Flexible intramedullary nailing for treatment of proximal humeral and humeral shaft fractures in children: A retrospective series of 118 cases.

BACKGROUND: The aim of this study was to analyze outcomes of treatment and complications in children treated with flexible intramedullary nailing (FIN) due to humeral fracture. HYPOTHESIS: The FIN for treatment of humeral fractures in children would allow an early functional and cast-free follow-up with a quick pain reduction and low complication rate. PATIENTS AND METHODS: From May 2002 until May 2016 case records of all children who underwent fixation with titanium intramedullary nails because of humeral fracture were retrospectively reviewed. The study included 118 patients treated with FIN for proximal humeral or humeral shaft fracture. The average age at the time of trauma was 12 years. Mean follow-up was 77 months. Left hand was affected in 51% of patients. The most common mechanism of injury was fall (n=58), followed by sports injuries, road traffic accidents, pathological fractures, motorbike accidents and bicycle riding. RESULTS: There were no residual valgus/varum deformities. All patients achieved complete radiographic healing at a mean of 7.5 weeks. Nine complications were recorded: 1 humeral shaft fracture in patient with osteogenesis imperfecta, 4 entry site skin irritations, 2 skin infections and 2 radial nerve injuries. There were no cases of delayed union, nonunion or mal-union. After removal of the nails, all patients regained full function and all complications resolved. DISCUSSION: The FIN for humeral fractures is a minimally invasive, simple and well reproducible technique with very low complication rate. CONCLUSION: The FIN for treatment of humeral fractures shows very good functional and cosmetic results. It allows an early functional and cast-free follow-up with a quick pain reduction. LEVEL OF EVIDENCE: Level IV - retrospective study.

Apoptotic pathways and stemness in the colorectal epithelium and lamina propria mucosae during the human embryogenesis and carcinogenesis.

AIM: Programmed cell death is essential both during normal organ development and carcinogenesis. In this study we immunohistochemically analyzed different pathways of cell death in 11 human conceptuses 5th-10th-weeks old, 10 low and high grade colorectal carcinomas (CRC), and 10 normal colon samples by using markers for apoptosis (caspase-3, AIF, TUNEL), proliferation (Ki-67) and stemness (Oct-4). RESULTS: Between the 5th and 10th week of development, caspase-3 and AIF showed moderate-to-strong expression in the developing gut wall. During development, number of caspase-3-reactive cells decreased, while AIF increased. While healthy colorectal control and low grade CRC showed moderate expression of caspase-3 and AIF, in high grade CRC their expression was strong. Tumor tissues displayed significantly higher number of positive cells than controls. Occasionally, co-expressing of both markers characterized dying cells. In developing colon, Oct-4 and Ki-67 showed moderate-to-strong expression, while some cells co-expressed both markers. Their number decreased in the epithelium and increased in the connective tissue in later development. Healthy colorectal control displayed moderate Ki-67 and mild Oct-4 reactivity. While in low-grade CRC expression Oct-4 and Ki-67 was moderate, in high-grade CRC their expression was strong. Although Oct-4 and TUNEL occasionally co-expressed in all samples, both grades of CRC contained cells that were Oct-4 positive only. CONCLUSION: Our study revealed two different parallel pathways of cell death, with characteristic increase of AIF-mediated apoptosis when compared to caspase-3, and presence of stemness cells both during colon development and carcinogenesis. These finding might be considered as important diagnostic, survival and CRC therapy predictors.

Plasma cortisol in men--relationship with atherosclerosis of retinal arteries.

The production of cortisol increases in acute stress but the effects of chronic stress on plasma cortisol are still controversial. Stress on the other hand plays a role in coronary artery disease (CAD) and carotid atherosclerosis. Since there is no data about plasma cortisol and atherosclerosis of the retinal arteries, the purpose of this study was to explore the relationship between plasma cortisol in 101 adult males with the degree of their retinal vessels atherosclerosis. The results were compared with those in 47 matched apparently healthy men with no retinal vessels changes. The atherosclerotic changes of retinal vessels were determined by direct ophthalmoscopy and graded (1-4) according to Scheie. Morning plasma cortisol levels were determined by radioimmunoassay using commercial kits. The results were compared by using chi-square test. No association between morning plasma cortisol concentrations and retinal vessels atherosclerosis could be found. The results of this study do not support a role for physiological levels of plasma cortisol in the development of atherosclerosis, at least of the retinal arteries, in men.

[Snoring and obstructive sleep apnea]. / Hrkanje i opstruktivna apneja za vrijeme spavanja.

Snoring and obstructive sleep apnea are similar disorders in etiology, with differences in clinical presentation and treatment. 5-20% of young and 40-50% of older population are affected by either of these disorders. Etiology of snoring should be sought in the anatomic irregularities of commencing portions of the upper respiratory and gastrointestinal tracts, obesity, alcohol abuse, use of some medications as well as in the sleep architecture disturbance. Treatment success depends on correctly established diagnosis and precise localisation of anatomic irregularity implicated in snoring. A wide array of diagnostic tests exist some of which are mandatory while the others are used on a case-by-case basis. Treatment is either conservative or surgical. The success rate is 30-90% depending on the type and the management of disorder. An algorithm for diagnosis and treatment of snoring and obstructive sleep apnea is shown at the end of the paper.

Effect of simvastatin on micropulmonary red cell mass in patients with hyperlipoproteinemia.

The purpose of this study was to compare the macrocirculatory and microcirculatory effects of simvastatin in hyperlipemic patients. In vitro measurements of lipoprotein levels and macrocirculatory hemorheology were complemented by in vivo measurements of the pulmonary capillary red cell volume (RCVpc) before and after 6 weeks of treatment with 40 mg of simvastatin daily in 30 male patients with hyperlipoproteinemia type IIa. RCVpc was assessed from the vascular component of the lung diffusing capacity for carbon monoxide, using the modification of the Roughton-Forster's method. RCVpc was increased in patients (60.9+/-9 versus 40+/-9 ml in healthy controls) and it decreased to 47+/-6 ml after treatment (P=5x10(-11)). The decreases in RCVpc correlated to concomitant decreases in peripheral hematocrit (R=0.68) and serum total cholesterol (-34% on average; R=0.59). Membrane diffusing capacity was normal in patients and not affected by the therapy; suggesting that increased RCVpc was due to increased micropulmonary hematocrit. Thus, it appears that viscosity in microcirculation is greatly increased in hyperlipemic patients and that simvastatin is able to normalize it. Since microcirculatory conditions can only partly be inferred from in vitro measurements the use of lung diffusional parameters was advocated, which enable in vivo assessment of hemorheology in microcirculation.

Serum prolactin levels after seizure and syncopal attacks.

Loss of consciousness and falling are the key features of syncope. Common accompaniments include tonic and myoclonic muscle activity, eye deviations, automatisms, vocalizations and hallucinations that may render the distinction from epileptic seizures difficult. The frequently increased levels of serum prolactin (SPRL) were observed immediately after generalized and complex partial seizures. Presumably, the hormone release is caused by the propagation of epileptic activity, usually from the temporal lobe to the hypothalamic pituitary axis. Numerous reports have demonstrated that the post-ictal SPRL level may be used to differentiate between epileptic and syncopal, non-epileptic attacks. In order to confirm the hypothesis, the SPRL levels were measured in patients with complex partial seizures (CPS) and patients with vaso-vagal syncopal attacks (VVS). The SPRL levels were prospectively measured for each patient as soon as possible after the event (within 1 hour), then 1 hour after the first determination and finally blood was sampled 24 hours later. During the study period (18 months), 18 patients with CPS and 15 patients with VVS were investigated in total. The mean values of SPRL levels in both groups were increased immediately after the event (CPS group: 1142 +/- 305 mIU/l; VVS group: 874 +/- 208 mIU/l). The elevated SPRL levels were found in 14 (78%) patients immediately after CPS and in 9 (60%) patients immediately after VVS. After examining the results of the present study we conclude that the elevated serum prolactin level after an epileptic attack is of no significant value in differential diagnosis between epileptic and vaso-vagal syncopal attacks.

Determination of ethanol in chocolate shell pralines and filled chocolates by capillary gas chromatography.

The paper describes a simple gas chromatographic method for quantification of ethanol in distillates of chocolate shell pralines and fillings. The samples were prepared in two steps. The first step consisted of ethanol distillation from the product and the second involved capillary gas chromatography of 10% v/v distillate with expected ethanol content between 0.06% and 2.5% w/w. Quantification was carried out using iso-propanol as internal standard. The range of linear method response was 0.05-3.16% w/w of ethanol, which corresponded to products with ethanol content between 0.5 and 31.6% w/w. The detection limit was 0.0158% w/w and the quantification limit was 0.058% w/w of ethanol with the relative standard deviation of 2.5%.

Effect of maternal hyperoxygenation on experimentally produced uteroplacental insufficiency in the rat.

The paper examines the effects of maternal hyperoxygenation on uteroplacental insufficiency produced by ligation of the uterine artery. Maternal hyperoxygenation did not significantly affect experimentally produced growth retardation or survival of the fetuses from the ligated horn. Analysis of the vascular anatomy revealed that additional oxygen improves the survival of fetuses compromised by uteroplacental insufficiency only in the presence of anastomosis between the uterine and ovarian arteries. The study demonstrated the importance of that anastomosis in evaluating the results obtained by this experimental model.

An increase in micropulmonary red cell mass in hyperlipidaemic patients.

It is known that pulmonary microcirculation rheology is partly affected by plasma levels of lipoproteins, but only a few data are available for humans. Therefore, in a sample of 30 normal volunteers and 90 patients with various types of primary hyperlipoproteinaemia, the plasma levels of total cholesterol (Chol), low density cholesterol (LDL), the high density cholesterol (HDL), triglyceride (Tg) and fibrinogen (Fib) were measured in conjunction with determinations of plasma viscosity (PV) and the pulmonary capillary red cell volume (RCVc). RCVc was estimated from measurements of the vascular component of the single-breath-diffusing lung capacity for carbon monoxide, using our own modification of the Roughton-Forster's method. By stepwise regression analysis, the variation in RCVc was almost completely accounted for (r2 = 0.87) by variations in PV, Chol, Tg and the anthropometric confounding factors. The proposed explanations for increased pulmonary capillary red cell mass (up to 151% of the predicted value) in hyperlipidaemic patients included the hypothesis of increased pulmonary microhaematocrit, which agrees with the observed in-vitro lipoprotein-dependent increase in erythrocyte aggregability.

Lenticulostriate arteries in aging process: an angiographic study.

Histological studies describe in detail the changes of the small arteries wall with controversial results concerning lumen narrowing during the aging process. In this study, the anatomic and the angiographic parameters of the medial and lateral lenticulostriate arteries were analysed in 64 carotid angiograms. Only 20% of the total number of lenticulostriate arteries were shown on angiograms. Collateral branches were rarely visible, especially those of medial group. The course of the lenticulostriate arteries was mostly straight or moderately tortuous. No significant differences were noted in any of the measured parameters when compared with the age (p greater than 0.05). It appears that age-related changes spread over external layers of small arteries, with no lumen narrowing or filling defect.