[Clinical results and complications of meniscal repair in children and adolescents]. / Resultados clínicos y complicaciones de la reparación meniscal en niños y adolescentes.

INTRODUCTION: there is scarce information on meniscal repair in the paediatric population in terms of outcomes of this technique. The aim of this study was to evaluate the clinical outcomes and complications of meniscal repair in paediatric population with isolated lesions, associated with ACL rupture and discoid meniscus with unstable lesions. MATERIAL AND METHODS: data from 78 patients 18 years of age, with arthroscopic diagnosis of isolated meniscal lesion, associated with ACL tear or discoid meniscus, in whom arthroscopic repair was performed, were retrospectively analyzed for demographic characteristics, surgical technique, and perioperative complications. Functional results were assessed with the Lysholm and Pedi-IKDC scales. Time to repair failure was defined as the interval between meniscal repair and revision (re-repair or subtotal meniscectomy). RESULTS: mean age was 14 years (SD 3.1, range 3-19). The patients in group C were significantly younger (15.4 years in group A vs 14.9 in group B vs 12.1 in group C, p = 0.001). The average follow-up was 33.8 months. The mean Lysholm score and Pedi-IKDC were 96.1 points (range, 76-100) and 93.8 points (range, 59.8-100), respectively. The overall failure rate was 14.1% (11/78). There were 4 (13%) failures in group A, 3 failures (12%) in group B, and 5 failures (17%) in group C (p = 0.429). We found a tendency towards a greater number of failures in bucket handle injuries (p = 0.08) and a significant association when 4 sutures were used (p = 0.041). CONCLUSION: in this series, meniscal repair demonstrated a clinical success rate of 85.9%. Patients with discoid meniscus, bucket handle injuries, and those who required a greater number of sutures had a higher risk of failure. Repair should be considered the first surgical treatment option for most meniscal injuries in children and adolescents.

INTRODUCCIÓN: existe escasa información de la reparación meniscal en la población pediátrica en cuanto a resultados de esta técnica. Los objetivos de este estudio fueron evaluar los resultados clínicos y las complicaciones de la reparación meniscal en población pediátrica con lesiones aisladas, asociadas a ruptura del LCA y menisco discoide con lesiones inestables. MATERIAL Y MÉTODOS: los datos de 78 pacientes 18 años de edad, con diagnóstico artroscópico de lesión meniscal aislada, asociada a rotura del ligamento cruzado anterior (LCA) o menisco discoide, en los que se realizó reparación artroscópica, se analizaron retrospectivamente. Los resultados funcionales fueron valorados con las escalas de Lysholm y Pedi-IKDC. El tiempo hasta la falla de la reparación se definió como el intervalo entre la reparación meniscal hasta la revisión artroscópica. RESULTADOS: la edad media fue de 14 años (DE 3.1, rango 3-19). Los pacientes del grupo C eran significativamente más jóvenes (15.4 años en el grupo A frente a 1.9 en el grupo B frente a 12.1 en el grupo C, p = 0.001). El seguimiento medio fue de 33.8 meses. La puntuación media de Lysholm y Pedi-IKDC fueron 96.1 puntos (rango, 76-100) y 93.8 puntos (rango, 59.8-100), respectivamente. La tasa de fallas global fue de 14.1% (11/78). Hubo 4 (13%) fallas en el grupo A, 3 fallas (12%) en grupo B, y 5 fallas (17%) en el grupo C (p = 0.429). Encontramos una tendencia a un mayor número de fallas en las lesiones por mango de cubo (p = 0.08) y una asociación significativa cuando se utilizaron 4 suturas (p = 0.041). CONCLUSIONES: la reparación meniscal demostró una tasa de éxito clínico de 85.9%. Los pacientes con menisco discoide, lesiones asa de balde y aquellos que requirieron mayor número de suturas presentaron un mayor riesgo de falla. La reparación debe considerarse como la primera opción de tratamiento quirúrgico para la mayoría de las lesiones meniscales en niños y adolescentes.

Análisis comparativo in vitro del grado de filtración marginal de restauraciones de resina compuesta realizadas con dos métodos de grabado ácido distintos / In vitro comparative analysis of microleakage in composites resin restorations made with a conventional and a modified acid etch technique

La técnica de grabado ácido en esmalte representa el hito que marca la puerta de entrada para el establecimiento de la odontología adhesiva. Producto de que el sustrato adamantino pudiese presentar comportamiento refractario a la técnica convencional de grabado ácido es que se plantea una técnica en dos tiempos operatorios, la cual pudiese disminuir dicho comportamiento resistente al grabado ácido y combatir así el fenómeno de la filtración marginal de las resinas compuestas. En este estudio se utilizaron 30 terceros molares sanos, en los cuales se realizaron cavidades clases V en las caras vestibulares y linguales/palatinas, las cuales fueron obturadas con resina compuestas utilizando técnica de grabado ácido convencional y técnica de grabado ácido en dos tiempos operatorios, respectivamente. Estos especímenes fueron sometidos a un proceso de termociclado en presencia de un agente colorante marcador. Luego de un proceso de termociclado, las muestras fueron cortadas transversalmente para evaluar el porcentaje de penetración del agente marcador. El análisis de los resultados demostró que las restauraciones realizadas con técnica de grabado ácido en dos tiempos operatorios presentaron menores valores de filtración marginal, existiendo diferencias significativas entre ambos grupos estudiados.

The acid etch technique is the fact that marks the starting point for the establishment of the adhesive dentistry era. But as the enamel structure may have a resistant behavior towards the conventional acid etch technique ,a two-step acid etch technique is presented. This would diminish the aforementioned resistant behavior of enamel to the conventional acid etch technique, and minimize as well, the marginal leakage phenomenon of the composite materials. In this study 30 sound recently extracted molars were used. Equal class V cavities preparations were made in the buccal and palatal/lingual faces of each tooth. Buccal cavities were filled with composite before the use of the conventional acid etch technique, as adhesive method, while in the lingual/palatal faces the two-step acid etch technique was used. The samples were subjected to thermal cycles in the presence of a dying agent. After the thermocycling process, the samples were cut transversely to assess the percentage of penetration of the staining agent. The analysis of the results showed that there was a significant statistical difference between both groups. Moreover the restorations made with the two-step acid etch technique presented lower values of marginal leakage.

Genotype × environment interaction for long-yearling weight in Canchim cattle quantified by reaction norm analysis.

The objective of this study was to investigate the presence of genotype × environment interactions (G×E) for long-yearling weight in Canchim cattle (5/8 Charolais + 3/8 zebu) in Brazil using reaction norms (RN). The hierarchical RN model included the fixed effect of age of the animal (linear coefficient) and random effects of contemporary groups and additive animal genetic intercept and slope of the RN and contemporary group effects as random effects. Contemporary groups as the most elemental representation of management conditions in beef cattle were chosen to represent the environmental covariate of the RN. The deviance information criteria demonstrated that a homoskedastic residual RN model provided a better data fit compared with a heteroskedastic counterpart and with a traditional animal model, which had the worst fit. The environmental gradient for long-yearling weight based on contemporary group effects ranged from -105 to 150 kg. The additive direct variance and heritability estimates increased with increasing environmental gradient from 74.33 ± 22.32 to 1,922.59 ± 258.99 kg(2) and from 0.08 ± 0.02 to 0.68 ± 0.03, respectively. The high genetic correlation (0.90 ± 0.03) between the intercept and the slope of the RN shows that animals with the greatest breeding values best responded to environmental improvement, characterizing scale effect as the source of G×E for long-yearling weight. The phenotypic plasticity demonstrated by the slope of the RN of the animal indicates the possibility to change genotype expression along the environmental gradient through selection. The results demonstrate the importance of accounting for G×E in the genetic evaluation of this population.

Larrea divaricata Cav (Jarilla): production of superoxide anion, hydrogen peroxide and expression of zymosan receptors.

Larrea divaricata is a plant widely used in folk medicine in Argentina. This work aimed to study the mechanisms of decoction activity on the release of oxygen reactive species. Decoction increased the binding of zymosan-FITC and superoxide production. Cadmium decreased the superoxide production as well as malonate and barbital. Decoction decreased the release of hydrogen peroxide. Decoction increased the reduction of MTT but not when malonate and barbital were included. Together, decoction increased the expression of dectin-1 leading to increased superoxide production. It is possible that decoction increases the activity of peroxidase, and decreases the Cu, Zn-superoxide dismutase.

Survival of Yersinia enterocolitica and mesophilic aerobic bacteria on eggshell after washing with hypochlorite and organic acid solutions.

Populations of Yersinia enterocolitica 0:9 and mesophilic aerobic bacteria on the shell of fresh chicken eggs were assessed prior and after washing with 0.75%, 1%, and 3% acetic and lactic acids, 50, 100, and 200 mg/liter (ppm) of chlorine, and water. Highest reductions of mesophilic aerobic bacterial populations (normal flora) on trypticase soy agar were 1.28 and 2.15 log10 cycles with 100 and 200 mg/liter of chlorine, 0.28 and 0.36 log10 cycles with 1% and 3% acetic acid, and 0.70 and 0.71 log10 cycles with 1% and 3% lactic acid, respectively, as compared to the control group. No Salmonella or Yersinia were detected among the natural flora of the eggs. On Y. enterocolitica O:9-inoculated eggs, reductions of 2.66, 2.77, and 2.92 log10 cycles by 50, 100, and 200 mg/liter of chlorine, of 2.47, 2.48, and 2.49 log10 cycles by 0.75%, 1%, and 3% of acetic acid, and of 2.48 and 2.72 log10 cycles with 1% and 3% of lactic acid, respectively, were observed with respect to the control. Organic acids at 3% caused detachment of the surface cuticle of the eggshell. Y. enterocolitica was more sensitive to the wash treatments than the natural microflora. The absence of potentially pathogenic Y. enterocolitica, observed for other fresh foods, should be a norm for fresh eggs sold in retail stores.

Appearances of paranasal fungal sinusitis on computed tomography.

The primary invasive granulomatous form of fungal sinusitis, due to inhalation of aspergillus spores, is commonest in the Sudan and the Gulf states. This condition often presents clinically as a chronic, severe sinusitis which has not responded to antibiotics. On CT scanning, the major feature is a soft tissue mass, which is either homogeneous or has lower attenuation components. There may be erosion or expansion of the bony margins of the sinuses. Intraorbital and/or intracranial extension sometimes occur.

Non-haematological traits associated with congenital dyserythropoietic anaemia type 1: a new entity emerging.

Dysmorphic features in three sibs with congenital dyserythropoietic anaemia type 1 are described. These findings include growth retardation/short stature, congenital ptosis, abnormal tarsal bones, metatarsal duplication/hypoplasia, nail/phalangeal hypoplasia of fingers and toes, Madelung deformity, syndactyly of toes, and hallux valgus. The patients also showed a very low mitotic index of their peripheral blood lymphocyte cultures. Phenotypic heterogeneity was elicited amongst the three Bedouin sibs. The present report confirms the association between a subset of congenital dyserythropoietic anaemia type 1 and a specific form of distal limb anomalies and suggests that other traits, congenital ptosis and low mitotic index, could represent part of the syndrome profile.

Alpha-toxin production by Clostridium septicum at different culture conditions.

Clostridium septicum is responsible for a number of diseases, the most serious of which are a frequently fatal non-traumatic gas gangrene in man and braxy malignant oedema and blackquarter in farm animals. Immunity to these diseases is mediated mainly by antitoxin raised against C. septicum alpha toxin, which has hemolytic, lethal and necrotizing activities. Clostridium septicum produces lethal antigen only in low titre and in a variable way. In addition, the immunogenicity of native toxic filtrates is weak, which results in poor antibody response in animals. The aim of this work was to determine the best culture conditions for obtention of the protective antigen. To do this, the presence of the alpha toxin was identified in culture filtrates by means of SDS-polyacrylamide gel electrophoresis (SDS-PAGE) under different culture conditions. The strain used was C. septicum 3606. The cultures were performed in anaerobic conditions at 37 degrees C. Two systems were employed: (a) batch (0.5% initial glucose concentration); and (b) batch with partial feeding of the carbon source (0.1% glucose concentration) at controlled pH. The hemolytic activity of supernatants was determined using human erythrocytes, and the final biomass concentration was estimated by dry weight determination. The proteins present in supernatants were concentrated by ultrafiltration and identified in 10% SDS-polyacrylamide gels. With partial feeding of the carbon source the final biomass (2.22 g/L) was three times higher than the amount reached in batch system (0.70 g/L), however, no difference was found in the hemolytic activity (16 HU50/mL) showing no correlations between cell growth and hemolytic activity of the supernatants. Electrophoresis of filtrate cultures obtained with partial feeding of the carbon source allowed us to identify several bands, two of them corresponded to non-active alpha-protoxin (46 kDa) and the active toxin (42 kDa) and the aggregate of the active toxin at the seeding line. On the other hand, the ultrafiltrate from batch system showed less number of bands and the 46 kDa band was much weaker, suggesting a lower toxin production in this system. It becomes important to determine culture conditions and correlate with extracellular protein presence to optimize C. septicum antigen protector production.

Urinary bladder perforation: an unusual complication of neonatal nasogastric tube feeding.

Nasogastric tube (NGT) feeding is an accepted method of feeding premature infants. This case report records an unusual and previously unreported complication of NGT feeding in a neonate.

Renal papillary necrosis in Kuwait.

In 2,158 consecutive routine urograms, 85 patients (51 males and 34 females) were found to have typical changes of renal papillary necrosis, an incidence of 3.9% (2.8% in males, 9.4% in females). The changes were bilateral in 60 patients (71.6%) and unilateral in 25 (29.4%). 3 patients were diabetics, 4 had sickle cell anaemia and 7 had obstructive uropathy. 19 patients admitted to analgesic abuse. The remaining 52 patients were idiopathic but a combination of analgesic abuse and dehydration may have been the cause in this group. The possible reasons for the high incidence of RPN especially in females in this hot desert environment are discussed. The literature on the subject is briefly reviewed.

Degenerative changes and detection of plasminogen in fetal membranes that rupture prematurely.

Amniochorion obtained at caesarean section and vaginal delivery, at 34-36 weeks gestation and at term, have been studied by electron microscopy and immunofluorescence for evidence of amniotic epithelial degenerative changes and the presence of plasminogen. When delivery was by caesarean section between 34-36 weeks, electron microscopy revealed no degenerative changes in four cases, but in two cases they were widespread. All but one membrane obtained at term showed only minimal amniotic epithelial cell degenerative changes, but extensive change was seen when delivery was premature after premature membrane rupture. Plasminogen was seen in amniotic epithelium proportional to the degree of cell degeneration; it was absent from healthy membranes. These findings demonstrate that degenerative changes are extensively present in membranes that rupture prematurely, particularly before the onset of premature labour, and suggest a role for plasminogen in membrane rupture.

Pharmacokinetics of methicillin in patients with cystic fibrosis.

The disposition of methicillin in normal subjects and in subjects with cystic fibrosis (CF) was studied after administration of single intravenous doses of 15 mg/kg. The area under the serum concentration vs. time curve for CF patients was, on the average, only 75% of that found for normal subjects. The low concentrations in serum were caused by more rapid urinary excretion of the antibiotic, with rates of renal clearance averaging 425 ml/min per 1.73 m2 in the patients with CF and 362 ml/min per 1.73 m2 in the normal subjects. No differences were found in volumes of distribution and metabolic clearance rates of methicillin or in rates of creatinine clearance between the two groups of subjects. These data support previous findings with dicloxacillin which show that patients with CF exhibit unusually rapid, active tubular secretion of certain penicillins that may necessitate use of larger doses of these drugs in treatment of infections.

Enhanced renal excretion of dicloxacillin in patients with cystic fibrosis.

Single oral doses of 6.25 mg/kg of dicloxacillin suspension were given to ten cystic fibrosis (CF) patients and eight normal subjects. Peak serum concentrations and areas under the concentration versus time curves for dicloxacillin were variable and, on average, were 2 1/2 times lower in the CF patients. The time of occurrence of the peak serum concentration was similar in both groups and the total urinary recovery of dicloxacillin was normal or increased in the CF patients, suggesting that the intestinal absorption of the drug was unaffected by the disease. The low serum concentrations in the CF patients were caused by unusually high renal clearances of dicloxacillin which average 282 +/- 135 compared to 95 +/- 28 ml/min/1.73 sq m in the normal subjects. Creatinine clearances were also elevated in the CF patients by 55% on average, while urea clearances were normal. The serum protein binding of dicloxacillin was similar in both groups of subjects. Because the rapid excretion results in low and variable serum concentrations of the antibiotic, treatment of CF patients with dicloxacillin may warrant use of increased or more frequent doses and monitoring of serum antibiotic levels.

Inadequacies in the pharmacologic management of ambulatory children.

The compliance with treatment of acute otitis media in 300 pediatric outpatients was evaluated. Complete compliance in taking prescribed antibiotics was noted in 7.3% of the patients. Pharmacists dispensed less than prescribed amounts of antibiotics to 15% of patients. Bottles were incorrectly labeled 3% of the time. Volumes of 130 "teaspoons" examined varied from 2 to 9 ml. Parental understanding of the illness and of the effects of medication was inadequate and erroneous in many instances. Parents gave fewer than the prescribed number of doses in 36% of cases, and therapy was discontinued early in 37%. Recommendations for improving the quality of therapy for ambulatory pediatric patients are outlined.

Pharmaceutic factors affecting pediatric compliance.

Evaluation of treatment given at home was studied in children with otitis media who were seen in an outpatient clinic. Full compliance was present in only 5% of the initial 100 patients (Study A). Practical factors limiting their compliance included inadequate dispensing of medication at drug stores, 15%; incorrect therapy schedule, 36%; early termination, 37%; spilled medicine, 7%; therapy shared, 5%. Because of these findings, a plan was implemented (Study B) in which hospital pharmacy personnel gave patient families verbal and written instructions for administering medications that were dispensed, together with a calibrated measuring device and a calendar to record doses taken. Full compliance was raised to 51% in this pilot group (of 33 patients) as compared with 8.5% in 20 concurrent controls who went to neighborhood drug stores. The importance of detailed therapy instructions is stressed. The potential role of the pharmacist in improving compliance is demonstrated.