Computed tomography for evaluation of rotation dislocation of supracondylar elbow fractures in children.

We describe a simple method for evaluation rotation dislocation of supracondylar elbow fractures.

Repeatability of sonographic measurements in clubfeet.

PURPOSE: To assess the intra- and interobserver agreement of ultrasound assessment of clubfoot patho-anatomy in early childhood. MATERIAL AND METHODS: Seventeen clubfeet in 12 children were sequentially scanned by 2 examiners and repeat assessments were carried out independently. Three well-defined imaging planes were chosen to evaluate navicular displacement: the medial malleolus-navicular (MM-N) distance, soft tissue thickness, talar deformity and the calcaneo-cuboid (C-C) distance. Intra- and interobserver agreement was analysed using Cohen's kappa for the discrete variables and by Bland-Altman's graphic technique for measurements. RESULTS: Kappa values for intra-observer agreement were 0.82 for navicular displacement, 0.93 for "talar head pointing laterally", and 0.70 for medial deviation of the talar neck. The corresponding interobserver kappa values were 0.70, 0.68, and 0.36. The mean difference between the two observers for the MM-N distance was 0.42 +/- 3.0 mm and for the soft tissue thickness 0.35 +/- 2.0 mm; the C-C distance showed a mean interobserver distance of 0.0 +/- 2.8 mm. CONCLUSION: The imaging planes used to study the talo-navicular and calcaneo-cuboid relationships are reproducible and relatively easy to learn. Intra- and interobserver assessments were acceptable for MM-N distance, soft tissue thickness, navicular displacement and "talar head pointing laterally", but questionable for the C-C distance and medial deviation of the talar neck.

Distal radioulnar instability is an independent worsening factor in distal radial fractures.

Distal radial fractures in patients who are younger than the age when osteoporosis usually develops are different from fractures in the elderly. Arthroscopy has revealed these fractures often have a complex pattern of fracture related chondral and ligament injuries in the wrist. In Lund, Sweden, of the 92 distal radial fractures that occurred during 1 year in patients younger than the age when osteoporosis usually develops, 76 patients were assessed after more than 1 year (range, 14-38 months). The examination included questions, a visual analogue scale for pain, a physical examination, bilateral radiographic assessment, and wrist score determination according to Gartland and Werley. Instability at clinical examination of the distal radioulnar joint was associated with a worse wrist score and doubled the visual analogue measures for pain at rest and pain at load. This instability was not correlated to any radiographic variable at the time of fracture or at followup. The distal radioulnar joint was painful in 17 of the 27 patients with instability. Radiographic scapholunate dissociation did not affect the outcome. However, radiographic osteoarthrosis Grade 1 was associated with a worse wrist score. The outcome was dependent on the stability of the distal radioulnar joint, which in turn was not correlated to any radiographic parameter. Thus, destabilizing ligamentous injuries are thought to be an important cause of residual problems.

Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures.

The aim of this prospective study was to determine whether peripheral tears of the triangular fibrocartilage complex (TFCC) in patients younger than the osteoporotic age (males,<60 years; females, <50 years) were related to chronic distal radioulnar joint (DRUJ) instability. Fifty-one patients (27 women) with displaced distal radial fractures were included in the study. The median age was 41 years (range, 20-57 years). Arthroscopy at the time of fracture showed complete or partial TFCC tears in 43 patients (24 had only peripheral tears, 10 had only central perforations, and 9 had combined tears). The 1-year (range, 11-27 months) follow-up period included an interview, physical examination, and radiographic evaluation. Ten of the 11 patients with complete peripheral TFCC tears had DRUJ instability at the follow-up examination compared with 7 of the 32 patients with only partial or no peripheral tears. Patients with instability of the DRUJ had a worse Gartland and Werley wrist score. Instability was not associated with any radiographic finding either at the time of fracture or at the follow-up examination. Initial fracture or nonunion of the styloid was even slightly more common in stable patients.

Soybean phytoestrogen intake and cancer risk.

Because many Western diseases are hormone-dependent cancers, we have postulated that the Western diet, compared with a vegetarian or semi-vegetarian diet, may alter hormone production, metabolism or action at the cellular level. Recently, our interest has been focused on the cancer-protective role of some hormone-like diphenolic phytoestrogens of dietary origin, the lignans and isoflavonoids. The precursors of the biologically active compounds originate in soybean products (mainly isoflavonoids but also lignans), as well as whole grain cereals, seeds, probably berries and nuts (mainly lignans). The plant lignan and isoflavonoid glycosides are converted by intestinal bacteria to hormone-like compounds with weak estrogenic and antioxidative activity; they have now been shown to influence not only sex hormone metabolism and biological activity but also intracellular enzymes, protein synthesis, growth factor action, malignant cell proliferation, differentiation and angiogenesis, making them strong candidates for a role as natural cancer protective compounds. Epidemiological investigations support this hypothesis, because the highest levels of these compounds are found in countries or regions with low cancer incidence. This report is a review of results that suggest that the diphenolic isoflavonoids and lignans are natural cancer-protective compounds.

Lithium lowers renal, cardiac and splenic ornithine decarboxylase activity in mice.

A single i.p. injection of lithium chloride (5-7.5 mumoles/g b.wt) in mice caused a 70-80% decrease in renal, cardiac and splenic ornithine decarboxylase (ODC) activity within 1 h, whereas pulmonary ODC activity was unaffected. Lithium chloride did not have any effect on ODC activity in vitro when added to homogenates of the tissues studied. We suggest that the effect of lithium on ODC activity is not direct, but mediated via e.g. hormonal or nervous influence.