Injuries in survivors of elephant attack: Report of three cases / 中华创伤杂志(英文版)

Human-elephant conflict (HEC) in India is becoming a growing health problem causing many fatalities every year. Elephants produce injuries by trampling, stomping, squeezing, tossing in the air, or crushing/targeting the head and chest commonly. The adult elephants are most aggressive in their mating season, leading to maximum incidences of HECs in this period. These attacks are mostly unprovoked, though most HECs are provoked. In this case series, the authors described the injuries sustained by three survivors in a short span of one month due to the sudden and unprovoked elephant attack. All the injuries were mild to moderate in severity and involved the chest in common. Timely rescue and prompt initiation of treatment were pivotal in their survival. The authors also want to create awareness about the mating season of elephants to minimize these unfortunate events in the future.

The Frozen Elephant Trunk Technique: European Association for Cardio-Thoracic Surgery Position and Bologna Experience

Complex lesions of the thoracic aorta are traditionally treated in 2 surgical steps with the elephant trunk technique. A relatively new approach is the frozen elephant trunk (FET) technique, which potentially allows combined lesions of the thoracic aorta to be treated in a 1-stage procedure combining endovascular treatment with conventional surgery using a hybrid prosthesis. These are very complex and time-consuming operations, and good results can be obtained only if appropriate strategies for myocardial, cerebral, and visceral protection are adopted. However, the FET technique is associated with a non-negligible incidence of spinal cord injury, due to the extensive coverage of the descending aorta with the excessive sacrifice of intercostal arteries. The indications for the FET technique include chronic thoracic aortic dissection, acute or chronic type B dissection when endovascular treatment is contraindicated, chronic aneurysm of the thoracic aorta, and chronic aneurysm of the distal arch. The FET technique is also indicated in acute type A aortic dissection, especially when the tear is localized in the aortic arch; in cases of distal malperfusion; and in young patients. In light of the great interest in the FET technique, the Vascular Domain of the European Association for cardio-thoracic Surgery published a position paper reporting the current knowledge and the state of the art of the FET technique. Herein, we describe the surgical techniques involved in the FET technique and we report our experience with the FET technique for the treatment of complex aortic disease of the thoracic aorta.

Macroanatomy of the ones of thoracic limb of an Asian elephant (Elephas maximus) / Macroanatomía de los huesos del miembro torácico de un elefante asiático (Elephas maximus)

Bones of forelimb were studied from a prepared skeleton of an adult female Asian elephant (Elephas maximus) in Anatomy Museum of Chittagong Veterinary and Animal Sciences University to understand the morphological form and structure of Asian elephant forelimb. The angle was approximately 123 between caudal border of scapula and caudal border of humerus. The scapula, humerus and bones of the antebrachium (particularly the ulna) were massive bones. The bones of manus were the short and relatively small. The dorsal border of scapula extended from the level of proximal extremity of first rib to the middle of the 6th rib. Ventral angle of scapula articulated with humerus by elongated shaped glenoid cavity (cavitas glenoidalis) of scapula and head of humerus (caput humeri). The major tubercle (tuberculum majus) of humerus was situated laterally to the head, which had smaller cranial part with large caudal part and extended cranially to the head. The crest of minor tubercle (tuberculum minus) was present as the rough line on the mediocaudal surface of humerus that ends in a slight depressed or elevated area, known as teres major tuberosity (tuberositas teres major). The lateral supracondyler crest (crista supra condylaris lateralis) at the caudal surface of the shaft limit the musculo-spiral groove in body of humerus. The radius and ulna are twin bones of forearm and the attachment between ulna and radius occurs in such a way, the radius articulates craniomedially with the ulna in the proximal part. But the shaft spirals laterally over the cranial surface of the ulna to articulate distally with the medial aspect of the ulna. There were 8 carpal bones, 5 metacarpal bones and 5 digits. The comparative size of the proximal and distal raw of carpal bones were ulnar carpal > radial > intermediate > accessory carpal and IV > III > II > I respectively. The gradual lengths of the metacarpal bones were III > IV > II > V > I. Digits I and V were vertical and digit II, III and IV were horizontal.

En el Museo de Anatomía de la Universidad de Veterinaria y Ciencias de Animales de Chittagong fueron estudiados los huesos del miembro torácico de un esqueleto preparado de un elefante asiático (Elephas maximus), hembra adulta, para analizar su morfología y estructura. El ángulo entre el margen caudal de la escápula y el margen caudal del húmero era de aproximadamente 123°. La escápula, húmero y los huesos del antebrazo (en particular la ulna) eran huesos macizos. Los huesos de las manos eran cortos y relativamente pequeños. El margen dorsal de la escápula se extendía desde el nivel de la porción proximal de la primera costilla para la parte media de la sexta costilla. El ángulo ventral de la escápula está articulado con el húmero por la cavidad glenoidea (cavitas glenoidalis), de forma alargada, de la escápula y la cabeza del húmero (caput humeri). El principal tubérculo (tuberculum majus) del húmero estaba situado lateralmente a la cabeza, que tenía una parte craneal pequeña y una mayor parte caudal, extendiéndose cranealmente en la cabeza. La cresta del tubérculo menor (tuberculum minus) estaba presente como la línea áspera sobre la superficie mediocaudal del húmero que termina en una pequeña zona deprimida o elevada, conocida como tuberosidad redonda mayor (tuberositas teres major). La cresta supracondilar lateral (crista supra condylaris lateralis) en la superficie caudal del eje limita la ranura músculo-espiral en el húmero. El radio y la ulna son huesos gemelos del antebrazo y la unión entre la ulna y el radio se produce de tal manera, que el radio articula, craneal y medialmente, con la ulna en la porción proximal. Pero el eje en espiral está ubicado lateralmente sobre la superficie craneal de la ulna para articular distalmente con la cara medial de la ulna. Se identificaron 8 huesos del carpo, 5 metacarpianos y 5 dígitos. El tamaño comparativo de las porciones proximal y distal de los huesos del carpo fue ulna > radial > Intermedio> carpiano accesorio y IV > III > II > I, respectivamente. Las longitudes graduales de los huesos metacarpianos eran III > IV > II > V > I. Dígitos I y V eran verticales y dígitos II, III y IV fueron horizontales.

Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection

A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up.

Successful Repair of Type I Endoleak Using the Frozen Elephant Trunk Technique

Thoracic endovascular aortic repair (TEVAR) has emerged as an effective therapy for a variety of thoracic aortic pathologies. However, various types of endoleak remain a major concern, and its treatment is often challenging. We report a case of type I endoleak occurring 19 months after zone II hybrid TEVAR. The endoleak was successfully repaired by the frozen elephant trunk technique, without removal of a previous stent graft, combined with ascending aorta and total arch replacement.

Change of Proximal Descending Aortic False Lumen after Conventional Repair of Acute Type I Dissection: Is It Always Unfavorable?

BACKGROUND: Some patients show favorable changes in the descending aortic false lumen after conventional repair of acute type A dissection, although the incidence of favorable changes has been reported to be low. We aimed to investigate the incidence of positive postoperative changes in the false lumen and the factors associated with positive outcomes. METHODS: In 63 patients who underwent surgery for type A acute dissection as well as serial computed tomography (CT) scanning, morphological parameters were compared between the preoperative, early postoperative (mean interval, 5.4 days), and late CT scans (mean interval, 31.0 months) at three levels of the descending thoracic aorta. RESULTS: In the early postoperative CT images, complete false lumen thrombosis and/or true lumen expansion at the proximal descending aorta was observed in 46% of the patients. In the late images, complete thrombosis or resolution of the proximal descending false lumen occurred in 42.9% of the patients. Multivariate analysis found that juxta-anastomotic false lumen thrombosis was predictive of favorable early changes, which were in turn predictive of continuing later improvement. CONCLUSION: Even after conventional repair without inserting a frozen elephant trunk, the proximal descending aortic false lumen showed positive remodeling in a substantial number of patients. We believe that the long-term prognosis of type A dissection can be improved by refining surgical technique, and particularly by avoiding large intimal tears at the anastomosis site during the initial repair.

Macroanatomy of the bones of pelvis and hind limb of an asian elephant (elephas maximus) / Macroanatomía de los huesos de la pelvis y del miembro posterior de un elefante asiático (elephas maximus)

Recent excavated skeleton of an adult female Asian Elephant (Elephas maximus), died in dystokia in Bangladesh was used for macro anatomical study. Some unique morphological features of bones of hind limb were observed. Pelvic canal was more oval and the wings of ilium were wider. Rump slope was about 36°. Angle between femur and tibia was close to 180°. In Femur, the major trochanter was located at the lower level of head. Minor trochanter, fovea capitis and trochanteric ridge were absent. Supracondyloid fossa was shallow but the intercondyloid fossa was deep. Posterior surface of patella possessed a blunt vertical ridge. The articular surfaces of both tibial condyles were clearly concave. The tibia and the fibula were articulated proximally and distally with keeping a wide interosseous space. Instead of tibial tuberosity, there was an elongated triangular depression in proximal part. There were six tarsal bones arranged in three rows. The comparative size of the distal tarsal bones were III+IV > I > II. The comparative lengths of the metatarsal bones were III > II > IV > V> I. Digits I and V were the most vertical and digit III was the most horizontal. The proximal phalanx was the biggest of all.

Fue utilizado para su estudio anatómico macrocroscópico, el esqueleto de un elefante asiático (Elephas maximus) hembra adulta, excavado recientemente y con muerte por distocia en Bangladesh. Se observaron algunas características morfológicas únicas de los huesos de los miembros posteriores. El canal pélvico era más ovalado y las alas del ilion eran más amplias. La pendiente de la rabadilla era de unos 36° aproximadamente; el ángulo entre el fémur y la tibia era próximo a los 180°. En el fémur, el trocánter mayor se encontraba en el nivel inferior de la cabeza. El trocánter menor, la fovea capitis y cresta del trocánter estuvieron ausentes. La fosa supracondílea era superficial, mientras que la fosa intercondílea era profunda. La superficie posterior de la patela poseía una cresta vertical sobresaliente. Las superficies articulares de ambos cóndilos tibiales eran claramente cóncavas. La tibia y la fíbula se articulan proximal y distalmente, manteniendo un amplio espacio interóseo. En lugar de la tuberosidad tibial, había una depresión triangular alargada en parte proximal. Se observaron seis huesos del tarso dispuestos en tres filas. El tamaño relativo de los huesos del tarso distal eran III + IV > I > II. Las longitudes comparativas de los huesos metatarsianos fueron III > II > IV > V > I. Los dígitos I y V fueron los más verticales y el dígito III fue el más horizontal. La falange proximal fue la de mayor tamaño.

Total Arch Replacement with Stented Elephant Trunk in DeBakey Type I Acute Aortic Dissection

A 67-year-old female patient was treated with conventional total arch replacement and insertion of a stented elephant trunk (SET) graft into the descending thoracic aorta for acute DeBakey type I aortic dissection at one time. She had been treated with right coronary artery stent insertion for acute myocardial infarct 4 days earlier, and at that time, she was diagnosed with acute DeBakey type I aortic dissection from the ascending aorta to the suprarenal artery based on trans-esophageal echocardiography and aorta computed tomography. Through a median sternotomy, we inserted the SET graft through the opened aorta to the descending aorta. We also performed anastomosis between the proximal stented graft and the distal aortic arch, and then performed total arch replacement. For acute DeBakey type I aortic dissection, we report total arch replacement with insertion of a SET graft as a combination of conventional surgery and the interventional technique.

Physicians for 'here and now'

Three reports published in the 20th century have functioned as standard guidelines for medical education: the General Professional Education of the Physician report by the Association of American Medical Colleges, Tomorrow's Doctors from the General Medical Council of the UK, and Korean Physicians for the 21st Century by the Korean Association of Medical Colleges. At the moment, a great deal of innovation is occurring in Korean medical societies. However, these innovations bring to mind the parable of the blind men and an elephant in which each blind man feels part of an elephant with his hands and misunderstands the elephant's nature because he cannot see the whole animal. In the same way, there is no comprehensive picture of 'what is the good doctor' for here and now. Korean society is changing more and more rapidly in the 21st century due to influences such as an influx of immigration and resulting multiculturalism. We could not predict these changes even in the 1990s, when Korean Association for Medical Colleges was preparing its report. In light of a dynamically changing society, we must review and revise our definitions of a 'physician for here and now' every ten or twenty years.

Image of Plastic Surgeons and Plastic Surgery Illustrated in Korean Movies and TV Dramas

Nowadays, plastic surgical operations are increasingly being performed in Korea. We have gained added interest in this because some professional pictures contain plastic surgery in their venue. In the films, we intend to see the recognition of society for plastic surgeons and which field of plastic surgery. The list of movies for analysis were 'Plastic Beauty (1975)', 'Penthouse Elephant (2005)', '200 Pounds Beauty (2006)', 'Cinderella (2006)', and 'Time (2006)'. The TV dramas were 'She is looking (2005)', 'Lovers (2006-2007)', and 'Before & After Plastic Surgery Clinic (2008)'. Films were analyzed according to the following: the chief complaints and names of the operations, character of plastic surgeons, result of the operation and its possibility in reality, and its effect of plastic surgery on the life of the patients. Most of the film contained facial transplantation or the change of the face or body different from the original shape. Character type of the plastic surgeons was mostly medical realism, rather than ideal humanism. Most of the plastic surgeons have capability as a doctor; however, some of them had extramarital affairs. The surgery was successful in most of the cases, but were the patients happy with the results? This was not the case in the movies. In only one movie, '200 Pounds Beauty', the patient became happy; rest of them were eminently unhappy with the outcome. Why the discrepancy? It is difficult to analyze the minds of the people in the films, but considering that the majority of the characters in the films were rather unsavory, one may deduce that a crooked mind functions differently. Perhaps it is too much to hope for a day that will come when we will see a film that portrays the mental anguish that accompanies each and every procedure the Korean plastic surgeons make.

La parádola de los seis ciegos y el elefante indostano o comprendiendo la esencia de la medicina interna / The fable of the six blind men and the elephant from indostan or understanding the internal medicine essence

Existe una antigua fábula popularizada en un poema escrito por el poema norteamericano John G Saxe en 1860. En él se demuestra como podemos estar equivocados si sustentamos nuestras opiniones con base a una insuficiente evidencia obtenida a través de un inadecuado estudio. Cada uno de los seis ciegos del poema se acercó al elefante para investigar cómo era pero tomando solo una parte aislada del animal. Cada uno se hizo de una solida pero errónea opinión de lo que realmente era un elefante. Discutieron entre sí defendiendo sus impresiones y como Saxe escribiera, "Los ciegos disputan y se querellan: cada uno está seguro de haber hecho bien su prueba...¡Cada uno tiene un poco de razón...y todos están equivocados!". El autor asimila al elefante a un paciente cuya queja es interpretada de manera diferente al ser analizada a través del juicio prejuiciado de diversos especialistas al interpretar fragmentos inconexos del todo indivisible que es el ser humano

There is old Indian fable made popular in a poem written by John G. Saxe in 1860. It demonstrates how we can be so very wrong by basing our opinions on insufficient evidence gained through inadequate studies. Each of the six blind men in the poem walked up to an imposing elephant to investigate what it investigate what it was-but each touched only one part of the animal. Each man had a faulty yet strong opinion of what an elephant was really like and disputed the others with great vigor. As Saxe wrote, "through each was partly in the right, and all were in the wrong! "The author compares the elephant to a patient whose complaint is interpreted differently when analyzed through the prejudiced judgment of various specialist who interpret unconnected fragments of the fully indivisible human being

Extraction and antioxidant activity of collagen from elephant skin, pig skin and fish scales / 中国中药杂志

<p><b>OBJECTIVE</b>To study collagen structure of the traditional Chinese medicine elephant skin and the proposed alternatives such as pig skin, fish scale, and antioxidant activity.</p><p><b>METHOD</b>Orthogonal experimental design method was employed to determine the optimal extraction condition of collagen from the elephant skin, and the structure and content of collagen of proposed alternatives were compared, their scavenging ability were determined by salicylic acid.</p><p><b>RESULT</b>Collagen extracted from elephant skin with the optimal conditions was the structural integrity and good quality first time, and collagen structure of the elephant skin was similar to the proposed alternatives. Free radical scavenging capacity of collagen, values of IC50, were 0.51 g x L(-1) of elephant skin, 0.60 g x L(-1) of pig skin and 0.42 g x L(-1) of fish scale.</p><p><b>CONCLUSION</b>By comparing and identification of proteins that the collagen of elephant skin is type I collagen, with a strong antioxidant capacity, is the active ingredients of elephant skin. It provides a further study of alternatives as an important reference.</p>

Population structure of the gomphothere Stegomastodon waringi (Mammalia: Proboscidea: Gomphotheriidae) from the Pleistocene of Brazil

The Quaternary fossil record of Águas de Araxá (Q AA) is represented mainly by an accumulation of skeletal elements of several sizes, which are assigned to a population of Stegomastodon waringi. We analyzed 97 molars according to the ear stages of Sipson and Paula-Couto (1957), and developed a orphoetric ear index. The population structure (proportion of immature, subadult, adult, mature adult and senile adult individuals) was identified, and these five age classes were compared to those of extant elephant populations and defined with social implications. The analysis made possible to establish that the population is largely composed of adults: 14.89 percent are immature individuals, 23.04 percent subadults, 27.65 percent adults, 17.21 percent mature adults and another 17.21 percent senile adults. Based on population structure, we do not discard the possibility that the fossil population was stable or in recovery, and/or was experiencing a high-predation period on younger individuals. The number of individuals composing the past population studied here could suggest that the occupied environment was open due to comparisons to populations of extant elephants. We consider this population as an aggregation of family units, which suggests a time of low environmental humidity. Based on literature and our findings, their extinction appears to be regional and probably related to a catastrophic event.

O registro fossilífero do Quaternário de Águas de Araxá (QAA) é representado principalmente pelo acúmulo de restos dentários e de esqueleto de diversos tamanhos, atribuídos a uma população pretérita do mastodonte Stegomastodon waringi. Foram analisados 97 molares de acordo com os estágios de desgaste propostos por Simpson e Paula-Couto 1957, e desenvolveu-se um índice morfométrico de desgaste. A estrutura populacional (proporção entre indivíduos imaturos, subadultos, adultos, adultos maduros e adultos senis) foi identificada e comparada com populações de elefantes atuais. Foi possível estabelecer que esta população era amplamente composta por adultos: 14,89 por cento eram indivíduos imaturos; 23,04 por cento eram subadultos; 27,65 por cento eram adultos; 17,21 por cento eram adultos maduros e outros 17,21 por cento eram adultos senis. Baseados na estrutura populacional observada, não se descartou a possibilidade desta população estar estável ou em recuperação e/ou de ter passado por um período de predação dos indivíduos mais jovens. O número de indivíduos encontrados nesta população sugere que esta ocupava um ambiente aberto, de acordo com comparações com populações de elefantes atuais. Considerou-se a assembléia de mastodontes do Quaternário de Águas de Araxá como uma agregação de unidades familiares, o que sugere um momento de baixa umidade ambiental. Baseados em literatura e nos resultados encontrados, a sua extinção parece ser regional e possivelmente relacionada a um evento catastrófico.

Aortic Arch Aneurysm Repair using a Prosthetic Graft with a Pre-mounted Distal Stent (Frozen Elephant Trunk) / 대한흉부외과학회지

Difficulty in exposing anastomotic sites is a frequently encountered problem during surgical repair of a distal aortic arch aneurysm via median sternotomy or lateral thoracotomy. Endovascular repair has the limitation that it usually requires surgical rerouting of some of the brachiocephalic branches in order to get sufficient length for proximal fixation of the stent-graft. To take advantage of each approach, we fixed the distal end of the prosthetic graft by means of a pre-mounted metallic stent instead of performing conventional surgical anastomosis during the repair of distal arch aneurysms with using median sternotomy and hypothermic circulatory arrest. We report here on our experience with such 3 patients.

Purification and some properties of carbonic anhydrase from Elephas trogontherii (Steppe elephant) bone.

Four isoenzymes of carbonic anhydrase (CA) were purified from Elephas Irogontherii (steppe elephant) bone (approx 0.3-0.5 million years old) from different locations (outer peripheral, cytosolic, inner peripheral and integral) using Sepharose 4B-L-tyrosine sulphanilamide affinity chromatography and their kinetics properties were investigated and compared with known CA isoenzymes. The purification degree of CAs was monitored by SDS-PAGE. Purification fold for outer peripheral, inner peripheral, cytosolic and integral CA was 395.6, 652.8, 1091 and 429.3 and the molecular mass (as determined by gel filtration chromatography) was 37, 36, 35, and 39 kDa, respectively. The optimal temperature for isozymes was 10-20, 30, 30 and 60 degrees C and optimal pH- was between 7.5-11, 7.5-10, 7.5-10 and 7.5 respectively. K(m) values (at optimum pH and 20 degrees C) for p-nitrophenyl acetate as substrate were 4.83, 6.80, 4.525 and 3.86 mM and the Vmax values for the same substrate were 0.00097, 0.0149, 0.00249 and 0.00072 micromol/L*min, respectively. I50 values of isoenzymes for the inhibitors of CA - sulphanilamide, KSCN, acetazolamide and NaN3 were also determined.

Hastyăyurvĕda--a complete treatise on elephants.

Ayurvĕda, the oldest existing medical science of India, which is not only responsible for the health of human beings but also, plays an important in Veterinary sciences. In India, history of traditional Veterinary medicine dates back to the era of Mahăbhărata i.e.5000 B.C., recorded in the form of "Nakula Samhhită". Hastăyurvĕda is a treatise on elephants, Palkăpya wrote this Samhită. The present book is available as a complete Samhită, edited by Pandit Shivadutta Sharma. Hastăyurvĕda was printed at Anandăśrama press in 1894. Hastăyurvĕda has 160 Adhyăyăs. This Samhită is based on fundamental principles of Ayurvĕda, containing all aspects of Sharir including Anatomy & Physiology, Rog Vigyăna, Surgery and Treatment of elephants as well as their care. It is the one and only complete printed Samhită and rare book on Hastăyurvĕda by Palkăpya.

Allometric scaling of biological rhythms in mammals

A wide spectrum of cyclic functions in terrestrial mammals of different size, from the 3-gram shrew to the 3-ton elephant, yields an allometric exponent around 0.25, which is correlated - as a kind of common denominator - with the specific metabolic rate. Furthermore, the applicability of these empirical findings could be extrapolated to chronological events in the sub-cellular realm. On the other hand, the succession of growth periods (T98 percent) until sexual maturity is reached also follows the 1/4 power rule. By means of Verhulst's logistic equation, it has been possible to simulate three different biological conditions, which means that by modifying the numerical value of only one parameter, revertible physiological and pathological states can be obtained, as for instance isostasis, homeostasis and heterostasis.

Treatments of the Nonunion of Femoral Shaft Fractures after Interlocking Intramedullary Nailing

PURPOSE: To investigate and analyze the clinical result in the treatment of aseptic nonunion of femoral shaft fracture after interlocking intramedullary nailing MATERIALS AND METHODS: We reviewed 23 cases of aspetic nonunion of femoral shaft fracture after interlocking intramedullary nail from March 1995 to February 2003 and follow up more than one year. 8 cases were treated by metal exchange, 3 cases by autogenous bone graft and the rest 12 cases by metal exchange and bone graft on the basis of fracture gap and type of nonunion. We evaulated nonunion type, union time and clinical result. Those patients were treated by interlocking intramedullary nail with or without bone graft. Union were accepted when the radiographic evidences showed bridging callus on both end of femoral shaft fracture with clinical evidences showing abscence of pseudomotion or pain. RESULTS: All patients were united by one operation. Average union time were 4.8 months in metal exchange group, 3.9 months in metal exchange with autograft bone graft group, and 4.3 months in bone graft group. 15 patients (65.2%) showed hypervascular nonunion including 7 Elephant foot types (46.7%) and 8 oligotrophic types (53.5%), and 8 patients (34.8%) showed avascular nonunion according to Weber-Brunner classification CONCLUSION: Based on our analysis on clinical outcome and stability of nonunion occuring after initial interlocking intramedullary nailing in femoral shaft fracture, interlocking intramedullary nailing with bone graft made early ambulation possible and promoting returning to normal daily life much earlier, thus based on this data, we recommend interlocking intramedullary nailing for treating femoral shaft fracture along with bone graft.

The effect of some ecological factors on the intestinal parasite loads of the Asian elephant (Elephas maximus) in southern India.

Some ecological factors that might potentially influence intestinal parasite loads in the Asian elephant (Elephas maximus Linn.) were investigated in the Nilgiris, southern India. Fresh dung samples from identified animals were analysed, and the number of eggs/g of dung used as an index of parasite load. Comparisons across seasons and habitats revealed that parasite loads were significantly higher during the dry season than the wet season, but were not different between the dry-deciduous and dry-thorn forests in either season. After accounting for the effect of age on body condition, there was no correlation between body condition, assessed visually using morphological criteria, and parasite load in either season. Individuals of different elephant herds were not characterized by distinct parasite communities in either season. When intra-individual variation was examined, samples collected from the same individual within a day differed significantly in egg densities, while the temporal variation over several weeks or months (within a season) was much less. Egg densities within dung piles were uniform, enabling a simpler collection method henceforth.