Mechanisms of hepatotoxicity of chloroacetonitrile: an end product of water chlorination

Chloroacetonitrile is a disinfectant by-product of chlorination of drinking water and is considered as a directacting mutagenic and carcinogenic agent. Time-course and dose-response studies were performed to examine the mechanism of chloroacetonitrile-induced hepatotoxicity. In the time-course study, animals were scarified at 2, 4, 6 and 12 h after a single oral dose of chloroacetonitrile [38 mg/kg, p.o.]. In the dose-response study, rats were scarified at 2 h after a single oral dose of chloroacetonitrile [9, 19, 38, and 76 mg/kg]. In the time-course study chloroacetonitrile induced a significant decrease of hepatic glutathione, and activities of glutathione-S-transferase, glutathione proxidase and superoxide dismutase accompanied with an increase of hepatic malondialdehyde, plasma cytokines [IL-6 and 10 and TNF-alpha], serum aminotransferases and total bilirubin after 2 h of administration. Maximal alteration of the estimated parameters was observed at 4 h and returned to normal value at 6 h and/or 12 h after chloroacetonitrile treatment. Moreover, the alterations in oxidant, antioxidant parameters, inflammatory cytokines and the liver function tests were dose dependant. Histopathological findings supported the biochemical results. These data indicate that the mechanism of chloroacetonitrile-induced hepatotoxicity may be mediated through depletion of antioxidants, induction of oxidative stress and inflammatory cytokines

Comparative study of arthroscopic anterior cruciate ligament [ACL] reconstruction with mini arthrotomy

This study is based on 49 patients with chronic anterior cruciate ligament [ACL] deficiency who had ACL reconstruction using free patellar tendon graft. Its main objective was to compare the results of ACL reconstruction done by arthroscopy and with that done by mini arthrotomy. Patients were 37 males and 12 females; their average age was 25 years [range 17 to 37 years]. 1 female had bilateral ACL reconstruction. The patients were divided into two groups: Group /: had undergone the arthroscopic procedure and Group II: had mini arthrotomy. Our results showed that mini arthrotomy patients [Group I], as compared to Group II, had longer hospital stay, had delay in resuming sport activity and had longer sick leave; however, there was no significant difference in the final outcome between both procedures. This, in addition to the high cost and fragility of arthroscopic material led us to recommend mini arthrotomy as the procedure of choice for ACL reconstruction

Intramedullary K-wire fixation of displaced proximal humeral fractures

To evaluate intramedullary K-wire fixation as a surgical technique in the management of displaced two or three parts proximal humeral fractures. Retrospective study of 16 patients with displaced proximal humeral fractures managed by closed reduction and intramedullary K-wire fixation at King Khalid University Hospital. All fractures treated healed with minimal complications. One wire migrated proximally and had to be replaced. A second patient had stiffness of elbow which resolved following removal of K-wires. Intramedullary K-wire fixation of displaced proximal humeral fractures following closed reduction is a recommended technique

Ultrasonography detection of radiolucent foreign bodies in soft tissue compared to computed tomography scan

Thirty-one patients with suspected radiolucent foreign bodies [wooden splinters] in soft tissues of extremities were investigated by plain radiography, computed tomography [CT] scan and ultrasonography to the area suspected clinically. Ultrasonography detected and localized radiolucent foreign bodies in 18 of the 31 patients, while only 14 were seen on CT scan. Following surgical exploration, the presence of foreign bodies was confirmed in 20 patients; thus, the accuracy of ultrasonography was 90% while that of CT scan was 70%. The size of foreign body, the presence of infection or the delay in diagnosis had no effect on results. Ultrasonography is clearly a reliable method of detecting radiolucent foreign bodies in soft tissues of extremities

value of percutaneous needle biopsy in the diagnosis of lytic lesions of the spine

The aim of this paper is to evaluate the value of percutaneous needle biopsy in the diagnosis of lytic lesions in the spine. Over a five-year period, 47 percutaneous needle biopsies were performed on 45 patients for lytic lesions shown by plain radiography in one or more vertebrae. There were 24 lesions in the dorsal, 19 in the lumbar and 4 in the cervical spine. A variety of pathological conditions were found which included tuberculosis, brucellosis, tumor metastasis, myeloma and non-specific infections. Of the 47 biopsies, there were 39 positive results, 6 unreliable and 2 were negative where no pathology was found. The reliability of the biopsy was assessed either by further specimens taken during the operation for treatment of the lesion or by the result of the treatment during the follow-up period. The accuracy of diagnosis in the present study was found to be 83%. No major complications were encountered in this series

Two stage surgery for treatment of neglected club foot

A two stage surgery was carried out on 35 feet belonging to 24 patients [17 males, 7 females] with neglected talipes equinus varus. The ages of the patients ranged from 16 to 26 years old. The first stage was postero-medial soft tissue release, while the second stage was triple arthrodesis. The protocol of the procedure was described. Almost all patients were happy following this procedure. Our aim is to present our experience in two staged surgery for the treatment of neglected talipes equinovarus

Role of gastrocnemius release in treatment of equinus deformity in cerebral palsy

Equinus deformity is one the common deformities seen in Cerebral Plasy. Various methods have been used to correct the deformity but failed to give good result. Study done on 22 patients [total 40 limb] who had gastrocnemius release with or without an additional elongation of the Achilles tendon. There were seventeen patients with spastic diplegia, 4 patients with infantile hemiplegia and one patient with spastic quadriplegia. Twelve patients were females. Average age was 10 years and 7 months and the mean period of follow-up was 30 months. Elongation of Achilles tendon was done for 2 patients with spastic paraplegia and 4 with infantile hemiplegia. The result was 70% excellent, 20% good and 10% poor. Most of the excellent and good results were in younger age group. The aim of this paper is to describe this method which gave satisfactory results in correction of the spastic equinus deformity

Flucloxacillin induced neutropenia during treatment of osteomyelitis

The neutropenia was associated with a characteristic clinical sequence starting with fever, followed by generalised maculopapular rash. We report on 11 patients with Flucloxacillin induced neutropenia during treatment of acute and chronic osteomyelitis. The time of onset ranged from 10 to 14 days after beginning of treatment. The thrombo-cytopenia occurred in 8 patients. Discontinuation of the drugs resulted in recovery from the neutropenia within 2 to 4 days. Neutropenia and concomitant symptoms should be kept in mind when treating osteomyelitis with flucloxacillin. Complete blood count and differential leukocyte count should be checked regularly during the treatment