Recovery of pre-injury functional state following operative treatment of displaced femoral neck fractures; a prospective cohort study.

BACKGROUND: The incidence of fracture neck of femur (FNF) has been projected to increase significantly. This study sought to determine the recovery of preinjury functional state following operative treatment of displaced FNF. MATERIALS AND METHODS: A six-month prospective cohort study was conducted at Kenyatta National Hospital (KNH) and PCEA Kikuyu Mission Hospital (KMH) between November 2008 and May 2009. Sixty patients were enrolled using a pre-tested questionnaire. The Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) scores were used. The functional outcome measures included pain, stiffness and activities of daily living (ADL). Stratification and subgroup analysis were done especially based on age. Student's t-test and χ 2 test were used for comparison between variables as appropriate with a p < 0.05 being considered statistically significant. RESULTS: Majority of the patients recruited were males (68%) with a mean age of 51.6 years. Eighty eight percent of the patients had a mean negative early functional outcome score. Hemiarthroplasty (HA) and Total Hip Arthroplasty (THA) had comparable early post-operative functional outcome while Osteosynthesis (OS) had a poorer ADL outcome. Prolonged hospital stay was associated with a poor ADL outcome (p = 0.020). Use of the antero-lateral approach to the hip was associated with a better ADL outcome in patients older than 50 years (p = 0.007). CONCLUSIONS: At three months post-operatively, most patients have not fully recovered their pre-injury level of function and independence. Both HA and THA are associated with better early functional outcome compared to OS. STUDY TYPE: Original research.

Microscopic features of the rat adrenal gland associated with chronic codeine phosphate administration.

Codeine is an opioid analgesic and antitussive that has been widely abused. Some adverse effects noted with its abuse include adrenocortical insufficiency and activation of the hypothalamic-pituitary-adrenal axis. The structural basis for these dysfunctions is not clearly understood. Twenty-five adult male rats were used for the study. They were divided into intervention and control groups that were administered 40 mg/kg of codeine phosphate and normal saline respectively by gavage daily for 50 days. Subsequently, both groups were given normal saline for a further fourteen days to note recovery changes. At day 0, 50 and 64, rats were randomly selected from both groups, euthanized and adrenal glands harvested for histological processing and analysis. At day 50 of codeine administration, the adrenal glands demonstrated an increase in zona fasciculata thickness but a decrease in zona reticularis thickness. Lower values were noted in the volume density of zona reticularis and cells count of the medulla in the experimental compared to the control groups (P-value<0.05). The experimental group also showed an increase in vascularization and connective tissue in the glands. After 14 days of recovery, most of the changes observed in experimental animals were reversed and the adrenal glands in both groups had similar features. A decrease in cell count of the adrenal medulla was however observed (P-value<0.05). In conclusion administration of codeine phosphate causes discernible changes in the microscopic structure of the adrenal gland, most of which appear to be reversed after two weeks recovery period.

Conventional and variant termination of the portal vein in a black Kenyan population.

BACKGROUND: Knowledge of the variant terminations of the portal vein is important in surgical and interventional radiological procedures of the liver. Their pattern and frequency are important in planning surgery to minimize complications. They differ between populations, but data from Africa is unavailable. AIM: To investigate the variant termination of the main portal vein. MATERIALS AND METHODS: One hundred livers from adult black Kenyans (age range 35 - 79 years) were studied at the Department of Human Anatomy, University of Nairobi, Kenya, by gross dissection. The livers were cleared of blood, fixed with 10% formaldehyde solution and the venous system infused with Acrylate monomers to keep the veins firm. The level of termination relative to the capsule and the branching pattern of the portal vein were examined. Various patterns were photographed using a digital camera. Data was analyzed using SPSS version 16.0 for windows and presented in tables and macrographs. RESULTS: Main portal vein termination was extracapsular in 14%, capsular in 40% and intrahepatic in 46%. Variant termination occurred in 49% of cases while conventional bifurcation occurred in 51% cases. Types, 2, 3 and 4 pattern of termination of main portal vein occurred in 15%, 22% and 12% cases respectively. The level of termination of the MPV had a positive correlation with its pattern (p=0.05). CONCLUSIONS: The high prevalence of variant termination of MPV in the current study suggests that the population is more vulnerable to inadvertent injury during surgery and radiological intervention. Besides, an extra hepatic termination of the MPV is more likely to have a conventional branching pattern compared to an intra-hepatic termination.