Fluorine-programmed nanozipping to tailored nanographenes on rutile TiO2 surfaces.

The rational synthesis of nanographenes and carbon nanoribbons directly on nonmetallic surfaces has been an elusive goal for a long time. We report that activation of the carbon (C)-fluorine (F) bond is a reliable and versatile tool enabling intramolecular aryl-aryl coupling directly on metal oxide surfaces. A challenging multistep transformation enabled by C-F bond activation led to a dominolike coupling that yielded tailored nanographenes directly on the rutile titania surface. Because of efficient regioselective zipping, we obtained the target nanographenes from flexible precursors. Fluorine positions in the precursor structure unambiguously dictated the running of the "zipping program," resulting in the rolling up of oligophenylene chains. The high efficiency of the hydrogen fluoride zipping makes our approach attractive for the rational synthesis of nanographenes and nanoribbons directly on insulating and semiconducting surfaces.

Surgery and training in surgery in remote rural hospitals.

Surgery is an important part of primary health care in remote rural areas of third world countries. It is essential that doctors and nurses who are working in rural hospitals are adequately trained in surgery. Special consideration should be given to the surgical pathology encountered in the rural tropical environment. Teaching should take place in the set-up of the rural hospital and should include anaesthesia, sterilisation and maintenance of equipment. A concept of teaching in surgery in peripheral hospitals is presented.

The problem of post-partum fistulas in developing countries.

Postpartum fistulas are frequent in the tropical environment. They are mostly found in very young women who live in remote areas. Without treatment women with fistulas will be condemned to the disconsolate life of social outcasts. Good operative treatment is crucial. The different operative methods are discussed. The operation through vaginal approach can be performed in any hospital. It does not need special surgical skill. More important than surgery is prevention of postpartum fistulas through a well-organised primary health care program which reaches out into the villages and which includes adequate prenatal controls and competent midwifery.

PIP: In tropical environments, fistulas between the vagina and the bladder or rectum are common in postpartum women. This condition is most frequent in very young women from remote rural areas whose deliveries are attended by midwives untrained in the management of obstructed labor. As a result of the continuous seepage of urine and/or feces associated with this condition, women with fistulas face social ostracism. Thus, the prevention and adequate treatment of postpartum fistulas are important tasks for health services in the tropics. Unlike complicated transperitoneal procedures, a vaginal approach to fistula treatment does not require special surgical skills and can be performed under spinal anesthesia. 75-85% of first surgeries for postpartum fistula are successful (defined as no leakage of urine or feces and resumption of normal sexual relations). The success rate depends, however, on factors such as the exact localization and extension of the fistula, involvement of the urethra, the closing mechanism of the bladder, and the experience of the surgeon. Prevention of postpartum fistula requires good prenatal care, including the referral of primiparas with small or abnormal pelvic proportions to a hospital for delivery, and adequate maternity facilities, especially the availability of midwifery staff trained in vacuum extractor use and symphysiotomy performance.

Open fractures and internal fixation in a major African hospital.

Between September 1992 and June 1994, 20 patients with 27 open fractures were treated at a major Ethiopian hospital by open reduction and internal fixation. Sixteen fractures were caused by gunshots, eight by road traffic accidents, two by direct blows, and one by a fall. Twenty-one fractures were stabilized with ASIF plates, and six with screws and wires. Five fractures out of 27 (18.5 per cent) developed infection postoperatively. In one case secondary wound infection subsided after wound excision and plate removal. In three others the implants were replaced by external fixators, in two of which the infection subsided and the patients left hospital without infection. The two remaining patients were treated for 4 1/2 months and 18 months respectively for chronic osteitis. Ten of the 15 patients without postoperative infection returned for follow-up. None of them had developed osteitis. The overall functional results were good.