Freier Paraskapular-/Skapularlappen bei frakturbegleitendem Weichteildefekt an Talus oder Kalkaneus

BASIS: Fractures of the talus or calcaneus with accompanying soft tissue damage require precisely planned treatment to prevent infection of the wound over time, especially in severely injured patients. MATERIAL AND METHODS: Seven patients with fractures of the talus or calcaneus and accompanying 2nd and 3rd degree open or 3rd degree closed soft tissue injuries were followed up retrospectively. These patients were operated on between January 1999 and January 2006 with free fasciocutaneous scapular or parascapular flaps. The average age was 34 (range 16-54). Follow-up was at 6-36 months. RESULTS: Osteosynthesis was primarily in six cases, post-primarily in one, and in four cases exterior fixation was used additively. Temporary vacuum therapy was performed for a mean of 28 days (6-42). Parascapular, scapular, and Latissimus dorsi flap coverage was performed six, one, and one times, respectively. Six flaps healed without complication. One necrosis of a parascapular flap occurred and made a Latissimus dorsi flap necessary. In one case of donor-site wound dehiscense, a local rotation flap became necessary. There was no joint infection or osteomyelitis. Bony consolidation was achieved within all fractures. CONCLUSION: Traumatic soft tissue damage must be taken into account when primary or secondary internal fixation is performed and should influence the choice of implant. Free fasciocutaneous parascapular or scapular flaps are a powerful tool for preventing infection if local flaps are not sufficient to achieve stable soft tissue coverage.     

Bone mineral density of the proximal tibia following uncemented arthroplasty

Bone mineral density (BMD, g/cm2) was measured using dual-photon absorptiometry (DPA) in selected areas of the proximal tibia following uncemented PCA knee prosthesis. In nine patients with 14 alloplastic operations, measurements were taken at 3-6-month intervals for the first 3 1/2 years after operation. There was a significant increase in BMD of about 15% during the first 6 months after operation. The following year it remained increased, although not significantly, compared with the initial values, then gradually diminished. Increased bone density after arthroplasty may be explained mainly by stimulation of bone formation from weight bearing due to improved walking ability. Stress shielding of the proximal part of the supporting tibial bone did not seem to occur.     

Enhanced repair of pyrimidine dimers in coding and non-coding genomic sequences in CHO cells expressing a prokaryotic DNA repair gene

We have previously demonstrated that the active dihydrofolatereductase (DHFR) gene is efficiently repaired in Chinese hamsterovary (CHO) cells which remove only a small fraction of u.v.-inducedpyrimidine dimers from the overall genome. Preferential DNArepair of essential genes may explain why the u.v. resistanceof normal CHO cells is as high as that of fully repair-proficientnormal human cells. In this report, we have studied the removalof pyrimidine dimers in a CHO cell line expressing the cloneddenV gene from bacteriophage T4 which codes for the pyrimidinedimer specific enzyme T4 endonuclease V (T4 endo V). This cellline was derived from a u.v.-sensitive excision deficient mutantof a CHO wild type line by transformation with the denV gene,and partial restoration of u.v. resistance was achieved. Wehave examined an important aspect of the u.v. excision repairin these denV⁺ cells by studying the repair efficiencies inthe active DHFR gene and in a non-coding sequence located downstreamfrom it. In the u.v.-sensitive CHO mutant cell line from whichthe denV⁺ was derived, we detected no pyrimidine dimer removalfrom the gene or from the downstream sequence after irradiationof the cells with 20 J/m² u.v. (254 nm) light. In the wild typeCHO cells, 50% of the pyrimidine dimers were removed from asequence in the DHFR gene within 8 h, whereas none were removedfrom the downstream sequence in that period. This representsthe normal pattern of preferential DNA repair of active genes,which we have described in previous communications. In the denV⁺cells, 70% of the pyrimidine dimers were removed from both theDHFR gene and from the downstream sequence; these cells thusrepair both coding and non-coding regions of the genome andshow no pattern of preferential repair. The endogenous activitythat initiates excision repair in normal CHO cells is evidentlymuch more restricted in its accessibility to DNA lesions inchromatin than is the activity in cells containing substantialamounts of the small T4 endo V enzyme.     

Dual Vulnerability of Being Both a Teen and an Immigrant Parent: Illustrations from an Italian Context

Italy has experienced a recent surge in immigration, which has led to an increase in the country’s birth rate. Many immigrant mothers are adolescent parents. 30 adolescent mothers (17 recent immigrants and 13 adolescents of Italian descent) completed measures of adolescent self-development and motherhood, perceived availability and satisfaction with social support, and emotional and behavioral characteristic of their children. Findings suggest that immigrant teen mothers show more difficulties related to parenting than do Italian born teen mothers. In particular, immigrant teen mothers report lower levels of social support satisfaction and availability, higher levels of parent–child dysfunction, and experience motherhood and child behavior as more problematic. The findings highlight and confirm the need for well-designed, specific supportive services for adolescent immigrant mothers.     

875 Cases of bacterial meningitis: Diagnostic procedures and the impact of preadmission antibiotic therapy Part III of a three-part series

Data on the bacteriological findings, diagnostic measures and clinical course of 875 patients with bacterial meningitis are presented. Findings from the medical records and from a follow-up questionnaire survey of 667 of these cases revealed no significant difference between patients treated with antibiotics before admission (pretreated) and those who were not treated before admission (non-pretreated) with respect to clinical condition on admission, mortality and late sequelae. Pretreatment was, however, associated with a longer duration of symptoms. Apart from cases due to Neisseria meningitidis, there were no significant differences in diagnostic findings between pretreated and non-pretreated cases. In the group of pretreated meningococcal patients, however, positive blood cultures, pleiocytosis in the cerebrospinal fluid (CSF) and positive cultures from sites other than blood and CSF were less frequent than in the non-pretreated cases.     

Mechanical properties of carotid arteries from DOCA hypertensive swine

Carotid arteries from control and deoxycorticosterone acetate (DOCA) hypertensive swine were examined for alterations in structure and in contractile properties. Vessels were excised 7 weeks after subcutaneous implantation of the steroid and subsequent elevation in mean arterial pressure from 102 to 133 mm Hg. The carotid media was 1.8 times thicker in arteries from hypertensive animals than in arteries from control animals. This enlargement was associated with an increase in muscle mass, as the fraction of the media composed of smooth muscle cells remained unchanged. Maximal active stress induced by several agonists normalized for cell cross-sectional area was unaltered. No change was observed in sensitivity or maximal response to norepinephrine, histamine, or KCl depolarization. Isotonic shortening rates were also comparable, as was the time course of shortening velocity to a constant afterload during tonic contractions. It is concluded that an enlargement of the carotid media develops in this model of hypertension. However, this response is not associated with detectable alterations in contractile system function.     

Altered spectra of hypermutation in antibodies from mice deficient for the DNA mismatch repair protein PMS2

Mutations are introduced into rearranged Ig variable genes at a frequency of 10⁻² mutations per base pair by an unknown mechanism. Assuming that DNA repair pathways generate or remove mutations, the frequency and pattern of mutation will be different in variable genes from mice defective in repair. Therefore, hypermutation was studied in mice deficient for either the DNA nucleotide excision repair gene Xpa or the mismatch repair gene Pms2. High levels of mutation were found in variable genes from XPA-deficient and PMS2-deficient mice, indicating that neither nucleotide excision repair nor mismatch repair pathways generate hypermutation. However, variable genes from PMS2-deficient mice had significantly more adjacent base substitutions than genes from wild-type or XPA-deficient mice. By using a biochemical assay, we confirmed that tandem mispairs were repaired by wild-type cells but not by Pms2^−/− human or murine cells. The data indicate that tandem substitutions are produced by the hypermutation mechanism and then processed by a PMS2-dependent pathway.