[Chronic lunotriquetral instability of the wrist. Presentation of our method of treatment]. / Chronické lunotriquetrální nestability zápestí--vlastní metoda osetrení

PURPOSE OF THE STUDY: One of the causes of pain on the ulnar side of the wrist is post-traumatic lunotriquetral (LTq) instability, which is difficult to detect on radiographs. For diagnosis, arthroscopic examination is most reliable. The methods for treatment of LTq instability include mere immobilization, ligament reconstructions and LTq joint stabilization with Kirschner's wires in acute conditions, and stabilization of the LTq joint by tenodesis or arthrodesis. In this study our method of treating chronic isolated injury to the lunotriquetral ligament is described. MATERIAL: The group comprised 43 wrists with isolated lunotriquetral ligament injuries diagnosed by arthroscopy. In 19 patients with persisting complaints, stabilization was performed using our original method. At 4 months after surgery, the results were evaluated by the method of Green and O'Brien. METHODS: Access to the LTq joint was gained through the fifth extensor compartment. At about 3 cm proximal to the ulnar head, one third of the extensor capri ulnaris (ECU) tendon was detached, without doing damage to the tendinous sheath on the ulnar head, and stretched distally up to the triquetrum-hamate joint level. Using a 3.2-mm drill, a tunnel was made on the dorsal side of the triquetrum, starting at the distal third of the ulnar side of the triquetrum and opening at the attachment site of the dorsal LTq ligament. In the middle part of the dorsal side of the lunate, a groove 4 mm deep and 6 mm long was made with a cutter and a two-suture Mitek anchor was inserted in its radial side. The graft was passed through the tunnel in the triquetrum, tightened up and inserted in the groove on the lunate, and sutured to the anchor. The rest of the tendon was reinserted to the ECU tendon. After suturing the dorsal structures and skin, a high plaster cast reaching up above the elbow was applied for 4 weeks, followed by application of a short plaster splint for another 2 weeks. RESULTS: Using the method of Green and O'Brien, we assessed pain, function (return to full activity), range of motion and grip strength. An excellent result was recorded in 48%, good in 42% and satisfactory in 10% of the patients; there were no poor results. DISCUSSION: Our method gives better results than the published methods of tenodesis, because it secures stability of both the triquetrum and lunate bones. Also, these methods restrict motion to a lesser degree than LTq joint arthrodesis. CONCLUSIONS: LTq instability of the wrist is a limiting condition for the patient's daily activities. It appears when, for gripping, the hand is positioned in dorsal flexion and ulnar duction. The diagnosis and therapy are complicated and only arthroscopy is reliable for LTq instability detection. The method described here provides an option for treating this disorder with good outcome and, in case of failure, does not interfere with a subsequent LTq joint arthrodesis.

[A new group of potential antitubercular agents: antimycobacterial N-benzylsalicylamides]. / Nová skupina potenciálních antituberkulotik: antimykobakteriální N-benzylsalicylamidy.

Linking up with a previous study of antimycobacterial compounds, several groups of N-benzylsalicylamides were prepared and their antimycobacterial activities against the strains Mycobacterium tuberculosis, Mycobacterium kansasii, and Mycobacterium avium were evaluated. The obtained data were analyzed by Free-Wilson method in comparison with their isosteric analogues of 3-hydroxypicolinic and 2-sulfanylbenzoic acids described in the previous communication.

Evaluation of in vitro antifungal activity of N-benzylsalicylamide derivatives.

A series of 65 derivatives of N-benzylsalicylamide was tested against eight potentially human pathogenic fungi by microdilution broth method modified according to M27-A standard. The majority of these compounds showed only weak in vitro antifungal activity. The most significant effect was observed against filamentous fungi Trichophyton mentagrophytes, Absidia corymbifera, and Aspergillus fumigatus while yeasts, in general, were less susceptible. N-(4'-Chlorobenzyl) salicylamides, N-(3',4'-dichlorobenzyl)-salicylamides, and partially N-benzylsalicylamides exhibited relatively high in vitro antifungal activity. The most efficient derivatives had MIC < or = 7.8 mumol/L against T. mentagrophytes. Regression analysis suggested an indirect relationship between MIC values and lipophilicity (log P).

Chronic bilateral pallidal stimulation and levodopa do not improve gait in the same way in Parkinson's disease: a study using a video motion analysis system.

Chronic bilateral internal globus pallidus (GPi) stimulation allows control of levodopa induced dyskinesias (LID) and motor symptoms in severe Parkinson's disease (PD). The effect on gait has not been clearly established. Different results have been reported, mostly consisting of clinical data. The aim of this study was to evaluate, by means of a video motion analysis system (optoelectronic VICON system), the influence of bilateral GPi stimulation on gait in PD. Five patients underwent bilateral GPi stimulation. The preoperative and postoperative (3 months after surgery) clinical gait disturbances (items 29 and 30 of the motor UPDRS), as well as spatial and temporal gait measurements (namely cadence, velocity, stride and step times, single and double limb support times, stride and step lengths) were analysed in off condition (the patient had received no treatment for 12 hours or merely the lowest dose of levodopa allowing him to walk for the gait analysis) and in the on drug condition (after administration of 200 mg of levodopa). The gait analysis was performed with the VICON system. In off condition, there was a statistically significant improvement after surgery for UPDRS III and gait (clinically assessed). In on drug condition, there was a significant improvement for LID whereas UPDRS III and clinical assessment of gait were unchanged. The VICON system also showed that surgery improved gait especially in off condition, but also in on drug condition. Our method allowed exact quantification of the influence of surgery on gait characteristics. As compared with levodopa treatment, the effect of stimulation seems to be different. Indeed, the results suggest only limited effects of pallidal stimulation on the control of stride length and rather point to compensatory additional mechanisms.