Wrist arthroplasty for treatment of infected distal radius nonunion using free vascularised proximal fibular bone graft.

OBJECTIVE: Management of infected distal radius nonunion with a bone defect and radiocarpal and distal radio-ulnar joint arthritis is considered an orthopaedic challenge. Although several methods have been described but none provide a satisfactory solution. Free vascularised fibula bone graft constitutes a good option to eradicate the infection, correct the deformity, compensate for the shortening and maintain motion. MATERIAL AND METHODS: This study included 15 cases with infected distal radius nonunion associated with bone defects. Nine cases were males and six were females. The average age of the patient was 20 years (range 8 - 60 years). The right wrist was involved in 10 patients and left was affected in 5 patients. Nine cases resulted from a motor vehicle accident, four cases after a firearm injury and two cases due to falling from a height. The average number of previous surgical procedures was three (range 2 -6). The principle of treatment was debridement, excision of distal radius and trimming of the proximal part of radius back to healthy bleeding bone, inserting the free vascularised proximal fibular bone graft to compensate the defect and fixation of the graft. RESULTS: The procedure was successful in 13 of 15 cases. Bone union was achieved at an average of 4 months. No clinical evidence of osteomyelitis or or infection at final follow-up. Pain was completely relieved in all cases. Wrist joint range of motion averaged flexion 50˚, extension 45˚ and handgrip was the same as the normal site. Twelve cases out of 15 returned to their daily activities. CONCLUSION: Free vascularised proximal fibula bone graft is a new indication for the treatment of an infected distal radius nonunion with a bone defect.

Peri-implant femoral fractures: The risk is more than three times higher within PFN compared with DHS.

INTRODUCTION: Information is lacking regarding incidence rates, treatment regimens, and outcomes concerning peri-implant femoral fractures (PIF). Therefore, we performed a retrospective study to provide scientific data concerning incidence and outcome of PIF following osteosynthesis of proximal femoral fractures (PFF). MATERIAL AND METHODS: We retrospectively included all patients who received osteosynthesis for PFF between 2006 and 2015 and in whom PIF was confirmed postoperatively. All available patients with PIF were contacted minimum one year post-surgery. RESULTS: A total of 1314 osteosynthesis procedures were performed, of which 705 were proximal femoral nails (PFNs), 597 were dynamic hip screws (DHSs), and 12 were screws appliances only. During the same period, 18 PIFs (1.4%) were reported. However, PIF was 3.7 times higher within PFN when compared to DHS (15/705:2.1% versus 3/597:0.5%; odds ratio: 3.7). The following analysis also included 8 patients with PIF who were referred from other hospitals, resulting in a total of 26 patients. Mean patient age was 84.8 years (range, 57-95), with a predominance in female (23×) and in the left femur (19×). PIF occurred after an average of 23.6 months (range, 1-81) post-surgery. The fractures, most of which were spiral-shaped, were most commonly treated with locking plate osteosynthesis. The surgical revision rate was 7.7%, and the one-year mortality was 23.1%. At an average of 43.0 months (range, 12-100) post-surgery, it was possible to contact 18/26 patients (69.2%), and their mean Parker Mobility Score was 5.2 points (range 2-9). CONCLUSIONS: Peri-implant femoral fracture is a rare incident within the old age traumatology of PFF. However, based on our small number of cases, it occurred within PFN much more frequently compared with DHS. Locking plate osteosynthesis has been shown to be effective and reliable. Surgical revision and mortality rates do not appear to be increased when compared to those with the initial treatment of proximal femoral fractures.

A combined experimental and theoretical study of the Ti2 + N2O reaction.

The reactivity of diatomic titanium with nitrous oxide has been studied in solid neon. Two molecules with the same Ti2-N2O stoichiometry are identified from concentration, temperature, and irradiation effects. The more stable one is characterized by five fundamental vibrational transitions located below 1000 cm(-1), the high frequency one at 946 cm(-1) corresponding to a pure TiO stretching mode. Its structure, a rhombus OTiNTiN with the extra O atom fixed on one Ti, is confirmed by quantum chemical calculations, at the CCSD(T) level, which predict a Cs structure in the singlet state with a Ti-O bond length close to 1.66 Å, two nonequivalent Ti-N distances close to 1.94 and 1.75 Å, and a OTiTi angle of 119.2°. The second Ti2-N2O molecule, only observed after annealing, is easily converted into the first one upon irradiation above 12 000 cm(-1) and its kinetics of photoconversion allows vibrational transitions to be identified. The strongest one located at 2123.4 cm(-1) characterizes an N-N stretching mode. Corresponding ab initio calculations complete this picture with details on the electronic structure and allow us to identify a most adequate density functional to describe the spectroscopic properties of the studied species in a simpler broken-symmetry open-shell DFT context. The theoretical results predict the existence of a metastable product OTi2N2 and correctly account for the observed spectra of the various isotopic varieties.

Identification and characterization of Streptococcus agalactiae isolates using 16S rRNA sequencing and cellular fatty acid composition analysis.

This study was undertaken to apply 16S rRNA sequence and Cellular Fatty Acid (CFA) composition analysis techniques for the identification and characterization of seven individual bacteria isolates obtained from seven infected fish samples. All samples were cultured on brain heart infusion agar. All the seven isolates were Gram positive and were identified as Streptococcus sp. The 16S rRNA sequencing method yielded about 1500 bps for each strain where upon the sequence was compared to nucleotide data in Gene Bank using BLASTN 2.2.1 sequence alignment from NCBI for the nucleotide comparison. The 16S rRNA gene sequence for all the seven samples had no sequence variation between the isolates and gave a 100% similarity to plus, plus strand with Streptococcus agalactiae strain A909 Accession number NC_007432.1 and S. agalactiae strain H36B (Accession number AAJS01000007). Also the 16S rRNA sequence showed a high (92-93%) similarity between S. agalactiae and S. equi, S. suis and S. uberis. All strains appeared to be nearly identical to each other after CFA analysis using Library Generation System (LGS) software (MIDI) and were consistent to that of S. agalactiae ATCC 12386, the CFA analysis not only confirmed the results of 16S rRNA sequence but also indicated a possibility of single source of infection. Despite their accuracy to identify the poorly described, rarely isolated, or phenotypically aberrant strains, 16S rRNA gene sequence analysis and CFA analysis lacks widespread use beyond the large and reference laboratories because of technical and cost considerations.

Significance of antinuclear antibodies and rheumatoid factor in patients with advanced peripheral arterial disease.

OBJECTIVE: To determine whether or not elevated titers of antinuclear antibodies (ANA) and/or rheumatoid factor (RF) are associated with patients with advanced peripheral arterial disease (PAD). SUBJECTS AND METHODS: A cross-sectional study was done between September 2005 and December 2006. Fifty-eight patients with clinical and angiographic evidence of PAD and 41 controls were studied. Controls had no documented history of peripheral, coronary or cerebral vascular disease. All subjects were screened for metabolic syndrome and C-reactive protein (CRP) as risk factors for peripheral vascular disease. Additionally, all were tested for anti-mitochondrial, anti-neutrophil cytoplasmic and anti-smooth muscle antibodies; those with positive results were excluded. ANA and RF were measured in sera from cases and controls. RESULTS: One case and 3 controls had positive anti-smooth muscle antibodies and were therefore excluded from statistical analysis. Metabolic syndrome was significantly more prevalent in patients than controls (p<0.05). Mean CRP level was 4.78+/-7.70 and 2.65+/-3.86 mg/dl in cases and controls, respectively (p=0.021). ANA were detected at a titer of >or=1:40 in 6 (10.5%) of the advanced PAD patients but none of the controls; the difference was not statistically significant. RF was less prevalent in cases than controls (p<0.05). CONCLUSION: RF and ANA do not appear to be associated with PAD in a Kuwaiti population.

A new tyrosinase inhibitor from Crinum yemense as potential treatment for hyperpigmentation.

A new pyran derivative, 6-hydroxy-2H-pyran-3-carbaldehyde, has been isolated from the methanolic extract of Crinum yemense along with the known alkaloid haemanthamine, benzoic acid and 1,1'-bis(1,1'-carboxyethyl) ether which is isolated from a natural source for the first time. Structure elucidation of these compounds based on spectroscopicevidences. The pyran derivative was found to be a tyrosinase inhibitor more potent than kojic acid.

Prevalence of metabolic syndrome in patients with clinically advanced peripheral vascular disease.

The aim of this cross-sectional study was to determine the prevalence of metabolic syndrome (MetS) and its components among 100 patients with progressive peripheral arterial disease (PAD) referred for diagnostic angiography in preparation for a revascularization procedure. The prevalence of MetS was more than 95%. Diabetes mellitus was the most prevalent component followed by hypertension and low high-density lipoprotein. Almost half the patients aggregated in the highest metabolic score category. A direct relationship was identified between the number of MetS components and serum uric acid (P = .001) and C-reactive protein (P = .826), whereas an inverse relationship was seen between the clustering of components and androgen levels in men (P < .001). For PAD, which could have a benign clinical course, early screening for MetS might identify those at greater risk of failing conservative therapy and progressing to a more aggressive atherosclerotic disease typically associated with high morbidity and mortality.

Metabolism of parthenin by Beauveria bassiana ATCC 7159.

Two new metabolites were isolated from the biotransformation reaction of parthenin by Beauveria bassiana ATCC 7159 along with the known naturally occurring sesquiterpene lactones hymenolin and dihydrocoronopilin. The new metabolites: are 3beta,4beta,6beta-trihydroxy-10alphaH,11alpha-methyl-ambrosa-1 -en-12-oic acid-gamma-lactone and 3alpha,6beta-dihydroxy-4beta-hydroperoxy-10alphaH, 11alpha-methyl-ambrosa-1-en-12-oic acid-gamma-lactone. The structure elucidation of these compounds was achieved by different spectroscopic methods.

Value of P53 protein as a tumor marker in patients with transitional cell bladder cancer

Objective: The aim of this work is to determine the value of P53 as a biochemical marker in patients with bladder cancer. Patients and Methods: This study was conducted on 30 patients with transitional cell carcinoma (TCC) of different grades and 10 healthy men as a control group who had been admitted to the Urology Department; Benha Faculty of Medicine between August 1999 and November 2001. The mean age of the patients was 56.3 years (range 38-80 years). They were evaluated by history taking; clinical examination; laboratory investigations; radiological examination and cysto-scopy-guided biopsies. P53 was determined in the serum preoperatively and postoperatively after 21 days and 6 months; as well as in the tissue specimens taken by transurethral resection or by radical cystectomy. Results: The mean serum P53 value in the control group was 10.0 + 1.83 Pg/ml. In the patients with grade-1 tumors it was 25.6 + 4.8 Pg/ml compared to 44.8 + 14.73 Pg/ml and 131.1 + 15.28 Pg/ml for grade-2 and grade-3 tumors; respectively (P 0.05). In tumors larger than 2 cm the mean serum P53 value was 87.54 + 10.81 Pg/ml; while in tumors less than 2 cm it was 32.91 + 2.32 Pg/ml (P 0.05). The mean serum P53 value in a single tumor was 27.8 + 7.1 Pg/ml compared to 102.3 + 20.4 Pg/ml in multiple tumors (P 0.05). On follow-up after 21 days the mean serum P53 value was 14.0 + 2.71 Pg/ml in grade-1 tumors; 17.0 + 3.79 Pg in grade-2 and 55.3 + 12.4 Pg/ml in grade-3 tumors (P 0.05). Eleven patients developed recurrence; their mean serum P53 was 125.6 + 13.46 Pg/ml preoperatively and significantly decreased to 59.9 + 18.2 Pg/ml postoperatively; but then rose again to 91.5 + 20.1 Pg/ml. The mean P53 in the tissues of the control group was 11.3 + 2.31 Pg/ml; while the tissues of the cancer patients showed values of 29.8 + 4.42 Pg/ml; 46.6 + 11.08 and 140.2 + 14.85 Pg/ml for grade-1; grade-2 and grade-3 tumors; respectively (P 0.05). Conclusion: P53 seems to be a promising tumor marker for transitional cell bladder cancer and a valuable tool for identifying subgroups of patients that may have a poor prognosis

Seasonal studies on commensal rats and their ectoparasites in a rural area of Egypt: the relationship of ectoparasites to the species, locality, and relative abundance of the host.

The present study was carried out in 3 villages, namely Kafr Ayoub Soliman, Kafr Ibrahim El-Aidi, and El-Sa'adat, Sharqiya Governorate, Egypt. A total of 519 rats was collected from the 3 study sites: 46.6% Rattus rattus, and 53.4% Rattus norvegicus. A total of 20,643 ectoparasites was recovered from R. rattus: 33.3% mites, 33.8% fleas, and 32.9% lice. From R. norvegicus a total of 40,997 ectoparasites was recovered: 28.9% mites, 31% fleas, and 40.1% lice. Three common mite species were recovered from both rat hosts, i.e., Ornithonyssus bacoti, Radfordia ensifera, and Laelaps nuttalli. Three common flea species were also recovered from both rat hosts, i.e., Echidnophaga gallinacea, Leptopsylla segnis, and Xenopsylla cheopis. Polyplax spinulosa was the only dominant louse species that infested both rat hosts. Rats did not show a definite breeding season, and the seasonal rat indices were generally low in different study sites. There were no significant differences between the prevalence of each of mites, fleas, and lice in both rat species. The total general indices of mites and fleas, on the other hand, was significantly higher in R. norvegicus. The general index of X. cheopis was high and ranged between 5.9 in R. rattus and 14.5 in R. norvegicus. Season-related changes were observed in the general index of each of L. segnis infesting both rat species and R. ensifera and O. bacoti infesting R. norvegicus. The prevalence and general indices of some ectoparasites showed differences related to the locality of their rat hosts. Seasonal changes in the general indices of some ectoparasites paralleled seasonal changes in the relative abundance of their rat hosts.

Fine structure of the synganglion of unfed female Rhipicephalus (Rhipicephalus) sanguineus (Latreille) (Ixodoidea: Ixodidae).

The synganglion of unfed female Rhipicephalus (Rhipicephalus) sanguineus (Latreille) is enclosed within a well defined neural lamella underlined by the perineurium. No organelles were observed in the neural lamella, whereas axons containing neurosecretory vesicles, tracheal elements and glycogen deposits are visible in the perineurium. Below the perineurium, a cortical layer of nervous and non-nervous elements surrounds an inner neuropile, the latter is enclosed by a thin subperineurial layer. The neuropile is formed of nerve fibers containing neurotubules.

Genital system structure of unfed female Rhipicephalus (Rhipicephalus) sanguineus (Latreille) (Ixodoidea: Ixodidae).

The reproductive system of female Rhipicephalus sanguineus consists of a single ovary, paired oviducts fusing into a single common oviduct, connecting tube, the vagina that in turn divides into cervical and vestibular regions, a wide receptaculum seminis and tubular accessory glands that open into the vagina between the cervical and vestibular regions. The histological structure of each part of the female reproductive system is described. The fine structure of the ovary, connecting tube and accessory glands is also provided in this study.

Effect of sex, size, and age of commensal rat hosts on the infestation parameters of their ectoparasites in a rural area of Egypt.

The present study was carried out in the Bilbeis area, Sharqiya Governorate, Egypt. A total of 127 male and 115 female black rats Rattus rattus and 124 male and 153 female Norway rats R. norvegicus was collected during the study period. A total of 20,643 and 40,997 ectoparasites was recovered from R. rattus and R. norvegicus, respectively. Three common mite species were recovered from both rat hosts: Ornithonyssus bacoti, Radfordia ensifera, and Laelaps nuttalli. Three common flea species were also recovered from both rat hosts: Echidnophaga gallinacea, Leptopsylla segnis, and Xenopsylla cheopis. Polyplax spinulosa was the only louse species that infested both rat hosts. Rats that lived more than 12 mo formed about 24 and 14% of the populations of the black and Norway rats, respectively. The prevalences and general indices of many ectoparasites were significantly higher on males than on females of both rat hosts. Seasonal differences in prevalences and general indices of many ectoparasites were recorded between the 2 sexes of both rat species. Prevalences and general indices of most ectoparasites on both rat species showed a tendency to increase with increasing size and age of rat hosts. The type and degree of correlation between prevalences and general indices on the one hand and each of body size and age on the other hand differed among the species of ectoparasites.

Effects of permethrin on the salivary glands and neuroendocrine organs of unfed female Hyalomma (Hyalomma) dromedarii (Ixodoidea: Ixodidae).

Permethrin-impregnated fabric has been shown to be an effective repellent against various tick species. However, some tick species are not repelled by this chemical. In Hyalomma dromedarii (Koch), permethrin exposure is reported to actually enhance the tick's attachment behavior. This study evaluated the histological effects of permethrin exposure on the salivary glands and neuroendocrine organs of unfed, virgin H. dromedarii ticks of uniform age. Three fabric treatments consisting of unwashed-untreated (control), washed after treatment (0.125 mg [AI] / cm2) and unwashed-treated were used after 5- and 10-min exposure times for unfed, unmated females. For all of the organs examined, the cellular structure of treated ticks differed from controls as evidenced by increases in cellular activity, as well as significant increases in the size of the cells of the organs under study (P < 0.05). These data conclusively demonstrate that an unexpected enhanced attachment response observed in this tick species after permethrin exposure is the direct result of increased neurosecretory and salivary gland activity induced by that exposure.

Peritonitis in Patients on CAPD at King Khalid University Hospital: Less Infection-rate with More Center-experience.

Continuous ambulatory peritoneal dialysis (CAPD) was started at the King Khalid University Hospital in 1986. Peritonitis remains the most significant complication of the procedure. Earlier rates of peritonitis were high, but after gaining sufficient experience, the rates are declining. To evaluate the change in peritonitis trend, 55 new patients who were recruited to our CAPD program between the periods October 1993-October 1996 were analyzed for the development of peritonitis on annual basis. There were 37 (67%) males and 18 (33%) females with a mean age of 43.3 years (range 12-72 years). A total of 34 episodes of peritonitis were recorded with a rate of 1.5 episode/patients year in 1993, 0.5 episode/patient year in 1994 and 0.8 in 1995. only 40% of episodes showed positive cultures whereas 60% remained culture-negative despite use of recommended modified culture techniques. Organisms causing peritonitis included staphylococcus eipdermides (6.7%), E. coli (3.3%), Streptococcus fecalis (3.3%) and pseudomonas (6.7%). Out of 34 episodes of peritonitis, 29 (85.3%) showed response to treatment and five episodes could only be treated after removal of catheter. Of the 29 episodes that responded to treatment, three relapsed and one had recurrent infection . However, all were successfully treated though one responded only after removal of catheter. Thus, a total of six catheters (20%) necessitated removal and replacement. In spite of high diabetic patients population in our series (27.2%) only one died of peritonitis related sepsis and another died of myocardial infarction after clearing the infection. Thus mortality remains low in spite of potential risk. Although we still use straight system CAPD rather than Y system peritonitis rates have declined considerable and we hope that the procedure will gain more acceptability amongst patients with ESRD in Saudi Arabia.

Effect of 25-azacholestane on Argas (Argas) hermanni (Ixodoidea:Argasidae).

Unfed and fed nymphal Argas hermanni Audouin were treated topically with 1, 5, 10, 15, and 20 micrograms of 25-azacholestane. The azasteroid did not inhibit feeding but had a dose-related lethal effect on unfed nymphs. Generally, it had little effect on nymphs treated after feeding. The 10-micrograms dose reduced the premolting period of nymphs treated before feeding. Some adults emerging from the 5- to 20-micrograms dosage groups that had been treated before feeding failed to shed their exuvia and others also had deformed legs. Greater numbers of adult females emerged from nymphs treated before feeding. The preoviposition period was almost the same in control females and of female mates, with males emerging from treated nymphs. Females from nymphs treated before feeding have a prolonged preoviposition period. Fecundity was reduced when males were treated with 10-20 micrograms as unfed nymphs. Egg hatch was reduced for females treated with 15 and 20 micrograms as fed nymphs, females treated with 5 and 10 micrograms as unfed nymphs, and as progeny of males treated with 10 micrograms as unfed nymphs. Results suggest possible interference with juvenile hormone titer in treated ticks.

Incidence of insulin-dependent diabetes (IDDM) and non-insulin-dependent diabetes (NIDDM) (0-34 years at onset) in Benghazi, Libya.

The incidence of insulin-dependent diabetes (IDDM) and non-insulin-dependent diabetes (NIDDM) in Benghazi, Libya in the < 35-year age group during the period 1981-1990 are reported. Incidence data for IDDM were based on prospective registration of patients while incidence data for NIDDM were based on analysis of files. Case ascertainment of IDDM cases was estimated to be > 95%. Incidence of total diabetes (IDDM and NIDDM) (per 100000 population) was significantly higher in females (43.8; 95% confidence Interval (CI) 40.6-47.2) than in males (28.9, 26.6-31.3) (P < 0.001). The overall incidence rates of IDDM and NIDDM were 9.0 (CI, 8.1-10.0) and 27.3 (CI, 25.4-28.2), respectively. Rates of IDDM were 9.4 (CI, 8.1-10.9) among males and 8.5 (CI, 7.3-10.0) among females. Rates of NIDDM were 19.6 (CI, 18.1-22.2) among males and 35.3 (CI, 32.4-37.8) among females. IDDM patients showed a female predominance in the 0- to 14-year age range (P > 0.05) and a male predominance in the 15- to 34-year age range (P > 0.05). NIDDM showed equal incidence in males and females in the 0- to 14-year age range and twofold higher incidence in females than in males in the 15- to 34-year age group (P < 0.001). Yearly variation and seasonality of onset were not significant in IDDM cases (P > 0.05). Fifty-six percent of NIDDM cases were obese compared to only 6% of IDDM cases. The study revealed that diabetes mellitus is a common chronic disease in children and young Libyan Arabs. It has shown that NIDDM in Benghazi is twofold higher in females than in males in the 15- to 34-year age group. It has also shown that age per se is not a reliable criterion for the classification of diabetes into IDDM and NIDDM.

[Malignant adrenocortical tumors. Apropos of 9 cases]. / Cortico-surrénalomes malins. A propos de neuf cas.

The authors report 9 cases of adrenocortical carcinoma: 6 women and 3 men. 5 cases (55%) had a "nonfunctioning" tumor and 4 cases (45%) presented a clinical endocrinologic syndrome. According to the MacFarlane classification, patients were classified as: stage I: 1 case, stage III: 6 cases and stage IV: 2 patients. Adrenalectomy was performed in 7 cases. There was one postoperative death. 5 patients obtained clinical improvement.