Cuboid nutcracker fracture in children: Management and results

Introduction

Compression fractures of the cuboid bone in children and adolescents are rare. Fracture morphology, associated lesions, treatment options and long-term outcomes of this very rare injury are published in a few case reports. This study with review of the literature aims to support the understanding of fracture pattern and optimize pathways of decision making.

Mortality and quality of life after proximal femur fracture—effect of time until surgery and reasons for delay

Introduction

Studies yield conflicting results from the effect of early surgery on mortality. Some observed a positive, others a negative and some did not find any effect of early operation. In this study, mortality and quality of life in relation to time until surgery as well as reasons for delay were observed prospectively.

Material and methods

Data of 138 patients (>65 years) with proximal femoral fractures and consecutive surgery were observed. Demographic data as well as mortality rate, survival time and Barthel Index up to 1 year in relation to different time frames were observed. Reasons for operative delay were divided into being administrative or patient-related.

Results

Three-month mortality was 10.1% and 1-years was 23.9%. Neither time from injury until hospital admission nor from injury until surgery or from hospital admission until surgery up to 48 hours had any effect on mortality and survival time. The age of patients dying in the follow-up period was significantly higher than the age of patients surviving (86.8 vs. 84.4 years). No influence of any delay in time until surgery on the Barthel Index was observed.

Conclusion

In proximal femoral fractures, a delay of surgery up to 48 hours did not influence mortality and Barthel Index negatively, nor did other associating factors. Only the patients age at the time of injury influences mortality rate, survival time, and Barthel Index significantly. The older the patient at the time of injury; the higher the mortality rate, the shorter the survival time and the lower the Barthel Index.     

Triplane Fracture of the Distal Fibula

This is a case report of a 14-year-old girl with a triplane fracture of the distal fibula. The fracture showed displacement and was treated by open reduction, internal fixation, and 5 weeks of external immobilization. The follow-up 5 months after injury yielded an excellent clinical result. Triplane fractures are also seen in locations other than the growth plate of the distal tibia. Due to the occurrence close to the end of the growth period, the potential for growth deformity is negligible. There has been no previous report of a transitional fracture in this location.     

Induction of Orthotopic Rat Adrenomedullary Neoplasia by Intraadrenal Pheochromocytoma Cell Transplantation

We aimed to establish a technically feasible, easily reproducible model of orthotopic adrenomedullary neoplasia. Male rats received adrenal injection of rat pheochromocytoma cells infected with the Escherichia coli gene for beta-galactosidase (lac Z). Each of 10 animals was perfused 7 or 24 days after tumor cell injection; 5 animals of each group were injected with cyclosporin. Animals without tumor cell injection served as controls. Tumor cells were identified and characterized in frozen sections by histochemical and immunohistochemical methods. Immunosuppressed animals had enlarged adrenals 7 days after tumor cell injection. In the rats without immunosuppression the adrenals seemed unaltered despite microscopic demonstration of tumor cells. After 24 days tumors had developed in all animals, weighing 50 times more than normal adrenals in animals with immunosuppression, and 9 times more in animals without immunosuppression. Intraadrenal catecholaminergic tumor cells could be identified by beta-galactosidase expression. No animal showed systemic spread. Generation of adrenomedullary neoplasia by intraadrenal pheochromocytoma cell transplantation is easily reproducible and technically feasible. This model allows simultaneous study of neoplastic and normal adrenal tissues (e.g., regarding their response to drugs intended for diagnostic and therapeutic purposes). The decreased tumor growth in animals without immunosuppression is presumably due to the high number of intraadrenal immunocompetent cells.     

Predicted arterial oxygenation at commercial aircraft cabin altitudes

INTRODUCTION: The degree of hypoxia manifested by airline passengers during flight is not well characterized. Statistical models to predict age-specific levels of Pao2 manifest at altitudes between sea level and 8000 ft (Pao2alt) are described. METHODS: The relationship between age and Pao2 at sea level (Pao2sl) and the relationship between Pao2alt, and Pao2sl, Pco2 at sea level (Pco2sl), and pulmonary health status were investigated using linear regression techniques to analyze previously published data. RESULTS: In persons with normal pulmonary health, the relationship between Pao2sl (mmHg) and age (yr) was Pao2sl = 105.9 - 0.44 * age (R2 = 0.582, MSE = 25.314); Pco2sl (38.1 +/- 2.8 mmHg) was not related to age over the range 18-75 yr. In persons with chronic obstructive lung disease (COPD), neither Pao2sl (78.2 +/- 11.3 mmHg) nor Pco2sl (40.5 +/- 5.7 mmHg) were related to age (77.0 +/- 9.0 yrs).The relationship between PaO2alt and Pao2sl, Pco2sl and altitude (ft) was: Pao2alt = 1.59 + 0.98 * Pao2sl + 0.0031 * Alt - 0.000061 * Pao2sl * Alt - 0.000065 * Pao2sl * Alt + 0.000000092 * Alt2 (R2 = 0.932, MSE = 22.774). DISCUSSION: Pao2sl declines with age in persons with normal pulmonary health; Pco2sl remains constant. Neither vary with age in persons with COPD. Pao2alt can be estimated with acceptable precision from knowledge of Pao2sl, Pco2sl, and altitude. These models predict a substantial proportion of older passengers will manifest a Pao2alt at 8000 ft below the threshold at which supplemental oxygen is recommended.     

Diffuse malignant mesothelioma of pleura. Diagnosis and survival in 92 cases

Clinical, radiographic, surgical, and pathologic findings and survival in 92 patients with diffuse malignant mesothelioma (DMM) of the pleura who were examined at the Mayo Clinic between 1950 and 1980, were studied retrospectively. With the use of defined criteria and ordinary tissue stains, the 92 cases were classified into the following histologic subtypes: purely epithelial, 42 cases; mixed, 29 cases; and sarcomatous, 21 cases. Eight of the sarcomatous cases were desmoplastic. Median survivals were 12, 5, and 3 months for the patients in the epithelial, mixed, and sarcomatous groups, respectively. Survival was significantly longer for patients with epithelial DMM. Women survived longer than men but more often had epithelial DMM. Early disease manifested as multiple discrete pleural nodules, predominantly on the parietal pleura. However, nine patients had a dominant mass. Radiographic signs especially suggestive of DMM were nodular pleural thickening, irregular thickening of interlobar fissures, a dominant mass, or decreased volume of the affected hemithorax.     

A program to calculate sample size, power, and least detectable relative risk using a programmable calculator

A program for the Hewlett Packard 41 series programmable calculator that determines sample size, power, and least detectable relative risk for comparative studies with independent groups is described. The user may specify any ratio of cases to controls (or exposed to unexposed subjects) and, if calculating least detectable relative risks, may specify whether the study is a case-control or cohort study.     

Elastisch–stabile intramedulläre Nagelung einer Unterschenkelfraktur bei chronischer Querschnittslähmung

Therapy of lower leg fractures in patients with chronic spinal cord injury is discussed controversially in the literature. Pros and cons are pointed out for both conservative and operative therapy. Getting out of his wheelchair a 59-year-old patient with chronic spinal cord injury suffered a lower leg fracture. Minimally invasive elastic stable intramedullary nailing (ESIN) was performed to gain sufficient stability for physiotherapy. The follow-up yielded excellent clinical and radiological results. ESIN is an adequate therapeutic alternative for lower leg fractures in patients with chronic spinal cord injury.     

The evaluation of tracheal abnormalities by tomography.

At present, linear plain-film tomography of the trachea is the method of choice for demonstrating the location of post-tracheostomy stenotic lesions and tracheal tumors. This technique does not further compromise the patient's respiratory status, as sometimes occurs with positive-contrast studies using iodine-containing materials, and the radiation dose to the patient from plain-film tomography is considerably less than that from xerotomography.