A Galeazzi-variant type fracture-dislocation in adults

Objective：Fracture of either radius or ulna with a dislocation either at the proximal or distal radioulnar joint （DRUJ） is not a common injury and is inherently unstable.Here we report a case series,with both-bone forearm fractures associated with dislocation of DRUJ,as a Galeazzi-variant type fracture-dislocation,and try to analyze this injury pattern.Methods：The study was based on 6 patients having Galeazzi-variant type fracture-dislocation of different age （20 to 45 years）.All fractures were closed type.Two fractures involved the same level and three fractures were at different levels of radius and ulna shaft.After thorough examination and investigations they were treated with limited contact dynamic compression plate without additional fixation for DRUJ.Results：All cases were followed up for 24 weeks.The maximum incidence occurred in age group between 31 and 40 years.All the fractures of both radius and ulna were united in average time of 12 weeks.Range of motion of wrist and elbow,supination and pronation at final follow-up were normal.There was no subsequent re-subluxation or dislocation of the DRUJ in any of the cases.Conclusion：Galeazzi variant in adult is a new undescribed pattern of forearm with wrist injury.Stable open reduction and internal fixation of both-bone forearm fractures is mandatory,followed by 3 to 4 weeks of immobilization in a cast for the healing of disrupted DRUJ.     

Biochemical characterization of atherosclerotic plaques by endogenous multispectral fluorescence lifetime imaging microscopy

ObjectiveTo investigate the potential of endogenous multispectral fluorescence lifetime imaging microscopy (FLIM) for biochemical characterization of human coronary atherosclerotic plaques.MethodsEndogenous multispectral FLIM imaging was performed on the lumen of 58 segments of postmortem human coronary artery. The fluorescence was separated into three emission bands targeting the three main arterial endogenous fluorophores (390 ± 20 nm for collagen, 452 ± 22.5 nm for elastin, and 550 ± 20 for lipids). The fluorescence normalized intensity and average lifetime from each emission band was used to classify each pixel of an image as either “High-Collagen”, “High-Lipids” or “Low-Collagen/Lipids” via multiclass Fisher's linear discriminant analysis.ResultsClassification of plaques as either “High-Collagen”, “High-Lipids” or “Low-Collagen/Lipids” based on the endogenous multispectral FLIM was achieved with a sensitivity/specificity of 96/98%, 89/99%, and 99/99%, respectively, where histopathology served as the gold standard.ConclusionThe endogenous multispectral FLIM approach we have taken, which can readily be adapted for in vivo intravascular catheter based imaging, is capable of reliably identifying plaques with high content of either collagen or lipids.     

Cerebral venous sinus thrombosis at high altitude

Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening medical condition. We describe a case of a 47-year-old woman who presented with headache, speech defects, and visual disturbances, and was later diagnosed with cerebral venous sinus thrombosis. The article describes a possible risk of such thrombotic events with exposure to high altitude environment in patients with coagulation defects such as Factor V Leiden mutation. Besides, such neurological conditions can occur independent of altitude illness and need to be recognized as their management differs.     

Catastrophic household expenditure on health in Nepal: a cross-sectional survey

Objective

To determine the incidence of – and illnesses commonly associated with – catastrophic household expenditure on health in Nepal.

Methods

We did a cross-sectional population-based survey in five municipalities of Kathmandu Valley between November 2011 and January 2012. For each household surveyed, out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household’s total expenditure over the same period was considered to be catastrophic. We estimated the incidence and intensity of catastrophic health expenditure. We identified the illnesses most commonly associated with such expenditure using a Poisson regression model and assessed the distribution of expenditure by economic quintile of households using the concentration index.

Findings

Overall, 284 of the 1997 households studied in Kathmandu, i.e. 13.8% after adjustment by sampling weight, reported catastrophic health expenditure in the 30 days before the survey. After adjusting for confounders, this expenditure was found to be associated with injuries, particularly those resulting from road traffic accidents. Catastrophic expenditure by households in the poorest quintile were associated with at least one episode of diabetes, asthma or heart disease.

Conclusion

In an urban area of Nepal, catastrophic household expenditure on health was mostly associated with injuries and noncommunicable diseases such as diabetes and asthma. Throughout Nepal, interventions for the control and management of noncommunicable diseases and the prevention of road traffic accidents should be promoted. A phased introduction of health insurance should also reduce the incidence of catastrophic household expenditure.     

Evaluation of recombinant fusion protein comprising dog zona pellucida glycoprotein-3 and Izumo and individual fragments as immunogens for contraception

Vaccines based on gamete specific proteins have been proposed for fertility inhibition. In the present study, immunogenicity and contraceptive potential of E. coli-expressed recombinant fusion protein TT-KK-ZP3-GGG-Iz, comprising promiscuous T cell epitope of tetanus toxoid (TT) followed by dilysin linker (KK), a fragment of dog zona pellucida glycoprotein-3 (ZP3), triglycine spacer (GGG) and a fragment of dog Izumo (Iz) without any affinity tag has been evaluated in female FvB/J mice. In addition, recombinant TT-KK-ZP3 and Izumo linked to the promiscuous T cell epitope of bovine RNase (bRNase-KK-Iz) and their physical mixture were also used. SDS-PAGE and immunoblot studies revealed ∼32 kDa band corresponding to TT-KK-ZP3-GGG-Iz, ∼22 kDa band of TT-KK-ZP3 and ∼11 kDa band of bRNase-KK-Iz. Groups of mice immunized with the above recombinant proteins led to the generation of high antibody titres against the respective proteins. Immunization with recombinant TT-KK-ZP3-GGG-Iz generated higher antibody titre as compared to mice immunized with physical mixture of TT-KK-ZP3 and bRNase-KK-Iz. Antibodies against TT-KK-ZP3-GGG-Iz and TT-KK-ZP3 recognized mouse and dog ZP and those against TT-KK-ZP3-GGG-Iz and bRNase-KK-Iz recognized mouse and dog acrosome-reacted sperm in an indirect immunofluorescence assay. Immune sera from groups of mice immunized with the above recombinant proteins led to a significant reduction in mouse in vitro fertilization. Mating studies revealed significant reduction in fertility as compared to adjuvant control group. Highest infertility was observed in group of mice immunized with TT-KK-ZP3 followed by TT-KK-ZP3-GGG-Iz. Infertility was associated with the antibody titres against ZP3, whereas no association in the inhibition of fertility and antibody titres against Izumo was observed. In conclusion, these studies revealed the contraceptive potential of ZP3, which could not be further enhanced by the inclusion of Izumo.     

Is single dose povidone iodine sclerotherapy effective in chyluria?

Purpose

To evaluate the effectiveness and safety of single dose 0.2 % povidone iodine renal pelvic instillation sclerotherapy for the treatment for chyluria.

Methods

In a prospective study from August 2010 till July 2013, 41 patients presenting with milky urine were included. Apart from ether test, the presence of lymphocytes in urine and urine triglycerides levels were also done to confirm chyluria. On a day care basis under local anesthesia, 5F open-ended ureteric catheter was introduced in the ureteric orifice of affected side. Freshly prepared 7–10 ml of 0.2 % povidone iodine solution was instilled with the patient in Trendelenburg position.

Results

Total of 41 patients were enrolled (27 males and 14 females; mean age 40 years, SD 8.9, range 19–61) with a mean follow-up of 20 months. Immediate clearance was seen in all patients and recurrence in 7 (17 %). Mean disease-free duration was 18 months. Two patients had moderate to severe flank pain.

Conclusion

Single dose 0.2 % povidone iodine sclerotherapy is safe and effective treatment for chyluria. As it offers treatment on a day care basis, continuous ureteral and urethral catheterizations can be avoided.     

Intestinal anisakiasis treated successfully with conservative therapy: Importance of clinical diagnosis

Intestinal anisakiasis is not only a rare parasitic disease,but is also difficult to diagnose.The symptoms are not specific and are often very severe and abrupt,and the findings of clinical imaging are very remarkable.Therefore,intestinal anisakiasis is often misdiagnosed as acute abdomen or intestinal obstruction and is treated surgically.However,if intestinal anisakiasis could be diagnosed correctly,it is well treated conservatively.We experienced three cases of intestinal anisakiasis,which were diagnosed correctly and treated successfully with conservative therapy.A correct clinical history and imaging interpretation helped us diagnose intestinal anisakiasis correctly and thus treat the patients successfully with conservative therapy.