Ureteral triplication: a rare anomaly with a variety of presentations.

Ureteral triplication remains a very rare congenital malformation of the urinary tract with a wide spectrum of presentation. The sporadic nature of this condition and its association with other anomalies makes evidence-based management difficult. We report two cases of triplication in association with the VACTERL syndrome, one developing pelvi-ureteric junction obstruction and the other vesico-ureteric reflux.

Flexible intramedullary nails for unstable fractures of the tibia in children. An eight-year experience.

Flexible intramedullary nailing is gaining popularity as an effective method of treating long-bone fractures in children. We retrospectively reviewed the records and radiographs of 56 unstable fractures of the tibia in 54 children treated between March 1997 and May 2005. All were followed up for at least two months after the removal of the nails. Of the 56 tibial fractures, 13 were open. There were no nonunions. The mean time to clinical and radiological union was ten weeks. Complications included residual angulation of the tibia, leg-length discrepancy, deep infection and failures of fixation. All achieved an excellent functional outcome. We conclude that flexible intramedullary fixation is an easy and effective method of management of both open and closed unstable fractures of the tibia in children.

Late orthopaedic sequelae following meningococcal septicaemia. A multicentre study.

Between 1990 and 2001, 24 children aged between 15 months and 11 years presented with late orthopaedic sequelae after meningococcal septicaemia. The median time to presentation was 32 months (12 to 119) after the acute phase of the disease. The reasons for referral included angular deformity, limb-length discrepancy, joint contracture and problems with prosthetic fitting. Angular deformity with or without limb-length discrepancy was the most common presentation. Partial growth arrest was the cause of the angular deformity. Multiple growth-plate involvement occurred in 14 children. The lower limbs were affected much more often than the upper. Twenty-three children underwent operations for realignment of the mechanical axis and limb-length equalisation. In 15 patients with angular deformity around the knee the deformity recurred. As a result we recommend performing a realignment procedure with epiphysiodesis of the remaining growth plate when correcting angular deformities.

Nancy nailing of diaphyseal forearm fractures. Single bone fixation for fractures of both bones.

We identified 25 children (10 girls and 15 boys) who had been treated with single bone intramedullary fixation for diaphyseal fractures of both forearm bones. Their mean age was 10.75 years (4.6 to 15.9). All had a good functional outcome. We conclude that in selected children, single bone intramedullary nailing is a suitable method of treatment for diaphyseal fractures of both bones of the forearm.

The role of nitric oxide in the neural control of nasal fluid production.

The production of nasal fluids serves an important role in the protection of the upper respiratory system, but can also be a troublesome symptom of rhinitis. The chief sources of nasal fluids are serous and mucous glandular secretion, epithelial goblet cell exocytosis, and exudation from submucosal blood vessels. This study was designed to investigate the role of nitric oxide in neurogenically mediated nasal vascular exudation and mucus secretion. A rat model of the naso-nasal reflex was developed in which one nasal cavity was challenged with histamine while albumin and mucin production were measured in the continuously perfused contralateral side. Histamine challenge was associated with a significant rise in contralateral albumin and mucin content. Perfusion with a nitric oxide synthase inhibitor (L-NAME) in the nasal cavity contralateral to nasal challenge was found to block albumin leakage, but not mucin secretion, on that side. The inhibition of vascular exudation was overcome by the addition of L-arginine, the natural substrate of nitric oxide synthase, to the perfusate. Treatment of the ipsilateral nasal of the ipsilateral nasal cavity with L-NAME did not significantly after the contralateral response. A high correlation was observed between albumin and mucin concentration in the perfusate. These findings indicate that NO is a mediator of the effector arm of the naso-nasal reflex that increases vascular permeability, but is not involved in the sensory nerve afferent pathway or in reflex mucin release. Further elucidation of the role of NO in nasal physiology may lead to novel pharmacotherapeutic approaches to the treatment of allergic and non-allergic rhinitis.

Fibular hemimelia: a preliminary report on management of the severe abnormality.

The introduction of Ilizarov leg lengthening techniques has allowed a change in philosophy in treatment of fibular hemimelia. Between January 1990 and October 1993, eight patients with 10 involved extremities underwent correction of severe grades of fibular hemimelia by the Ilizarov technique. Mean follow-up from operation was 26.7 months. Because the lengthening desired was achieved in all cases, this form of treatment is an attractive alternative to the more traditional Syme's amputation. However, complications are common. Frequency and severity of complications apparently is less in younger patients who require less extensive, staged lengthening.

Closure mechanisms of laryngeal vestibule during swallow.

This study examined the temporal effects of bolus volume on closure of the laryngeal vestibule at the arytenoid to epiglottic base and the mobile portion of the epiglottis, the temporal relationships between these levels of airway closure and cricopharyngeal opening for various bolus volumes, and the mechanisms responsible for these two levels of airway protection during deglutition. Closure of the laryngeal vestibule progressed inferiorly to superiorly at all bolus volumes. Duration of closure of the airway at the arytenoid to epiglottic base increased systematically with bolus volume, as did the duration of descent of the epiglottis below horizontal. Closure at the arytenoid to epiglottic base occurred earlier in relation to maximal laryngeal elevation as bolus volume increased. In contrast, descent of the epiglottis to horizontal and the temporal relationship between closure of the airway at the arytenoid to epiglottic base and cricopharyngeal opening were independent of bolus volume. These findings indicate a tightly organized neural program for some pharyngeal swallow events with systematic variability with volume in other pharyngeal events, possibly modulated by afferent input from the periphery. The neuromuscular mechanisms responsible for closure of the airway at the arytenoid to epiglottic base and at the mobile epiglottis appear to be quite different. Closure at the arytenoid to epiglottic base is apparently under direct neural control by active anterior tilting of the arytenoid cartilage and posterior projection of the epiglottic base as the larynx elevates, whereas epiglottic downward movement to closure is the biomechanical effect of hyolaryngeal movement, downward bolus movement, and tongue base retraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Chitin utilization by marine bacteria. Chemotaxis to chitin oligosaccharides by Vibrio furnissii.

The adhesion/deadhesion apparatus of the marine bacterium Vibrio furnissii (Yu, C., Lee, A., Bassler, B. L., and Roseman, S. (1991) J. Biol. Chem. 266, 24260-24267) probably catalyzes the first step in colonizing chitin. Evidence is presented here for a second step, chemotaxis to chitin hydrolysis products. V. furnissii swarms toward chitin oligomers (GlcNAc)n, n = 1-6, at initial concentrations as low as 10 microM. A modified capillary assay was used for quantitation; the cells exhibit low level constitutive taxis to GlcNAc but not to the oligosaccharides. A mutant defective in the GlcNAc receptor (IINag of the phosphotransferase system) showed inducible taxis to the oligosaccharides. Two (or more) independently inducible receptors with overlapping specificities recognize (GlcNAc)n, n = 2-4. (GlcNAc)5 and (GlcNAc)6 were inactive in the capillary assay; expression of this receptor(s) apparently require special induction conditions. The (GlcNAc)n, n = 1-4, chemoreceptors of V. furnissii may be the most potent reported for bacteria. L-Amino acids were weak, constitutive attractants; glutamine, not known to be an attractant in other bacteria, was the most effective amino acid. The most potent receptor in Escherichia coli, Tar (aspartate), is not expressed in V. furnissii. The chemotactic responses were greatly affected by growth and induction conditions and the presence of nutrients in the assay media. Taxis to GlcNAc and GlcNAc oligomers was optimally induced by growth in lactate medium containing 0.6 mM sugar, while growth on the sugar per se resulted in poor taxis. Chemotaxis to the sugars increased 2- to 3-fold when the cells were starved. Nutrients in the assay medium, especially compounds that feed into or are part of the Krebs cycle, were potent inhibitors of taxis to the sugars and Gln. With the exception of isocitrate, inhibition of taxis correlated with the rate of oxidation of these compounds. The results suggest a link between catabolism and taxis in this organism, i.e. interactions or "cross-talk" between systems that are regulated by protein phosphorylation (Stock, J. A., Ninfa, A. J., and Stock, A. M. (1989) Microbiol. Rev. 53, 450-490).