Safety and reliability of external fixation for basicervical and intertrochanteric fractures in high-risk elderly patients

Forty elderly patients with basicervical and pertrochanteric fractures were managed with uniplanar AO external fixator under regional anaesthetic block of the femoral nerve and lateral cutaneous nerve of the thigh from April 2003 to March 2006. The mean age of the patients was 67.9 ± 5.5 years. External fixator application was performed under radiological control after closed reduction had been obtained. Comorbid factors, duration of surgery, duration of hospitalisation, complications, walking ability, time to union and mortality rate were recorded. Patients were followed up for a mean period of 12 ± 4.5 months. Superficial pin tract infection occurred in 13 patients, healing in varus >10° and with shortening >2 cm occurred in six patients, and one patient suffered a spontaneous ipsilateral femoral neck fracture after removal of the fixator. The mean time for union was 10.4 ± 1.2 weeks. Rapid union rate and minor complications obtained in the present study are comparable to those obtained with standard internal fixation techniques. Minimal intraoperative blood loss, short operative time and early patient mobilisation are advantages signifying uniplanar external fixator application under regional anaesthetic block to be a viable option in treatment of basicervical and pertrochanteric fractures in high-risk elderly patients.     

Genetic analysis of host responses in sepsis

During much of the past century, the microbe itself stood at the heart of microbial pathogenesis. Little thought was devoted to the host per se, though it was granted that differences in susceptibility to certain infections did exist between individuals, and between different ethnic groups. During the past 20 years, extraordinary strides in our grasp of mammalian genetics have made the host side of the equation far more approachable. A restricted collection of genes now presents itself as the likely repository for genetic differences that foretell susceptibility to infectious disease. The Toll-like receptors, of which 10 are presently known to exist in humans, offer an excellent example of this genetic reductionism, in that they embody the afferent component of the innate immune system, and strongly influence the containment of an infection from its earliest stages. The Toll-like receptors were identified as the culmination of a long and relentless inquiry into the yet-unsolved clinical problem of sepsis.     

Extracellular Enzyme Activities by Basidiobolus and Conidiobolus Isolates on Solid Media./Extrazelluläre Enzymaktivitäten bei Basidiobolus- und Condiobolus-Isólaten auf festen Medien

Summary: Fifty-seven isolates of Basidiobolus from reptiles and amphibians, and 7 other obtained from the American Type Culture Collection (ATCC) in Maryland were studied for their extracellular enzyme activities on solid media. The Conidiobolus isolates studied included 4 recovered from Nigerian soil and additional 4 obtained from the ATCC All these isolates produced active extracellular lipase and protease and failed to exhibit amylase, deoxyribonuclease and ribonuclease activities. The significance of the findings is discussed.
Zusammenfassung: Fünfundsiebzig Basidiobolus-Isolate aus Reptilien und Amphibien und sieben weitere aus der American Type Culture Collection (ATCC) in Maryland wurden auf Aktivtäten extrazellulärer Enzyme auf festen Medien untersucht Die untersuchten Conidiobolus-Isolate schlossen vier aus nigerianischen Böden und vier weitere aus der ATCC ein. Alle Isolate zeigten extrazellulär Lipase- und Proteaseaktivität Amylase-, Desoxyribonuclease- und Ribonucleaseaktivität war jedoch nicht nachzuweisen. Die Bedeutung dieser Befunde wird diskutiert.     

Production of elastase and other exoproducts by environmental isolates of Pseudomonas aeruginosa.

Pseudomonas aeruginosa isolates from environmental sources and bacteremic patients were compared for their levels of elastolytic activity. No significant differences were found. The incidence of production of toxin A, phospholipase C, alkaline protease, and elastase among the environmental strains was also as high as that previously reported for clinical isolates.     

Transient entrapment neuropathy of the posterior interosseous nerve in violin players.

Eleven white male right handed violin players complained of transient muscular deficit of the extensor compartment of the left forearm during and after prolonged playing. This was associated with paraesthesiae and pain. Relief was achieved keeping the wrist and the elbow flexed, with the supinated forearm held by the contralateral hand. An anatomical study showed changes of the relationship of the posterior interosseous nerve with its surrounding structures with pronation and supination of the forearm. On the basis of the clinical features, the anatomical studies and the response to a simple physiotherapeutic regime, it is suggested that prolonged pronation of the forearm may cause transient entrapment of the nerve.