Remanipulation of forearm fractures in children

AIMS: To determine whether operator experience or time of operation affects the outcome of fractures of the forearm in the paediatric age group as measured by the need for remanipulation. METHODS: A retrospective analysis of 1155 children with forearm fractures requiring manipulation was undertaken. RESULTS: The remanipulation rate for these 1155 children was 136 or 11.7%. There was a significant difference in those fractures requiring remanipulation dependent upon the experience of the operator and the time of day the procedure was performed. The lowest rate of remanipulation was obtained by senior registrars operating between the hours of 0800-1700 (6/113 or 5.3%). The highest rate was found to be junior registrars between the hours of 1700-2200 (39/167 or 23.3%). It is especially interesting to note the relatively low rate (31/437 or 7.1%) obtained by junior registrars during the night shift (2200-0800 hours). CONCLUSIONS: The current overall remanipulation rate is acceptable. The low rate between 2200-0800 hours means rescheduling of these patients is unnecessary. The rate for junior registrars between 1700-2200 hours needs to be improved.     

Intramedullary fixation of unstable both-bone forearm fractures in children

Mesaconitine, one of the main alkaloids contained in Aconiti tubers, is a centrally acting analgesic without affinity to opioid receptors. It has been reported that the antinociception is due to an interaction with the noradrenergic system. In the present study, the effect of mesaconitine on the uptake of noradrenaline and on neuronal activity was examined in rat hippocampus. Experiments were performed as a study of [3H]noradrenaline uptake into rat hippocampal synaptosomes. Mesoconitine inhibited [3H]noradrenaline uptake in a concentration-dependent manner with a Ki of 111.95+/-18 nM. In a further series of experiments, the effects of mesaconitine on the extracellularly recorded population spike were investigated in rat hippocampal slices. At a concentration of 10 nM, mesaconitine increased the amplitude of the postsynaptic population spike by 31.10%+/-6.7% of control and elicited one or two additional spikes. The presynaptic fiber spike and the field excitatory postsynaptic potential were not affected by this alkaloid. The enhancement of neuronal activity was abolished by 1 microM propranolol as well as by 1 microM timolol. It is concluded that mesoconitine increased the excitability in rat hippocampal pyramidal cells by an involvement of the noradrenergic system, with at least one mechanism being inhibition of noradrenaline uptake leading to an enhanced extraneuronal noradrenaline level.     

Displaced aggression in young children.

Young children played a card game in which some Ss associated losses with a child-figure card and winnings with a plain card, while others associated losses with a plain card and winnings with the child-figure card. Following the card game, Ss played a shooting game in which they selected targets from among pairs of figures that varied from the card game figure on a dimension of physical similarity. Both sexes showed a significant tendency to select, as targets, either figures more like or figures less like the card game figure. There were no differences in target choices as a function of conditions. Among Ss who lost to the card game figure, boys and girls differed, boys favoring more like figures and girls favoring less like figures. The Ss also shot the card game figure itself. Boys who lost the most to that figure shot the greatest number of times; those who lost less, the fewest numbers of times; and boys who won from the figure were in between. No differences were found for girls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Open reduction and internal fixation of forearm fractures in children

We retrospectively reviewed 16 children younger than 13 years with 17 fractures of the shafts of the radius or ulna or both who had undergone an open reduction-internal fixation (ORIF). ORIF was performed when a closed reduction was deemed unacceptable in 14 radius fractures and for three unstable open fractures of the radius. The average age was 9.4 +/- 2.3 years (range, 5.0-12.5). Of the 14 fractures with an unacceptable closed reduction, soft-tissue interposition was encountered in seven. Fixation was secured by plates and screws, percutaneous Steinmann pins, or intramedullary Steinmann pins. There were no delayed unions or nonunions, no infections, and no neurovascular injuries. The average follow-up was 12.3 months; all 17 fractures had excellent results (forearm rotation loss of < 10 degrees). Our study indicates that excellent results can be expected with no increased risk of complications if the treating physician elects to proceed with an ORIF in a pediatric forearm fracture with proper indications.     

Ventrolateral hernias of the abdominal wall. The anatomicopathologic, clinical and therapeutic considerations]

Ventral lateral hernias of the abdominal wall are rare. On the basis of their location we can classify them as follows: hernias of the aponeurosis of the transversus muscle, hernias of the rectal sheath and transmuscular hernias of the iliac region. In a group of 3134 hernias of the abdominal wall observed in a period of 16 years, 11 ventral lateral hernias have been encountered (0.3%). The diagnosis often presents great difficulties as the symptoms and the clinical findings are not typical. They must be differentiated from hematomas of the rectus sheath, abscess or intra-abdominal processes. Echography and Computed Tomography have an important role in their detection. Nevertheless in some patients the true diagnosis is reached only intraoperatively. The treatment generally consists in surgical correction by layer closure of the fascial or muscular defect. In selected cases the use of prosthetic material and video laparoscopic repair are indicated.     

Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation

Displaced fractures of the glenoid fossa are an uncommon and anatomically diverse group of injuries. Failure to restore anatomy in these fractures results in poor outcome in most cases. The success of a treatment protocol that encompasses appropriate preoperative imaging, injury pattern assessment, prudent approach choice, and a comprehensive reduction and fixation tactic was evaluated. Twenty-seven patients were assessed clinically and radiographically at a mean followup interval of 43 months from surgery. Anatomic reconstruction was achieved in 24 (89%) patients. Three patients had residual joint incongruities measuring 2 mm or less. The only perioperative complication was a partial superficial wound dehiscence. Two additional patients had infraspinatus palsies of indeterminate origin. Functional rating revealed six (22%) excellent, 16 (60%) good, three (11%) fair, and two (7%) poor outcomes. The fair and poor outcomes largely were related to associated injuries. These findings show that anatomic surgical reconstruction with a low complication rate and good functional outcome can be obtained for most patients with glenoid fossa fractures.     

Intramedullary fixation of forearm fractures in adults

The arrangement of the smooth muscle and elastic and collagen fibers of the minor papilla of the human duodenum was studied on 53 duodenopancreatic specimens obtained from adults of both sexes. Methods included stereological analyses of gross anatomical specimens and thick and thin microscopic sections. The muscular and elastic fibers of the minor papilla have a unidirectional arrangement by which the contraction of its smooth muscular fibers causes opening of its orifice allowing the flow of the pancreatic juice into the duodenum. It is not a typical anatomical sphincter.     

The management of segmental bone loss associated with forearm fractures

Eighteen fractures of one or both bones of the forearm, including fourteen with segmental defects, were treated with an interposed corticocancellous iliac-bone graft. A plate and screws were used to fix the fracture fragments and graft. The technique allowed early motion of the extremity. Good results were achieved in all but six of the patients. The one poor result with non-union and five others with limited motion were related primarily to infection.     

Hydrocephalus in cerebral cysticercosis. Pathogenic and therapeutic considerations

The cases of 11 patients with hydrocephalus secondary to cerebral cysticercosis are analyzed. Most of the patients had suffered from epilepsy before they developed hydrocephalic symptoms, and computerized tomography showed that infestation of the parenchyma coexisted with ventricular or cisternal colonization. In four cases, the parasitic vesicles compromised cerebrospinal fluid (CSF) flow in the ventricular system, resulting in internal hydrocephalus. Communicating hydrocephalus, caused by the presence of Cysticercus larvae in the basal cisterns (Cysticercus racemosus), or by the occurrence of a chronic basal meningitis, or both, developed in seven more patients. Changes in CSF pressure were related to the number and location of the cysts and to the leptomeningeal inflammatory reactions evoked by them. The majority of patients presented with a chronic and relatively normotensive hydrocephalus. All patients except one had identifiable ventricular or cisternal Cysticercus larvae; these patients were treated with open removal of the cysts, and did well. However, most of them had impairment of CSF flow through the basal cisterns and required permanent CSF shunting. Communicating hydrocephalus due to leptomeningeal scarring was also successfully managed with extracranial shunting. Epilepsy was controlled with anticonvulsant therapy. Although good lasting results may be obtained with aggressive treatment of neurocysticercosis, patients are liable to relapse because surgery is only palliative in most instances.     

Adenomatoid tumor of testicular tunica albuginea: a case report. Histogenetic and therapeutic considerations]

A first generation synthesis of 22 is described constituting the first disclosure of the preparation of an appropriately protected and fully functionalized vancomycin CDE ring system complete with the C and E ring monochloro substitution pattern. The approach, which is based on two aromatic nucleophilic substitution reactions for sequential CD and DE macrocyclization, provided the opportunity to define and indirect solution to the control of the CDE atropisomer stereochemistry through selective thermal equilibration of the DE versus unaltered CD ring system. Its success provides a rationale for a preferred order to the CD and DE ring system introductions.     

The contextual therapeutic relationship: Ecological considerations in psychotherapy research and practice.

While the psychotherapeutic relationship has been assumed to be relatively free from external influence, we suggest that the therapeutic alliance develops within a larger environment, much of which is beyond the control of client and therapist. The reticence of practitioners and researchers to recognize and explore ecological issues is likely related to therapeutic tasks that are necessary for insight-oriented treatments (e.g., developing a therapeutic setting that protects clients from the intrusion of outside influences). Two sources of ecological disruption are discussed, managed care and psychotherapy research, and an illustrative case example of ecological disruption within a psychotherapy research setting is presented. We suggest that addressing ecological disruptions in the context of the therapeutic relationship may facilitate the establishment and maintenance of a positive therapeutic alliance. By doing so, the therapist can integrate the demands of the external world into the therapeutic relationship, thereby increasing the meaningfulness of interpersonal interventions and easing discussions about therapeutic alliance ruptures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Results of treating forearm bone shaft fractures with a 3.5 mm self compressive plate]

Elevated levels of the phaeomelanin metabolite 5-S-cysteinyldopa and the eumelanin metabolite 6-hydroxy-5-methoxyindole-2-carboxylic acid in urine and serum have been shown in previous studies to correlate with disseminated malignant melanoma. Immunohistochemical detection of S100B protein is an acknowledged method for the diagnosis of malignant melanoma, and it has been suggested that rising serum levels of S100B protein are associated with the survival rate of patients with malignant melanoma. In the present study serum levels of S100B protein and urinary concentrations of 5-S-cysteinyldopa and 6-hydroxy-5-methoxyindole-2-carboxylic acid were measured in 91 patients with histopathologically verified malignant melanoma. At the time of sampling 13 patients were in clinical stage I, 13 in stage II and 65 in stage III. The urinary levels of the melanin metabolites were determined by automated high performance liquid chromatography, and the serum levels of S100B protein by an immunoradiometric assay with two monoclonal antibodies. The overall survival rate was most strongly associated with the serum levels of S100B protein (P < 0.001), but there was also a significant correlation to urinary levels of 5-S-cysteinyldopa (P < 0.001). A corresponding association with urinary levels of 6-hydroxy-5-methoxyindole-2-carboxylic acid was found in only a very few patients with extremely high urinary concentrations. A statistically significant increase in relative hazard was found for S100B protein levels exceeding 0.6 microgram/l (P < 0.001), and predictably for patients in clinical stage III (P < 0.001). An analysis of S100B protein levels in patients in clinical stage III showed a significant correlation to survival (P = 0.005). Our study suggests that of the three biochemical tumour markers, S100B and to a lesser extent 5-S-cysteinyldopa have the greatest potential to be used as predictors of survival prognosis in patients with malignant melanoma.     

Management of impotence. Diagnostic considerations and therapeutic options

Impotence affects an estimated 10 million American men. The cause is usually organic in men over age 50; psychogenic impotence is more common in younger men. Vascular disease is the most common cause of impotence. Evaluation in patients with impotence includes thorough history taking and diagnostic testing. Once the cause of impotence is determined, appropriate management can be chosen. Current therapeutic options include vacuum tumescence devices, self-injection, oral therapy, psychotherapy, and penile prostheses.     

The therapeutic use of ball play in psychotherapy with children.

Describes how ball play—noted as one of the earliest and most enduring forms of play—can be used as a directive play therapy technique to facilitate talk therapy with children. Four stages of the ball play therapy process are outlined: (1) rapport building, (2) creating a therapeutic context, (3) pacing and punctuating the dialogue, and (4) anchoring a solution. The author illustrates, using case examples, how the integration of ball play with talk therapy can be an effective intervention in psychotherapy with children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic personality in the therapeutic community.

Identified personality characteristics associated with the rated ability of various types of mental hospital support personnel to interact in a therapeutically beneficial manner with patients. The Gordon Personal Profile, the Gordon Personal Inventory, the Work Environment Preference Schedule, and an experimental mental health aptitude test were administered to the female support personnel in 6 state hospitals (N = 257). Ss judged by peers to be the more effective were inclined to take their responsibilities seriously, to be emotionally stable, to be cautious, to have trust and confidence in other people, to be nonbureaucratic in their work orientation, and to be aware of the therapeutically preferred procedures for handling patients. Few significant relationships were found with the supervisory ratings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cerebral cavernous hemangiomas in childhood. Clinical presentation and therapeutic considerations

Cerebral cavernous hemangiomas (CCH) are relatively rare vascular hamartomas. Since the introduction of MRI there has been an increase in the number of case reports of CCH in the medical literature. CCH are often asymptomatic; they may, however, cause epilepsy or neurological deficits due to their space-occupying effects or hemorrhagic sequelae. The tendency of CCH to bleed has been well recognized, though gross hemorrhage is infrequent owing to the relatively low blood pressure and small blood flow in CCH. MRI findings of a CCH are characteristic and can differentiate the lesions from other vascular abnormalities. To date, there has been no consensus on indications for surgical intervention. Three cases are presented, which together demonstrate by their different presentation, clinical course and MRI findings that each patient with a CCH requires an individually tailored management. Presentation, clinical course and accessibility for operation are the factors that determine whether a surgical or a conservative approach should be adopted.