A guide to classify tattoo motives in Mexico as a tool to identify unknown bodies.

JUSTIFICATION: In Mexico, the number of unidentified bodies has been steadily rising for years. By now, more than 50,000 bodies are considered unidentified. Forensic laboratories that could perform comparative molecular genetic investigation are often overburdened and examinations can take months. Therefore, pragmatic approaches that can help to identify more unknown bodies must be sought. The increased use of distinctive physical features might be one, and the high rate of tattooed people in Mexico points towards a great potential of tattoos as a tool for identification. The prerequisite for a comparison of antemortem (missing persons) and postmortem (unknown bodies) data is an objective description of the particularities, e.g., of the tattoos. The aim of this study was to establish an objective classification for tattoo motives, taking into consideration local preferences. METHODS: In the database of the medicolegal services of the Instituto Jaliscience de Ciencias Forenses (IJCF) in Guadalajara, postmortem data of 1000 tattooed bodies from 2019 were evaluated. According to sex and age, the tattooed body localization and the tattoo motives were categorized. RESULTS: The 1000 tattooed deceased showed tattoos on 2342 body localizations. The motives were grouped and linked to the following 11 keywords (with decreasing frequency): letters/numbers, human, symbol (other), plant, symbol (religious), animal, object, fantasy/demon/comic, tribal/ornament/geometry, other, unrecognizable. CONCLUSION: Using the proposed classification, tattoo motives can be described objectively and classified in a practical way. If used for antemortem (missing persons) and postmortem (unknown bodies) documentation, motives can be searched and compared efficiently-helping to identify unknown bodies.

Incertidumbre y afrontamiento en familiares de personas dependientes del alcohol: apoyo social y espiritualidad / Uncertainty and coping among relatives of alcohol dependent persons: social support and spirituality / Incerteza e enfrentamento em parentes de pessoas dependentes de álcool: apoio social e espiritualidade

Resumen Introducción: La dependencia al alcohol, considerada como una enfermedad crónica, es un detonante de incertidumbre para el familiar de la persona con dependencia, lo cual genera trastornos emocionales negativos. El apoyo social y la espiritualidad son mecanismos de afrontamiento que podrían disminuir la incertidumbre y favorecer el bienestar tanto físico, como psicológico. Objetivos: Determinar la relación y el efecto del apoyo social y la espiritualidad sobre la incertidumbre del familiar de la persona dependiente del alcohol. Métodos: Estudio descriptivo y correlacional, muestra de 135 mujeres pertenecientes a grupos Al-Anon, se utilizaron la Escala de Percepción de Incertidumbre en Padres y Miembros de la Familia (PPUS-FM) de Mishel, el cuestionario MOS-SSS de Sherbourne y Stewart y la Escala de Perspectiva Espiritual elaborada por Reed. Resultados: Se identificó un coeficiente de correlación negativo y significativo de la incertidumbre con el apoyo social (r s= -.356, p <.01) y la espiritualidad (r s= -.216, p <.05). Mediante un modelo de regresión lineal general univariado se determinó que únicamente el apoyo social influye en la disminución de la incertidumbre (β= -.280, t= -3.62, p= .001) con un coeficiente de determinación o varianza explicada del 11.5%, mientras que la espiritualidad no mostró efecto (β= -.041, t= .218, p >.05) sobre la incertidumbre. Conclusiones: El apoyo social es identificado como un mecanismo de afrontamiento efectivo que permitirá al personal de enfermería desarrollar intervenciones dirigidas a reducir la incertidumbre en familiares de personas con algún tipo de dependencia.

Abstract Introduction: Alcohol dependency is a chronic illness which generates uncertainty and other emotional problems among the relatives of persons who suffer alcoholism. Social support and spirituality are some coping mechanisms which could reduce uncertainty and favor the physical and psychological wellbeing. Objective: To determine the relationship and the effect of social support and spirituality on the uncertainty experienced by relatives of alcohol dependent persons. Methods: This is a descriptive and correlational study. The sample was constituted by 135 women members of Al-Anon. The Mishel Scale of Perception of Uncertainty among Parents and Family Members (PPUS-FM), the Sherbourne and Stewart Questionnaire, and the Reed Spiritual Perspective Scale were all used. Results: Significant negative correlation coefficients between uncertainty and social support (r s= -.356, p .05). and spirituality (r s= -.216, p .05). were identified. Using a univariate general linear regression model, it was determined that only social supports reduced uncertainty (β= -.280, t= -3.62, p= .001) with 11.5% of variance explained; while spirituality did not produce any effect (β = -.041, t= .218, p >.05). Conclusions: Social support is identified as a coping mechanism which can be used by nursing staff to develop interventions aimed at reducing uncertainty among relatives of alcohol dependent persons.

Resumo Introdução: A dependência do álcool, considerada como uma doença crónica, é um gatilho de incerteza para o familiar da pessoa com dependência, o qual gera transtornos emocionais negativos. O suporte social e a espiritualidade são mecanismos de enfrentamento que poderiam diminuir a incerteza e favorecer o bem-estar tanto físico, quanto psicológico. Objetivos: Determinar a relação e o efeito do suporte social e a espiritualidade sobre a incerteza do familiar da pessoa dependente de álcool. Métodos: Estudo descritivo e correlacional, amostra de 135 mulheres pertencentes aos grupos Al-Anon, utilizaram-se a Escala de Percepção de Incerteza em Pais e Membros da Família (PPUS-FM) de Mishel, o questionário MOS-SSS de Sherbourne e Stewart e a Escala de Perspectiva Espiritual elaborada por Reed. Resultados: Identificou-se um coeficiente de correlação negativo e significativo da incerteza com o apoio social (r s= -.356, p <.01) e a espiritualidade (r s= -.216, p <.05). Mediante um modelo de regressão linear geral univariado determinou-se que unicamente o apoio social influencia a diminuição da incerteza (β= -.280, t= -3.62, p= .001) com um coeficiente de determinação ou variância explicada do 11.5%, enquanto a espiritualidade não mostrou efeito (β= -.041, t= .218, p >.05) sobre a incerteza. Conclusões: O suporte social é identificado como um mecanismo de enfrentamento eficaz que permitirá ao pessoal de enfermagem desenvolver intervenções dirigidas a reduzir a incerteza em familiares de pessoas com algum tipo de dependência.

Colorimetric Analysis of Hibiscus Beverages and their Potential Antioxidant Properties.

In food industry, roselle beverages and their subproducts could be functional ingredients since they are an excellent source of bioactive compounds with improved performance due to their important anthocyanins content. The aim of this study was to analyze anthocyanin content and antioxidant properties of aqueous infusions elaborated with color contrasting Hibiscus materials and design a mathematical model in order to predict color-composition relationship. Color measurements of beverages from roselle (Negra, Sudan and Rosa) were made by transmission spectrophotometry, anthocyanins quantification was determined by HPLC, and antioxidant potential was evaluated by in vitro methods (ABTS and FRAP assays). Beverages prepared with particle size minor of 250 µm presented until 4- and 2- times more anthocyanins content and antioxidant capacity respectively, in comparison to beverages prepared with powders with particle size major of 750 µm. Positive correlations among pigments composition and color parameters were found (p < 0.05), showing that anthocyanins content, antioxidant capacity, C*ab and hab values increased in relation with the smallest particle size of flours. Also, mathematical models were stablished to predict anthocyanin content (r ≥ 0.97) and antioxidant capacity (r ≥ 0.89) from color data; we propose equations for quick estimation of the antioxidant capacity in the Hibiscus beverages with high anthocyanin content. The obtained models could be an important tool to be used in food industry for pigment characterization or functional compounds with potential health benefits.

[Analysis of the refusal of the flu vaccination (REGRIVI study)]. / Análisis de la renuncia a la vacunación antigripal (Estudio REGRIVI).

INTRODUCTION: The objective of this study is to determine the reasons for refusing the flu vaccination in the Primary Care Health Centre of Vilanova de Arousa, Spain, as well as to evaluate the flu vaccination coverage after an educational intervention. MATERIAL AND METHODS: A quasi-experimental before and after study was conducted after an educational intervention on a total of 73 people that included those Primary Care Health Centre patients from Vilanova de Arousa who had refused the flu vaccination in 2014, and who did not meet the exclusion criteria (death during 2014 and 2015 campaigns, non-acceptance of participation, vaccine registration mistakes, contraindication or no indication for the vaccine, inability to contact). After a brief educational intervention, vaccination data from those patients in the 2015 and 2016 campaigns were checked. A descriptive analysis of the variables under study was then carried out. Of the 73 patients initially included, 72 completed the study. RESULTS: The main reasons for refusing a vaccination were the concerns about the adverse effects and patient perception of good health. Vaccination coverage was 50.7% in 2015, and 48.6% in 2016. CONCLUSIONS: The reasons for refusing vaccination are approachable with a brief intervention since the refusal decreases by half in the long-term.

Bioelectrochemical treatment of table olive brine processing wastewater for biogas production and phenolic compounds removal.

Industry of table olives is widely distributed over the Mediterranean countries and generates large volumes of processing wastewaters (TOPWs). TOPWs contain high levels of organic matter, salt, and phenolic compounds that are recalcitrant to microbial degradation. This work aims to evaluate the potential of bioelectrochemical systems to simultaneously treat real TOPWs and recover energy. The experiments were performed in potentiostatically-controlled single-chamber systems fed with real TOPW and using a moderate halophilic consortium as biocatalyst. In conventional anaerobic digestion (AD) treatment, ie. where no potential was applied, no CH4 was produced. In comparison, Bio-Electrochemical Systems (BES) showed a maximum CH4 yield of 701 ± 13 NmL CH4·LTOPW(-1) under a current density of 7.1 ± 0.4 A m(-2) and with a coulombic efficiency of 30%. Interestingly, up to 80% of the phenolic compounds found in the raw TOPW (i.e. hydroxytyrosol and tyrosol) were removed. A new theoretical degradation pathway was proposed after identification of the metabolic by-products. Consistently, microbial community analysis at the anode revealed a clear and specific enrichment in anode-respiring bacteria (ARB) from the genera Desulfuromonas and Geoalkalibacter, supporting the key role of these electroactive microorganisms. As a conclusion, bioelectrochemical systems represent a promising bioprocess alternative for the treatment and energy recovery of recalcitrant TOPWs.

Activation of PPAR gamma receptors reduces levodopa-induced dyskinesias in 6-OHDA-lesioned rats.

Long-term administration of l-3,4-dihydroxyphenylalanine (levodopa), the mainstay treatment for Parkinson's disease (PD), is accompanied by fluctuations in its duration of action and motor complications (dyskinesia) that dramatically affect the quality of life of patients. Levodopa-induced dyskinesias (LID) can be modeled in rats with unilateral 6-OHDA lesions via chronic administration of levodopa, which causes increasingly severe axial, limb, and orofacial abnormal involuntary movements (AIMs) over time. In previous studies, we showed that the direct activation of CB1 cannabinoid receptors alleviated rat AIMs. Interestingly, elevation of the endocannabinoid anandamide by URB597 (URB), an inhibitor of endocannabinoid catabolism, produced an anti-dyskinetic response that was only partially mediated via CB1 receptors and required the concomitant blockade of transient receptor potential vanilloid type-1 (TRPV1) channels by capsazepine (CPZ) (Morgese et al., 2007). In this study, we showed that the stimulation of peroxisome proliferator-activated receptors (PPAR), a family of transcription factors activated by anandamide, contributes to the anti-dyskinetic effects of URB+CPZ, and that the direct activation of the PPARγ subtype by rosiglitazone (RGZ) alleviates levodopa-induced AIMs in 6-OHDA rats. AIM reduction was associated with an attenuation of levodopa-induced increase of dynorphin, zif-268, and of ERK phosphorylation in the denervated striatum. RGZ treatment did not decrease striatal levodopa and dopamine bioavailability, nor did it affect levodopa anti-parkinsonian activity. Collectively, these data indicate that PPARγ may represent a new pharmacological target for the treatment of LID.

Comparative study of anthocyanin and volatile compounds content of four varieties of Mexican roselle (Hibiscus sabdariffa L.) by multivariable analysis.

Anthocyanins are a group of water-soluble pigments that provide red, purple or blue color to the leaves, flowers, and fruits. In addition, benefits have been attributed to hypertension and cardiovascular diseases. This study compared the content of total anthocyanins and volatile compounds in aqueous and ethanolic extracts of four varieties of Mexican roselle, with different levels of pigmentation. The multivariable analysis of categorical data demonstrated that ethanol was the best solvent for the extraction of both anthocyanins and volatile compounds. The concentration of anthocyanin in pigmented varieties ranged from 17.3 to 32.2 mg of cyanidin 3-glucoside/g dry weight, while volatile compounds analysis showed that geraniol was the main compound in extracts from the four varieties. The principal component analysis (PCA) allowed description of results with 77.38% of variance establishing a clear grouping for each variety in addition to similarities among some of these varieties. These results were validated by the confusion matrix obtained in the classification by the factorial discriminate analysis (FDA); it can be useful for roselle varieties classification. Small differences in anthocyanin and volatile compounds content could be detected, and it may be of interest for the food industry in order to classify a new individual into one of several groups using different variables at once.

Pulmonary injury after combined exposures to low-dose low-LET radiation and fungal spores.

Exposure to infectious microbes is a likely confounder after a nuclear terrorism event. In combination with radiation, morbidity and mortality from an infection may increase significantly. Pulmonary damage after low-dose low-LET irradiation is characterized by an initial diffuse alveolar inflammation. By contrast, inhaled fungal spores produce localized damage around pulmonary bronchioles. In the present study, we assessed lung injury in C57BL/6 mice after combined exposures to whole-body X radiation and inhaled fungal spores. Either animals were exposed to Aspergillus spores and immediately irradiated with 2 Gy, or the inoculation and irradiation were separated by 8 weeks. Pulmonary injury was assessed at 24 and 48 h and 1, 2, 4, 8, and 24 weeks later using standard H&E-stained sections and compared with sham-treated age-matched controls. Immunohistochemistry for invasive inflammatory cells (macrophages, neutrophils and B and T lymphocytes) was performed. A semi-quantitative assessment of pulmonary injury was made using three distinct parameters: local infiltration of inflammatory cells, diffuse inflammation, and thickening and distortion of alveolar architecture. Radiation-induced changes in lung architecture were most evident during the first 2 weeks postexposure. Fungal changes were seen over the first 4 weeks. Simultaneous combined exposures significantly increased the duration of acute pulmonary damage up to 24 weeks (P < 0.01). In contrast, administration of the fungus 8 weeks after irradiation did not produce enhanced levels of acute pulmonary damage. These data imply that the inhalation of fungal spores at the time of a radiation exposure alters the susceptibility of the lungs to radiation-induced injury.

Efficacy of preoperative recombinant human erythropoietin administration for reducing transfusion requirements in patients undergoing surgery for hip fracture repair. An observational cohort study.

BACKGROUND: Preoperative anaemia is a major risk factor for allogeneic blood transfusion (ABT) in patients undergoing hip fracture repair. We investigated the efficacy of preoperative recombinant human erythropoietin (rHuEPO) administration for reducing ABT requirements in a series of consecutive hip fracture patients presenting with haemoglobin (Hb) between 10 g/dl and 13 g/dl. METHODS: The blood conservation protocol consisted of the application of a restrictive transfusion trigger (Hb < 8 g/dl) and the perioperative administration of intravenous iron sucrose (3 x 200 mg/48 h) (group 1, n = 115). Additionally, some patients received preoperative rHuEPO (40 000 IU sc) on admission to the orthopaedic ward (group 2, n = 81). RESULTS: Overall, 103 of 196 patients (52.5%) received at least one ABT unit (2.1 +/- 1.0 U/patient). However, there were significant differences in perioperative ABT rates between groups (60% vs. 42%, for groups 1 and 2, respectively; P = 0.013). Postoperative Hb on postoperative days 7 and 30 was higher in group 2 than in group 1. In addition, in group 2, Hb levels were higher on postoperative day 30 than on admission (12.7 +/- 1.0 g/dl vs. 11.9 +/- 0.8 g/dl, respectively; P = 0.030). Administration of rHuEPO did not increase postoperative complications or 30-day mortality rate. Only three mild intravenous iron adverse effects were witnessed. CONCLUSIONS: In anaemic hip fracture patients managed with perioperative intravenous iron and restrictive transfusion protocol, preoperative administration of rHuEPO is associated with reduced ABT requirements. However, appropriate training, education and awareness are needed to avoid protocol violations and to limit further exposure to ABT and ABT-related risks.

Philos plate fixation for proximal humeral fractures.

PURPOSE: To evaluate the efficacy of Philos plate fixation for proximal humerus fractures. METHODS: Functional outcomes of 31 men and 27 women aged 36 to 73 (mean, 61) years who underwent Philos plate fixation for proximal humeral fractures were retrospectively reviewed. Indications for surgery were 3-part (n=33) or 4-part (n=25) closed proximal humeral fractures with angulation of more than 45 degrees or displacement of more than 1 cm. Functional outcomes and shoulder range of movement were assessed based on the Constant scoring system. RESULTS: Patients were followed up for 12 to 18 (mean, 15) months. All fractures healed satisfactorily, except in one patient with a valgus 4-part fracture who had malunion. No wound infections, vascular injuries, avascular necrosis, or loss of fixation ensued. Two patients with axillary nerve palsy recovered spontaneously within 3 months. Functional outcome was excellent in 13 patients, good in 36, moderate in 8, and poor in 1. The mean Constant score was 80 (range, 40-100). CONCLUSION: The Philos plate fixation is appropriate treatment for proximal humeral fractures.

Fracturas del trapecio: clasificación, diagnóstico y tratamiento / Trapezial fractures: classification, diagnosis and treatment

Objetivo. Revisión de la etiología, clasificación, diagnóstico y tratamiento de las fracturas de trapecio.Material y método. Revisión bibliográfica y experiencia del autor.Conclusiones. Las fracturas del trapecio presentan una baja incidencia, por lo que su diagnóstico puede pasar desapercibido. El diagnóstico se basa en la exploración y estudio de imagen, con proyecciones radiológicas apropiadas (incluyendo la tomografía axial). El tratamiento puede ser ortopédico en las fracturas del cuerpo no estables con una incongruencia articular inferior a 1 mm; la excisión de fragmentosestaría indicada en aquellas fracturas parcelares delcuerpo y el tipo II de la cresta; la osteosíntesis se indicará en fracturas del cuerpo inestables, con una incongruencia articular mayor de 1 mm o una diastasis mayor de 2 mm. El resultado del tratamiento suele ser satisfactorio, mientras que si la fractura pasa desapercibida puede desembocar en secuelas como rizartrosis, pseudoartrosis dolorosa o tendinopatía

Purpose. To review the etiology, classification, diagnosis and treatment of trapezial fractures.Materials and methods. Review of the literature and ananalysis of the authors’ experience.Conclusions. Trapezial fractures have a low incidence andthey may even go undiagnosed. Diagnosis is based on anexamination of the patient and a series of imaging studies including a CT-scan. Treatment of not unstable trapezial body fractures with an articular incongruence of less than 1 mm may be treated conservately for comminuted trapezial body fractures or type II crest fractures fragment excision may be indicated; and osteosynthesis should be reserved for instable body fractures with incongruency higher than 1 mmor a gap wider than 2 mm. The result of treatment tends to be satisfactory. However, if the fracture goes undetected it can result in sequelae like rizarthrosis, painful nonunion or tendinopathy

Fracturas del trapecio: clasificación, diagnóstico y tratamiento / Trapezial fractures: classification, diagnosis and treatment

Objetivo. Revisión de la etiología, clasificación, diagnóstico y tratamiento de las fracturas de trapecio.Material y método. Revisión bibliográfica y experiencia del autor.Conclusiones. Las fracturas del trapecio presentan una baja incidencia, por lo que su diagnóstico puede pasar desapercibido. El diagnóstico se basa en la exploración y estudio de imagen, con proyecciones radiológicas apropiadas (incluyendo la tomografía axial). El tratamiento puede ser ortopédico en las fracturas del cuerpo no estables con una incongruencia articular inferior a 1 mm; la excisión de fragmentosestaría indicada en aquellas fracturas parcelares delcuerpo y el tipo II de la cresta; la osteosíntesis se indicará en fracturas del cuerpo inestables, con una incongruencia articular mayor de 1 mm o una diastasis mayor de 2 mm. El resultado del tratamiento suele ser satisfactorio, mientras que si la fractura pasa desapercibida puede desembocar ensecuelas como rizartrosis, pseudoartrosis dolorosa o tendinopatía

Purpose. To review the etiology, classification, diagnosis and treatment of trapezial fractures.Materials and methods. Review of the literature and ananalysis of the authors’ experience.Conclusions. Trapezial fractures have a low incidence andthey may even go undiagnosed. Diagnosis is based on anexamination of the patient and a series of imaging studies including a CT-scan. Treatment of not unstable trapezial body fractures with an articular incongruence of less than 1 mm may be treated conservately for comminuted trapezial body fractures or type II crest fractures fragment excision may be indicated; and osteosynthesis should be reserved for instable body fractures with incongruency higher than 1 mmor a gap wider than 2 mm. The result of treatment tends to be satisfactory. However, if the fracture goes undetected it can result in sequelae like rizarthrosis, painful nonunion or tendinopathy

Paciente con hipertensión arterial y tumor renal / Patient with arterial hypertension and renal tumor

Los tumores renales son causantes de hipertensión arterial en un bajo porcentaje de casos. El más frecuentemente implicado es el feocromocitoma, aunque están descritos otros tumores. Uno de ellos es el hipernefroma, caso que a continuación se describe y que además utilizamos como ejemplo de cronoterapia

Renal tumors cause arterial hypertension in a low percentage of cases. The most frequently involved is pheochromocytoma, although other tumors are described. One of them is hypernephroma, a case is described in the following and is also used as an example of chronotherapy

Perioperative stimulation of erythropoiesis with intravenous iron and erythropoietin reduces transfusion requirements in patients with hip fracture. A prospective observational study.

BACKGROUND AND OBJECTIVES: Patients undergoing surgery for hip fracture (HF) often receive perioperative allogeneic blood transfusions (ABT) to avoid anaemia. However, concerns about the adverse effects of ABT have prompted the review of transfusion practice and the search for a safer treatment of perioperative anaemia. MATERIALS AND METHODS: We prospectively investigated the effect of a blood-saving protocol of perioperative iron sucrose (3 x 200 mg/48 h, intravenously) plus erythropoietin (1 x 40,000 IU, subcutaneously) if admission haemoglobin level < 130 g/l, on transfusion requirements and postoperative morbid-mortality in patients with HF (group 2; n= 83). A parallel series of 41 HF patients admitted to another surgical unit within the same hospital served as the control group (group 1). Perioperative blood samples were taken for haematimetric, iron metabolism and inflammatory parameter determination. RESULTS: This blood-saving protocol reduced the number of transfused patients (P < 0.001), the number of transfused units (P < 0.0001), increased the reticulocyte count and improved iron metabolism. In addition, the blood-saving protocol also reduced the rate of postoperative infections (P = 0.016), but not the 30-day mortality rate or the mean length of hospital stay. CONCLUSIONS: The blood-saving protocol implemented seems to reduce ABT requirements in patients with HF, and is associated with a lower postoperative morbidity. The possible mechanisms involved in these effects are discussed.

[Preoperative blood test results and type of fracture as transfusional risk factors in patients older than 65 years with trochanteric hip fracture]. / Valores hematimétricos preoperatorios y tipo de fractura como factores de riesgo transfusional en fracturas trocantéreas de cadera en pacientes mayores de 65 años.

OBJECTIVE: To determine the effect of risk factors for allogenic blood transfusion in surgery for trochanteric hip fractures. PATIENTS AND METHODS: A retrospective study of all the trochanteric hip fracture patients older than 65 years who underwent surgery to repair trochanteric hip fracture related to osteoporosis in 2000 and 2001 in a regional hospital. Data recorded were age; gender; type of fracture (international AO classification); level of anesthetic risk (ASA classification); hemoglobin concentration and hematocrit upon admission, on the day of surgery and 2 days later; time elapsing between admission and surgery; blood transfusion and blood product use. RESULTS: One hundred two patients (29 men and 73 women) with trochanteric hip fractures were studied. Mean (+/- SD) patient age was 82.9 +/- 8.8 years (range, 65-99 years). Upon admission, mean hemoglobin was 123 +/- 18.1 g/L (range, 56-154 g/L), hematocrit was 37% +/- 5% (range, 10%-40%). Time elapsing until surgery was 3.5 +/- 1.6 days (range, 0-8 days). Admission hemoglobin concentration was lower in patients who required transfusion (116 g/L) than in patients who did not (133 g/L) (P < 0.001). Logistical regression analysis identified only AO classification of fracture type (P < 0.05) and admission hemoglobin concentration (P < 0.001) as independent risk factors for transfusion. CONCLUSIONS: The hemoglobin level at admission and the trochanteric fracture type bear a relation to transfusion needs. These results suggest that in elderly patients we should improve hemoglobin levels and initiate blood salvage measures in order to reduce the need for allogenic blood transfusion, with its inherent risks.

Marchetti nailing of closed fresh humeral shaft fractures.

INTRODUCTION: The purpose of this study was to analyse the results of Marchetti nailing. METHOD: Between 1995 and 2003, 143 patients with closed fresh humeral shaft fractures were treated with the Marchetti-Vicenzi nail. The fractures were classified according to the AO classification: 37 A1, 24 A2, 25 A3, 22 B1, 15 B2, 7 B3, 7 C1, 4 C2 and 2 C3. RESULTS: Fracture healing was obtained in 136 cases. The mean healing time was 11 weeks. There were seven non-unions. The range of motion of the shoulder was excellent in 95 patients (66.4%), moderate in 43 (30%) and poor in five (4.2%). The elbow had an excellent range of motion in 89 patients (62.2%), moderate in 48 (33.5%) and poor in six (4.2%). The functional result was excellent in 56 patients (39.1%), good in 62 (43.3%), fair in 18 (12.6%) and poor in seven (4.9%). CONCLUSION: Marchetti-Vicenzi nailing appears to be a good method for the treatment of humeral shaft fractures. It is technically easy and its results are satisfactory.

The incidence of distal forearm fractures in Zaragoza (Spain).

We present the results of a retrospective study of the epidemiology of distal forearm fractures in patients over 15 years of age in Zaragoza (Spain) during 1998-1999. We analysed a total of 2506 fractures of the distal forearm. Fractures were classified according to age, sex, Frykman classification and mechanism of injury. Fractures were Frykman type III in 23.5% of cases, Frykman II in 17.9%, Frykman IV in 14.5% and Frykman I in 12.8%. The rest of fractures were distributed homogeneously between the remaining fracture types. The mechanisms of injury was low energy in 78.2% of cases and high in 21.8%. Analysis of the age distribution showed an increase in the incidence of this type of fracture over 50 years of age, with a peak between 60 and 69 years as a result of accidental falls. We found an increased incidence in males below 49 years of age, as a result of traffic accidents, and a predominance of females over 50 years of age due to osteoporosis and an increased number of falls.

Marchetti-Vicenzi nailing of humeral shaft fractures.

Between 1995 and 1999, 46 acute nonpathological humeral shaft fractures were treated with retrograde Marchetti-Vicenzi humeral nailing. The mean healing time of all fractures was 10.8 weeks. Forty-five fractures (97.9%) united primarily, and one needed bone grafting (2.1%). Function of the shoulder was excellent in 35 patients (76.1%) and moderate in 11 (23.9%). Elbow function was also excellent in 35 patients and moderate in 11. Global functional results were excellent in 16 patients (34.8%), good in 22 (47.8%) and fair in 8 (17.4%). There were 4 cases of 10 degrees varus malunion (8.6%), one case of 15 degrees varus malunion (2.1%), and one case of 15 degrees anterior angulation malunion (2.1%). These malunions were clinically well tolerated. Four patients required removal of the nail because of posterior elbow pain. Retrograde Marchetti-Vicenzi nailing is an acceptable alternative for the treatment of acute humeral shaft fractures with a low complication rate.