Isolated "Tillaux" fracture in adulthood: rarity where the key of success is not to miss it.

BACKGROUND: Fracture of the lateral border of the distal tibia is often referred as Tillaux fracture. It is an avulsion fracture due to the tension of the anteroinferior portion of the anterior tibiofibular ligament (1). This type of fracture is scarce in adulthood and can be easily overlooked. METHODS: From 2006 to the present day, 7 case reports describing the Tillaux fracture were found in the PubMed and Web of Science database, to which one case from our set of patients was added. Our goal was to focus on the diagnostic and a selected treatment described in each published case. RESULTS: We found no gender difference. The injury mechanism was mostly an external rotation. Treatment and diagnosis were, in all cases differentiated at specific points. Fixation and load reduction were indicated at least for six weeks in all of the patients. After three months, in almost all cases, a return to full function was achieved. CONCLUSION: Our assessments are not statistically significant, but our goal was to point out the existence of such a rare type of fracture. At the same time, based on previous publications, we developed an algorithm of diagnosis and treatment to facilitate the management of this type of fracture (Tab. 1, Fig. 5, Scheme 1, Ref. 21).

Reconstructive surgery after postraumatic infected talus necrosis.

OBJECTIVES: A case of a young female patient is presented who underwent a tibiocalcaneal arthodesis for infected necrosis of the talus after total talus extrusion. We report our surgical technique of tibiocalcaneal arthrodesis as a salvage procedure for this complex problem. It was performed in two stages. Total talectomy and implantation of antibiotic spacer was followed by tibiocalcaneal fusion using a blade plate. The bone loss was compensated with autodigested, antigen extracted allogeneic bone. BACKGROUND: Total extrusion of the talus is a rare and severe injury of the foot. The outcome is unpredictable and the presence of infection and bone loss is a challenge for the surgeon to achieve a successful outcome. METHODS: Union was defined both clinically and radiographically. The clinical outcomes were mesured using a AOFAS hindfoot score. The radiographic healing was determined by the presence of trabeculation across the arthrodesis. RESULTS: The time of follow up was 18 months and the fusion was achieved after 8 months. CONCLUSION: The presented technique for tibiocalcaneal arthrodesis is an option for the treatment of these serious lower extremity injuries and chemosterilized, antigen-extracted autolyzed allograft is appropriate for the reconstructive procedures of the foot and ankle (Fig. 2, Ref. 6).

Our experience with chemosterilized antigen-extracted autolyzed allografts (AAA) in a series of elective foot and ankle procedures.

BACKGROUND: It is generally accepted that the golden standard for bone grafting is the autogenous bone. OBJECTIVES: The purpose of our retrospective study was to review and show a single-surgeon experience with chemosterilized antigen-extracted autolyzed (AAA) bone allograft in foot and ankle procedures. METHODS: The study population consisted of 35 patients who were operated on between January 2005 and Januray 2009. All patients were eligible for inclusion in this study if their surgery was performed using the chemosterilized antigen-extracted autolyzed allogeneic bone (AAA). In this study, the authors wanted to emphasize the effectiveness of AAA bone grafts in reconstructive foot surgery. All allografts were harvested, prepared and obtained from West Hungarian Regional Tissue Bank Gybr. RESULTS: Union was defined both clinically and radiografically and was established on subjective and objective criteria. A total of 35 consecutive foot and ankle implant procedures were performed, there were 32 healed sites (91.43%) 2 nonunion (5.71%) and 1 deep infection complication (2.86%). CONCLUSION: The authors have shown that AAA allograft is appropriate for reconstructive procedures of the foot and ankle with a low rate of complication (Tab. 1, Fig. 2, Ref. 8).

Successful human vascular reconstructions with long-term refrigerated venous homografts.

Fresh autologous vein grafts are commonly used for infrainguinal vascular reconstructions with good results. Previously we have confirmed the high viability index of homografts even after long-term storage at 4 degrees C in tissue culture medium. In this clinical study, we have evaluated the in vivo efficiency of this storage method in humans with major peripheral graft infections. Between April 2006 and November 2008, data from patients who underwent graft excision and venous allograft reconstruction were collected prospectively (5 men, 2 women, mean age 68 years). Six patients had acute ischemia at the time of allograft reconstruction, while 3 had experienced anastomosis rupture. Allograft reconstruction was performed as an emergency procedure in 3 cases. The observed parameters included patient survival, limb salvage, persistence or recurrence of infection and allograft patency. In the follow-up period reoperation, excision or thrombectomy was necessary in 3 cases. There were no perioperative deaths, early amputations, persistent or recurrent infections. In conclusion, this study demonstrates the efficacy of long-term 4 degrees C storage of venous allografts for revascularization in cases with peripheral bypass graft infection. We suggest that this technique is a useful option for graft preservation and propose a wide-scale introduction.

[Unusual infection complication of total hip arthroplasty]. / Neobvyklá infekcná komplikácia totálnej náhrady bedrového klbu.

Authors present the case history of a 66-year old patient after repeated reimplantations of the THA with a deep infect caused by a rare aetiological agent (Serratia marcescens) associated with a pyogenic sinus. They describe the disease history, therapeutic procedure, complications associated with the surgery as well as postoperative course after the reimplantation of a customized total hip replacement. In the conclusion they state that in case of an infected total hip arthroplasty the treatment is focused on the salvage of the infection process and preservation of the function of the affected limb. Of essential importance is surgical revision with a radical removal of necrotic tissues and hardware in combination with an intensive parenteral antibiotic administration.

[Synthesis and investigation of protonation properties and lipophilicity of some new quinazolone-3-carboxylic acid derivatives]. / Kinazolon-3-karbonsav származékok szintézise, protonálódási és lipofilitási vizsgálata.

Several new quinazolone-carboxylic acid derivatives as potential NMDA and AMPA receptor antagonists have been synthesized, and the protonation properties and lipophilicity of some representative molecules have also been studied. The protonation macroconstants (logK) of 4(3H)-quinazolone (Q0) and two 2-methyl-4-oxo-3H-quinazoline-3-carboxylic acids (Q1, Q2) were determined by pH-potentiometry. The acid-base chemistry of Q1 and Q2, where protein-bindings take place in an overlapping fashion, was described in terms of protonation microconstants (logk) as well. Microspeciation was carried out by UV-pH titration and deductive method. Microspeciation revealed remarkable differences between the two homologue compounds (Q1 and Q2), namely insertion of a second methylene moiety into the aliphatic acid side-chain reversed the predominantly zwitterion-involved protonation pathway into neutral form-involved one. Lipophilicity of our molecules was described by the octanol-water partition coefficients. The apparent partition coefficients of Q1 and Q2 were determined by shake-flask method and converted into true logP values using the protonation microconstants. The unexpected differences between their true logP values were explained, similarly to the different protonation pathways with conformational preferences and formation of intramolecular interactions. Out of the other 15 monoprotic quinazolone compounds the lipophilicity of 10 molecules (Q8-Q17, experimental set) was determined by RP-TLC method with the help of a calibration set consisting of 12 standard molecules, five quinazolones (Q3-Q7, determined by shake-flask method) and seven pyrido[1,2a]pyrimidines (PP1-PP7). The obtained logP values proved mostly the expected structure-property relationships. These physico-chemical investigations are pieces of predictive information for the pharmacokinetics of our compounds. These are also discussed in the paper.

[Synthesis and reactivity of debenzorutaecarpine derivatives]. / Debenzorutekarpin származékok szintézise és reaktivitása.

A series of 7,12-dihydropyrimido[1',2';1,2]pyrido[3,4-b]indol-4(6H)-ones was prepared by Fischer indolization of 9-arylhydrazono-6,7,8,9-tetrahydro-4H-pyrido[1,2-a]pyrimidin-4-one s. Quantumchemical calculations (ab initio and AM1) indicate that position 3 of 7,12-dihydro-pyrimido[1',2';1,2]pyrido[3,4-b]indol-4(6H)-one can be involved in electrophilic substitutions, while position 2 is sensitive towards nucleophilic attack. Bromination of 6-methyl-7,12-dihydropyrimido[1',2';1,2]pyrido[3,4-b]indol-4(6H)-o ne (16) with bromine afforded 3-bromo derivative (25), which was reacted with cyclic amines to give 2-amino-7,12-dihydro-pyrimido[1',2';1,2]pyrido[3,4-b]indol-4(6H)-ones (26-30) in an addition-elimination reaction. Vielsmeier-Haack formylation of compound (16) give 12-formyl (31) and 3,12-diformyl (32) derivatives (an N-formyl-1-aza derivative of nauclefidine alkaloid (34) at 60 degrees C and 100 degrees C, respectively. 3,12-dformyl compound (32) was oxidized to 3-carboxyl derivative (33). The quaternary salt (35), obtained from compound (16) with dimethyl sulphate, suffered a ring opening on the action of aqueous sodium hydroxide. The new compounds have been characterized by elemental analyses uv, 1H nmr and in some cases by 13C ruler, CD spectra and X-ray investigations.

Characterization of potential NMDA and cholecystokinin antagonists I. acid-base properties of 2-methyl-4-oxo-3H-quinazoline-3-alkyl-carboxylic acids at the molecular and submolecular levels.

The protonation macroconstants (log K) of 4(3H)-quinazolone (1) and two 2-methyl-4-oxo-3H-alkyl-quinazoline-3-carboxylic acid derivatives (2,3) were determined by pH-potentiometry. The acid-base chemistry of compounds 2 and 3, where proton-bindings take place in an overlapping fashion, was described in terms of protonation microconstants as well. Microspeciation was carried out by two means: UV-pH titration (selective, pH-dependent monitoring of the N1-binding site), and deductively (using a derivative compound as covalently fixed model of one of the protonation isomers). The microconstant values obtained by the two different methods are in agreement within 0.05 log K units. Microspeciation revealed remarkable differences between the two homologue compounds (2 and 3). The microconstant values show that insertion of a second methylene moiety into the aliphatic acid side-chain (1) increases the electron-density and most basicity parameters of both functional groups; (2) significantly modifies the extent of site-site interactions in the molecule; (3) opens new conformational preferences by N1 ring nitrogen-carboxylic group intramolecular hydrogen bond formation and (4) reverses the predominantly zwitterion-involved protonation pathway into a neutral form-involved pathway. These molecules exemplify that microconstant values allow the comparative prediction and quantitative evaluation of pharmacokinetic behaviour, and signify the fact that microspeciation is a powerful tool in the process of drug development.

Characterization of potential NMDA and cholecystokinin antagonists. II. Lipophilicity studies on 2-methyl-4-oxo-3H-quinazoline-3-alkyl-carboxylic acid derivatives.

The lipophilicity of 17 newly synthesized potential NMDA and cholecystokinin antagonist 2-methyl-4-oxo-3H-quinazoline-3-alkyl-carboxylic acid derivatives has been investigated. The apparent partition coefficients of two amphoteric compounds of overlapping protonation (Q1 and Q2) were determined by shake-flask method and converted into true log P values using the protonation microconstants. The difference between their lipophilicity expressed with the true partition coefficients was less, than it could be expected from the 2D structures and was explained with conformational preferences and formation of intramolecular interactions. Out of the other 15 monoprotic quinazolone compounds the lipophilicity of ten molecules (Q8-Q17, experimental set) was determined by TLC method with the help of a calibration set consisting of 12 standard molecules, five quinazolones (Q3-Q7) and seven pyrido[1,2-a]pyrimidines (PP1-PP7). In order to justify the suitability of pyrido-pyrimidines as standards for the chromatographic log P determination of quinazolones, first Q3-Q7 were examined by TLC and HPLC using PP1-PP7 for calibration. Data showed good agreement of results obtained by shake-flask and two different chromatographic methods indicating the similar chromatographic behavior of the two bicyclic systems and the relevance of PP1-PP7 to extend the calibration set of quinazolones. The obtained log P values proved mostly the expected structure-activity relationships. Some findings, however, have revealed specific partition behavior of the compounds providing useful information in the estimation of their pharmacokinetics, and these are discussed in the paper.

[Synthesis of hetero-condensed quinazolones: 1,2,4-triazino[6,1-b]- and 1,2,5-triazino[2,3-b]quinazolones]. / Heterokondenzált kinazolonok szintézise: 1,2,4-triazino[6,1-b]- és 1,2,5-triazepino[2,3-b]kinazolonok elöállítása.

In the course of the systematic investigation of heterocondensed quinazolones derivatives of a new heterocyclic ring system, [1,2,5]triazepino[2,3-b]quinazolone have been developed as potential biologically active agents, which are new bioisoteric analogues of cholecystokinin antagonist diazepino[2,1-b]quinazolones. The authors worked out an original synthetic route for preparation of ring analogue [1,2,4]triazino[6,1-b]quinazolines from intermediates of the synthesis, too. Starting 2-alkyl-3-amino-quinazolones are easily prepared by reaction of 2-alkyl-benzoxazone with hydrazine hydrate. In the next step bromination reaction of the alpha-methylene group of 2-alkyl-substituents gave a mono-bromo derivative as major product. In the reaction of the bromo compound with N-nucleophyles 2-alkylamino-3-amino-quinazolones were obtained which reacted with alpha-halogeno-carbonyl compounds and led to the tricyclic quinazolones in ring closure reaction. The structural properties of the heterocyclic compounds were characterized by UV-VIS and NMR data and molecular modelling calculation.

Advantages of list-mode data acquisition in gated blood-pool studies.

Because of physiologic R-R interval variability and arrhythmia, frame-mode acquisition of gated images may produce erroneous left ventricular volume curves, particularly in the diastolic filling phase. Eighteen patients in sinus rhythm underwent gated imaging in which both frame-mode and list-mode acquisitions were used. The systolic portions of the volume curves were similar in both studies, and the ejection fractions correlated well (R = 0.97). "Dropout" of data in the late diastolic phase, noted in 15 patients in whom frame mode was used, was not present in list mode, in which the atrial kick was clearly delineated. In additional patients with various arrhythmias, separate volume curves were obtained with list mode for premature, post-premature, and sinus beats. In patients with atrial fibrillation, a prominent peak mid-range on the R-R histogram was selected, and a complete volume curve was obtained. It was concluded that list-mode acquisition provided improved volume curves, with particular applicability in arrhythmic patients.

Radiation measurements aboard Spacelab 1.

The radiation environment inside Spacelab 1 was measured by a set of passive radiation detectors distributed throughout the volume inside the module, in the access tunnel, and outside on the pallet. Measurements of the low-LET (linear energy transfer) component obtained from the thermoluminescence detectors ranged from 102 to 190 millirads, yielding an average low-LET dose rate of 11.2 millirads per day inside the module, about twice the low-LET dose rate measured on previous flights of the space shuttle. Because of the higher inclination of the orbit (57 degrees versus 28.5 degrees for previous shuttle flights), substantial fluxes of highly ionizing HZE particles (high charge and energy galactic cosmic rays were observed, yielding an overall average mission dose-equivalent of about 150 millirems, more than three times higher than measured on previous shuttle missions.

Time course of dopaminergic hypersensitivity following chronic narcotic treatment.

Guinea pigs were injected SC for 3 weeks with 3 different dosage schedules of morphine or methadone, or with saline. For 8 weeks thereafter they were challenged weekly with the dopamine agonist apomorphine. Hypersensitivity was manifested in more intense stereotypies, as compared to the saline group, by all morphine and methadone groups. Hypersensitivity persisted longer after the termination of methadone treatment (maximum of 8 weeks) than after morphine administration (maximum of 3 weeks). The degree of hypersensitivity, and its duration after treatment, was positively related to methadone dosage. In some groups a period of hyposensitivity was seen following hypersensitivity. These data are interpreted with reference to the hypothesized mechanism underlying the development of hypersensitivity, the different durations of action of morphine and methadone, and the retention of methadone in brain following treatment.

Behavioral supersensitivity to apomorphine following chronic narcotic treatment in the guinea pig.

Male albino guinea pigs were treated for 3 weeks with methadone, morphine, haloperidol, or saline. One week and 5 weeks following termination of treatment they were challenged with the directly acting dopaminergic agonist apomorphine. At the week 1 test the haloperidol and saline groups did not differ, but behavioral supersensitivity was apparent in significantly elevated mean stereotypy scores of the methadone and morphine groups relative to the saline group. The source of differences in mean scores was a higher peak score rather than increased duration of action. At the week 5 test the scores of the methadone group were even higher, the morphine group's scores were equivalent to the saline group's, and the haloperidol group's scores were significant depressed. This study indicates that a 3-week treatment period with methadone or morphine is sufficient to induce dopaminergic supersensitivity and suggests that there may be different time courses for the retention or expression of supersensitivity following these narcotics.

Sensitivity to apomorphine in the guinea pig as a function of age and body weight.

Male albino guinea pigs aged 4--10 weeks were challenged with 0.1, 0.2, and 0.4 mg/kg apomorphine. Mean stereotypy scores rose signfiicantly as a function of age. Stereotypy scores were better correlated with age than with body weight, suggesting that CNS maturation, rather than weight-related factors, were responsible. Although age and body weight were correlated, there was enough variability to make bvody weight an unreliable indicator of age.