[Upper extremity fractures in the elderly]. / Frakturen der oberen Extremitäten im Alter.

Upper extremity fractures in the elderly are very frequent and second only to hip fractures in the group of fragility fractures. Their impact on mobility and functional decline seems to be underestimated especially when they occur in combination with lower extremity fractures. Fractures of the proximal humerus and the distal radius can often be treated conservatively; however, the indications for operative treatment must not be based on fracture morphology alone and due consideration should be given to all concomitant circumstances affecting functional aspects of patients. Operative treatment of proximal humeral fractures may aim either at preserving the humeral head or at prosthetic replacement. There is broad agreement that this decision should depend on the condition of the humeral head fragment (degree of damage, perfusion). Fixation of distal radial fractures is commonly performed with angular volar stable plates. The more complex the fracture, the more likely conservative treatment will fail.

Is proximal femoral nailing a good procedure for teaching in orthogeriatrics?

BACKGROUND: Proximal femoral nailing is a common operation in orthogeriatrics and a highly standardized procedure. For teaching purposes, this operation is often performed by residents and supervised by attending physicians. The objective of this study is to investigate if teaching this operation influences the surgical in-house complication rate. PATIENTS AND METHODS: All patients who received a proximal femoral Targon PF nail (Aesculap AG, Tuttlingen, Germany) for trochanteric fractures were included in a cohort at our urban academic teaching hospital between 1998 and 2010. To evaluate potential effects of patient age, we separately analyzed several age groups. Complications including wound infection, hematoma, intraoperative malreduction or implant malpositioning causing revision, pain, cut-out and readmission due to nonunion were recorded. RESULTS: Our collective consists of 1,516 patients (m/f: 410/1,106). The mean age was 78.7 years (range: 19-103 years). The overall complication rate was 7.9 %. In 857 cases operated by attending physicians, the complication rate was 6.9 %. However in the 659 operations performed by residents, we found a higher complication rate of 9.3 %. Further investigating this difference by χ(2) test, we found no significance (p = 0.09). Whilst analyzing the complication rates for the different age groups, we did not find a statistically significant difference except in the age group between 71 and 80 years, for which the odds ratio indicated a 2.6-fold increased complication risk for operations performed by residents (p = 0.01). Further analysis revealed that this increased complication rate was mainly due to increased numbers of cut-out. CONCLUSION: We conclude that proximal femoral nailing is an operation suitable for teaching purposes. However, patients between 71 and 80 years of age seem to be at an increased risk for cut-out if operated by a resident.

Prevalence of carpal tunnel syndrome and median mononeuropathy among dentists.

BACKGROUND: The authors undertook a study to determine the prevalence in dentists of abnormal sensory nerve conduction and/or symptoms of carpal tunnel syndrome, or CTS, the most common nerve entrapment syndrome. METHODS: In a cross-sectional study, dentists (n = 1,079) were screened during the American Dental Association's Annual Health Screening Program in 1997 and 1998 by means of standard electrodiagnostic measures in the dominant hand and a self-reported symptom questionnaire. The authors diagnosed a median mononeuropathy from a 0.5- or 0.8-millisecond, or ms, prolongation of the median sensory-evoked peak latency compared to the ulnar latency. They diagnosed CTS if the subject also had accompanying symptoms of numbness, tingling or pain. RESULTS: Thirteen percent of screened dentists were diagnosed with a median mononeuropathy (using a 0.5-ms prolongation as the criterion), but only 32 percent of these had symptoms consistent with CTS (4.8 percent overall). When the 0.8-ms prolongation was used as the electrodiagnostic criterion, only 2.9 percent (overall) were diagnosed with CTS. People with diabetes, rheumatoid arthritis and obesity were more likely to have a median mononeuropathy. CONCLUSIONS: The prevalence of symptoms consistent with CTS in the dominant hand among dentists was higher than the prevalence in the general population. However, when electrodiagnostic confirmation is added, the prevalence of CTS was nearly the same as that among the general population. CLINICAL IMPLICATIONS: Early recognition of CTS can lead to more effective management. Education regarding ergonomic risk factors can be an effective preventive measure.

Pharmacokinetics of bisphenol A released from a dental sealant.

BACKGROUND: Limited information is available regarding potentially estrogenic bisphenol A, or BPA, released from dental sealants. This study determined the rate- and time-course of BPA released from a dental sealant (Delton Opaque Light-cure Pit and Fissure Sealant, Preventive Care/Dentsply) when applied at a dosage of 8 milligrams (one tooth) or 32 mg (8 mg on each of four teeth) to 40 healthy adults. METHODS: The authors recruited 40 healthy subjects (18 men and 22 women, 20-55 years of age) who did not have histories of pit and fissure sealant placement or composite resin restorations. The authors collected saliva (30 milliliters) and blood (7 mL) specimens from all subjects immediately before sealant placement (baseline) and at one hour, three hours, one day, three days and five days after sealant placement. They used high-pressure liquid chromatography to determine BPA (detection sensitivity 5 parts per billion, or ppb) in all specimens. RESULTS: The authors detected BPA in some saliva specimens (5.8-105.6 ppb) collected at one hour and three hours. The BPA, however, was not detectable beyond three hours or in any of the serum specimens. For the one- and three-hour saliva samples, the BPA concentration in the high-dose (32 mg) group was significantly greater than in the low-dose (8 mg) group (P < .05, Wilcoxon signed rank test). In the high-dose group, there was a significant decrease in saliva BPA concentrations from one hour to three hours (P < .01, Wilcoxon signed rank test). CONCLUSION: This study showed that BPA released orally from a dental sealant may not be absorbed or may be present in nondetectable amounts in systemic circulation. The concern about potential estrogenicity of sealant may be unfounded.

Recombinant human uncoupling protein-3 increases thermogenesis in yeast cells.

The long form of human uncoupling protein-3 (hUCP3L) is highly homologous to thermogenin (UCPI), the uncoupling protein of brown fat mitochondria, but is expressed predominantly in skeletal muscle. Its putative role is to regulate the coupling efficiency of oxidative phosphorylation and thus thermogenesis in skeletal muscle, a major thermogenic tissue in higher mammals. To study the functional relevance of hUCP3L, the protein was expressed in yeast cells under the control of the galactose promoter. Expression of hUCP3L induced a series of phenotype changes in the yeast cells. The cellular growth and the mitochondrial membrane potential were both diminished. The portion of cellular respiration coupled to oxidative phosphorylation decreased from 57% to 11% (P<0.001) and the cellular heat production, as measured by direct microcalorimetry, was increased by 33.3 +/- 3.2% (P<0.001) after induction of UCP3L. These observations demonstrate for the first time the intrinsic thermogenic properties of hUCP3L in intact cells.

Properties of the human long and short isoforms of the uncoupling protein-3 expressed in yeast cells.

Two splice variants of the human uncoupling protein-3 (UCP3L and UCP3S) are highly expressed in skeletal muscle. The properties of UCP3L and S have been compared to those of UCP1 in a heterologous yeast expression system under the control of the galactose promoter. Both UCP3 isoforms were found to strongly impair the coupling efficiency of respiring cells thus resulting in increased thermogenesis. The uncoupling properties of both UCP3L and S could be clearly demonstrated also in isolated yeast mitochondria both in terms of coupled respiration and in the capacity to polarize the inner membrane in conditions of limited substrate availability. Contrary to what was observed with mitochondria containing UCP1, millimolar GDP and ATP had little if any effect on the uncoupling activity of UCP3. A very marked uncoupling of whole cells and isolated mitochondria was observed at very low expression levels of UCP3S indicating that the short isoform is more active than the long one.

Occupational blood exposure and HIV infection among oral and maxillofacial surgeons.

OBJECTIVE: The purpose of this study was to examine occupational blood exposure and the seroprevalence of HIV infection among oral and maxillofacial surgeons. STUDY DESIGN: Three hundred twenty-one oral and maxillofacial surgeons attending an annual meeting voluntarily and anonymously participated in an HIV serosurvey and completed a questionnaire assessing practice and demographic factors. Statistical tests included the Wilcoxon rank-sum test and the chi-squared test. RESULTS: Eighty percent of those who completed the survey reported one or more blood-skin contacts within the previous month. The mean number of percutaneous injuries within the previous year was 2.36 +/- 0.2. Wire was most commonly associated with percutaneous injuries. Oral maxillofacial surgeons who reported three or more percutaneous injuries performed more fracture reductions than oral and maxillofacial surgeons reporting no percutaneous injuries (p < 0.01). No participant was HIV-positive; the upper limit of the 95% confidence interval was 1.15%. CONCLUSION: The findings suggest that the occupational risk for HIV infection in oral surgery is very low even though most oral and maxillofacial surgeons experienced blood contact. Associations of percutaneous injuries with fracture reductions and wire may assist in the development of new techniques and equipment to minimize blood exposures.

Natural rubber latex hypersensitivity: incidence and prevalence of type I allergy in the dental professional.

The authors investigated the prevalence of immediate (Type I) hypersensitivity to gloves made from natural rubber latex, or NRL, by performing skin-prick tests on 2,166 dental workers over the course of a two-year period (with two one-year intervals). The investigator used two separate eluents made from different brands of natural rubber latex gloves. The study, conducted in 1994 and 1995 as part of the American Dental Association's Annual Health Screening Program, found that 6.2 percent of the participants (dentists, hygienists and assistants) tested positive for Type I hypersensitivity to NRL proteins.

Detection and quantification of the leptin receptor splice variants Ob-Ra, b, and, e in different mouse tissues.

Ob-Ra, b, and e are the major splice forms of the leptin receptor. This study was performed to map the tissue distribution and to quantify the 3 receptor isoforms by heterologous competitive Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) and RNase Protection Assay (RNase PA). The mRNA of the truncated, membrane bound isoform Ob-Ra was found to be represented ubiquitously. Messenger RNA for the putative functional isoform Ob-Rb could be detected in brain, hypothalamus and in some peripheral tissues (e.g. heart, lung, lymph nodes). The highest ratio between Ob-Rb and Ob-Ra mRNA was found in the hypothalamus, where leptin probably exerts its satiety action. The fact that Ob-Rb mRNA was found in peripheral tissues could indicate possible additional functions of leptin. Transcripts for the shortest splice variant, Ob-Re, which is expected to encode a soluble form of the receptor, were detected in relatively high amounts in many tissues. The levels were comparable to those of leptin mRNA in fat tissue. It is conceivable, therefore, that Ob-Re might be secreted in sufficient amounts to act as a buffering system for freely circulating leptin.

Hepatitis B vaccination and infection among U.S. dentists, 1983-1992 .

The hepatitis B vaccine became commercially available in 1982. Since then, health care workers, including dentists, have been encouraged to be vaccinated. This study examines the prevalence of hepatitis B vaccination and infection among U.S. dentists from 1983 to 1992.

Ca2+ sensitization in idiopathic dilated human myocardium. Differential in vitro effects of (+)-(5-methyl-6-phenyl)-1,3,5,6-tetrahydro-3,6-methano-1,5-benzodiazoci ne-2,4-dione, a novel purely Ca2+sensitizing agent, and (+)-5-(1-(3,4-dimethoxybenzoyl)-1,2,3,4-tetrahydroquinolin-6-yl)-6-meth yl-3, 6-dihydro-2H-1,3,4-thiadiazin-2-one on skinned fibres and isolated ventricular strips.

(+)-(5-Methyl-6-phenyl)-1,3,5,6-tetrahydro-3,6-methano-1, 5-benzodiazocine-2,4-dione (CAS 165755-40-8, CGP 48506) is a novel Ca2+ sensitizing agent devoid of any other positive inotropic mechanism, particularly phosphodiesterase (PDE) III inhibition. 5-(1-(3,4-Dimethoxybenzoyl)-1,2,3,4-tetrahydroquinolin-6-yl)-6-met hyl-3, 6-dihydro-2H-1,3,4-thiadiazin-2-one (CAS 120223-04-3, EMD 53998) is a PDE III inhibitor with a Ca2+ sensitizing activity residing in its (+)-enantiomer, EMD 57033 (CAS 147527-31-9). In skinned fibres and electrically stimulated left ventricular strips from idiopathic dilated human hearts, New York Heart Association (NYHA) class IV, the Ca2+ sensitizing and inotropic effects of the benzodiazocine CGP 48506 and the thiadiazinones EMD 53998 or EMD 57033 were compared. Both CGP 48506 and EMD 53998 induce a left shift of the Ca2+ activation curve of force towards lower Ca2+ concentrations in skinned fibres, which indicates Ca2+ sensitization. Only EMD 53998, but not CGP 48506, increases skinned fibre force at both minimum (resting) and maximally activating Ca2+ concentrations. This is taken as an argument for a principal difference in the mechanisms of the Ca2+ sensitizing actions of the two compounds. CGP 48506 is shown not to influence the amplitude of the Ca2+ transient in rat cardiomyocytes. On the other hand, both CGP 48506 and EMD 57033 show comparable, though quantitatively different, positive inotropic effects in electrically stimulated left ventricular strip preparations. It is unclear whether the PDE III inhibitory component of the profile of actions of EMD 57033 may play a role in preventing the increase in diastolic tension as expected from the skinned fibre experiments. It is noteworthy that both Ca2+ sensitizing agents act as positive inotropic compounds in the end-stage failing human heart where other inotropic agents like beta 1-adrenergic agonists or PDE inhibitors have been described to fail.

Occupational risk of hepatitis C infections among general dentists and oral surgeons in North America.

PURPOSE: To assess the occupational risk of hepatitis C virus (HCV) infection among dental personnel. METHODS: Three hundred forty-three oral surgeons and 305 general dentists were recruited at national meetings of the American Dental Association and matched by gender, age, years of practice, and location of practice. Each participant completed a detailed questionnaire designated to measure occupational risk of blood-borne infections and supplied a sample of blood. Antibodies to HCV (anti-HCV) were assessed by second-generation enzyme immunoassay and recombinant immunoblot assay. As a marker of occupational exposure to blood-borne viruses, hepatitis B virus (HBV) surface antigen and antibodies to HBV surface and core antigens were measured by enzyme immunoassay. RESULTS: Anti-HCV was found in 2.0% of oral surgeons and 0.7% of general dentists (odds ratio [OR] = 3.2, P = 0.133). Anti-HCV was more prevalent (P < 0.01) in dental personnel who were older, had more years of practice, and had serologic markers of HBV infection. Serologic markers of HBV infection were found in 7.8% of general dentists and 21.2% of oral surgeons (OR 3.1, P < 0.001). CONCLUSIONS: These data confirm high rates of HBV infection among dental personnel, but suggest that the risk of HCV infection is considerably lower.

Percutaneous injuries in practicing dentists. A prospective study using a 20-day diary.

A novel diary study of 2,304 practicing U.S. dentists examined the frequency and nature of percutaneous injuries over one dentist-month. Burs were responsible for most extraoral injuries (40 percent), and syringe needles accounted for most intraoral injuries (32 percent). The annualized mean injury rate was 3.35, which represents about a threefold decrease since 1987.

Factors associated with hepatitis B vaccine response among dentists.

The objective of this study was to evaluate personal and immunization factors associated with serologic evidence of hepatitis B virus (HBV) vaccine response. A study was conducted using data from United States dentists participating from 1987 to 1991 in the Health Screening Program of the American Dental Association's annual session. This study included dentists (n = 507) who (1) received their most recent dose of HBV vaccine within the previous 10 months, (2) completed a core questionnaire, and (3) were tested for HBV markers (HBsAg, anti-HBs, and anti-HBc) and were found not to have evidence of past or present infection. Non-responders were defined as dentists testing negative for all three markers (n = 100). Responders were defined as dentists having serological evidence of anti-HBs alone (n = 407). Logistic regression models were used to assess the relationship of vaccine response to the variables sex, age, number of vaccine doses, site of vaccination, type of vaccine, and history of hepatitis. Vaccine response was most strongly associated with sex, age, and number of doses. Factors unrelated to vaccine response included type of vaccine and history of hepatitis. Adherence to the recommended number of doses and early vaccination are critical to adequate protection against hepatitis B infection of dentists, who are often exposed to blood and other body fluids.

[5-year experience with De Bastiani's method of extremity lengthening]. / 5 Jahre Erfahrungen mit der Extremitätenverlängerung nach De Bastiani.

From 1987-1991 19 patients had 20 lengthenings in 23 bones. The average hospitalisation time was 54 days. The time to lengthen one limb was 30 weeks on an average. In a retrospective study the cases were analysed according to Paley's criteria. Our complication rate is compared to that of other authors. We have to cope with a rather high rate of complications. 17 out of 19 patients showed good or very good final results.

Transamidase and collagenase activity in healthy and diseased human gingival tissues.

Transamidases are a class of calcium-dependent mammalian enzymes which cross-link proteins by catalyzing the formation of (gamma-glutamyl)-epsilon-lysine bonds. It is possible that these enzymes play an important anabolic role in tissue healing. This study was to quantitate transamidase activity in human gingival tissue and examine the relation between transmidase activity and degree of inflammation. Forty-four out of a total 120 collected human gingival specimens from healthy and diseased patients were selected based on histometric and microbiologic criteria. Specimens were minced and homogenized in 10 mM CaCl2 and then extracted for 30 min, in 50 mM tris-HCl buffer (pH 7.5) containing 100 mM CaCl2. Following low speed centrifugation at 4 degrees C, the supernatant solution was assayed for both transamidase and collagenase activities by radioactive amine incorporation, and digestion of tritiated collagen, respectively. Appreciable levels of transamidase and collagenase activities in healthy gingivae were found. These enzyme activities were significantly elevated in the diseased and healing tissues. Unlike other transamidases, calcium was required in the enzyme extraction process.

Human immunodeficiency virus type I. Infection among dentists.

The largest collection yet assembled of year-to-year data on the seroprevalence of antibody to HIV in practicing dentists confirms that dentists--along with other health care workers--remain at low risk for occupationally acquired HIV infection.

Procedure for the study of acidic calcium phosphate precursor phases in enamel mineral formation.

Considerable evidence suggests that an acidic calcium phosphate, such as octacalcium phosphate (OCP) or brushite, is involved as a precursor in enamel and other hard tissue formation. Additionally, there is in vitro evidence suggesting that fluoride accelerates and magnesium inhibits the hydrolysis of OCP to hydroxyapatite (OHAp). As the amount of OCP or brushite in enamel cannot be measured directly in the presence of an excess of hydroxyapatite, a procedure was developed that allows for their indirect in vivo quantification as pyrophosphate. This permits study of the effects of fluoride and magnesium ions on enamel mineral synthesis. Rat incisor calcium phosphate was labeled by intraperitoneal injection of NaH2(32)PO4. The rats were then subjected to various fluoride and magnesium treatments with subcutaneous implanted osmotic pumps. They were then killed at predetermined intervals; the nascent sections of the incisors were collected, cleaned, and pyrolyzed at 500 degrees C for 48 hours to convert acidic calcium phosphates to calcium pyrophosphate; the pyrophosphate was separated from orthophosphate by anion-exchange chromatography; and the resulting fractions were counted by liquid scintillation spectrometry. The activities of the pyro- and orthophosphate fractions were used to calculate the amount of acidic calcium phosphate present in the nascent mineral. The results demonstrated that the percentage of radioactive pyrophosphate in nascent incisors decreased with time, with increasing serum F- concentration, and with decreasing serum magnesium content. The technique described here should prove to be a powerful new tool for studying the effects of various agents on biological mineral formation.

Factors affecting blood mercury concentrations in practicing dentists.

It has been suggested that mercury vapor may be transformed into highly toxic organomercury compounds by micro-organisms in the oral cavity and gastrointestinal tract. If this hypothesis is correct, practicing dentists might be expected to have concentrations of organic mercury in their blood higher than that found in non-dentists. Blood mercury concentrations of practicing dentists and non-dentists were determined by means of cold-vapor atomic absorption spectrophotometry. Potential sources of mercury exposure were identified in both dentists and non-dentists through a questionnaire completed at the time of sampling. Concentrations of total and inorganic blood mercury were significantly higher in dentists than in non-dentists. The organomercury concentrations of the two groups were not statistically different (p greater than or equal to 0.05). The high concentration of inorganic mercury in the blood of dentists was not related to the organomercury level, suggesting that biotransformation of inorganic mercury to organomercury does not occur in vivo. However, the concentration of blood organomercury was positively correlated with the frequency of fish consumption. There was no correlation between the number of amalgam restorations and the concentration of inorganic blood mercury for both groups. Accidental mercury spills in the dental operatory may contribute most to the concentration of inorganic blood mercury in the blood of dentists.