The Radial Bow following Square Nailing in Radius and Ulna Shaft Fractures in Adults and its Relation to Disability and Function.

One of the points made against nailing in radius and ulna shaft fractures has been the loss of radial bow and its impact on function. The aims of the study were to assess the change in magnitude and location of the radial bow in radius and ulna shaft fractures treated with intramedullary square nails and to assess the impact of this change on functional outcome, patient reported disability and the range of motion of the forearm. We measured the magnitude of radial bow and its location in the operated extremity and compared it to the uninjured side in 32 adult patients treated with intramedullary square nailing for radius and ulna shaft fractures at our institute. The mean loss of magnitude of maximum radial bow was 2.18 mm which was statistically significant by both student-T test and Mann-Whitney U test with p value less than 0.01. The location of maximum radial bow shifted distally but was statistically insignificant. The magnitude of maximum radial bow had a negative correlation with DASH score that was statistically insignificant (R=- 0.22, p=0.21). It had a positive, statistically significant correlation to the extent of supination in the operated extremity (R = 0.66, p = 0.0004). A loss of up to 2mm of radial bow did not influence the functional outcome as assessed by criteria reported by Anderson et al. The magnitude of radial bow influenced the supination of the forearm but not the final disability as measured by DASH score. Intramedullary nailing did decrease the magnitude of radial bow but a reduction of up to 2mm did not influence the functional outcome.

Urinary Glycosaminoglycan Estimation as a Routine Clinical Service.

Mucopolysaccharidoses, a group of inherited disorders are associated with defects in glycosaminoglycan metabolism. Thus, assessment of urinary glycosaminoglycan is used as a screening test for mucopolysaccharidoses. The detection methods range from qualitative spot tests to quantification using metachromatic dyes. In our laboratory we optimized a spectrophotometric quantitative method using a metachromatic dye, dimethylmethylene blue. Heparan sulfate was used for quantification. The glycosaminoglycan-dye complex showed a marked shift in color with increase in concentration. The color complex was quantified at 520 nm. The method was linear from 10-89 mg/L. An age matched normal range was obtained in 177 healthy individuals, grouped in 8 different age groups from neonates to adults. Urinary glycosaminoglycan concentration varied distinctly amongst the study population wherein the lowest range in healthy neonates was more than 3 times the upper limit of healthy adults. Urine samples from 10 patients with mucopolysaccharidoses were also included in the study for clinical validation. The method qualified both analytical and clinical validation and was found to be simple, robust and ideal to be offered as a screening test for mucopplysaccharidoses in a routine clinical chemistry laboratory.

Maintenance hemodialysis in patients with HIV-associated nephropathy.

OBJECTIVE: End-stage renal disease (ESRD) patients infected with human immunodeficiency virus (HIV) have poor survival on maintenance hemodialysis. Only a few studies have evaluated survival time on the basis of demographic and clinical factors. The clinical category of the HIV infection and total CD4 counts are commonly considered determining factors of survival in these HIV-infected dialysis patients. PATIENTS AND METHODS: A retrospective case review of all ESRD patients with HIV infection on maintenance hemodialysis, from January 1987 through December 1996, was performed to determine the impact of different clinical categories of HIV infection and CD4 counts on survival and to see if there are other factors that can predict survival among these patients. From a total of 75 ESRD patients with HIV infection, 58 patients with ESRD due to HIV-associated nephropathy (HIVAN) on maintenance hemodialysis are reported here. RESULTS: During the 10 year study period, 52 of 58 ESRD patients with HIVAN expired. Infection (60%), cardiogenic conditions (13%), cerebro-vascular accidents (6%), HIV wasting (8%) and noncompliance with dialysis (11%) were common causes of death. Fifty patients who were on long term hemodialysis (Group I), had a median survival time of 11 months (4-69). Among 44 diseased patients in Group I, various demographic, clinical and laboratory markers, including age, sex, race, acquired immunodeficiency syndrome (AIDS)-associated conditions, HIV clinical categories, hemodialysis access and initial serum albumin level were not significantly associated with mean or median survival time. Those with initial CD4 counts of more than 50 had a significantly longer median survival (11.3 months) than those whose counts were below 50 (5.3 months). Patients with < or = 2.5 g/100 ml initial serum albumin level and < or = 50 initial CD4 counts had a median survival time of 5.3 months compared to 13.6 months in the group of patients with initial serum albumin level of > 2.5 g/100 ml and initial CD4 counts > 50. Both of these findings were statistically significant. CONCLUSIONS: Our 10 year experience of maintenance hemodialysis in ESRD patients with HIVAN shows that long term survival is possible. Initial CD4+ T cells of < or = 50 in these patients is a poor prognostic marker. HIV clinical categories, as reported by others, failed to predict survival in our long term experience. Initial serum albumin of < or = 2.5 g/100 ml was associated with poor survival, though statistically not significant. When initial serum albumin of < or = 2.5 g/100 ml was combined with CD4+ T cells of < or = 50, it became another marker of poor survival.

Hepatitis B virus: a possible cause of serositis in hemodialysis patients.

An epidemiologic survey in a maintenance hemodialysis population of 300 patients was undertaken to relate the appearance of acute serositis (pericarditis, pleuritis or ascites) to HBsAg antigenemia. A significant number of incidents of serositis occurred in patients acutely or chronically infected with hepatitis B surface antigen (HBsAg) suggesting an etiologic role for the virus in the serositis of uremia. In 2 patients with both end-stage renal disease and chronic HBsAg antigenemia, immunofluorescent studies of serosal tissues showed fluorescent clusters interpreted to be HBs antigen-antibody complexes. It is concluded that an immunologic response to viremia may be one of the causes of serositis in uremia.