Inflammatory bowel disease: Are there gender differences in the genetics of signal transduction? A preliminary study of cytosolic low molecular weight protein tyrosine phosphatase.

The phenotype of cytosolic Low Molecular Weight Protein Tyrosine Phosphatase (cLMWPTP or ACP1), an enzyme involved in signal transduction of insulin, PDGF and T-cell receptors, has been determined in 71 patients with Crohn's Disease (CD: 37 males and 34 females), 49 patients with Ulcerative Colitis (UC: 27 males and 22 females) and 358 consecutive newborns (194 males and 164 females). cLMWPTP phenotypes showing a high concentration of F isoforms are associated with CD in females and with UC in males. Since PTPases counteract the effects of protein tyrosines kinases, a high concentration of F isoform of cLMWPTP may influence the mucosal response to pathogenic factors, increasing susceptibility to CD in females and to UC in males.

Surgical correction of vertebral axial rotation in adolescent idiopathic scoliosis: prediction by lateral bending films.

The pre- and postoperative radiographs of 45 patients with scoliosis were compared with the preoperative lateral bending radiographs. The purpose was to compare correction of Cobb angle and apical vertebral rotation between preoperative lateral bending and operative spinal instrumentation. Twenty-one patients had Harrington instrumentation, 12 had Drummond/Wisconsin spinous process segmental instrumentation, and 12 had Texas Scottish Rite Hospital instrumentation. From the pre- and postoperative radiographs, each vertebra was marked and digitized for computerized measurements of Cobb angle and apical vertebral rotation. Correction of Cobb angle on the lateral bending radiograph averaged 22 +/- 10 degrees, which was less than that achieved at operation (Harrington 23 +/- 7 degrees, Drummond/Wisconsin 29 +/- 10 degrees, and Texas Scottish Rite Hospital 36 +/- 6 degrees; p < 0.01, paired t test). In contrast, correction of apical vertebral rotation on the lateral bending radiograph averaged 4 +/- 8 degrees, which was not significantly different from that achieved at operation (Harrington 1 +/- 8 degrees, Drummond/Wisconsin 1 +/- 7 degrees, and Texas Scottish Rite Hospital 4 +/- 8 degrees). Spinal instrumentation markedly corrected the Cobb angle but minimally corrected apical vertebral rotation. In contrast, preoperative lateral bending produced a similar proportional correction of both.

Changes in shape of the adolescent idiopathic scoliosis curve after surgical correction.

STUDY DESIGN: The effect of spinal instrumentation in idiopathic scoliosis was studied in 21 patients who had Harrington instrumentation and 15 who had Wisconsin-Drummond instrumentation. OBJECTIVE: Radiographs were analyzed to determine if the frontal and transverse plane shape of the scoliosis curve was changed by surgery, with and without segmental fixation. SUMMARY OF BACKGROUND DATA: Previous reports were based on frontal plane measurements of the curve (Cobb angle). The study reports correction in the frontal plane (Cobb angle) and transverse plane (apical vertebral rotation), as well as the regional distribution of the correction. METHODS: Radiographs before surgery, soon after, and between 5 and 48 months after surgery were marked and digitized to measure the regional distribution of the frontal plane shape and transverse plane vertebral rotation. RESULTS: Despite improvement in the magnitude of the deformity, the scoliosis curve shape remained almost constant postoperatively. There was minimal correction of the apical vertebra axial rotation in either group. CONCLUSION: This study documents that although the Harrington and Wisconsin-Drummond instrumentation systems decrease the Cobb angle, they do not change the shape of the curve or correct apical vertebra axial rotation. Newer instrumentation designs need to look beyond the Cobb angle as the only measure of outcome.

Comparison of curve shape between children with cerebral palsy, Friedreich's ataxia, and adolescent idiopathic scoliosis.

Fourteen patients with cerebral palsy (CP), 12 with Friedreich's ataxia (FA) and 26 with adolescent idiopathic scoliosis (AIS) were studied to determine whether the shape of the scoliosis curve differs between these categories. The slope of the regression relationship between vertebral rotation and lateral deviation was greater for the CP group compared with the FA and AIS groups. The authors conclude that the scoliosis curve pattern of children with Friedreich's ataxia and adolescent idiopathic scoliosis is similar. In contrast, the scoliosis curve of children with CP was distinctly different, with more rotation of the apical vertebrae into the convexity of the scoliosis curve (transverse plane deformity) in relation to the amount of lateral deviation of the apical vertebrae from the spinal axis (coronal plane deformity).

Penetration of piperacillin-tazobactam into cancellous and cortical bone tissues.

The penetration characteristics of piperacillin-tazobactam into cortical and cancellous bone tissues were investigated in 10 patients undergoing total hip replacement. The concentration ratios of piperacillin/tazobactam were 9.4 +/- 1.8 in cancellous bone tissue and 8.0 +/- 2.2 in cortical bone tissue, which were close to the 8:1 ratio of drugs administered. The mean ratios of drug concentrations in bone and plasma for cancellous and cortical tissue were 23 and 18%, respectively, for piperacillin and 26 and 22%, respectively, for tazobactam. The concentrations of tazobactam achieved are sufficient to exert anti-beta-lactamase activity and supportive of clinical trials involving bone and joint infections, including those caused by beta-lactamase-producing pathogens.

Tibial plateau coverage in total knee arthroplasty.

Optimizing coverage of the resected tibial plateau is an important consideration in total knee arthroplasty. The tibial coverage of eight different tibial tray designs was examined in 35 resected tibial specimens. When no component overlap was permitted, the average tibial coverage of the different designs ranged from 76.4% to 80.8%. When the component was allowed slight overlap, a "surgical fit," the average coverage ranged from 78.5% to 85.5%. As a group, the six symmetric designs provided more coverage than the two asymmetric designs (p < 0.05). Areas of poor coverage were identified, and different tray geometries were compared. Asymmetric tibial components are thought to be more anatomic in nature and therefore cover the tibial plateau surface more completely than symmetric components. The results of this study do not support this, and in fact demonstrate that symmetric components can provide more coverage when compared with two asymmetric component designs.

Reexamination of the Cobb and Ferguson angles: bigger is not always better.

In scoliosis, the Cobb measure of curve severity has been recommended over the Ferguson method because it had greater magnitude and appeared more sensitive to changes during progression and after treatment. This study made comparisons between the Cobb and Ferguson measures in radiographs of patients with idiopathic scoliosis to test whether the methods were really different, and to compare their precision. In 138 observations of 77 untreated patients there was a very high correlation (R2 = 0.98) between Cobb and Ferguson angle, with Cobb angle averaging 1.35 times greater. For sequential measures (mean interval 10 months), the percent changes agreed closely (R2 = 0.5). The relationship between Cobb and Ferguson angles remained the same in measurements of 24 patients wearing a brace compared with the unbraced condition and in 18 patients measured before and after Harrington rod surgery. Repeated measurements were made by three observers with the apex and end vertebrae pre-marked and held constant. For Cobb angle, the greatest range of measurements on any film was 8 degrees (pooled SD = 1.3 degrees). For Ferguson angle the greatest range was also 8 degrees (pooled SD = 1.8 degrees). Ferguson angle was slightly more sensitive to incorrect selection of end vertebrae. It was concluded that both methods can be useful for measuring curve magnitude. Ferguson angle should be measured and then adjusted by multiplying it by 1.35 in situations where Cobb angle measurement is technically difficult or invalid. Ferguson angle is better suited to automated measurement.

[Intensive care in gastroenterology. 1st experiences and verification]. / Terapia intensiva in gastroenterologia. Prime esperienze e verifiche.

The history of intensive care in gastroenterology is briefly discussed. The insertion of intensive care units in the hospital scene is also examined and illustrative examples of emergency cases treated in recent years at the Rome United Hospitals gastroenterology division are presented. It is felt that centres tailored to hospital dimensions should be formed, though their cost is likely to prove a bar to their early institution. Intensive care can, it is urged, be furnished by specialist departments, provided they manage to find a new dimension in keeping with the more difficult tasks involved.