Loss of synaptophysin and synaptosomal-associated protein 25-kDa (SNAP-25) in elderly Down syndrome individuals.

AIMS: This study quantified the density of the synaptic proteins synaptophysin and synaptosomal-associated protein 25-kDa (SNAP-25) in brains from elderly Down's syndrome individuals. METHODS: Six areas (frontal, occipital, parietal and temporal lobes, cerebellum and hippocampus) of post mortem brains from elderly Down's syndrome (DS) individuals (with reported functional memory problems and pathologically established Alzheimer's disease) and elderly controls were studied. RESULTS: Collectively in the six brain areas studied, there were significantly lower levels of both synaptophysin and SNAP-25 immunostaining in the DS group compared with controls. The elderly control group displayed a significant decrease in the densities of synaptophysin and SNAP-25 as a function of age at death (AAD; P < or = 0.001), whereas the DS group only showed a significant decrease as a function of AAD for synaptophysin. Assessing synaptic density as a function of Braak stage (BST) revealed a significant decrease in synaptophysin density for both groups. SNAP-25 was only significantly decreased as a function of BST in the DS group. Synaptic protein density was also shown to vary according to gender. Thus, both DS and control female subjects had a higher synaptic density of SNAP-25 than their male counterparts. In contrast, male DS and control individuals had a significantly greater density of synaptophysin than females. CONCLUSIONS: These results indicate that elderly DS individuals have lower synaptic densities of both analysed proteins than cognitively intact elderly individuals. Although AAD and BST show varying significance to decreases in protein density for both DS and control groups, results suggest that gender differences also play a role in the type of synaptic protein lost in elderly DS individuals.

Does patient controlled analgesia delay the diagnosis of compartment syndrome following intramedullary nailing of the tibia?

We report on four cases in which the diagnosis of compartment syndrome was delayed by the administration of patient controlled analgesia (PCA) following intramedullary nailing of tibial shaft fractures. We believe that this poses a diagnostic problem and can lead to lasting sequelae as decompression is delayed. We recommend extra vigilance with the use of PCA in patients with intramedullary nailing following tibial shaft fractures.

The ABG hydroxyapatite-coated hip prosthesis: one hundred consecutive operations with average 6-year follow-up.

One hundred consecutive ABG (Anatomique Benoist Giraud, Howmedica) hydroxyapatite-coated hip arthroplasties in 97 patients were evaluated prospectively with a follow-up time of 4 to 10 years (mean, 6 years). Clinical results were excellent with an improvement in the Merle d'Aubigne score from 9 preoperatively to 17.4 at 5 years. Thigh pain was persistent in only 3%; it was mild in nature and controlled with simple analgesics. Kaplan-Meyer survivorship analysis was 100% for the femoral stem and 95% for the acetabular cup at 6 years. Of concern was the high polyethylene wear measured with an average of 0.24 mm/y (range, 0.05-0.76 mm/y).

Microwave endometrial ablation in the management of menorrhagia: current status.

Menorrhagia is a common clinical problem. Recently several different ablative techniques have been described to treat it in the expectation of reducing hysterectomy rates. This paper describes the current status of microwave endometrial ablation, its clinical efficacy, its safety profile and future development.

Osteitis pubis and instability of the pubic symphysis. When nonoperative measures fail.

Seven rugby players with osteitis pubis and vertical instability at the pubic symphysis were treated operatively after nonoperative treatment had failed to improve their symptoms. The vertical instability was diagnosed based on flamingo view radiographs showing greater than 2 mm of vertical displacement. The players had undergone at least 13 months of nonoperative therapy before surgery was considered. Operative treatment consisted of arthrodesis of the pubic symphysis by bone grafting supplemented by a compression plate. At a mean follow-up of 52.4 months, all patients were free of symptoms and flamingo views confirmed successful arthrodesis with no residual instability of the pubic symphysis. Based on our results with this procedure, we believe that arthrodesis of the pubic symphysis has a role in the treatment of osteitis pubis that is recalcitrant to nonoperative treatment. The combination of osteitis pubis and vertical pubis symphyseal instability may be the cause of failure of nonoperative treatment.

How do UK gynaecologists manage endometrial carcinoma? A national survey.

OBJECTIVE: The objective of this study was to examine the management of endometrial carcinoma in the United Kingdom (UK). METHODS: Consultant gynaecologists were sent an anonymous postal questionnaire requesting information on investigation and management of endometrial carcinoma. RESULTS: Completed questionnaires were received from 701 respondents (51% response). Most responders were general gynaecologists who saw less than five new cases of endometrial cancer annually; 98% of respondents preferred surgical procedure for endometrial carcinoma was total abdominal hysterectomy and bilateral salpingo-oophorectomy. There was a wide variation in diagnostic investigations and radiotherapy practice.

Split peroneus longus tenodesis for chronic lateral ligamentous instability of ankle.

A new procedure is described that uses a split peroneus longus tendon to reconstruct the anterior talofibular and calcaneofibular ligaments for chronic post-traumatic lateral ligamentous instability of the ankle for patients who wish to return to sporting activities. Subtalar inversion, which is essential for many sporting activities, is not affected. It is not a difficult procedure. In this small series of four patients followed out of six, over a period of 6 years with an average follow-up of 31.7 months, it has given good results, both subjectively and objectively, enabling them to return to active sports.

An open twin incision technique of carpal tunnel decompression with reduced incidence of scar tenderness.

We retrospectively compared a single curved incision for carpal tunnel decompression (group A, 29 wrists in 26 patients) with a twin incision technique (group B, 34 wrists in 30 patients), leaving an intact bridge of skin at the base of the palm. Patients in group B reported statistically significant subjective improvement in the early post-operative period, with fewer residual symptoms and earlier recovery of function compared to patients in group A. After a mean post-operative period of 23 months, 5/29 wrists were symptomatic in group A compared to 1/34 wrists in group B at 13 months, but this was not statistically significant. The twin incision technique is easy to perform and allows rapid post-operative recovery. The incidence of scar tenderness is reduced as palmar cutaneous branches of the median nerve are avoided. Because the distal portion of the transverse carpal ligament is divided under direct vision, this technique is not associated with any significant neurovascular complications.

How well do perimenopausal patients accept outpatient hysteroscopy? Visual analogue scoring of acceptability and pain in 100 women.

There is growing interest in performing hysteroscopic examination of the uterine cavity as an outpatient procedure. Its sensitivity and specificity in detecting uterine abnormalities are well recognised. This study assessed how outpatient hysteroscopy was tolerated and accepted by 100 women attending a hospital-based menopause clinic. Patients were asked to complete a questionnaire following an outpatient hysteroscopy. Using visual analogue scoring (0 = no pain/completely acceptable, 10 = worst pain imaginable/completely unacceptable), the mean maximum pain experienced during the procedure was 3.25 (S.D. 2.08) and the degree of acceptability was 3.02 (S.D. 1.96). Three percent (N = 3) of patients stated they would prefer a repeat hysteroscopy to be performed under general anaesthetic and 3% (N = 3) of patients stated they would prefer an inpatient stay following a repeat hysteroscopy. These findings demonstrate that outpatient hysteroscopy is well tolerated by perimenopause patients. The advantages of outpatient hysteroscopy to the perimenopausal woman are discussed.