ABSTRACT
Residual paresis and deformity of the ankle-foot is a common sequel of chronic poliomyelitis. Twenty patients with a mean age of 18.6 years [range 18 - 20 years] suffering paralytic flail deformed ankle-foot, but with adequate gluteus maximus muscle power and stable knee, secondary to chronic poliomyelitis acquired during infancy, had been treated with ankle-midtarsal arthrodesis using Charnley's external fixator-compression for the ankle and staples for the midtarsal joints. They were retrospectively evaluated for the results after arthrodesis at a mean interval of 3.8 years [range, 2 - 6 years] by physical examination and radio-graphs. All patients had a stable painless plantigrade resilient foot after arthrodesis. Neither nonunion [pseudoarthrosis] developed nor did talar avascular necrosis. Complications included wound slough [one], and reflex sympathetic dystrophy [one]. Four cases [20%] were classified as excellent, 10 cases [50%] as good, 5 cases [25%] as fair, and one case [5%] as poor. With the numbers available for study, it could be possible to show that the extent of the arthrodesis and involvement of hindfoot and midfoot joints sparing the subtalar joint affected functional outcome in a significant fashion. The principle, though applied to paralytic cases, can also be used in other non-paralytic ankle-foot deformity
Subject(s)
Humans , Male , Female , Poliomyelitis/diagnostic imaging , Arthrodesis , Postoperative Complications , Chronic DiseaseABSTRACT
Differences between chronic hepatitis C virus [HCV] and hepatitis B virus [HBV] infections have been established in incidence percentage and course of development of chronic liver disease as well as lymphoproliferative disorders. Lymphotropism has been regarded as one factor underlying persistence and chronicity of both diseases. However, this could not explain the variation in their clinical outcome which could be elucidated by a comparative study of the differential morphological behaviour of the peripheral blood mononuclear cells [PBMCs] harbouring the virus. An ultrastructural analysis by transmission electron microscopy [TEM] was hence performed on PBMCs isolated from patients with chronic HCV and HBV infections and from healthy subjects as controls. In this work, a morphological difference at the ultrastructural level was demonstrated in the PBMCs isolated from HCV and HBV- infected patients. Whereas minimal nuclear and cytoplasmic alterations and few intact forms of the virus were seen in hepatitis C patients, more aggressive degenerative and apoptotic features as well as more viral particles were viewed in cells of hepatitis B patients. These findings imply latency and quiescence of HCV in PBMCs leading to a state of chronic infection in most of the cases but with a very insidious course of progression towards cirrhosis or hepatocellular carcinoma [HCC]. In addition, stimulation and expansion of B cells could lead to various lymphoproliferative disorders. In the case of HBV infections, there is an earlier and more destructive effect of the virus on the infected cells which helps their rapid eradication with less propensity to persistence in the majority of cases. However in those patients where infection persists [possibly with lower immune response], chronicity could develop with rapid progression to cirrhosis due to the release of many viral particles from the uneliminated damaged PBMCs