutures augmented with a quadriceps tendon flap)

Quadriceps tendon ruptures are rare orthopaedic injuries. Although they are generally seen after the age of 50, they may occur in younger patients with certain underlying conditions, including chronic haemodialysis. Several repair techniques have been proposed but the choice of the best method is still a matter of controversy. This paper presents the case of a renal failure patient with 10 years' history of haemodialysis treatment suffering from bilateral quadriceps tendon rupture. The treatment was with transpatellar sutures augmented with a reverse quadriceps tendon flap. His short-term clinical and radiological results are satisfactory.