MIS Distal Metatarsal Metaphyseal Osteotomy in the treatment of metatarsalgia: MOXFQ patient reported outcomes.

INTRODUCTION: The aim of this paper is to present validated patient reported outcomes for MIS Distal Metatarsal Metaphyseal Osteotomy (DMMO) in the treatment of metatarsalgia. The study aims to evaluate the DMMO procedure, report patient satisfaction with the operated foot and report any complications of this procedure. PATIENTS AND METHODS: Between 2014 and 2016, patients who had failed conservative treatment for metatarsalgia were identified in the orthopaedic outpatient clinic. Twenty four consecutive patients requiring DMMO plus/minus toe straightening were prospectively studied. Patients requiring additional procedures at the time of surgery were excluded. Patients completed the validated Manchester-Oxford Foot Questionnaire (MOXFQ) three weeks pre-operatively and 1 year postoperatively. The MOXFQ results were analysed using Paired t-tests. A supplementary question was asked regarding patient satisfaction with the operated foot. RESULTS: There were 20 women and 4 men with a mean age of 64 years (sd 8.6). Statistically significant differences were found between the pre and postoperative MOXFQ. The postoperative MOXFQ score demonstrated a poorer result for two patients, no change for two patients and improvement in 20 patients, with four of these patients recording the lowest possible score. There was a 29.5 point improvement in mean metric MOXFQ Index score. Seventy-nine percent (n = 19) of patients were satisfied or very satisfied with the operated foot. The average recoil of the metatarsal heads following DMMO was M2 4.01 mm, M3 4.55 mm, M4 4.16 mm. There was one delayed union and no non-unions. Further reported complications were a gastric bleed, pulmonary embolism (VTE), and one intra operative broken burr. CONCLUSION: Our study demonstrates a clinically important and statistically significant improvement in patient reported outcomes following DMMO, with 79% of patients satisfied or very satisfied with this procedure. The average recoil of the metatarsal heads following DMMO was M2 4.01 mm, M3 4.55 mm, M4 4.16 mm with one delayed union and no non-unions.

Outcomes following excision of Morton's interdigital neuroma: a prospective study.

AIMS: This is the first prospective study to report the pre- and post-operative patient reported outcomes and satisfaction scores following excision of interdigital Morton's neuroma. PATIENTS AND METHODS: Between May 2006 and April 2013, we prospectively studied 99 consecutive patients (111 feet) who were to undergo excision of a Morton's neuroma. There were 78 women and 21 men with a mean age at the time of surgery of 56 years (22 to 78). Patients completed the Manchester-Oxford Foot Questionnaire (MOXFQ), Short Form-12 (SF-12) and a supplementary patient satisfaction survey three months pre-operatively and six months post-operatively. RESULTS: Statistically significant differences were found between the mean pre- and post-operative MOXFQ and the physical component of the SF-12 scores (p = 0.00081 and p = 0.00092 respectively). Most patients reported their overall satisfaction as excellent (n = 49, 49.5%) or good (n = 29, 29.3%), but ten patients were dissatisfied, reporting poor (n = 8, 8.1%) or very poor (n = 2, 2.0%) results. Only 63 patients (63%) were pain-free at follow-up: in eight patients (8.1%), the MOXFQ score worsened. There was no statistically significant difference in outcome between surgery on single or multiple sites. However, the MOXFQ scores were significantly worse after revision surgery (p = 0.004). CONCLUSIONS: The patient-reported outcomes after resection of a symptomatic Morton's neuroma are acceptable but may not be as good as earlier studies suggest. Surgery at several sites can be undertaken safely but caution should be exercised when considering revision surgery. Cite this article: Bone Joint J 2016;98-B:1376-81.

Metallic hemiarthroplasty for the treatment of end-stage hallux rigidus: mid-term implant survival, functional outcome and cost analysis.

AIMS: To examine the mid-term outcome and cost utility of the BioPro metallic hemiarthroplasty for the treatment of hallux rigidius. PATIENTS AND METHODS: We reviewed 97 consecutive BioPro metallic hemiarthroplasties performed in 80 patients for end-stage hallux rigidus, with a minimum follow-up of five years. There were 19 men and 61 women; their mean age was 55 years (22 to 74). No patient was lost to follow-up. RESULTS: A total of 12 patients (15 first metatarso-phalangeal joints (MTPJs)) required a revision; one for infection, two for osteolysis and 12 for pain. The all cause rate of survival at five years was 85.6% (95% confidence interval (CI) 83.5 to 87.9). Younger age was a significant predictor of revision (odds ratio 1.09, 95% CI 1.02 to 1.17, p = 0.014) on excluding infection and adjusting for confounding variables (Cox regression). Significant improvements were demonstrated at five years in the Manchester Oxford Foot Questionnaire (13.9, 95% CI 10.5 to 17.2) and in the physical component of the Short Form-12 score (6.5, 95% CI 4.1 to 8.9). The overall rate of satisfaction was 75%. The cost per quality adjusted life year at five years, accounting for a 14% rate of revision was between £4431 and £6361 depending on the complexity and morbidity of the patient. CONCLUSION: The BioPro hemiarthroplasty offers good short to mid-term functional outcome and is a cost effective intervention. The relatively high revision rate is associated with younger age and perhaps the use of this implant should be limited to older patients. Cite this article: Bone Joint J 2016;98-B:945-51.

Effect of immune-enhancing diets on the outcomes of patients after major burns.

The use of immune-enhancing diets (IEDs) has been shown to be beneficial in some categories of critically ill patients. This study aimed to evaluate the effect of early enteral feeding supplemented with glutamine and omega-3 fatty acids, as immune-enhancing diets, on the outcomes of patients after major burns. Forty thermally injured adult patients with 30-50% total body surface area (TBSA) burns, including deep areas ranging from 5-20%, were randomized into a prospective, double-blind, controlled clinical trial. They were placed into two equal groups: group A (IED group), in which patients received early enteral feeding supplemented with glutamine and omega-3 fatty acids as immune-enhancing diets; and group B (control group), in which patients received early enteral feeding not supplemented with immune-enhancing diets. Laboratory assessment of serum albumin, serum C-reactive protein, total lymphocytic count and serum immunoglobulins (IgA, IgG and IgM) was performed at admission, and on days 4, 7 and 14. Finally, outcomes were assessed by monitoring the survival rate, the length of hospital stay and the incidence of infection. There were no significant differences between the IED and control group regarding age (28.7±5.32 versus 29.85±5.94), sex, weight, %TBSA (37.75±4.4 versus 38.3±4.84) and %burn depth (11.7±2.36 versus 10.7±2.036). The incidence of infection (2 versus 8) and the length of hospital stay (16.3±0.92 days versus 17.95±2.96 days) were decreased significantly in the IED group versus the control group. There was no significant difference between the survival rates in both groups as there was only one death in the control group. Thanks to IEDs, patient outcome was improved and infectious morbidity and length of hospital stay were reduced, but there was no effect on the survival rates following major burns.

L'utilisation de régimes qui stimulent le système immunitaire a été montrée à être bénéfique dans certaines catégories de patients gravement malades. Cette étude sur les patients atteints de grands brûlés visait à évaluer l'effet de l'alimentation entérale précoce complétée par la glutamine et les acides gras oméga-3 pour stimuler le système immunitaire. Quarante patients adultes thermiquement blessés avec 30-50% de la surface corporelle totale (SCT) brûlée, y compris les zones profondes allant de 5 à 20%, ont été randomisés dans une étude prospective et clinique contrôlée, en double aveugle. Ils ont été placés en deux groupes égaux: le groupe A, dans lequel les patients ont reçu une alimentation entérale précoce complété avec de la glutamine et acides gras oméga- 3 pour stimuler le système immunitaire; et le groupe B (groupe de contrôle), dans lequel les patients ont reçu une alimentation entérale précoce sans la régime pour stimuler le système immunitaire. L'évaluation en laboratoire de la sérum-albumine, sérum protéine C-réactive, la numération lymphocytaire totale et les immunoglobulines sériques (IgA, IgG et IgM) a été réalisée à l'admission et aux jours 4, 7 et 14 après l'admission. Enfin, les résultats ont été évalués en surveillant le taux de survie, la durée du séjour à l'hôpital et l'incidence de l'infection. Il n'y avait pas de différence significative entre le groupe A et le groupe de contrôle relative à l'âge (28,7 ± 5,32 contre 29,85 ± 5,94), le sexe, le poids, le % de la SCT (37,75 ± 4,4 contre 38,3 ± 4,84) et la profondeur de la brûlure (11,7 ± 2,36 ± contre 10.7 2.036). L'incidence de l'infection (2 contre 8) et la durée du séjour à l'hôpital (16,3 ± 0,92 jours contre 17,95 ± 2,96 jours) ont diminué significativement dans le groupe A par rapport au groupe de contrôle. Il n'y avait pas de différence significative entre les taux de survie des deux groupes car il y avait seulement une mort dans le groupe de contrôle. Il y avait une amélioration dans les résultats des patients, et une réduction de la morbidité infectieuse et la durée du séjour à l'hôpital, mais aucun effet sur les taux de survie après des brûlures importantes.

In vitro effect of Nigella sativa oil on adult Toxocara vitulorum.

Since the integrity of Toxocara vitulorum cuticle is essential for the nutritive and protective functions, light and scanning electron microscopic studies were undertaken to assess, for the first time, whether the Nigella sativa oil (NSO) had any effect on the cuticle of adult T. vitulorum following incubation in vitro. Differences in response to NSO action were observed, depending on the used concentration. After 24 h incubation with 0.5 mg mL(-1) NSO, the cuticle of the anterior end of worms appeared to be slightly more swollen than normal. This swelling became pronounced and so severe, with lips showed wrinkled cuticular surface and deformed sensory papillae on increasing the concentration to 1.0 mg mL(-1). With the higher concentration of 1.5 mg mL(-1), extensive and severe disorganization of the cuticle and body musculature was observed. Structural alterations in the cuticle as observed in the present investigation were thus, clear indication of nematocidal activity of NSO that could offer a suitable and cheaper alternative for the more expensive anthelmintics.

Identification of mealybug pest species (Hemiptera: Pseudococcidae) in Egypt and France, using a DNA barcoding approach.

Pseudococcidae (mealybugs) is a large taxonomic group, including a number of agronomic pests. Taxonomic identification of mealybug species is a recurrent problem and represents a major barrier to the establishment of adequate pest management strategies. We combined molecular analysis of three DNA markers (28S-D2, cytochrome oxidase I and internal transcribed spacer 2) with morphological examination, for the identification of 176 specimens collected from 40 mealybug populations infesting various crops and ornamental plants in Egypt and France. This combination of DNA and morphological analyses led to the identification of 17 species: seven in Egypt (Planococcus citri (Risso), Planococcus ficus (Signoret), Maconellicoccus hirsutus (Green), Ferrisia virgata (Cockerell), Phenacoccus solenopsis Tinsley, Phenacoccus parvus Morrison and Saccharicoccus sacchari (Cockerell)) and 11 in France (Planococcus citri, Pseudococcus viburni Signoret, Pseudococcus longispinus (Targioni-Tozzetti), Pseudococcus comstocki (Kuwana), Rhizoecus amorphophalli Betrem, Trionymus bambusae (Green), Balanococcus diminutus (Leonardi), Phenacoccus madeirensis Green, Planococcus vovae (Nasonov), Dysmicoccus brevipes (Cockerell) and Phenacoccus aceris Signoret), Pl. citri being found in both countries. We also found genetic variation between populations considered to belong to the same species, justifying further investigation of the possible occurrence of complexes of cryptic taxa.

Effects of Mirazid(®) and myrrh volatile oil on adult Fasciola gigantica under laboratory conditions.

OBJECTIVE: To evaluate the effects of Mirazid(®) and myrrh volatile oil on adult Fasciola gigantica (F. gigantica ) under laboratory conditions. METHODS: The effects of oleoresin extract of myrrh (Mirazid(®)) and myrrh volatile oil on the surface morphology of adult F. gigantica following treatment in vitro had been determined by scanning electron microscopy. The results were compared with those observed in the fluke tegument following incubation in triclabendazole sulphoxide (TCBZ-SO), active form, (Fasinex(®), Ciba-Geigy). RESULTS: Observations of the efficacy of Mirazid(®) oleoresin extract and myrrh volatile oil indicated that both products showed dose-dependent anthelmintic efficacy. The anterior half of the fluke was consistently more severely affected than the posterior half. The surface changes induced by Mirazid(®) oleoresin extract were less severe than those observed after exposure to either myrrh volatile oil or TCBZ-SO. Flukes showed swelling after these treatments, but its level and blebbing were much greater with myrrh volatile oil; in which patches of tegumental sloughing were observed in the apical cone and the posterior mid-body region of flukes. This was not observed after treatment with Mirazid(®) oleoresin extract. CONCLUSIONS: The comparatively more disruption, observed in myrrh volatile oil exposed specimens, compared to that exposed to Mirazid(®) oleoresin extract might suggest that the anthelmintic activity of Mirazid(®) oleo resin extract was attributed to its content of volatile oil. So, increasing the concentration of myrrh volatile oil in Mirazid(®) might possibly help to developing its anthelmintic activity.

The role of dogs in transmission of Ascaris lumbricoides for humans.

The dog's role as a definitive host for a number of zoonotic parasites has been widely studied and recognized as being a significant public health problem worldwide. This study aimed to report, for the first time, our investigation into the role of dogs as a biological transmitter for Ascaris lumbricoides, via necropsy of a sample of rural stray dogs in a developing community in Giza governorate, Egypt, where promiscuous defecation by human was common, and examination for A. lumbricoides worms as well as other ascaridiod nematodes of dogs. The recovered worms were identified in the laboratory after observing cephalic alae and egg morphology under a microscope, as well as scanning electron microscopy of their anterior ends. Of the 25 dogs examined, 14 were infected with Toxocara canis (56.0%), two with Toxascaris leonina (8.0%), and two with A. lumbricoides (8.0%). One dog was co-infected with T. canis and T. leonina. A. lumbricoides eggs were shown to be viable and 75-80% of eggs embryonated following 3 weeks of incubation at 28 degrees C. The present study suggested that dogs could act as reservoir hosts of A. lumbricoides and environmental contaminators that increase risk of infection in humans.

Tegumental surface changes in adult Paramphistomum microbothrium (Fischoeder 1901) following in vitro administration of artemether.

The treatment of paramphistomiasis, a neglected tropical disease, has been carried out with different fasciolicidal compounds, all showing weak efficacy. Therefore, the search for alternative paramphistomicidal drugs is warranted. In the present study, the in vitro effects of artemether on adult Paramphistomum microbothrium were evaluated, for the first time, using scanning electron microscopy. After 24 h of incubation with 10 microg ml(-1) artemether, tegumental damage of both anterior and posterior ends of the fluke had occurred in the majority of the specimens examined. Sensory papillae surrounding the oral aperture were ruptured, while those at the acetabular region appeared to be sunken due to tegumental swelling. The tegumental disruption became more pronounced and both oral sucker and acetabulum were severely distorted, on increasing the concentration to 20 microg ml(-1). With higher concentration of 30 microg ml(-1), gross swellings of the body of the fluke, clearly visible to the naked eye, were observed, and damage to both oral sucker and acetabulum was so extreme that little recognizable structure remained.

Femoral lengthening with the Intramedullary Skeletal Kinetic Distractor.

Femoral lengthening using the Intramedullary Skeletal Kinetic Distractor is a new technique. However, with intramedullary distraction the surgeon has less control over the lengthening process. Therefore, 33 femora lengthened with this device were assessed to evaluate the effect of operative variables under the surgeon's control on the course of lengthening. The desired lengthening was achieved in 32 of 33 limbs. Problems encountered included difficulty in achieving length in eight femora (24%) and uncontrolled lengthening in seven (21%). Uncontrolled lengthening was more likely if the osteotomy was placed with less than 80 mm of the thick portion of the nail in the distal fragment (p = 0.052), and a failure to lengthen was more likely if there was over 125 mm in the distal fragment (p = 0.008). The latter problem was reduced with over-reaming by 2.5 mm to 3 mm. Previous intramedullary nailing also predisposed to uncontrolled lengthening (p = 0.042), and these patients required less reaming. Using the Intramedullary Skeletal Kinetic Distractor, good outcomes were obtained; problems were minimised by optimising the position of the osteotomy and the amount of over-reaming performed.

Relationship between endotracheal tube leakage and under-reading of tidal volume in neonatal ventilators.

AIM: Protective ventilation in neonates requires careful volume monitoring to prevent ventilator-induced lung injury caused by baro/volutrauma and hence chronic lung disease. This study investigated the effect of endotracheal tube (ET) leakage on the displayed tidal volume using an in vitro model. METHODS: A neonatal lung model was ventilated via a 3 mm ET using three ventilators [Babylog 8000 (BL), Leoni (LE) and Stephanie (ST)]. Tidal volume was measured by each ventilator at the Y-piece and by a pneumotach (CO(2)SMO(+)) in the model. ET leaks were simulated by open tubes of different lengths. PIP (20 cmH(2)O) and PEEP (5 cmH(2)O) were kept constant, and the respiratory rate (RR) was varied between 20/min and 70/min (Ti:Te = 1:1). RESULTS: Tidal volume displayed by a ventilator decreased independently of RR with increasing leakage up to 21% (BL), 30% (LE) and 33% (ST). However, the volume delivered to the lung was nearly constant. The displayed leakage varied between 0 and 78% and was dependent on RR and leakage resistance. There were distinct differences between the three ventilators in the relationship between displayed leakage and volume error. Accepting a volume error <10% for RR between 20 and 70/min, ET leakage of up to 20% for BL, 12% for LE, but only <5% for ST, was acceptable. CONCLUSION: Tidal volume underestimation arising from ET leakage depends on ventilator pressures, timing parameters and ventilator-specific algorithms for signal processing. Therefore, neonatologists should be aware of these issues to prevent lung over-inflation when adjusting target volume in the presence of ET leakage.

Comparative in vitro effect of artemether and albendazole on adult Toxocara canis.

Since the integrity of Toxocara canis cuticle is essential for the nutritive and protective functions, light and scanning electron microscopic studies were undertaken to assess, for the first time, whether artemether had any effect on the cuticle including lips and sensory organs following 24 and 48 h incubation in vitro. The results were compared with those observed in the worm cuticle following incubation in albendazole, as it was 100% effective against adult nematode. The body cover changes seen after in vitro administration of artemether were similar to that induced by albendazole sulfoxide, active form, (ABZ-SO). However, the earlier onset of those changes was recorded with the former. The swollen appearance of the anterior end of T. canis, including the lips, distortion of some sensory papillae, and appearance of a number of lesions on the lips, were observed during in vitro action of artemether. Cuticular disruption had also been observed in adult T canis exposed to ABZ-SO. The surface changes were more severe than those observed following incubation in artemether, with which limited loss of the cuticle occurred in the lips of nematode but was not as widespread as that seen with ABZ-SO. However, the cuticular swelling of the anterior end of T canis was more pronounced than that with ABZ-SO. In the present study, artemether presented itself as a drug that might become important in nematode chemotherapy, besides its broad spectrum of activity against various trematodes.

Microcurrent skin patches for postoperative pain control in total knee arthroplasty: a pilot study.

Pain control following painful orthopaedic procedures such as total knee arthroplasty (TKA) is an ongoing challenge, as current pain management techniques often result in under-medication and/or complications. In a study designed to test the effect of the micro-current skin patch (MCT) on pain relief in patients following TKA, we followed 24 patients, randomly divided into two groups, one group receiving MCT plus tramadol hydrochloride (tramadol) for pain relief and a control group receiving only tramadol, for 10 days postoperatively. Tramadol was given intramuscularly in increment doses of 100 mg, as needed, for the duration of the study period. Pain was assessed daily using a visual analogue score (VAS). Other parameters, including the effect of MCT on the dose of tramadol needed for pain relief, the degree of wound healing measured at the end of the follow-up period, category of the wound 10 days postoperatively (1, 2 or 3) and total drain fluid volume, were also assessed. During the 10-day postoperative period there was a progressive decrease in pain in patients of both groups, however the patients of the MCT group showed a consistently lower VAS throughout the observation period, most markedly on those follow-up days with the highest pain scores in patients of the control group. This effect was monitored on the basis of the average dose of tramadol administered per day: 200.0+/-7.0 mg/day in the control group and 63.3+/-15.8 mg/day in the MCT group. Wound healing was better with the application of the MCT patch: grade 1 wounds were observed in 50% of the patients of the MCT group as compared to 8.3% in control group. The total drain volume was lower in patients of the MCT group compared to the controls (1020.8+/-211.6 and 1170.8+/-243.5 ml, respectively). None of the patients indicated that they wished to discontinue MCT therapy. This pilot study shows that MCT therapy led to better pain control with a markedly lower need for tramadol as compared to the control group. This better pain control was accompanied by a better healing of the wound and a lower drain volume.

Correction of complex foot deformities using the V-osteotomy and the Ilizarov technique.

Complex foot deformity is a multiplanar deformity with or without foot shortening. It also includes deformed feet with poor soft-tissue coverage, relapsed or neglected cases, and those with acompanying problems such as leg-length discrepancy, lower leg deformity, osteomyelitis and nonunions. Traditionally, correction of these deformities can be achieved by extensive soft tissue releases, osteotomies or arthrodesis with or without internal fixation. This usually involves excision of large appropriate bony wedges and has many disadvantages, including neurovascular injury, soft tissue problems and a shortened foot. We present our experience with a group of severe deformities of the foot that we managed using the V-osteotomy combined with the Ilizarov technique. We present our algorithm of management of complex foot and ankle deformities, together with our prerequisites for patient selection. A detailed description of the operative technique, postoperative care and possible complications is also presented. The combination of the Ilizarov technique and the V-osteotomy offers versatility in foot deformity correction, enabling correction of individual components of the deformity at rates that may be tailored to achieve accurate three-dimensional control.

Value of Haemonchus longistipes purified antigens in diagnosis of gastro-intestinal nematodes infection in camels.

Fractionated Haemonchus longistipes crude antigen revealed 7 protein fractions at molecular weights of 93, 74, 67, 56, 32, 26 and 16 kDa. The bands at 56, 32 and 26 kDa reacted specifically with H. longistipes hyperimmune sera prepared in rabbit (1:100 dilution) using EITB technique. The eluted concentrated fractions as well as crude worm antigens were used in diagnosis of natural infection of Gastro-Intestinal Nematodes (GIN) only or associated with other parasites in camels using ELISA technique. H. longistipes crude antigen and fraction of 26 kDa induced high sensitivity in diagnosis of infection in animals harboring GIN only (sensitivity was 95-100%), while it was 85.0-93.3% with 32 kDa fraction and 55.5-73.3% with that of 56 kDa using ELISA technique. The two H. longistipes eluted protein fractions of 26 and 32 kDa showed higher sensitivity than their crude antigens in diagnosis of GIN infection mixed with other parasites. While, Protein bands of 26 kDa appeared more sensitive than the other protein bands in detection of anti- H. longistipes antibodies at higher serum dilution. With special superiority for fraction of 26 kDa, in comparison with the other antigens, sharp specificity or sensitivity in diagnosis, could not be achieved in this study especially in case of mixed infection with other parasites, where these animals might be immune-compromised.

Limb salvage for osteosarcoma of the distal tibia with resection arthrodesis, autogenous fibular graft and Ilizarov external fixator.

We report the results of limb salvage for non-metastatic osteosarcoma of the distal tibia using resection arthrodesis, autogenous fibular graft and fixation by an Ilizarov external fixator. In six patients with primary osteosarcoma of the distal tibia who refused amputation, treatment with wide en bloc resection and tibiotalar arthrodesis was undertaken. The defect was reconstructed using non-vascularised free autogenous fibular strut graft in three patients and a vascularised pedicular fibular graft in three, all supplemented with iliac cancellous graft at the graft-host junction. An Ilizarov external fixator was used for stabilisation of the reconstruction. In five patients sound fusion occurred at a mean of 13.2 months (8 to 20) with no evidence of local recurrence or deep infection at final follow-up. The mean post-operative functional score was 70% (63% to 73%) according to the Musculoskeletal Tumour Society scoring system. All five patients showed graft hypertrophy. Union of the graft was faster in cases reconstructed by vascularised fibular grafts. One patient who had a poor response to pre-operative chemotherapy developed local tumour recurrence at one year post-operatively and required subsequent amputation.

Hepatitis C virus-specific B cell activation: IgG and IgM detection in acute and chronic hepatitis C.

BACKGROUND/AIMS/METHODS: Immunological responses to hepatitis C virus infection have not been fully studied. In an attempt to clarify some immunopathogenetic aspects of B cell activation during acute and chronic hepatitis C virus infection and to identify markers of chronicity or of recovery, the humoral response in hepatitis C virus-infected patients was studied. RESULTS: In children with acute jaundice, with negative markers of acute hepatitis A, B and E, six of 87 (6.9%) had detectable anti-HCV IgM, and only one (1.1%) had detectable anti-HCV IgG. In adults with acute jaundice, with negative markers of acute hepatitis A, B and E, ten of 23 (43.5%) had detectable anti-HCV IgM associated in eight patients with detectable anti-HCV IgG. In chronic hepatitis C virus-infected adult patients, all anti-HCV IgG seropositive, four of 14 (28%) patients had detectable HCV-IgM in serum. In vitro specific antibody production was inducible in a minority of patients. In acute and chronic hepatitis C virus-infection, IgM-HCV serology did not correlate with viremia as detected by polymerase chain reaction. CONCLUSIONS: Therefore, the polymerase chain reaction remains at the moment the only direct marker to demonstrate hepatitis C virus viral replication in patients with acute and chronic hepatitis while anti-HCV IgM analysis alone has only a limited diagnostic value in hepatitis C virus-infection.

The distally based peroneal island flap.

A distally based island septocutaneous flap supplied by distal perforators of the peroneal vessels is described for repair of soft tissue defects of the lower third of the leg. The flap can be rotated up to 180 degrees on the axis of the pedicle vessels. A series of 10 patients is presented. 7 had uneventful reconstructions, 2 had partial necrosis of the tip of the flap but reconstruction was satisfactory, and one had necrosis of the distal third of the flap resulting in a recurrent leg ulcer.

The venous island flap: is it purely venous?

Histological study of the pedicles of long and short saphenous and cephalic venous flaps in fresh human cadavers and two clinical cases showed that one or two arterioles and multiple capillaries were present in the perivenous areolar tissue. This challenges the concept that these flaps are purely venous.