Isolated comminuted trapezium fracture: A case report and literature review

Introduction and importanceTrapezium, as a carpal bone positioned at the distal row, is often associated with other wrist injuries such as distal radius fracture. Isolated trapezium fracture, especially in a comminuted form, rarely occurs. There are only six reports of isolated comminuted trapezium fractures in the literature to the best of our knowledge.Case presentationWe present a case with an isolated comminuted trapezium fracture presenting pain in his thenar eminence and thumb motion limitation. He was treated by Open Reduction and Internal Fixation (ORIF) with the K wire pin.Clinical discussionWe searched the published related studies and summarized the signs and symptoms of patients presented with trapezium fracture. The most common presentation of trapezial fracture include pain/tenderness at the base of the first metacarpal bone, pain/tenderness at the snuffbox area and 1st digit motion limitation. The treatment options described in the literature for isolated comminuted trapezium fracture are also presented. Open reduction and fixation with pin is the most common treatment mentioned in the literature. The priority is restoring the scaphotrapezial and trapeziometacarpal joint congruency to save the 1st digit range of motion.ConclusionComminuted trapezial fracture may happen following either low energy (like our patient) or high energy trauma. This paper highlights the fact that even a comminuted trapezium fracture can be easily missed. Regardless of the trauma mechanism (high energy versus low energy trauma), a high index of suspicion and delicate work up would be necessary in order not to miss this type of fracture.     

Disgusting disruptions: Capturing the everyday experience and burden of managing gastrointestinal infections in the home

Gastrointestinal (GI) infections exert a significant public health burden in the United Kingdom and the numbers of episodes are increasing. Younger children are considered particularly vulnerable to infection, and can experience 2–3 GI infections episodes per year, with consequences being more severe for more disadvantaged children, who are much more likely to be admitted to hospital. Few qualitative studies have explored the lived experience of GI infection in the community in the UK. The aim of the study reported here was to contribute to addressing this evidence gap, by examining the consequences of GI infection for ‘normal’ family life. Eighteen mothers with young children who had recently experienced a gastrointestinal infection were recruited from two socioeconomically contrasting neighbourhoods in North West of England. The findings demonstrated that GI infections were particularly disruptive: experienced as disgusting, laborious and stressful and significantly impacted normal family routines. Women felt burdened by the heavy physical and emotional demands of caring for a GI infection, resulting in feelings of isolation and insufficient support in their caring role from male partners. Tensions also arose from interactions with external community organisations, particularly in complying with their regulations on infection which often undermined caregivers knowledge and expertise of what was best for their children. This study challenges assumptions that managing GI infections in the home is unproblematic and experienced by caregivers as a ‘minor ailment.’ Infection control measures need to incorporate insights gleaned from the day-to-day realities of caring for sick children in the community.     

运动对骨骼－肌腱界面愈合组织的影响

利用纽西兰兔作体内实验，来分析手术后石膏固定，笼内活动，连续被动性活动三种不同的复健方法对肌腱－骨骼间界面愈合组织的影响。结果显示在术后第１５天愈合组织所能承受的最大张力，笼内活动组为０．８７５ｋｇ，石膏固定组为２．０１４ｋｇ，是笼内活动组的２３１．５２％，而连续被动性活动组为２．６３８ｋｇ，是笼内活动组的２６１．３５％。石膏固定组虽有很高的张力，但关节内粘连也较多。     

Antimotion effect of nooglutyl and its neuronal mechanism

Experiments on rats demonstrate that nooglutyl exhibits pronounced vestibular-protective properties and by its antimotion activity does not rank below classic vestibular protectors, such as scopolamine and diprazine. Electrophysiological experiments on cats show that nooglutyl alters spontaneous activity in 80% of cortical neurons (somatosensory zone I and area 5 of the parietal association cortex) and considerably weakens effects caused by motion sickness: activation of single unit activity of somatosensory zone I and inhibition of neuron responses to somatic stimulation. This property of the preparation is believed to form the basis of its antimotion effect. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 119, No. 5, pp. 515–516, May, 1995 Presented by P. V. Sergeev, Member of the Russian Academy of Medical Sciences     

Functional coupling of the stabilizing eye and head reflexes during horizontal and vertical linear motion in the cat

Summary The otolith contribution and otolith-visual interaction in eye and head stabilization were investigated in alert cats submitted to sinusoidal linear accelerations in three defined directions of space: up-down (Z motion), left-right (Y motion), and forward-back (X motion). Otolith stimulation alone was performed in total darkness with stimulus frequency varying from 0.05 to 1.39 Hz at a constant half peak-to-peak amplitude of 0.145 m (corresponding acceleration range 0.0014–1.13 g) Optokinetic stimuli were provided by sinusoidally moving a pseudorandom visual pattern in the Z and Y directions, using a similar half peak-to-peak amplitude (0.145 m, i.e., 16.1°) in the 0.025–1.39 Hz frequency domain (corresponding velocity range 2.5°–141°/s). Congruent otolith-visual interaction (costimulation, CS) was produced by moving the cat in front of the earth-stationary visual pattern, while conflicting interaction was obtained by suppressing all visual motion cues during linear motion (visual stabilization method, VS, with cat and visual pattern moving together, in phase). Electromyographic (EMG) activity of antagonist neck extensor (splenius capitis) and flexor (longus capitis) muscles as well as horizontal and vertical eye movements (electrooculography, EOG) were recorded in these different experimental conditions. Results showed that otolith-neck (ONR) and otolith-ocular (OOR) responses were produced during pure otolith stimulation with relatively weak stimuli (0.036 g) in all directions tested. Both EMG and EOG response gain slightly increased, while response phase lead decreased (with respect to stimulus velocity) as stimulus frequency increased in the range 0.25–1.39 Hz. Otolith contribution to compensatory eye and neck responses increased with stimulus frequency, leading to EMG and EOG responses, which oppose the imposed displacement more and more. But the otolith system alone remained unable to produce perfect compensatory responses, even at the highest frequency tested. In contrast, optokinetic stimuli in the Z and Y directions evoked consistent and compensatory eye movement responses (OKR) in a lower frequency range (0.025–0.25 Hz). Increasing stimulus frequency induced strong gain reduction and phase lag. Oculo-neck coupling or eye-head synergy was found during optokinetic stimulation in the Z and Y directions. It was characterized by bilateral activation of neck extensors and flexors during upward and downward eye movements, respectively, and by ipsilateral activation of neck muscles during horizontal eye movements. These visually-induced neck responses seemed related to eye velocity signals. Dynamic properties of neck and eye responses were significantly improved when both inputs were combined (CS). Near perfect compensatory eye movement and neck muscle responses closely related to stimulus velocity were observed over all frequencies tested, in the three directions defined. The present study indicates that eye-head coordination processes during linear motion are mainly dependent on the visual system at low frequencies (below 0.25 Hz), with close functional coupling of OKR and eye-head synergy. The otolith system basically works at higher stimulus frequencies and triggers Synergist OOR and ONR. However, both sensorimotor subsystems combine their dynamic properties to provide better eyehead coordination in an extended frequency range and, as evidenced under VS condition, visual and otolith inputs also contribute to eye and neck responses at high and low frequency, respectively. These general laws on functional coupling of the eye and head stabilizing reflexes during linear motion are valid in the three directions tested, even though the relative weight of visual and otolith inputs may vary according to motion direction and/or kinematics.     

Reduction and stabilization of lumbar and thoracolumbar spine fractures with Louis' plates and internal fixator: a comparative study

Summary In this retrospective study, 28 patients who presented isolated fractures from T11 to L4 were surgically treated using a posterior approach. The fractures were reduced and stabilized in half of the cases with Louis' plates and in the other half with an internal fixator. Twelve patients had partial neurological deficits on admission. They were reviewed after a mean period of 24 months from time of injury, and 10 months after implant removal. The kyphosis of the fractured vertebral body was measured, and showed a mean value of 18° before surgery and 10.3° at the last visit. The regional statics of the spine were also studied. The residual mobility of the fixated and neighbouring spinal units was assessed, comparing long segment fixation (plates) with short segment fixation (internal fixator). The residual mobility of the adjacent, non-fixed segments was significantly better when the internal fixator had been used than with the Louis' plates. Of the 12 patients with neurological involvement, 11 had increased their Frankel score by one grade. Results were evaluated by clinical parameters (pain, neurological deficit, occupational disability); scores were as follows: 32% good, 57% satisfactory and 11% poor. There was no significant difference in clinical score between the two treatment modalities.     

The human motion onset VEP as a function of stimulation area for foveal and peripheral vision

We studied amplitude of the wave N200 of the motion-onset VEP by varying the side length of a square stimulation field between 0.5 and 7 degrees. A significant increase in amplitude was obtained between 0.5 and 1 degree of side length in central stimulation and between 0.5 and 5 degrees in 10-degree peripheral stimulation. Variations of spatial frequency between 0.34 and 6.8 c/deg did not modify the amplitude size, ie, no tuning effect could be found. The results of simultaneous and separate stimulation of foveal and parafoveal regions support the observation that the stimulation field size is a minor influence. Features of motion-sensitive cortical neurons, such as those found in monkeys, could account for this behavior.     

胃肠道间质瘤的免疫组化诊断及P53和P21表达

目的：探讨胃肠道间质瘤（GIST）的诊断及鉴别诊断。方法：GIST患50例,进行常规检查及P^53/P^21,HHF－35,vimentin,CD34免疫组化检测。结果：本组50例GIST,恶性34例,交界性10例,良性6例,以胃及小肠为多发（68％）。免疫组化以平滑肌细胞分化为主型占46％,神经源分化型占18％,平滑肌和神经双向分化型18％,未分化型24％。肌肉共同蛋白HHF－35为平滑肌细胞分化最敏感的标志物。未分化型间质瘤的免疫表型为vimentin和CD34阳性。P^53蛋白和P^21蛋白对GIST的良恶性可资鉴别。结论：尽管胃肠道间质瘤光镜下形态相似,但其免疫表型呈异源性,需要做免疫组化准确定性。