Age estimation using three established methods. A study on Indian population.

Age estimation is an important factor in the identification of an individual in forensic cases. Adult age determination from teeth was carried out using three methods, namely, Johanson method, methods of Kashyap and Koteswar Rao and the average stage of attrition method (ASA). A total of 100 patients were selected. Johanson and Kashyap method uses microscopic measurements, whereas ASA is purely a clinical method. ASA method was found to be the best method. Unsatisfactory results were seen more in Kashyap's technique. In all the three methods overestimates of age were common in mandibular teeth and in teeth taken from female individuals. More studies are needed in Kashyap's method as there are certain difficulties encountered in measuring a few criteria.

Fracture of the femoral head without associated hip dislocation following low-energy trauma. A report of two cases.

Two cases of fracture of the femoral head are reported in which no associated hip dislocation occurred after low-energy trauma. This unusual injury can be missed. A possible mechanism for this rare occurrence has been suggested.

Fracture through the bone of traumatic myositis ossificans. A report of three cases.

We describe three cases of traumatic myositis ossificans in which fractures occurred through a mature, quiescent ossification mass. None of the fractures reactivated the original pathological process, no callus was formed and union did not occur. The nonunion became painless over a period of months. This unusual late complication of myositis ossificans seems to require only symptomatic treatment by temporary splintage and subsequent mobilisation. We could find no previous report of a similar case.

Pseudoaneurysm of external iliac artery and compression of external iliac vein after total hip arthroplasty. Case report.

Serious vascular injury as a delayed complication of total hip arthroplasty is unusual. A case of pseudoaneurysm of the external iliac artery and compression of the external iliac vein following loss of acetabular fixation in an uninfected case is reported. There is no previous report of such a complication occurring in the absence of infection, which is considered by some as the main predisposing factor for the event.

The ABC carbon and polyester prosthetic ligament for ACL-deficient knees. Early results in 31 cases.

We treated 39 knees with chronic deficiency of the anterior cruciate ligament by reconstruction using the ABC carbon and polyester prosthetic ligament; 31 (79.5%) were reviewed at an average follow-up of 34 months. There had been four complete failures requiring revision. The remaining 27 were studied in detail. On the Lysholm rating, only 11 knees (41%) had good results with a score of over 76. The mean anterior drawer movement was reduced from 7.6 mm before operation to 5.8 mm at review. The mean difference from the opposite uninjured knee was 3.9 mm before operation, 1 mm (in 21 patients) at mean follow-up of 7.4 months and 2.5 mm (in 27 patients) at 34 months, indicating progressive loss of effect. In our opinion the results are unsatisfactory: we do not recommend the use of this prosthetic ligament.

Nonunion of fractures of the scaphoid tuberosity.

Fracture of the tuberosity of the scaphoid is common and usually heals without incident because of the good blood supply. We report four cases of nonunion of this fracture. Three of them were symptomatic and two required operative treatment.

The reliability of ultrasonographic assessment of neonatal hips.

Ultrasound scans were made of the hips of 209 neonates born consecutively over a two-week period. Of the 418 scans, 62 images were selected at random and 25 of these were duplicated to give a total of 87 scans. These static images were then presented to five experienced observers who each made nine different assessments and measurements. Interobserver and intraboserver agreement was calculated and expressed as kappa values. Our results showed poor reliability on both counts.

Recurrent anterior glenohumeral joint dislocation and torsion of the humerus.

Two computerized axial tomographic sections, one taken just below the coracoid process and the other about 2.5 cm proximal to the interepicondylar line, were used to determine glenoid version and humeral torsion in 19 patients with recurrent anterior glenohumeral joint dislocation and in 23 controls. Analysis of interobserver variation revealed the method to be reliable. There was no difference in glenoid version between the two groups. However, humeral torsion was greater in patients (153 degrees) than in controls (144 degrees). It appears that increased humeral torsion may predispose to glenohumeral joint dislocation.

Carpometacarpal dislocation of the thumb associated with fracture of the trapezium.

Dislocation of the first carpometacarpal joint combined with a vertical intra-articular fracture of the trapezium is a rare injury. A case is described treated by open reduction of the trapezial fracture and reconstruction of the first intermetacarpal ligament using a slip of abductor pollicis longus tendon.

A simple clinical test to differentiate rupture of flexor pollicis longus and incomplete anterior interosseous paralysis.

Incomplete anterior interosseous nerve paralysis and spontaneous rupture of flexor pollicis longus tendon are conditions which mimic each other closely and have been mistaken for each other, leading to unnecessary surgery. This is a report of a simple and reliable clinical test to differentiate between the two conditions. A search of the literature has not revealed a previous description of this test.

Vasoactive intestinal peptide hydrolysis by antibody light chains.

This paper describes evidence for hydrolysis of a neuropeptide, vasoactive intestinal peptide (VIP), by light chains purified from the IgG of a human subject positive for VIP binding antibodies. Purified IgG was digested with papain, resultant fragment antigen binding (Fab) fragments were reduced with 2-mercaptoethanol and alkylated with iodoacetamide, and light chains were purified by chromatography on immobilized antibodies to light chains and immobilized antibodies to heavy chains. Non-immunoglobulin components were undetectable in the light chain preparation, judged by sodium dodecyl sulfate-electrophoresis and Western blotting with anti-heavy and anti-light chain antibodies. The light chains hydrolyzed VIP with specific activity 32-fold greater than that of Fab, the pH optimum for light chain-mediated VIP hydrolysis was 7.0-7.5, and the hydrolytic activity was saturable (Vmax, 0.19 pmol/min/microgram light chains; substrate concentration at Vmax/2,380 nM).

Cleavage of vasoactive intestinal peptide at multiple sites by autoantibodies.

Vasoactive intestinal peptide (VIP) fragments generated by autoantibodies purified from the blood of two human beings were separated and sequenced. Based on the identity of these fragments, seven peptide bonds cleaved by the antibodies were identified. Six of the seven scissile bonds are clustered in the region of VIP spanning residues 14-22 and were cleaved by antibodies from both human subjects. The seventh scissile bond is located at residues 7-8 and was cleaved by antibodies from one of the subjects. The scissile bonds link amino acid residues with different size, charge, and hydrophobicity. The hydrolytic activity of the antibodies was selective in that they failed to hydrolyze polypeptides unrelated in sequence to VIP (insulin and atrial natriuretic peptide). These observations demonstrate substrate specific hydrolysis by naturally occurring antibodies and expand the range of peptide bonds hydrolyzed by these antibodies.

Damage to the plasma membrane in Escherichia coli K-12 induced by far-ultraviolet radiation and its repair.

Escherichia coli cells treated with low fluences of far-uv radiation (up to 90 J/m2) showed repairable damage to the plasma membrane. The loss of the ability of the cells to exclude citrate was evident from the respiratory stimulation of irradiated cells when citrate was provided exogenously. This loss of a barrier was a result of a structural disorganization of the plasma membrane as seen by freeze-etching electron microscopy. Analysis of the plasma membrane proteins by sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed a characteristic loss of certain membrane proteins. When irradiated cells were incubated in glucose minimal medium at 37 degrees C for various times, a gradual recovery of membrane structure and function was observed. The recovery process was inhibited in the absence of an energy source as well as protein synthesis. The majority of the recovery occurred in the initial 1 h of the postirradiation holding. These results demonstrated that far-uv radiation at a fluence less than the D10 value had a direct or indirect effect on plasma membrane proteins, causing their release from the membrane bilayer. The lost proteins were subsequently regained by de novo protein synthesis.

Total duodenal diversion for treatment of reflux esophagitis uncontrolled by repeated antireflux procedures.

The operations of Nissen, Hill, and Belsey are adequate in controlling esophaegeal reflux in the majority of patients. In a small percentage however, objective and subjective evidence of esophagitis persists in spite of repeated operations to restore lower esophageal sphincter competency. These failures are then usually treated by operative procedures of great magnitude involving organ interposition. Repeated antireflux operations directed to the gastroesophageal area may in some instances result in impairment of blood supply with an increased risk of both esophageal and gastric fistulae. In the past many observers have felt that reflux esophagitis resulted solely from the effects of acid-pepsin secretions bathing the distal esophagus. Recently experimental and clinical data have indicated the importance of duodenal contents in the etiology and perpetuation of reflux esophagitis. During a recent two year period, 6 patients with persistent reflux esophagitis uncontrolled by repeated antireflux procedures have been seen on our service. These 6 patients, underwent 12 unsuccessful antireflux operations elsewhere. Three of the 6 patients had also been subjected to vagotomy-antrectomy for a coexisting duodenal ulcer. A marked lowering of gastric acidity took place but esophageal reflux and esophagitis persisted. These three patients were treated on our service by takedown of the Billroth I anastomosis, closure of the duodenal stump and diversion of the duodenal contents into a Roux-en-Y limb. Three other patients who had undergone unsuccessful antireflux procedures alone were subjected to antral resection, Roux-en-Y diversion and transthoracid vagotomy. This simplified appraoch to the treatment of persistent esophageal reflux uncontrolled by repeated antireflux procedures has given satisfactory results. The operation should be considered when technical considerations preclude further surgical attempts to perform another effective antireflux operation. Total duodenal diversion should, however, not be considered as the primary operation for the patient suffering from reflux esophagitis. However, in circumstances discussed above this direct approach appears preferable to major resectional procedures.