Dorsal locking plates versus staples in four-corner fusion: a comparative clinical and radiological study.

INTRODUCTION: Four-corner fusion was described in 1984 by HK Watson for the treatment of SLAC wrist. This intervention has undergone few changes since that description, but the debate on the fixation method is still not resolved. HYPOTHESIS: Dorsal locking plates provide better stability, short immobilization and a quicker return to daily activities than traditional fixation methods such as staples. MATERIALS AND METHODS: Thirty-one fusions using the Medartis Aptus Four-Corner Fusion(®) plate at a mean 13.1 months' follow-up and 35 using staples at a mean 80.4 months' follow-up were reviewed in a clinical and radiographic retrospective comparative study. RESULTS: Results were comparable between the two groups in terms of range of motion (flexion-extension arc of 67.3° for plates and 60.6° for staples), force (29.6 and 28 kg.F), pain and disability (PRWE 34.8/150 and 40.9; QuickDASH 19.83/100 and 30). Mean time off work was significantly shorter in the plate group (4.5 vs. 7.9 months). There were no non-unions in the plate group, versus 2 in the staples group. Dorsal impingement implicating hardware was also less frequent in the plate group (2 vs. 11). DISCUSSION: The dorsal locking plate did not improve final results in four-corner fusion in terms of range of motion, force, pain or function compared to staples. However, it provided stable fixation, allowing a shorter immobilization and a quicker return to work. Although the initial cost is higher, it could allow significant savings on postoperative costs, shifting the technical debate into the field of public health. LEVEL OF EVIDENCE: Level IV, retrospective study.

Arthroscopic release of shoulder contracture secondary to obstetric brachial plexus palsy: retrospective study of 18 children with an average follow-up of 4.5 years.

INTRODUCTION: Children affected by obstetric brachial plexus palsy have an internal rotation contracture of the shoulder and a deformed glenohumeral joint. In 2003, Pearl proposed doing an arthroscopic release of the shoulder to restore external rotation and allow the glenohumeral joint to remodel. The goal of the current study was to evaluate the active and passive shoulder external rotation range of motion and glenohumeral joint remodelling in children treated with arthroscopic-directed release. MATERIALS AND METHODS: Between 2004 and 2010, 18 children with passive external rotation under 10° were treated with shoulder arthroscopy to release the anterior capsule and ligaments and perform a subscapularis tenotomy; no tendon transfer was performed. The average age was 4 years, 2 months. Nine children had an injury at C5C6, four had an injury at C5C6C7 and five had a complete injury. The average follow-up was 4.5 years. The clinical evaluation consisted of active and passive external rotation (ER) with elbow at the side, active internal rotation, and the modified Mallet score. One child who required an external rotation osteotomy of the proximal humerus was excluded from the clinical outcomes. An MRI was performed on both shoulders to assess glenoid retroversion, glenoid type, degree of posterior subluxation (measured by the percentage of humeral head anterior to the middle glenoid fossa) and humeral head hypoplasia. RESULTS: At the latest follow-up, passive ER was 58° on average and active ER was 42°. Eleven children had regained more than 30° of active ER. The average internal rotation had decreased after the release. The MRI assessment showed that the glenohumeral joint had remodelled in 66% of cases; the glenoid type had improved, the glenoid retroversion had diminished and the humeral head was recentred. Humeral head hypoplasia was found in 28% of cases. DISCUSSION AND CONCLUSION: Arthroscopic release of the shoulder results in more external rotation and allows for glenohumeral joint remodelling. Tendon transfer is not always necessary to restore active external rotation. LEVEL OF EVIDENCE: Level IV - Retrospective study.

[Surgical treatment of posterior instability of the shoulder joint using an iliac bone block or an acromial pediculated bone block: outcome in eighteen patients]. / Traitement de l'instabilité postérieure de l'épaule par butée iliaque ou acromiale: à propos d'une série de 18 cas.

PURPOSE OF THE STUDY: The posterior bone block procedure is a popular option for the treatment of involuntary posterior instability of the shoulder. The purpose of this study was to analyze the long-term results of this procedure using an iliac bone graft and to point out the advantages of Kouvalchouk technique using an acromial pediculated block. MATERIAL AND METHODS: Eighteen patients, ten men and eight women, mean age 27 years, were reviewed: thirteen were active in sports activities including four at the competition level. The duration of symptoms before surgery was four years on the average. One patient experienced recurrent dislocation, twelve suffered regular involuntary subluxation, and five had painful shoulders possibly related to posterior instability considering the arthroscopic findings. For nine patients (group 1), an iliac block was combined with the soft-tissue procedure. In nine others (group 2), the procedure described by Kouvalchouk was used to create a posterolateral acromial bone block with pediculated deltoid fibers. Functional outcome was assessed with the 100-point Duplay score. The position of the bone block and osteoarthritis were assessed on plain x-rays. RESULTS: Mean follow-up was 13.5 years in group 1 and 3.5 years in group 2. Four patients needed a revision procedure to remove a screw. At last follow-up, the average Duplay score was 78 points. Nine patients returned to their former sports activities. Seven patients were pain free and ten had moderate discomfort at effort. We did not observe any recurrent dislocation no subluxation but did have six patients who described apprehension. The mean Duplay score was 70 points in group 1 and 86 points in group 2. In two patients in group 1, the x-rays showed signs of grade 3 or 4 osteoarthritis, which was related to an intra-articular screw in one; the other patient had had the same degenerative signs before surgery. Two patients developed grade 1 osteoarthritis. DISCUSSION AND CONCLUSION: The bone block procedure is effective for posterior instability of the shoulder. Occurrence of osteoarthritis, compared with the anterior bone block, is lower after long-term follow-up. The results of the Kouvalchouk procedure with an acromial pediculated bone block look promising. We recommend an additional capsuloplasty when inferior hyperlaxity is associated with posterior instability.

Kinetics of the T-cell receptor CD4 and CD8 V beta repertoire in HIV-1 vertically infected infants early treated with HAART.

OBJECTIVES: To determine the kinetics and the relationship between the T-cell receptor V beta (TCRBV) complementary determining region 3 length, the CD4 T-cell count and HIV viral load changes in HIV-1 infected infants treated early with highly active antiretroviral therapy (HAART) during 1 year of follow-up. DESIGN: Two HIV-1 vertically infected infants, two HIV-1 vertically exposed uninfected and two healthy controls were analysed by spectratyping. Evaluation of viral load, CD4 naive and memory cell counts and a proliferation test were also carried out. METHODS: Twenty-six families and subfamilies of the TCR on CD4 and CD8 T cells were analyzed by spectratyping. Flow cytometric analysis on peripheral blood mononuclear cells for CD4CD45Ra, CD4CD45Ro, CD8CD38, proliferation tests and plasma viral load measurements were performed at baseline, 1, 6 and after 12 months of therapy. RESULTS: HAART induced a marked reduction of viral load in both HIV-1 infected infants and an increase to normal CD4 T-cell count in the symptomatic infant. At baseline the TCRBV family distribution in the majority of CD8 and a few of the CD4 T cells was highly perturbed, with several TCRBV families showing a monoclonal/oligoclonal distribution. During HAART a normalization of the TCR repertoire in both CD8 and CD4 subsets occurred. TCR repertoire normalization was associated with a good virological and immunological response. CONCLUSION: These results suggest that complete and early virus replication control as a result of early HAART leads to a marked reduction of T-cell oligoclonality and is an essential prerequisite to the development of a polyclonal immune response in HIV-1 infected infants.

Digital image analysis of bone allograft union in sheep.

We compared the reliability of computer-assisted radiographic analysis (CARA) and visual evaluation of radiographs to assess host-graft junctions. 68 host bone/allograft junctions were obtained from an ongoing study on bone allografting in sheep. At 6 months, the grafted tibias were explanted and healing of the host-graft junctions were macroscopically determined. 49 junctions were macroscopically healed, whereas 19 had not united. 51 (0.8) of the junctions were correctly classified by radiographs, while 63 (0.9) of the junctions were correctly classified by CARA (p = 0.03). These findings warrant further evaluation in a clinical setting.

[Triatomids and forest reservoirs of Trypanosoma cruzi in the state of Paraná, southern Brazil. Preliminary results]. / Estudo sobre triatomíneos e reservatórios silvestres de Trypanosoma cruzi no Estado do Paraná, Sul do Brasil. Resultados preliminares.

In the rural area of five municipalities of the Northeast of the State of Paraná, Brazil, 154 adults or nymphs of Triatoma sordida and 2 Panstrongylus megistus were captured in 21 (41.2%) of 51 dwellings at the peridomestic sites. Trypanosoma cruzi-like organisms were found in 58 out of the 135 (43.0%) triatomids. Moreover, it was also found in the blood of 4/7 opossum (Didelphis sp). The triatomine infestation was more prevalent in the peridomicile than inside house. The forsaken wooden house presented the highest level of infestation (53.8%). Although the rural area of the Northeast of the State of Paraná is considered under epidemiologic surveillance it still presents a high level of peridomestic infestation by triatomids highly infected with T. cruzi-like organisms.

Trypanosoma cruzi: chemotherapy with benznidazole in mice inoculated with strains from Paraná state and from different endemic areas of Brazil.

Strains of Trypanosoma cruzi from different geographical areas have shown different levels of susceptibility to trypanosomicidal drugs. The susceptibility in vivo to benznidazole was investigated in eighteen strains of T. cruzi. Twelve were isolated from chronic chagasic patients from different Chagas' disease endemic areas. The other six strains were isolated from the northwestern region of Paraná state; two of them from patients, three from triatomines (Triatoma sordida) and one from wild reservoir (Didelphis sp.). To test drug the infected mice were divided into two groups of twenty. One group was treated with benznidazole for twenty consecutive days and the other group was used as untreated control. The treatment began after detection of the infection by direct blood examination or haemoculture. The control of cure was done through haemoculture and indirect immunofluorescence test. The drug eliminated the inflammatory lesions of the skeletal muscle of mice considered cured and from the heart of most of them. Moreover, the inflammatory lesions were reduced in treated but not cured animals. The T. cruzi strains studied showed a gradient of drug susceptibility that varied from 0% to 100%. Ten strains were considered sensitive to the treatment (61 to 100% of cure), one strain was partially sensitive (50% of cure) and seven strains were considered resistant to the treatment (0 to 40% of cure). This variation was observed both in strains of T. cruzi isolated from domestic and sylvatic cycles.

Epidemiology of hepatitis B virus in non-institutionalized children and adolescents affected by handicap.

The aim of the study is to evaluate the prevalence of hepatitis B virus (HBV) markers in a population of non-institutionalized handicapped 1-19-year-old patients. Thirty-six out of 70 patients lived in southern Italy and 19 were affected by Down's syndrome. Only three (4.2%) were positive for anti-HBc (one of these also for anti-HBs) and none for HBsAg. Low prevalence seems to indicate that no particular anti-HBV vaccination strategy is to be considered on this subset of population and on their contacts. Serum prevalence of HBV among nurses and other members of personnel was 11.3%.

Differential effects of nifedipine and diltiazem on methacholine-induced bronchospasm in allergic asthma.

The protective effect of nifedipine and diltiazem on methacholine-induced bronchoconstriction was studied in 12 allergic asthmatic patients. Nifedipine significantly but weakly attenuated airway reactivity to methacholine, whereas no protective effect was shown by diltiazem. We conclude that the two calcium antagonists have different effects on human airways. Furthermore, our results suggest that the action of nifedipine on methacholine-induced bronchospasm is too weak to justify its recommendation as therapy.

Kinetics of bumetanide-sensitive Na+-K+ co-transport in erythrocytes of essential hypertensive patients.

Outward bumetanide-sensitive Na+-K+ cotransport was studied in the erythrocytes of 51 subjects, 24 normotensive subjects and 27 hypertensive patients, matched for sex and age. Three kinetic parameters of this cation transport system were considered: velocity of efflux at saturating internal sodium (Nai) concentrations (Vmax.), apparent affinity for sodium (K 50%) and index of co-operativity among Nai sites (Hill's n). We correlated these values with clinical and laboratory data determined routinely in hypertension. There were no significant differences between normotensive and hypertensive subjects for the values considered and we did not find any significant correlations between co-transport and clinical data.