Radiological analysis and outcomes of isolated greater tuberosity fracture-dislocations.

BACKGROUND: The purpose of this study was to investigate different radiological characteristics for isolated greater tuberosity (GT) fracture-dislocations and their effects on complication and reoperation rates. METHODS: A two-centre, retrospective study was performed on patients with a minimum 1-year follow-up (median 4.5 years). Patients were split into two groups, Group A (<65 years old) and Group B (≥65 years old). Outcomes included initial injury characteristics (dislocation and fracture type, AC/BC ratio and distances), the reduction environment and postreduction outcomes including complications. RESULTS: A total of 55 patients were included in this study, with a reduction in the emergency department (ED) performed in 93% of patients. Complication rates (47% overall) were similar in both groups, with an overall nonunion rate of 27%. No nonunions occurred in fractures reduced in theatre compared with 29% occurring in reductions in ED (p<0.001); 11% of patients experienced surgical neck fractures, the majority of which were in Group B (p=0.003). A larger fracture fragment (i.e. higher AC/BC or AC distances) was correlated with a higher incidence of nonunion in Group B compared with Group A (p=0.003), and a higher risk of stiffness in both groups (p=0.049); 16% of patients demonstrated delayed displacement of their GT. CONCLUSIONS: This study highlights the high complication rates associated with these injuries. Age and specific radiological parameters should be taken into consideration when risk stratifying, as should reducing these fractures in a theatre setting. Interval radiographs are also advised to monitor GT displacement for at least 2-3 weeks.

Significance of thyrotrophin and thyroxine estimations in type 1 diabetes.

OBJECTIVE: To investigate whether estimation of thyrotrophin (TSH) and thyroxine (T4) is significant to assess the thyroid status of diabetic patients. MATERIALS AND METHODS: Fifty patients with type 1 diabetes (25 male and 25 female) aged 9-50 years were included. The mean duration of diabetes was 6.7 +/- 4.3 years. Clinically they were not suffering from any systemic disease or endocrine ailment. Twenty-six, age and sex matched, normal controls were also included. The TSH and and T4 were estimated in the sera of all the subjects using the commercially available ELISA kits. RESULTS: The mean +/- SD concentration of TSH was raised significantly (p < 0.001) in the patients as compared to the controls, whereas the T4 concentration was comparable. Furthermore, 30% diabetics showed significantly elevated TSH concentration than the controls. CONCLUSION: It is proposed that the estimation of TSH in the patients with type 1 diabetes may be useful in the early identification of thyroid dysfunction.

Successful treatment of ceftazidime-resistant Klebsiella pneumoniae ventriculitis with intravenous meropenem and intraventricular polymyxin B: case report and review.

Increasing prevalence of multidrug-resistant gram-negative organisms has led to a rise in clinically significant infections with these organisms and an increasing therapeutic dilemma. We present a case of a neurosurgical patient who developed ventriculoperitoneal shunt-associated ventriculitis due to ceftazidime-resistant Klebsiella pneumoniae susceptible to cefepime, imipenem, meropenem, and polymyxin B only. Successful management was accomplished by removal of the shunt and therapy with systemic meropenem and intraventricular polymyxin B. Rapid cerebrospinal fluid (CSF) sterilization occurred, with CSF bactericidal titers of 1:32 to 1:128. Polymyxin B should be considered as adjunctive therapy for life-threatening multidrug-resistant gram-negative infections. Prior literature on use of intrathecal polymyxin B in therapy for meningitis supports its potential efficacy.

Safety, effectiveness and ease of use of a non-reusable syringe in a developing country immunization programme.

Unsterile needles and syringes may transmit blood-borne infectious agents such as HIV and hepatitis B virus. The emergence of these diseases as major public health concerns and the risk of nosocomial transmission has heightened interest in the development of single-use injection devices. WHO and UNICEF embarked on a programme to develop and introduce these devices in 1987. We report on a field trial in Karachi, Pakistan, of the SoloShot (SS) plastic disposable syringe, which has a metal clip in the syringe barrel to prevent second-time withdrawal of the plunger. A conventional disposable syringe (CS) was used as a comparison. We observed 48 vaccinators giving 2400 injections with the SS and 1440 with the CS; 98.7% of SS performed as designed. The average volume required per delivered dose was comparable for the two syringes and was delivered more quickly with SS. Training and experience had a small but statistically significant effect on several aspects of SS use. Vaccinators who indicated a syringe preference preferred SS on 7 out of 9 indicators. SS is safe and effective in preventing reuse and is easier and quicker to use than the CS. Vaccinators require little, if any, special training. It could directly replace disposable syringes in expanded programmes on immunization (EPI) in countries where use of unsterile disposable devices occurs or when sterilization is not practical.

PIP: The emergence of HIV and hepatitis B as major public health problems and the risk of nosocomial transmission demands that syringes and needles either be used one time and disposed of or reused only after thorough sterilization between patients. The World Health Organization and UNICEF launched a program in 1987 to develop and introduce single-use injection devices. Even so, incorrectly sterilized syringes and needles as well as disposables are frequently reused. Alternatives to existing injection devices are therefore clearly needed. The authors report on a field trial in Karachi, Pakistan, of the SoloShot (SS) plastic disposable syringe, which has a metal clip in the syringe barrel to prevent second-time withdrawal of the plunger. The use and acceptance of the SS was compared against that for the conventional plastic disposable (CS) syringe routinely used by the Expanded Program on Immunization in Pakistan. The SoloShot permits a single filling and emptying, after which a metal clip locks the plunger to prevent it from being drawn back a second time. A breakaway notch in the plunger inhibits twistout, while a barrier rib on the plunger guards the clip against intentional defeat. The metal clip is set to permit filling up to 0.575 ml of vaccine with an head space to allow the removal of air bubbles and adjustment for the exact dose. The clip is never in contact with the vaccine liquid. Researchers observed 48 vaccinators giving 2400 injections with the SS and 1440 with the CS. 98.7% of the SS performed as designed. The average volume required per delivered dose was comparable for the two syringes, but was delivered more quickly with the SS. Training and experience had a small but statistically significant effect on several aspects of SS use. Vaccinators who indicated a syringe preference preferred the SS on seven out of nine indicators. One may conclude that the SS is safe and effective in preventing reuse and is easier and quicker to use than the CS. Vaccinators require little, if any, special training. These encouragingly positive findings suggest that the SS could directly replace the CS in expanded programs on immunization in countries where the use of unsterile disposable devices occurs or when sterilization is impractical.