Sequential scintigraphy and orthoradiographic measurement of femoral shortening after femoral neck fracture

The objective of the study was to assess scintigraphic patterns and femoral shortening after femoral neck fracture in order to select predictive parameters for late complications. Eighty-eight patients with osteosynthesized femoral neck fractures were followed for 2 years with regular scintigraphic evaluations and orthoradiographic measurements of femoral length shortening. Four different patient categories were identified with regard to the late outcome: two different groups with uneventful healing and two different groups with late complications. Accordingly, a high scintigraphic uptake at 1 month may eiher point to an uneventful healing if combined with minor femoral shortening or indicate failure if combined with a high degree of femoral shortening. In contrast, low scintigraphic uptake may either reflect primary fracture healing if accompanied by minor femoral shortening or predict failure if a high degree of femoral shortening is present. Compared with using scintigraphy alone, combined scintigraphic evaluation and assessment of femoral shortening increased the accuracy for prediction of late failures from 80% to 93%. Early scintigraphic patterns after osteosynthesis of femoral neck fractures have to be validated with care. Radiographic assessment of femoral shortening, which is less invasive, gives better prognostic accuracy and should therefore be preferred for this purpose.     

Research on cultural and socioeconomic factors in criminal violence

This article has discussed two particularly influential approaches to the explanation of the role of social factors in criminal violence. One of these approaches emphasizes cultural orientations and the other, socioeconomic deprivation. The cultural perspective depicts criminal violence as the outcome of normal processes of social learning. Certain groups allegedly endorse values that are supportive of violent behavior. Consequently, well-socialized members of these groups are predisposed to employ violence as a means for dealing with common, interpersonal disputes. One variant of the cultural approach, the "thesis of a subculture of violence," has been used to explain the high rates of criminal violence that have been widely observed for certain sociodemographic groups in society. A similar type of argument has been formulated to account for high levels of homicide in the southern part of the United States. In this latter argument, a "regional culture of violence" has been hypothesized. Both of these arguments describe values supportive of violence as being deviant from the dominant values of society. A third cultural approach attributes violent behavior to values favorable to violence that are part of the dominant culture. The research pertaining to these cultural arguments is best described as inconclusive. In general, stronger support for the cultural perspective can be found in the qualitative evidence in comparison with the quantitative data. This may reflect the difficulties in devising truly satisfactory, quantitative measures of cultural orientations. The cultural approach nevertheless continues to be regarded by many as a useful way of explaining the social distribution of violent crime largely because of the supportive qualitative evidence and the rather compelling logic of the substantive arguments. The socioeconomic approach offers a slightly different explanation for violent crime. The key causal factors here are not so much positive cultural evaluations of violence but hardships and deprivations. In an important sense, individuals are viewed as being driven to violence because of their unfortunate location in the social structure. These socioeconomic approaches have directed attention to poverty, general economic inequality, and inequality based on ascribed characteristics such as race. The research in the socioeconomic perspectives is also mixed, but some general patterns appear. Measures of socioeconomic deprivation are typically related to indicators of criminal violence in the theoretically expected manner, even though statistical significance is often problematic.(ABSTRACT TRUNCATED AT 400 WORDS)     

Lyme disease: musculoskeletal manifestations

A previously unrecognized musculoskeletal syndrome led to the recognition of this "new" infectious disease. Several distinct patterns of musculoskeletal involvement can be seen throughout the course of untreated Lyme disease. Diffuse, nonspecific muscle achiness and stiffness can be seen early to be followed by characteristically brief, recurrent episodes of LIMP and transient arthritis that help to differentiate LD from other arthropathies. Chronic oligoarticular arthritis is seen in a few. Lyme arthropathy most closely resembles the reactive arthropathies. In a few cases, LD has mimicked other connective tissue disorders such as juvenile rheumatoid arthritis, rheumatoid arthritis, myositis, and scleroderma. It would appear that the full spectrum of musculoskeletal LD is still being defined.     

Beneficial effects of a polyamine biosynthesis inhibitor on lupus in MRL-lpr/lpr mice

Difluoromethylornithine (DFMO), an experimental drug that inactivates ornithine decarboxylase and thus reduces the production of polyamines has a beneficial effect on the mean survival time and the clinical and laboratory manifestations of murine lupus in female MRL-lpr/lpr mice. DFMO-treated mice showed a 29% increase in the mean survival time compared with age- and sex-matched control mice of the same strain. Lymphadenopathy was evident in untreated mice at 14 weeks of age, but was delayed until 19 weeks of age in DFMO-treated mice. In addition, the sera of DFMO-treated mice contained a significantly lower concentration of anti-DNA antibodies compared with untreated mice. These results open the possibility of development of a new class of therapeutic agents based on polyamine biosynthesis inhibitors for the treatment of human autoimmune disease. Possible mechanisms for the action of DFMO include its inhibitory action on cell proliferation as well as its ability to prevent DNA from assuming an immunogenic left-handed Z-DNA conformation.     

Suppression of human lymphocyte mitogenesis mediated by phagocyte-released reactive oxygen species: comparative activities in normals and in chronic granulomatous disease

Human blood monocytes and neutrophils stimulated in vitro with phorbol myristate acetate, N-formyl-L-methionyl-L-leucyl-L-phenylalanine, activated zymosan, or heat aggregated gamma-globulin were found to suppress lymphocyte mitogenic responses. In activated phagocyte-lymphocyte cocultures, both blast transformation and [3H]-thymidine incorporation were reduced while numbers of dead cells were increased, thus suggesting a cytolethal suppressive mechanism. Suppression was prevented by catalase but not by other oxygen radical scavengers nor by cyclooxygenase inhibitors, thus implicating H2O2 as the suppressive mediator. Activated monocytes and neutrophils but not lymphocytes released measurable quantities of H2O2 into cell supernatants. However, transfer of an inhibitory effect with these supernatants was not routinely achieved. Finally, as opposed to normals, lymphocyte blastogenesis in chronic granulomatous disease patients was not inhibited by their activated phagocytes. However, catalase -reversible suppression could be restored in cocultures of normal phagocytes and patient lymphocytes. In conclusion, these studies demonstrate a potentially important mechanism whereby activated phagocytes may alter lymphocyte reactivity.     

Ouabain decreases apparent potassium-conductance in proximal tubules of the amphibian kidney

According to a previous study from this laboratory, the electrochemical gradient for potassium across the peritubular cell membrane of proximal tubules in the isolated perfused frog kidney increases following the application of ouabain. In order to test, if this phenomenon were due to a decrease of potassium conductance, the effects of ouabain on cell membrane resistances and the sensitivity of the peritubular cell membrane potential difference (PD_pt) to step changes of peritubular potassium and bicarbonate concentration were studied. In the absence of ouabain, PD_pt averaged –60±3 mV (n=25). A step increase of peritubular potassium concentration from 3 to 18 mmol/l (pH 8.07) depolarises PD_pt (PD_k) by +24±2 mV (n=8). An increase of bicarbonate from 20 to 40 mmol/l (pH 8.07) hyperpolarises PD_pt (PD_b) by –2.8±0.4 mV (n=9). The resistance of the luminal and peritubular cell membranes in parallel (R _m) amounts to 45±9 k cm (tubule length) (n=4) and the voltage divider ratio (VDR) to 1.4±0.2 (n=7). The resistance of the cellular cable (cellular core,R _c) approaches 131±37 M/cm (n=4). Peritubular application of 0.1 mmol/l ouabain leads to a gradual decline of PD_pt (t _1/2 approx. 30 min), to an increase ofR _m, a decrease of PD_k and an increase of PD_b. VDR andR _c are not changed significantly. The data point to a functional link between the sodium/potassium ATPase and the potassium conductance of the peritubular cell membrane.     

Clinical outcomes in pediatric tibial lengthening and deformity correction: a comparison of the Taylor Spatial Frame with the Orthex Hexapod System

PurposeComparison of two hexapod frame systems in paediatric tibial deformity correction; the Taylor Spatial Frame (TSF) and Orthex Hexapod System.MethodsPaediatric patients with congenital and acquired tibial deformities treated with either TSF (between 2014 and 2016) or Orthex (between 2017 and 2019) frames were included in a retrospective comparative study. Outcome measures were healing index, pin infection rate, regenerate quality and density, software residual rate, deformity correction accuracy, strut exchanges and quality of life (QoL).ResultsThe TSF group had 17 patients (18 frames) and the Orthex group had 21 patients (25 frames). The most common indications for tibial deformity correction were fibular hemimelia (14) and septic or traumatic growth arrest (8). The median time in frame was 230 days (TSF) versus 203 days (Orthex) (p= 0.06). The mean lengthening achieved was 54 mm (TSF) and 51 mm (Orthex) (p = 0.41). The healing index was 41 days/cm (TSF) versus 43 days/cm (Orthex) (p = 0.70). Pin site infections occurred more in the TSF cohort (40%) than in the Orthex cohort (18%) (p < 0.001). The regenerate in the Orthex group showed higher density at three months (p = 0.029) and was more homogenous (p = 0.023) at six months after frame application. Strut exchanges were less frequent with the Orthex system (p < 0.0001). QoL measures were similar in both cohorts (p = 0.92).ConclusionsThis is the first study to compare two hexapod designs in paediatric orthopaedics. The Orthex system showed superiority in regenerate quality and a significant reduction in pin site infection rates. Both systems delivered predictable and accurate limb deformity correction.Level of evidenceIII     

Estrogen-dependent tensile properties of the rabbit knee medial collateral ligament

The influence of oophorectomy or continuous administration of estradiol on the tensile properties of the rabbit knee medial collateral ligament was investigated. Young postpubertal female New Zealand white rabbits were either oophorectomized or underwent a sham operation. The sham-operated animals received in addition a daily dosage of 4 mg 17beta-estradiol. After 5 months the animals were killed, and the material properties of the bone-ligament-bone complex in one knee were determined using a material testing machine and video system, and compared to non-treated control animals. There was no difference in elastic modulus between the groups. However, the ligaments from low-dose estrogen-treated animals had a smaller cross-sectional area and a higher ultimate tensile strength than those from controls or oophorectomized rabbits (P<0.04-0.0003).     

Liver transplantation for hepatocellular carcinoma]

Hepatocellular carcinoma (HCC) is the most frequent primitive cancer of the liver. It mostly develops on cirrhotic livers. Orthotopic liver transplantation is the only treatment that definitively addresses both the metachronous occurrence risk of HCC and the underlying disease. Under Milan criteria, i.e. less than 3 nodules of 3 cm max in diameter, or 1 nodule of 5 cm maximum, OLT has been shown effective and provides with survival rates almost equal to those obtained with HCC free cirrhotic patients. In Rennes, 195 patients with early HCC on cirrhotic livers have been transplanted from January 1995 to June 2005. Global and disease free 8 years patient survival rates were 73 and 70%, respectively. These results were significantly altered when the recipient was female, the cirrhosis due to C virus and the patient of B blood group. Despite these excellent results, the principal limit to the application of transplantation for HCC remains the long period of time patients have to wait for a graft. During this period of time, growth of the tumour may drop the patient out of Milan criteria and subsequently from the waiting list. The role of chemoembolisation, liver resection and thermal ablation while the patient is waiting for a graft remains debatable.