Comparison of tension-band and figure-of-eight wiring techniques for treatment of olecranon fractures

Two different internal fixation techniques for closed displaced fractures of the olecranon were evaluated at a mean of 18 years after injury. Thirty-two of the patients received tension-band wiring, and 35 received figure-of-eight wiring. There were 41 women (mean age, 52 years) and 26 men (mean age, 32 years) included. The results revealed that 80% of the patients had no subjective complaints, 16% had occasional pain, and 4% had daily pain. Comparison of the injured and uninjured elbows demonstrated a 3 degrees reduction of flexion (P <.05) and a 5 degrees loss of extension (P <.01). More than 50% of the fractured elbows had degenerative changes (joint space narrowing, subchondral cysts, subchondral sclerosis, and osteophytes) (P <.001), and 4 had osteoarthritis (P <.05). No subjective, objective, or radiographic differences were found when the two techniques were compared. Removal of the hardware was performed in 81% of the patients with tension-band wiring and in 43% of the patients with figure-of-eight wiring (P <.01). The figure-of-eight technique can, therefore, be recommended, as it is associated with less frequent secondary procedures for hardware removal.     

High-Dose Inhaled Budesonide May Substitute for Oral Therapy After an Acute Asthma Attack

Patients attending the emergency room with acute asthma, participating in a study comparing salbutamol (albuterol in the United States) via a dry powder inhaler (Turbuhaler®) with pressurized metered-dose inhaler (pMDI), were included in this 1-week follow-up study with the aim of assessing whether inhaled budesonide via Turbuhaler may be an alternative to prednisolone tablets after an acute asthma attack. Eighty-one patients with a mean age of 38 years and forced expiratory volume in 1 sec (FEV₁) of 64% predicted normal value after treatment with salbutamol were randomized in this double-blind, double-dummy, parallel-group study. The doses given were budesonide 1600 μg b.i.d. or prednisolone in daily doses from 40 mg (day 1) decreased to 5 mg (day 7). FEV₁ was recorded before and after the 7-day treatments and peak expiratory flow (PEF) morning and evening, clinical symptoms (visual analogue scale 0-100), and doses of rescue medication (terbutalineTurbuhaler 0.25 mg/dose) were recorded daily. The mean increase in FEV, from baseline to day 7 was 1 7.3% in the budesonide Turbuhaler group and 1 7.6% in the prednisolone group. Mean values of morning PEF increased from day 1 to day 7 by 67 L/min in the budesonide Turbuhaler group and by 57 L/min in the prednisolone group (not significant). There were no statistically significant differences between the groups in clinical symptoms and in the number of doses of rescue medication. Because of disease deterioration, five patients in the Turbuhaler group and three in the prednisolone group needed additional symptomatic as well as corticosteroid treatment. Inhaled budesonide in high doses may be a substitute for oral therapy as follow-up treatment after an acute asthma attack.     

Life-style and different fracture prevalence: A cross-sectional comparative population-based study

Summary In order to explain the higher prevalence of fractures in urban compared with rural areas, 782 residents in the city of Malmö, Sweden and 486 inhabitants from the nearby rural municipality of Sjöbo were invited to participate in an sex- and age-matched cross-sectional study on life-style differences; 73 and 80% respectively responded. Responders answered a questionnaire on medical and social background and were interviewed on past and present physical activity. The men and women of the rural area were found to be significantly more active physically at work and during spare time. Housing was larger in the rural area. For women, these differences are decreasing in the younger age groups. Bone mass was found to be correlated to heavier work load for men. Other life-style variable such as dairy calcium intake, coffee drinking, estrogen medication, and morbidity, could not explain this difference. Higher prevalence of fractures in the city could therefore be explained by physicall less active life-style.     

Modeling the color perception of port wine stains and its relation to the depth of laser coagulated blood vessels

To find the maximal depth of an ectatic vessel in the dermis that contributes to the abnormal color of a port wine stain (PWS), “normal” and “laser treated PWS skin” are modeled, respectively, as a two-layer plane parallel geometry consisting of an epidermis and a dermis, and as a three-layer geometry consisting of an epidermis, a dermis without additional blood (the “treated” part of the stain, assumed identical to the “normal” dermis), and a layer of dermis containing 5% or 10% of blood per volume (the untreated part of the PWS). Spectral remittances were calculated for various wavelengths using the diffusion approximation to the transport equation for light propagation. These remittances were transformed into the CIE 1976 (L*a*b*)-color system. Color differences between “normal” and PWS skin as a function of the dermal depth of “injured” ectatic blood vessels were calculated. The maximal depth where ectatic blood vessels just contribute to the abnormal PWS color is predicted as 0.9 mm for a “normally” pigmented epidermis (60 μm thick) and a 5% or 10% blood per volume content. For a darker pigmented epidermis (60 μm thickness) and again at both 5% and 10% blood per volume content, this depth was found to be 0.8 mm. © 1993 Wiley-Liss, Inc.     

Steroid production and responsiveness to gonadotropin in isolated stromal tissue of human postmenopausal ovaries

Specimens from the ovarian cortical stroma of 15 postmenopausal women were examined histologically and were incubated for 4 hours in Krebs' bicarbonate buffer containing 5.5 mM glucose and 1% bovine serum albumin. Specimens of normal postmenopausal stroma produced measurable amounts of androstenedione, estradiol, and progesterone in vitro. Specimens with stromal hyperplasia produced larger amounts of androstenedione and estradiol than those with normal stroma. Androstenedione was the predominant steroid produced in both groups. The nonnegligible formation of estradiol indicated an aromatizing capacity of the stromal tissue. The addition of hCG elicited a significant increase in cyclic AMP formation in specimens from ovaries with stromal hyperplasia, indicating a preserved responsiveness to gonadotropin in this type of ovaries.     

Ethyl sulfate: a metabolite of ethanol in humans and a potential biomarker of acute alcohol intake

This study identified ethyl sulfate (EtS) in human urine and compared the excretion characteristics of EtS with that of ethanol and ethyl glucuronide (EtG). Urine samples were collected from healthy subjects after a single ethanol dose, and also selected from routine clinical samples. Simultaneous analysis of EtS and EtG was performed by direct electrospray liquid chromatography-mass spectrometry in the negative ion mode, with selected-ion monitoring of the pseudomolecular ions at m/z 125 for EtS (M(w) 126 g/mol) and m/z 221 for EtG (M(w) 222 g/mol). The identity of EtS in authentic urine specimens was established by co-chromatography with reference substance, the presence of product ions (m/z 97 and 80 from m/z 125) with correct relative intensity, and a correct sulfur isotope ratio for (34)S (m/z 127). After healthy subjects drank ethanol, EtS showed a much longer, dose-dependent elimination half-life than the parent compound. No EtS was detected in urines collected after abstention from ethanol for several days prior to sampling. Among 354 consecutive clinical samples, 86 were positive for both EtS and EtG with a mean EtG/EtS molar ratio of 2.3 (median 1.7). Another three urine samples were only positive for EtS and four only for EtG. The present results confirm that sulfate conjugation is a normal but minor metabolic pathway for ethanol in humans, and EtS a common constituent in the urine after alcohol intake. It is also indicated that the concurrent determination of EtS and EtG will improve sensitivity, when being used as biomarkers of recent drinking.     

Decreased serum levels of clara cell secretory protein (CC16) are associated with bronchiolitis obliterans and may permit early diagnosis in patients after allogeneic stem-cell transplantation

BACKGROUND: Bronchiolitis obliterans (BO) is a common complication and is associated with high mortality after allogeneic stem-cell transplantation (SCT). Early diagnosis of BO may improve outcome. Low levels of Clara cell secretory protein (CC16) have previously been associated with BO in lung transplant recipients. METHODS: Serum samples were collected from eight patients with BO, eight patients with chronic graft-versus-host disease (GVHD), and eight control patients with neither BO nor chronic GVHD in a matched patient analysis. Patients were matched for diagnosis, conditioning, donor match, and GVHD prophylaxis. Another seven patients with BO were also analyzed separately. CC16 was measured with an enzyme-linked immunosorbent assay method. RESULTS: In the matched analysis, eight patients were diagnosed with BO at a median of 11.5 months (range, 4-13 months) after SCT and in non-matched BO patients at a median of 12 months (range, 9-36 months). In the matched patient analysis, patients with BO had significantly lower (P=0.03) or decreasing (P=0.02) levels of CC16 compared with patients with only chronic GVHD or controls. In the matched patient analysis, measurement of CC16 showed a sensitivity of 88% and a specificity of 81%.With the criteria of low levels of CC16 or a decrease of more than 40% compared with the previous sample, BO was detected with analysis of CC16 in 13 of 15 patients. In 11 of the 13 patients, low or decreasing values of CC16 were detected at a median of 10 months (range, 1-30 months) before BO was diagnosed clinically. CONCLUSIONS: Low levels of CC16 are associated with BO after allogeneic SCT. Monitoring of CC16 in serum after SCT may have potential as an early marker for BO.