Distally Based Pedicled Fibula Flap for Reconstruction of Infected Charcot’s Midtarsal Collapse—Diabetic Rocker Bottom Foot

Introduction and Methods  Diabetic rocker bottom foot with secondary infection exacts the expertise of a reconstructive surgeon to salvage the foot. The author selected 28 diabetic patients with secondarily infected Charcot’s degenerated rocker bottom feet and reconstructed their feet using distally based pedicled fibula flap. Reconstruction was done in a staged manner. Stage 1 surgery involved external fixation following debridement. In stage 2, struts were activated for distraction and arthroereisis. In stage 3, the distally based pedicled fibula was used for reconstruction and beaming of the arches. Results  In this retrospective study, the author analyzed the outcome of all 28 patients using the Musculoskeletal Tumor Society Rating (MSTSR) score. The average MSTSR score was 27.536 in an average follow-up of 30.5 months. The limb salvage rate with the author’s procedure was 96.4% ( p = 0.045). Conclusion  Author’s protocol for the staged reconstruction and salvage of the infected diabetic rocker bottom foot, using the pedicled fibula flap, will be a new addendum in the reconstructive armamentarium of the orthoplastic approach.     

Comminuted periprosthetic humeral fracture after reverse shoulder prosthesis

Periprosthetic fractures represent a severe complication after joint replacement. A case of comminuted displaced humeral fracture around the stem of a SMR reverse shoulder prosthesis is reported. The patient was a 81-year-old lady who had had a total shoulder replacement 28 months previously. The surgical solution consisted of a partial revision of the modular implant with conservation not only of the glenoid component but also of the prosthetic humeral body, which was well fixed in the humeral metaphysis. The humeral stem was removed and a long uncemented revision stem was implanted providing fracture stabilisation and allowing early mobilisation.     

Diagnostic cytology in breast cancer screening

In the period 1977-1978, 245 solid or cystic breast tumors and 134 nipple secretions were evaluated cytologically at the Trieste Cancer Institute. The results are discussed in the light of literature reports, and the high incidence of unsatisfactory smears observed in the group of malignant lesions (14,7%) is attributed to incorrect technique in specimen collection. The incidence of false positives and false negatives was 0,2% and 2,9%, respectively. The data reported are insufficient for significant statistical conclusion, but nevertheless confirm further the diagnostic importance of breast cytology whose routine practice in patient study protocols for breast cancer is highly recommended.     

Effects of amiloride on renal lithium handling in nonazotemic ascitic cirrhotic patients with avid sodium retention.

The reliability of lithium clearance as an index of distal fluid delivery in cirrhosis with ascites and in other clinical conditions characterized by low fractional sodium excretion has not yet been proven. In particular, lithium reabsorption in the amiloride-sensitive segment of the distal tubule, as evidenced in experimental studies, has not been excluded in such clinical conditions. Thus the acute effect of amiloride on renal lithium handling in 15 nonazotemic ascitic cirrhotic patients with avid sodium retention was evaluated after at least 5 days of controlled sodium intake. Renal plasma flow, glomerular filtration rate, fractional sodium excretion, fractional lithium excretion, fractional potassium excretion, fractional excretion of uric acid, plasma renin activity, plasma aldosterone and human atrial natriuretic peptide were evaluated before and for 6 hr after the administration of amiloride (20 mg/os). After amiloride administration a volume replacement scheme was enacted with intravenous amounts of saline solution, determined by the diuretic and natriuretic effect of the drug, to avoid volume depletion. Amiloride induced a prompt and sustained increase in fractional sodium excretion (from 0.28% +/- 0.09% to 1.0% +/- 0.41%, p less than 0.001) and a decrease in fractional potassium excretion (from 9.38% +/- 5.98% to 3.28% +/- 2.24%, p less than 0.0025), whereas it did not affect fractional lithium excretion and fractional excretion of uric acid. No change was observed in renal plasma flow, glomerular filtration rate, plasma renin activity, plasma aldosterone and human atrial natriuretic peptide. It was concluded that lithium is not reabsorbed in the amiloride-sensitive segment of the distal tubule in nonazotemic ascitic cirrhotic patients with avid sodium retention.     

Response latency in Canis familiaris: mental ability or mental strategy?

Animal studies of cognitive aging typically use measures of response accuracy (RA) to evaluate cognitive function, which declines with age. Human aging studies, by contrast, frequently measure response latency (RL), with faster responses being indicative of superior performance. To examine the influence of age on RL in an animal model, the authors assessed RA with RL in young and aged beagle dogs (Canis familiaris) tested on a 3-component delayed nonmatching-to-position task, which comprised 3 subtests. Young dogs displayed significantly slower RLs and higher RAs and showed RL slowing with greater complexity, compared with aged dogs. In addition, the slower responding young dogs made fewer errors. Thus, RL appears to reflect the learning strategy applied, rather than the level of mental ability.