Meningitis in a newborn infant with urosepsis, negative blood cultures and initially normal cerebrospinal fluid findings.

This case presentation supports the observation that initial cerebrospinal fluid findings can be normal in newborn infants with sepsis syndrome who then develop evidence for meningeal involvement. Therefore, if initial lumbar puncture results are negative, a repeat lumbar puncture is recommended to look for meningitis in newborns that are critically ill with sepsis syndrome.     

External duodenal fistula following closure of duodenal perforation.

AIM: Retrospective analysis of experience with management of external duodenal fistula (EDF) without using total parenteral nutrition (TPN). METHOD: Medical records of 31 patients with EDF following closure of duodenal ulcer perforation, treated over a 7-year period (1994-2001), were studied. Twenty-one patients (68%) had evidence of sepsis at presentation or during the course of treatment. None could afford TPN for optimum time. All patients received hospital-based enteral nutrition through nasojejunal tube, besides supportive medical treatment and/or surgery. Peritonitis or failure to insert nasojejunal tube for enteric alimentation led to early surgery. RESULTS: Two patients died of septicemia and multi-organ failure within 48 hours of admission. Fourteen patients (48.3%) initially received conservative treatment (Group I); six of them later required surgery. Fifteen patients (51.7%) underwent early surgery due to peritonitis (n=9) or failure to establish enteral feeding (n=6) (Group II); wound infection, intra-abdominal abscess and septicemia were more common in these patients than those in Group I. Survival rate was higher in Group I than in Group II (86% versus 40%; p< 0.05). Septicemia and gastrectomy were the independent factors associated with high mortality. CONCLUSIONS: EDF can be satisfactorily managed without TPN. Successful placement of enteral feeding line, supportive treatment and delayed surgery can achieve survival in 85% of patients. Minimum intervention is recommended when early surgery is performed in peritonitis or to establish enteral feeding line.     

Comparison of functional outcomes among subtypes of Fraser’s typeⅡfloating knee

Purpose The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement(Fraser’s typeⅡ).This study aims to evaluate and compare the functional outcomes among different Fraser’s typeⅡfloating knee injuries after surgical management.Methods Twenty-seven patients with Fraser’s typeⅡfloating knee injuries(54 fractures)between September 2014 and December 2015 were enrolled prospectively in this study and were distributed according to Fraser’s floating knee classification into three different groups as typeⅡA(ipsilateral femoral shaft and tibial intra-articular involvement,n=11),typeⅡB(ipsilateral tibial shaft and femoral intra-articular involvement,n=9)and typeⅡC(both femoral and tibial intra-articular involvement,n=7).The differences among the groups were evaluated and compared.The functional outcomes of these injuries at one year were analyzed using Knee Injury and Osteoarthritis Outcome Score(KOOS)which covers 5 subscales of pain,other symptoms,activities of daily living,sports and recreation,and quality of life.The result was also compared with standardized age-sex matched healthy population using paired samples t-test.Results All the patients were male,and the injury mechanism was solely roadside accident.The mean age was 29.8 years and injury severity score 17.9(comparable in all the three groups).Most injuries were observed on the right side(20 cases,74.1%).Based on paired samples t-test,the KOOS score of patients with Fraser’s typeⅡA was found to be better than that of typeⅡB and typeⅡC.Compared with the reference age-sex matched control group,patients with Fraser’s typeⅡB andⅡC fractures had significantly lower mean score in all KOOS subscales(all p<0.01).However,Fraser’s typeⅡA only revealed significant difference regarding the subscales of activities of daily living(p<0.0001),sports and recreation(p<0.0001),and quality of life(p<0.0001).Conclusion The results of this study show that patients with Fraser’s typeⅡA fractures had a better functional outcome as compared to those with typeⅡB andⅡC fractures.This might be due to the open intra-articular involvement of the distal femur of the latter two fracture types.     

Determination of Optimum Machining Parameters for Face Milling Process of Ti6A14V Metal Matrix Composite

This paper shows the novel approach of Taguchi-Based Grey Relational Analysis of Ti6Al4V Machining parameter. Ti6Al4V metal matrix composite has been fabricated using the powder metallurgy route. Here, all the components of TI6Al4V machining forces, including longitudinal force (F_x), radial force (F_y), tangential force (F_z), surface roughness and material removal rate (MRR) are measured during the facing operation. The effect of three process parameters, cutting speed, tool feed and cutting depth, is being studied on the matching responses. Orthogonal design of experiment (Taguchi L9) has been adopted to execute the process parameters in each level. To validate the process output parameters, the Grey Relational Analysis (GRA) optimization approach was applied. The percentage contribution of machining parameters to the parameter of response performance was interpreted through variance analysis (ANOVA). Through the GRA process, the emphasis was on the fact that for TI6Al4V metal matrix composite among all machining parameters, tool feed serves as the highest contribution to the output responses accompanied by the cutting depth with the cutting speed in addition. From optimal testing, it is found that for minimization of machining forces, maximization of MRR and minimization of Ra, the best combinations of input parameters are the 2nd stage of cutting speed (175 m/min), the 3rd stage of feed (0.25 mm/edge) as well as the 2nd stage of cutting depth (1.2 mm). It is also found that hardness of Ti6Al4V MMC is 59.4 HRA and composition of that material remain the same after milling operation.     

Genotoxic potential of an organophosphate insecticide, phosphamidon (dimecron): an in vivo study in mice

The genotoxic effect of phosphamidon in mice in an in vivo test system was investigated by 3 different assays: chromosomal aberration, micronucleus and sperm-shape abnormality. The chemical was administered to groups of mice via 3 routes (i.p., p.o. and s.c.), acutely in 3 dose regimens (5, 4 and 3 mg/kg) and subacutely or chronically (5 X 1 mg/kg). The animals were sacrificed at different times: after 6, 24, 48 and 120 h for chromosomal aberration, 30 h for micronucleus and 35 days for sperm-shape abnormality. Significant effects were observed in all assays. Chronic exposure to fractionated doses induced less effect than the equivalent acute dose. The results were dose- as well as time-responsive and indicated the genetic peril of phosphamidon in the present, in vivo system.