[Talus Fractures - an Update]. / Talusfrakturen ­ ein Update.

Background: Talus fractures are rare and often result from axial trauma. As most of the talus surface is covered by cartilage, the blood supply is limited. Thus talus fractures are seen as one of the most severe fractures and often lead to significant long-term complications. Several studies suggest that the initial fracture classification can lead to correct treatment and that this can influence the long-term outcome. The aim of the current study was to investigate the importance of the initial fracture classification in respect to the radiological outcome in a large patient cohort. Patients and Methods: Over a span of 12 years, 61 patients with talus fractures were treated at our institution. Overall 45 patients were available for a retrospective analysis. Correlation analysis was performed between the initial fracture severity and the radiological outcome. Results: The average follow-up was 17.3 months (range 6-68). Significant correlations were found between the Marti-Weber Classification and Bargon Score (rs = 0.78; p < 0.0001), as well as between the Hawkins Classification and the Bargon Score (rs = 0.80; p < 0.0001). Conclusions: Precise prediction of the expected radiological outcome of talar neck and body fractures is possible through the initial fracture classification alone. Computed tomography is the accepted standard to determine the exact diagnosis and extent of injury.

Distribution of 5-ht(1E) receptors in the mammalian brain and cerebral vasculature: an immunohistochemical and pharmacological study.

BACKGROUND AND PURPOSE: The 5-ht(1E) receptor is highly expressed in the human brain and its structure is conserved in humans, suggesting an important physiological role for 5-ht(1E) receptors. However, neither the function nor the distribution of this receptor has been characterized in the mammalian brain. EXPERIMENTAL APPROACH: Rats and mice lack the 5-ht(1E) receptor gene; thus, we used guinea pig brain tissue and immunofluorescent staining techniques to provide the first specific localization of 5-ht(1E) receptors in the mammalian brain. KEY RESULTS: High levels of 5-ht(1E) receptors are detected in olfactory bulb glomeruli as well as the molecular layer of the dentate gyrus (DG). In DG membranes, BRL54443, a 5-ht(1E) /5-HT(1F) agonist, selectively stimulated 5-ht(1E) receptors and potently inhibited forskolin-dependent cAMP production (IC50 = 14 nM). The staining pattern of 5-ht(1E) receptors in brain tissue suggests that this receptor is expressed predominantly in neurons rather than in glia. Additionally, 5-ht(1E) receptors were detected in the adventitial layer of cerebral arteries but not in the microvasculature, venous tissue or other brain arteries. CONCLUSIONS AND IMPLICATIONS: These observations should help to predict clinical effects of 5-ht(1E) -selective drugs. For example, the stimulation of 5-ht(1E) receptors and subsequent inhibition of adenylate cyclase activity in the DG suggests that 5-ht(1E) receptors may mediate regulation of hippocampal activity by 5-HT, making it a possible drug target for the treatment of neuropsychiatric disorders characterized by memory deficits (such as Alzheimer's disease) or as a target for the treatment of temporal lobe epilepsy.

Antagonist interaction with the human 5-HT(7) receptor mediates the rapid and potent inhibition of non-G-protein-stimulated adenylate cyclase activity: a novel GPCR effect.

BACKGROUND AND PURPOSE: The human 5-hydroxytryptamine(7) (h5-HT(7)) receptor is G(s) -coupled and stimulates the production of the intracellular signalling molecule cAMP. Previously, we reported a novel property of the h5-HT(7) receptor: pseudo-irreversible antagonists irreversibly inhibit forskolin-stimulated (non-receptor-mediated) cAMP production. Herein, we sought to determine if competitive antagonists also affect forskolin-stimulated activity and if this effect is common among other G(s) -coupled receptors. EXPERIMENTAL APPROACH: Recombinant cell lines expressing h5-HT(7) receptors or other receptors of interest were briefly exposed to antagonists; cAMP production was then stimulated by forskolin and quantified by an immunocompetitive assay. KEY RESULTS: In human embryonic kidney 293 cells stably expressing h5-HT(7) receptors, all competitive antagonists inhibited nearly 100% of forskolin-stimulated cAMP production. This effect was insensitive to pertussis toxin, that is, not G(i/o) -mediated. Potency to inhibit forskolin-stimulated activity strongly correlated with h5-HT(7) binding affinity (r(2) = 0.91), indicating that the antagonists acted through h5-HT(7) receptors to inhibit forskolin. Potency and maximal effects of clozapine, a prototypical competitive h5-HT(7) antagonist, were unaffected by varying forskolin concentration. Antagonist interaction with h5-HT(6), human ß(1), ß(2), and ß(3) adrenoceptors did not inhibit forskolin's activity. CONCLUSIONS AND IMPLICATIONS: The inhibition of adenylate cyclase, as measured by forskolin's activity, is an underlying property of antagonist interaction with h5-HT(7) receptors; however, this is not a common property of other G(s) -coupled receptors. This phenomenon may be involved in the roles played by h5-HT(7) receptors in human physiology. Development of h5-HT(7) antagonists that do not elicit this effect would aid in the elucidation of its mechanisms and shed light on its possible physiological relevance.

Serological studies of monoclonal RH antibodies with RH1 (D), RH2 (C), RH3 (E) and RH5 (e) variant RBCs.

One hundred and forty five Mabs against RH antigens were tested. In this paper, we chose to detail reactivity of MoAbs directed against variant RBCs of the CNRGS collection for which we studied the molecular background. Because we developed procedures to identify variants of the RhD, RhC, RhE and Rhe antigens, we were especially interested in finding new monoclonal antibodies that could help us to characterize more accurately these variants. Therefore, we drew parallels between our procedures and results obtained with the 2001 workshop antibodies.

Serological studies of monoclonal RH1(D) antibodies with RH1(D) variants.

In this paper we chose to emphasize three aspects of our work. First we underlined that "low grade and high grade" D weak red blood cells studied at the DNA level could, when monoclonal antibodies were used, give patterns of positive and negative reactions like partial RH1(D) cells. Secondly, we showed the importance of the technical conditions of the study which are essential for establishing a pattern of reactivity defining an epitope. It appears that the use of papain treated cells at room temperature can be misleading for the definition of epitope especially with IgM antibodies. Lastly we pointed out the interest of Rh variant cells, defined at the gene level, to study the expression of RH1(D) epitopes on the external part of the membrane.

A serologic study of red cells and sera from 18 Rh:32,-46 (RN/RN) persons.

The red cells (RBCs) and sera from 18 RN/RN persons were studied. The study confirmed the Rh type D+C+E-c-e+Cw-, which is characterized by an increased expression of the D antigen; a markedly decreased expression of the C and e antigens; the presence of a low-incidence antigen, Rh32; and the absence of a high-incidence antigen, Rh46, which is associated with an epitope recognized by a murine monoclonal antibody (MR432). Other Rh antigens of low and high incidence were investigated, and the presence of Rh17 and Rh44 on the RBCs was confirmed. Three persons exposed to Rh:46 cells by pregnancy or transfusion (or both) had anti-Rh46. This antibody gave positive reactions with all RBCs of common and rare Rh phenotype except Rhnull, and those of D--, D.., DCw-, and RN homozygotes. This antibody is considered to be of clinical significance in case of transfusion or pregnancy.

[The erythrocyte phenotype Rh: 32,-46: transfusional and obstetric importance]. / Le phénotype érythrocytaire Rh: 32,-46: importance transfusionnelle et obstétricale.

The red blood cells and sera from 21 RN/RN individuals were studied. The study confirmed the Rh type D+C+E-c-e+, CW-, characterized by an increased expression of the D antigen, a markedly decreased expression of the C and e antigens, the presence of a low incidence antigen (Rh32) and the absence of a high incidence antigen (Rh46) associated with an epitope recognized by a murine monoclonal antibody (MR 432). Four individuals exposed to Rh46 cells by pregnancy and/or transfusion had an anti-Rh46 antibody. This antibody gave positive reactions with all red blood cells of common and rare Rh phenotype except Rh null, D--, D.., DC(W-) and RN/RN cells. This antibody is considered to be of clinical significance in case of transfusion or pregnancy.

Emm. A red cell antigen of very high frequency.

Anti-Emm, an antibody to a public red cell antigen, was found in the serums of four Emm-propositi and in the serum of the Emm-brother of one of them. Three of the propositi were men, and their antibodies, as well as that of the compatible brother, were believed to be "naturally occurring." Since there are two Emm-siblings in one family, Emm is probably an inherited characteristic.

Study of anti-Fya in five black Fy(a-b-) patients.

Fya antibodies were detected in 5 Fy(a-b-) black patients during a 5-year period. The Duffy phenotype was confirmed using anti-Fya, anti-Fyb, and anti-Fy3 by an adsorption-elution technique. These 5 patients had sickle cell disease and had received multiple blood transfusions. The antibodies were all found during the investigation of a hemolytic transfusion reaction or failure to achieve the desired red cell increments after transfusion.

Anaphylaxis due to suxamethonium? A case report.

A case of profound cardiovascular collapse after the administration of Althesin (alphaxalone-alphadolone) and suxamethonium is described. During subsequent anaesthesia in the same patient, cardiovascular collapse followed the administration of thiopentone and suxamethonium. It is concluded that suxamethonium, rather than Althesin, was the provocative agent.

Ventilation monitors and alarms.

In this review we present a proposed classification of the various types of ventilation monitors and failure alarms used in anaesthetic practice. Each monitoring method is then discussed individually and the advantages and disadvantages are evaluated.

An evaluation of the Samson and Magill (Mapleson A) circuits during anaesthesia.

The valveless scavenging circuit of Samson was compared with a standard Magill (Mapleson A) circuit. Replacement of the scavenging unit of the Samson circuit by the Heidbrink valve of the Magill circuit at a given fresh gas flow rate allowed each patient to act as his own control. The minimum and maximum carbon dioxide levels were estimated at varying fresh gas flows related to the body weight of the patient. The carbon dioxide elimination of the two circuits showed no statistical difference and it is concluded that the Samson circuit requires fresh gas flows similar to the Magill circuit. The Samson circuit scavenged adequately during spontaneous breathing, manual ventilation and even when using the emergency oxygen bypass.

[Legal considerations of surgical sterilization]. / Considerations juridiques sur la sterilization chirurgicale.

PIP: Considered from a juridical point of view, sexual sterilization represents not only a voluntary attempt against physical integrity, but also a mutilation, since it deliberately suppresses reproductive functions. As such, sterilization has repercussions not only on the individual and his/her family, but on society itself. Some motivations for sterilization concern the individual, as in the case of therapeutic sterilization, some concern society, as in the case of eugenic, repressive, or social sterilization. Eugenic sterilization has as its goal the protection of the race against hereditary abnormalities; such a concept, however admissible, goes against the concept of the individual right to physical integrity. In Belgium there is no legislation or even regulamentation regarding any form of sterilization; thus, the principles guiding any sterilization case are essentially: 1) any attempt against physical integrity is against the law; 2) certain attempts, however, are justified; 3) when, then can sterilization be justified? Voluntary and informed consent of the patient is absolutely essential; still, it is not as essential as necessity, defined as medical necessity, as when further pregnancies would entail fatal risks or serious functional risks for the mother, and serious risks for the infant. Medico-social or purely social motivations for sexual sterilization are, from a juridicial point of view, a very touchy subject. Multiparity and serious threat to the well being of the entire family are usually considered by Belgian judges. It seems absolutely necessary that any modern nation should clearly legislate on the subject of sexual sterilization, were it only to avoid too much and unjustified responsibiliyt to fall on practising physicians.^ieng