Long term self esteem assessment after height increase by lengthening and then nailing.

The purpose of the study is to assess the long term psychosocial functioning after height increase, using the external fixation then nailing method. Rosenberg Self-esteem scale and a questionnaire to assess social functioning were completed by 28 patients both preoperatively and at a mean follow-up of 7 years. The mean total score of RSE self-esteem for the 28 patients before lengthening was 21.5 (SD 1.03) (20-24). The mean total score of RSE for the patients 1 year after lengthening was 22 (SD 1.17) (20-24) with highly significant difference (p = 0.002).The mean total RSE self-esteem score after 7 years was 21.7 (SD 1.12) (21-25) with no significant difference (p = 0.11) Improvement was an evident in the short term self esteem after 1 year of follow up of the patients with height increase. On the other hand, there was an evident deterioration in the long term psychosocial evaluation during follow up after 7 years of height increase, returning to near pre-operative levels of self esteem.

Vacuum-assisted closure for deep infection after spinal instrumentation for scoliosis.

Our aim was to review the efficacy of the wound vacuum-assisted closure (VAC) system in the treatment of deep infection after extensive instrumentation and fusion for spinal deformity in children and adolescents. A total of 14 patients with early deep spinal infection were treated using this technique. Of these, 12 had neuromuscular or syndromic problems. Clinical and laboratory data were reviewed. The mean follow-up was 44 months (24 to 72). All wounds healed. Two patients required plastic surgery to speed up the process. In no patient was the hardware removed and there was no loss of correction or recurrent infection. We believe that the wound VAC system is a useful tool in the armamentarium of the spinal surgeon dealing with patients susceptible to wound infections, especially those with neuromuscular diseases. It allows for the retention of the instrumentation and the maintenance of spinal correction. It is reliable and easy to use.

Delayed infections after posterior TSRH spinal instrumentation for idiopathic scoliosis: revisited.

OBJECTIVE: To determine the incidence of delayed infections in idiopathic scoliosis treated with TSRH instrumentation, proper wound management after instrumentation removal, and whether the previously identified bacterial trend remains consistent. METHODS: All patients with idiopathic scoliosis > or =2 years after surgery with posterior TSRH instrumentation were included. Those cases with delayed infections were retrospectively reviewed. Time of presentation (infection) from index operation, clinical picture, sedimentation rate, presence of pseudarthrosis, organisms grown on culture, type of wound closure, and duration of antibiotics were examined. RESULTS: A total of 489 patients were identified > or =2 years postoperation; 23 had delayed infections (4.7%). Time of presentation averaged 27 months after initial surgery. Spontaneous drainage occurred in 15 patients, fluctuance in 6, and neither in the remaining 2 (pain and fever). Sedimentation rate averaged 48 mm/hr. All patients had instrumentation removed. Primary closure (1 stage) was performed in 14 patients, and delayed primary closure (> or =2 stages) was performed in nine patients. All wounds healed uneventfully. Cultures at the time of instrumentation removal grew Propionibacterium acnes in 12 patients, Staphylococcus epidermidis (or Staphylococcus coagulase-negative) in 4, Micrococcus varians in 1, and Staphylococcus aureus in 1. Five patients had negative cultures. After removal, patients received parenteral antibiotics; in 21 of these patients this was followed by oral antibiotics. CONCLUSIONS: Low-virulent skin organisms are primarily responsible for delayed infections. Intraoperative seeding followed by subclinical quiescent periods appears to be the method by which infection occurs. The increased bulk and modularity of modern instrumentation systems can lead to inflammation and bursa formation, thus contributing significantly to the activation of these infections. Primary wound closure results in successful wound healing. Delayed closure after 48 hours is unnecessary. Short-term postoperative parenteral antibiotics (2-5 days) followed by short-term oral antibiotics (7-14 days) is recommended.

Tosic external fixator in the management of proximal tibial fractures in adults.

This retrospective clinical study assessed proximal tibial fractures managed with the Tosic external fixator. Nineteen patients with 21 proximal tibial fractures treated with the Tosic external fixator between July 1997 and October 1998 comprised the study population. Eleven fractures were graded as 41A2, 3 fractures as 41 A3, 4 fractures as 41C1, and 3 fractures as 41 C2. Fourteen fractures were closed, and 7 fractures were open. Average time to healing was 1 7 weeks. No revision of fixation was needed. There were five cases of pin tract infection. Average range of knee motion was 2 degrees-135 degrees. These results indicate the Tosic external fixator is an efficient and simple way to treat proximal tibial metaphyseal fractures.

Assessment of distal radial articular surface by angled radiography.

A common complication of surgical management of fractures of the lower radius involves hardware penetration of the articular surface. If neglected, this complication will lead to wrist joint degeneration. The authors of this study describe a plain roentgenographic angled view of the wrist that provides visualization of the distal radial articular surface to detect any hardware penetration. This view can also be used during surgery by means of an image intensifier.

Analysis of some antifungal drugs by spectrophotometric and spectrofluorimetric methods in different pharmaceutical dosage forms.

Simple spectrophotometric and spectrofluorimetric methods are suggested for the determination of antifungal drugs; clotrimazole, econazole nitrate, ketoconazole, miconazole and tolnaftate. Spectrophotometric one depends on the interaction between imidazole antifungal drugs as n-electron donor with the pi acceptor 2,3-dichloro-5,6-dicyano-1,4-benzoquinone (DDQ) in methanol or with p-chloranilic acid (p-CA) in acetonitrile. The produced chromogens obey Beer's law at lambda(max) 460, and 520 nm in the concentration range 22.5-200 and 7.9-280 microg ml(-1) for DDQ, and p-CA, respectively. Spectrofluorimetric method is based on the measurement of the native fluorescence of ketoconazole at 375 nm with excitation at 288 nm and or the induced fluorescence after alkaline hydrolysis of tolnaftate with 5 M NaOH solution at 420 nm with excitation at 344 nm. Fluorescence intensity versus concentration is linear for ketoconazole at 49.7-800 ng ml(-1) while for tolnaftate, it is in the range of 20.4-400 ng ml(-1). The proposed methods were applied successfully for the determination of all the studied drugs in their pharmaceutical formulations.

The polarographic behaviour of ketoprofen and assay of its capsules using spectrophotometric and voltammetric methods.

The quantitative determination of ketoprofen using spectrophotometric and voltammetric methods are described. The spectrophotometric procedure depends upon the reaction of ketoprofen with N-bromosuccinimide (NBS). The residual reagent is then determined by formation of violet colour with 2,2-diphenyl-l-picryl hydrazine (DPPH(2)). The consumed NBS would correspond to ketoprofen. Beer's law is valid over the concentration range 5-80 mug/ml of the drug. Direct current (DC) polarography allows to study the reduction behaviour of ketoprofen at the dropping mercury electrode (DME) using different supporting electrolytes at different pH values. Direct current stripping voltammetry (DCSV) was used for the quantitative measurements of the drug. The calibration graph of peak current vs concentration was linear from 0.254 x 10(-2) to 0.254 mug/ml. In model solutions as little as 5.08 x 10(-4) ng/ml ketoprofen can be detected by DCSV. Both methods were applied successfully for the determination of ketoprofen either in pure or dosage forms.

Colorimetric determination of isoniazid and its pharmaceutical formulations.

Two colorimetric methods for the estimation of isoniazid are developed. The first method depends on coupling of isoniazid with diazotized 1-amino anthraquinone zinc chloride salt (fast red AL salt) to form a red colour (lambda(max) 510 nm). The second one is based on the formation of a green complex (lambda(max) 655 nm) between the acid hydrazide and 2,6-dimethoxy-1,4-benzoquinone (DMBQ). All measurements of the two procedures were carried out in the presence of sodium hydroxide at room temperature (20 +/- 3 degrees C). The two methods are applied for the determination of isoniazid in presence of congenial drugs, vitamins and additives normally encountered with it in pharmaceutical dosage forms. The reliability of these methods was established by parallel determination with the reported and official methods.

Acute sporadic hepatitis E in an Egyptian pediatric population.

A study was conducted to determine the etiology of acute hepatitis among 261 children (age range 1-11 years) living in Cairo, Egypt. A blood sample was obtained from each subject when initially evaluated and a questionnaire was used to collect demographic and risk factor data. Sera were tested by enzyme immunoassay for acute hepatitis A (anti-hepatitis A virus IgM), hepatitis B (anti-hepatitis B core antigen IgM and hepatitis B surface antigen [HBsAg]), hepatitis C (total anti-HCV), delta hepatitis (total anti-delta), and cytomegalovirus infection (anti-CMV IgM). In addition, hepatitis E virus (HEV) infection was diagnosed using a new Western blot technique to test patients with non-A, non-B hepatitis for anti-HEV IgM. Among 261 children, acute hepatitis A was diagnosed in 85 (32.6%) patients, acute hepatitis B in 19 (7.3%), delta hepatitis in 3 (1.1%), mixed hepatitis A and B infection in 2 (0.8%), CMV infection in 1 (0.4%), hepatitis E in 58 (22.2%), and non-A, non-B hepatitis of unknown type in 51 (19.5%). Forty-two (16.1%) subjects had HBsAg without other markers of acute infection. Risk factor analysis indicated that patients living in homes not connected to a municipal source of water were at increased risk of hepatitis E infection. These data provide additional evidence that hepatitis E virus is a common cause of acute sporadic hepatitis in children living in Egypt.

Spectrophotometric determination of tetracycline and oxytetracycline in pharmaceutical preparations.

A simple, rapid and sensitive spectrophotometric procedure for the assay of tetracycline hydrochloride and oxytetracycline hydrochloride has been developed. 2,2-Diphenyl-l-picrylhydrazyl (DPH), an intensely violet-coloured stable free radical, is changed in colour on reaction with the antibiotics investigated. The decrease in the intensity of the violet colour is used to measure the concentration of the drug. All measurements are made at 520 nm on methanolic solutions of the drug and reagent, buffered at pH 6. Beer's law is obeyed in the concentration ranges 2.5-15 and 2.5-20 mug/ml for tetracycline and oxytetracycline respectively. The proposed method has been successfully applied to analysis of the bulk drugs and their pharmaceutical formulations.

Determination of phenyltoloxamine salicylamide, caffeine, paracetamol, codeine and phenacetin by HPLC.

A reversed-phase high-performance liquid chromatographic method for the determination of six common analgesics (phenyltoloxamine dihydrogen citrate, salicylamide, caffeine, paracetamol, codeine phosphate and phenacetin) is presented. The method is specific for detection and determination of each of these compounds in a complex mixture, without pretreatment. A 10-mum C(18) silica gel stationary phase is used with a methanol-acetonitrile-water-tetrahydrofuran mixture (20:20:55:5 v/v) and spectrophotometric detection at 254 nm. All six components are eluted within 7 min. The method has given good results for three commercial products containing two, three and five active ingredients respectively. Phenacetin, a common analgesic which might be found in other formulations, is used as an internal standard.