Mortality after pelvic fractures in the elderly

Theoretically, fissures and minor fractures of the pelvis sustained by the elderly after low-energy trauma may lead to thromboembolic complications. Few studies exist, but clinically, these injuries had been considered to have an excellent prognosis until a recent study reported a 10% fatality rate from pulmonary emboli in this group of patients(9). We retrospectively studied the outcome among 62 patients over the age of 60 years with minor pelvic fractures who were treated during a 4-year period. Pulmonary embolus was verified in only one patient, who survived. There was no clinical indication that thromboembolic complications were the cause of death among the 5% who died during the first month after admission. Prophylactic anticoagulation seems to be unwarranted among elderly patients with minor pelvic fractures.     

Preoperative traction in patients with hip fractures.

A series of 80 patients with cervical, trochanteric or subtrochanteric hip fractures were randomized to either treatment without traction, skin traction, or skeletal traction during the 1883 h between admission and operation. The institution of skin or skeletal traction was not particularly painful for the patient, but we found no indication that either was of discernible benefit. The number of analgesic medications needed was no higher in patients without traction. We conclude that traction should not be administered routinely to patients awaiting operation for hip fracture.     

Interleukin-1beta and tumor necrosis factor-alpha are expressed by different subsets of microglia and macrophages after ischemic stroke in mice

Background  

Interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) are expressed by microglia and infiltrating macrophages following ischemic stroke. Whereas IL-1β is primarily neurotoxic in ischemic stroke, TNF-α may have neurotoxic and/or neuroprotective effects. We investigated whether IL-1β and TNF-α are synthesized by overlapping or segregated populations of cells after ischemic stroke in mice.     

A quantitative in situ hybridization and polymerase chain reaction study of microglial-macrophage expression of interleukin-1beta mRNA following permanent middle cerebral artery occlusion in mice

Interleukin-1beta (IL-1beta) is known to play a central role in ischemia-induced brain damage in rodents. In comparison to the rat, however, the available data on the cellular synthesis of IL-1beta mRNA and protein in the mouse are very limited. Here, we report on the time profile, the topography and the quantitative, cellular expression of IL-1beta mRNA in mice subjected to permanent occlusion of the distal middle cerebral artery (MCA). The in situ hybridization analysis showed that IL-1beta mRNA was expressed during the first post-surgical hour in a small number of high-expressing macrophage-like cells, located in cortical layers I and II of the future infarct. At 2 h, a significant number of faintly labeled IL-1beta mRNA-expressing cells had appeared in the developing peri-infarct, and the number remained constant at 4 h and 6 h, when the hybridization signal began to distribute to the cellular processes. Quantitative PCR performed on whole hemispheres showed a significant 20-fold increase in the relative level of IL-1beta mRNA at 12 h and a highly significant 42-fold increase at 24 h, at which time single IL-1beta mRNA-expressing cells were supplemented by aggregates and perivascular infiltrates of intensely labeled IL-1beta mRNA-expressing cells. Immunohistochemistry and double immunohistochemical stainings in addition to combined in situ hybridization, confirmed that the intensely labeled IL-1beta mRNA-expressing and IL-1beta protein synthesizing cells predominantly were glial fibrillary acidic protein-immunonegative, macrophage associated antigen-1-immunopositive microglia-macrophages. By day 5 there was a dramatic decline in the relative level of IL-1beta mRNA in the ischemic hemisphere. In summary, the data provide evidence that permanent occlusion of the distal MCA in mice results in expression of IL-1beta mRNA and IL-1beta synthesis in spatially and temporally segregated subpopulations of microglia and macrophages.     

AO tension-band osteosynthesis of displaced olecranon fractures

This study reviewed 31 patients who underwent AO tension-band osteosynthesis of displaced olecranon fractures. Thirteen fractures were comminuted. Postoperative immobilization was short, and the median hospital stay was 3 days. In 2 patients, the stainless steel wire broke and required replacement. In 13 patients, the osteosynthesis material was removed after healing because of pain at the tip of the elbow; this did not influence the final result. Median time out of work was 12 weeks. There was no significant loss of elbow power. There was satisfactory mobility, function, and absence of pain. There were 29 good and 2 fair clinical results. Anatomic reduction was achieved in 24 elbows. Possible arthrosis was detected at follow-up in 5 elbows but these patients had a good clinical result. AO tension-band osteosynthesis of displaced olecranon fractures yields good clinical medium-term results with few serious complications.     

Initial experience with the Forte plate for dorsally displaced distal radius fractures

Open reduction and plate osteosynthesis is occasionally indicated for dorsally displaced distal radius fractures. We reviewed our medium term results with the Forte plate, one of the recently introduced purpose-made implants.Twenty-five patients operated on during the first year were reviewed 19 (12-24) months after surgery. Median age at operation was 53 (28-80) years. There were seven high energy and eighteen low energy injuries. Fourteen fractures extended into the radiocarpal joint.Three patients had a poor clinical result and were re-operated on before review with an arthrodesis, ulnar shortening, or Sauve-Kapandji operation. The remainder had six excellent, twelve good, and four fair results. Irritation of the extensor tendons was a minor problem.Initial radiological correction of deformity was satisfactory, but increased volar angulation of the distal radius was seen at follow up in twenty patients - by more than 10 degrees in nine. Seven patients had 20-30 degrees volar tilt at final review and tended to have a poorer clinical result than other patients.In our patients use of the Forte plate seems to have given satisfactory clinical results, but the increase in volar tilt after surgery is a cause for concern.     

Carpal tunnel syndrome during pregnancy

Carpal tunnel syndrome is common during pregnancy. The symptoms usually disappear after delivery, but how soon has not been established. Thirty pregnant women with the syndrome reported to us the degree of pain in their hands every week before, and daily after, delivery. Pain was graded on a scale from 0 (none) to 10 (worst imaginable). The prevalence of the syndrome during pregnancy was about 2%. The mean pain score was 5.6 (SD 2.0) at referral and this was reduced by 1.2 (SD 2.2) after wearing an orthosis for a week. After this, it stayed almost unchanged until delivery. The score fell by half during the first week after parturition and by half again during the next week. The reduction in score was strongly correlated with loss of the weight gained during pregnancy (r?=?0.97; p<0.001). Although symptoms may persist for some weeks after delivery, the severity declines quickly.     

Microglial cell population dynamics in the injured adult central nervous system

Reactive microgliosis is characteristic of trauma and stroke as well as inflammatory and chronic neurodegenerative disease. A conspicuous feature of the microglial reaction to acute neural injury is a massive expansion of the microglial cell population which peaks a few days following injury. New data based on the use of radiation bone marrow-chimeric mice suggest this expansion also involves recruitment of bone marrow-derived cells, which migrate into the neural parenchyma and differentiate into microglia. Here, we discuss the contribution of bone marrow-derived cells to the injury-induced expansion of the microglial cell population, seen in the dentate gyrus with ongoing anterograde axonal and terminal synaptic degeneration, subsequent to transection of the entorhino-dentate perforant path projection. In this paradigm of minor brain injury, the bone marrow-derived cells are grossly outnumbered by activated resident microglia, which express the stem cell antigen CD34 concurrent to a marked capacity for self-renewal. The observation of a mixed origin of lesion-reactive microglia, consisting of a smaller subpopulation of exogenous bone marrow-derived microglia, and a larger population of activated resident microglia, the majority of which express CD34 and undergo proliferation, suggests that lesion-reactive microglia consist of functionally distinct cell populations. The demonstration of an injury-enhanced recruitment of bone marrow-derived cells into the perforant path-denervated dentate gyrus, raises the possibility of using genetically manipulated cells as vectors for lesion-site-specific gene therapy even in minimally injured areas of the central nervous system.     

Memantine attenuates the increase in striatal preproenkephalin mRNA expression and development of haloperidol-induced persistent oral dyskinesias in rats

Tardive dyskinesia (TD) is a serious motor side effect of long-term neuroleptic treatment that may persist after drug withdrawal. Alterations in striatal enkephalinergic neurons due to excessive glutamatergic activity is a possible pathogenetic mechanism. We studied the effect of the NMDA antagonist memantine in a rat model of TD, in which vacuous chewing movements (VCM) were induced by 20 weeks of haloperidol administration. The striatal density of preproenkephalin mRNA was measured and the number of neurons estimated. Haloperidol induced persistent VCM that was associated with increased striatal expression of preproenkephalin mRNA. Memantine inhibited the development of haloperidol-induced persistent VCM and attenuated the increase in preproenkephalin mRNA expression. This suggests that glutamate-mediated up-regulation of striatal enkephalin plays a role in the development of haloperidol-induced persistent oral dyskinesias.     

Dynamics of microglia in the developing rat brain

Entrance of mesodermal precursors into the developing CNS is the most well-accepted origin of microglia. However, the contribution of proliferation and death of recruited microglial precursors to the final microglial cell population remains to be elucidated. To investigate microglial proliferation and apoptosis during development, we combined proliferating cell nuclear antigen (PCNA) immunohistochemistry, in situ detection of nuclear DNA fragmentation (TUNEL), and caspase-3 immunohistochemistry with tomato lectin histochemistry, a selective microglial marker. The study was carried out in Wistar rats from embryonic day (E) 16 to postnatal day (P) 18 in cerebral cortex, subcortical white matter, and hippocampus. Proliferating microglial cells were found at all ages in the three brain regions and represented a significant fraction of the total microglial cell population. The percentage of microglia expressing PCNA progressively increased from the embryonic period (25-51% at E16) to a maximum at P9, when the great majority of microglia expressed PCNA (92-99%) in all the brain regions analyzed. In spite of the remarkable proliferation and expansion of the microglial population with time, the density of microglia remained quite constant in most brain regions because of the considerable growth of the brain during late prenatal and early postnatal periods. In contrast, apoptosis of microglia was detected only at certain times and was restricted to some ameboid cells in white matter and primitive ramified cells in gray matter, representing a small fraction of the microglial population. Therefore, our results point to proliferation of microglial precursors in the developing brain as a physiological mechanism contributing to the acquisition of the adult microglial cell population. In contrast, microglial apoptosis occurs only locally at certain developmental stages and thus seems less crucial for the establishment of the final density of microglia.