Management and incidence of tibial tubercle fractures in bicondylar fractures of the tibial plateau.

Bicondylar tibial plateau fractures result from high-energy injuries. Fractures of the tibial plateau can involve the tibial tubercle, which represents a disruption to the extensor mechanism and logically must be stabilised. The purpose of this study was to identify the incidence of an independent tibial tubercle fracture in bicondylar tibial plateau fractures, and to report management strategies and potential complications. We retrospectively reviewed a prospectively collected orthopaedic trauma database for the period January 2003 to December 2008, and identified 392 bicondylar fractures of the tibial plateau, in which 85 tibial tubercle fractures (21.6%) were identified in 84 patients. There were 60 men and 24 women in our study group, with a mean age of 45.4 years (18 to 71). In 84 fractures open reduction and internal fixation was undertaken, either with screws alone (23 patients) or with a plate and screws (61 patients). The remaining patient was treated non-operatively. In all, 52 fractures were available for clinical and radiological assessment at a mean follow-up of 58.5 weeks (24 to 94). All fractures of the tibial tubercle united, but 24 of 54 fractures (46%) required a secondary procedure for their tibial plateau fracture. Four patients reported pain arising from prominent tubercle plates and screws, which in one patient required removal. Tibial tubercle fractures occurred in over one-fifth of the bicondylar tibial plateau fractures in our series. Fixation is necessary and can be reliably performed with screws alone or with a screw and plate, which restores the extensor mechanism and facilitates early knee flexion.

The sexual signals of speciation? A new sexually dimorphic Phymaturus species of the patagonicus clade from Patagonia Argentina.

Evolution is a multivariate process which, therefore, is expected to leave multiple recognizable signals after episodes of speciation. These signals express in the genome regardless of the mechanism driving speciation, and in a few or in multiple phenotypic traits when divergent selection has been implicated. In lineages that have undergone adaptive radiations (i.e. speciation accompanied by ecological diversification), the phenotypic signals of speciation can be substantially pronounced. In contrast, within non-adaptive radiations (i.e. lineage diversification with minimal ecological diversification linked to allopatric or parapatric species distributions), phenotypic signals of speciation can be minimal. The South American lizard genus Phymaturus is regarded as a candidate non-adaptive radiation given the tendency for non-overlapping distributions among its phenotypically and ecologically similar (i.e. niche conservatism) species. Thus, limited phenotypic divergence has evolved among closely related species. Within the patagonicus clade of the genus, sexual monochromatism is highly conserved, while sexual dichromatism is rare, and mostly negligible when observed. In this paper, we provide the description of a new sexually dimorphic and dichromatic species of this clade (Phymaturus camilae sp. nov.). This species is substantially isolated spatially and phylogenetically separated from P. ceii, P. delheyi and P. zapalensis, the most sexually dichromatic members of the clade. In addition, the new taxon was recently identified as a 'candidate new species' based on molecular (nuclear) phylogenetic evidence.

Efficacy of sodium hypochlorite and coconut soap used as disinfecting agents in the reduction of denture stomatitis, Streptococcus mutans and Candida albicans.

This study evaluated the reduction of denture stomatitis and the antimicrobial activity of 0.05% sodium hypochlorite opposed to Candida albicans and Streptococcus mutans (SGM) when associated with brushing complete dentures with coconut soap. The mucosal characteristics were evaluated according to Newton's classification at baseline, after cleansing the dentures with coconut soap for 15 days in group 1 (nine patients). In the other group (19 patients) the analysis were made before and after cleansing the dentures with coconut soap and with disinfection in a soak solution of 0.05% sodium hypochlorite for 10 min during 15 days. Microbiological tests were used to isolate C. albicans and SGM. Mann-Whitney and Wilcoxon tests were used to compare the mucosal characteristics and Fisher test and McNemar test to compare C. albicans and SGM levels. Statistical analysis at the 95% confidence level (P < 0.05) showed that: (i) the association of coconut soap and 0.05% sodium hypochlorite significantly reduced clinical signs of denture stomatitis, (ii) C. albicans did not reduce in counts, (iii) SGM were reduced but not significantly and (iv) the association of coconut soap and 0.5% sodium hypochlorite was effective in controlling denture biofilm.

L-arginine increases plasma homocysteine in apoE-/-/iNOS-/- double knockout mice.

Previous studies have shown that L-arginine (L-Arg) administration to apoE-/-/iNOS-/- double knockout mice (dKO) on a Western diet paradoxically results in an increase in atherosclerotic lesion size. We hypothesized that the potential beneficial effects of L-Arg could be offset, in part, by the byproducts of L-Arg catabolism, especially the atherogenic risk factor, homocysteine. In the kidney, L-Arg is converted to L-ornithine and guanidinoacetate (GAA) by L-arginine-glycine amidinotransferase. The efficient transmethylation of GAA by an S-adenosyl-methionine (SAM)-dependent methyltransferase in liver yields creatine and S-adenosylhomocysteine (SAH), which is readily hydrolyzed to homocysteine and adenosine. We, therefore, measured total plasma homocysteine in the dKO mice and control mice. We found that L-Arg supplementation caused a 37% increase in total plasma homocysteine (tHcy) levels in dKO mice compared to controls not treated with L-Arg (5.2+/-2.2 vs 3.8+/-1.5 microM Hcy, p<0.04). In a liver cell line, HepG2, addition of 10 and 50 microM GAA in the presence of 50 microM L-methionine (L-Met) increased tHcy production by approximately 1.47 (p<0.0001) and 2.3-fold (p<0.0001), respectively. In the presence of additional 100 microM L-Met, baseline homocysteine production was elevated by 20% (p<0.005), and 10 and 50 microM GAA augmented homocysteine production by an additional 1.88- (p<0.0001) and 3.4-fold (p<0.001), respectively, compared with 50 microM L-Met. These data suggest that increased concentrations of a methyl acceptor, such as L-Arg-derived GAA, drives SAM-dependent-methylation and consequent homocysteine formation. Furthermore, L-Met levels can also influence homocysteine production likely by regulating the synthesis of the methyl donor SAM. Epidemiological studies have suggested that homocysteine is a graded risk factor. In animal models, modestelevations of homocysteine can cause endothelial dysfunction and augment atherosclerosis. Our data suggest that L-arginine supplementation may contribute to vascular injury and atherogenesis under some circumstances by elevating homocysteine levels.

The eye of the magellanic penguin (Spheniscus magellanicus): structure of the anterior segment.

We undertook a light and scanning electron microscopic study of the eye in the Magellanic penguin (Spheniscus magellanicus). The anatomical peculiarities of the eyeball shape in Sphenisciformes have been previously described by others; here, we show that they are accompanied by several modifications in the organization of the anterior segment of the eye. The main change was found in the portion of opaque sclera extending from the cornea to the anterior border of the scleral ossicles, which was much broader than in other avian eyes. This scleral region was made of a very dense fibrous tissue and was as difficult to cut as the ossicles. The corneo-scleral boundary was also different from that of other birds, since the aqueous humor channel and the pectinate ligament were located 1.0-1.5 mm posterior to the cornea. The osseous ring was formed by 13 bones, including three pairs of over- and underplates. There was a single ciliary muscle, with meridionally oriented striated fibers. They were inserted on a circumference along the boundary between the fibrous sclera and the ossicles, far away from the wall of the aqueous humor channel. On their posterior end, the muscle fibers formed a tendinous structure attached to the inner surface of the sclera and to the outer surface of the ciliary body. Only short zonular fibrils were observed. These anatomical features are probably relevant for the adaptation of penguin eyes to vision on land and in the aquatic environment.

[Bluish cutaneo-digestive angiomatosis or Bean's blue rubber-bleb nevus. A rare syndrome]. / L'angiomatose bleutée cutanéo-digestive ou blue rubber bleb nevus de Bean. Un syndrome rare.

A 13 years old girl is admitted for severe chronic anemia. Few blood sac looking like lesion are discovered. A Blue Rubber Bleb Nevus Syndrome is confirmed discovery of multiple intestinal angioma. No deep lesion is discovered otherwise. Clinical characteristics, nosology and evolutive trend of this rare syndrome are recalled.

Upper digestive tract hemorrhage in cirrhotic patients. Contribution of multidimensional analysis to the study of variables related to the cause of the hemorrhage.

Sixteen clinical and biological variables were recorded in 116 episodes of upper digestive tract hemorrhage of known cause in cirrhotic patients. One-dimensional analysis reveals a significant correlation between six variables and the rupture of esophagogastric varices, whereas multiple linear regression and partial correlation analysis reduces the significant variables to two: a history of digestive hemorrhage and the nonalcoholic etiology of the cirrhosis. A value of the discriminant function exists for which the specificity and, consequently, the positive predictive value are equal to 100%, but with a sensitivity of 39%. These results mean that, in an explanatory approach, partial correlation analysis seems to constitute an indispensable complement to analysis of clinical and biological variables, since it reduces the chances of unwarranted explanatory interpretation. However, in a pragmatic approach, the recording of 16 variables does not permit a clear discrimination between ruptured varices and nonruptured varices; this suggests that either other factor(s) remain to be discovered or else that those related to ruptured varices and to acute ulcerations are the same.