Management of patients with pyogenic complications of long bones open fractures

122 patients with purulent complications of open diaphyseal fractures of long bones were treated. Comparative analysis of different surgical methods for treatment of pyogenic complications has shown that the most effective method is one of active sanation of the area of inflammation with the use of combined drainage ensured successful and steady decrease of pyogenic process (follow-up up to 4 years, 89.7% of patients). The drainage provides stable fixation of bones fragments by dipped fixators until consolidation of the fracture. It also promotes repain of residual diaphyseal defects without application of complicated plastic methods.     

Muscle function and gait in patients with knee osteoarthritis before and after muscle rehabilitation

Patients with knee osteoarthritis (OA) have reduced functional capacity and muscle function that improves significantly after quantitative progressive exercise rehabilitation (QPER). The effects of these changes on the biomechanics of walking have not been quantified. Our goal was to quantify the effects of knee OA on gait before and after QPER. Bilateral kinematic and kinetic analyses were performed using a standard link-segment analysis on seven women (60.9 +/- 9.4 years) with knee OA. All functional capacity, muscle function and gait variables were initially reduced compared to age-matched controls. Muscle strength, endurance and contraction speed were significantly improved (55%, 42% and 34%, respectively) after 2 months of QPER (p < 0.05), as were function (13%), walking time (21%), difficulty (33%) and pain (13%). There were no significant changes in the gait variables after QPER. To use the QPER improvements to the best advantage, gait retraining may be necessary to "re-programme' the locomotor pattern.     

Treatment of pseudarthroses and ununited crural bone fractures with transosseous compression-distraction osteosynthesis

The materials of clinical observations of 103 patients with pseudarthrosis and unhealing crural fractures, in whom 104 operations of compression-distraction osteosynthesis were accomplished, are analysed. The results of the treatment in various groups of patients are described.     

Prognostic indicators and early home rehabilitation in elderly patients with hip fractures

A program for early mobilization in the hospital and rehabilitation at home after hip fracture was developed in cooperation with local health and social authorities and applied to 103 consecutive patients having a mean age of 75 years. All were admitted to the hospital from their own homes. Three fourths of the patients returned home directly after postoperative mobilization periods of usually two to three weeks in hospital. Four months after the fracture 81 of 99 surviving patients were at home, most of them having regained their prefracture functional status. One year after the fracture 91 patients were alive, and 78 of these were at home with no functional loss, compared with their condition at four months. Some of the social and medical factors which may already be pertinent to the recovery outcome at the time of fracture are identified. Eight to nine of ten patients with two or three positive factors ("healthy," living with someone, and ability to walk two weeks postsurgery) returned directly home. This study suggests the importance of intensive support, in the form of information to patients and relatives, and close cooperation between hospital staff and community care authorities. By this means, a continuity of care and early permanent independence can be achieved for elderly hip fracture patients and institutionalized rehabilitation can be reduced with benefit for both the individual and society.     

Subcapital fractures of the four ulnar metacarpal bones

A strain of Chromobacterium violaceum isolated from a fatally infected patient was found to produce a beta-lactamase. When the organism was grown in drug-free medium, beta-lactamase activity was barely detectable, but when it was grown in the presence of penicillin G, a much larger amount of activity was produced. The beta lactamase was active primarily against cephalosporins; it was sensitive to inhibition by cloxacillin but resistant to p-chloromercuribenzoate. Thus this enzyme closely resembled the common type of beta-lactamase found in Pseudomonas aeruginosa. The organism was relatively susceptible to ticarcillin, carbenicillin, and cefoxitin, which resected hydrolysis by its beta-lactamase, but was quite resistant to 11 other beta-lactam antibiotics. Production of the beta-lactamase appeared to be mediated by chromosomal genes.     

Normal frontal perfusion in patients with frozen gait

With the aim to compare the diagnostic efficacy as regards acute myocardial infarction of two rapid dry-strip tests, one with both creatine kinase MB (CK-MB) and myoglobin (C + M) and the other with troponin T, and to test the reliability of bedside diagnosis by the coronary care unit (CCU) nurse, 151 patients with acute chest pain admitted to the CCU were investigated. There was no difference in diagnostic performance between rapid tests and quantitative determinations. With <6-hour duration of symptoms, the sensitivity was better for C + M than for troponin T (72% vs 33%, p < 0.05). With symptoms lasting >12 hours on arrival, troponin T performed better, with 100% sensitivity and a negative predictive value of 100% in the 6-hour retest. For exclusion of damage, the two tests have similar and reliable diagnostic capacities 12 hours after the onset of symptoms. The bedside diagnosis or exclusion of acute myocardial infarction was carried out rapidly (within 20 minutes) and reliably by the CCU nurses.     

The use of transosseous osteosynthesis in treating fractures of the tubular bones]

Comparative analysis was performed of results of the treatment of patients with ischemic stroke, including 140 ones treated by means of hemodilution method (control group) and 40 patients treated with cerebrolysin (test group). Barolin's scale of the neurorehabilitation was used for the analysis of the results. Statistically significant results of rehabilitation were better in the test group. Improvement of the parameters characterizing social contacts, working activity and behaviour was more pronounced than an improvement of motor functions. Cerebrolysin had accelerating effect on restoration of damaged functions, by creating more stable basis for rehabilitation.     

Physiotherapy in the rehabilitation of patients with chronic gastroduodenitis

Comparative study of the main pharmacokinetic characteristics and evaluation of the bioavailability of two experimental tablet forms of the new nootropic nooglutil in relation to the substance of the drug were conducted on rabbits. The nooglutil content in plasma samples was determined by high performance liquid chromatography. Significant advantage of one tablet of the drug containing tween-80 was demonstrated. Bioavailability of this drug form of nooglutil in relation to the substance of the drug was 104.3%.     

Compression-distraction osteosynthesis of pseudarthroses and ununited fractures of the long tubular bones

Venous blood leucoconcentrate was studied in 48 patients with malignant neoplasms of the genitalia before and after radiotherapy. The decrease in total number of leucocytes on account of the decreased lymphocytes number and young undifferentiated formed elements of blood was observed; a relative neutrophylosis, monocytosis, eosinophilia as well as lymphopenia developed. The study of venous blood leucoconcentrate in oncological patients characterizes more precisely the state of peripheral blood than the routine method of investigation.     

Compression-distraction osteosynthesis in the treatment of ununited fractures and pseudarthroses of the long tubular bones

A terminal deletion of the long arm of chromosome 11 is compatible with life, and the affected child uniformly shows growth and mental retardation and telecanthus. However, no clear-cut, distinctive clinical syndrome is apparent. Mental and growth retardation alone may be the sole indications for chromosome analysis, as the virtual absence of dysmorphic features in some cases (Case 2) is noteworthy. Other appropriate family members should be evaluated to determine whether there is a familial balanced reciprocal translocation present and proper genetic counseling provided.     

Clinical gait analysis in a rehabilitation context: some controversial issues

The goal of the present study was to establish the condition to obtain preparative amounts of the recombinant cytotoxin alpha-sarcin to be used for immunoconjugate production. alpha-Sarcin cDNA was isolated from Aspergillus giganteus strain MDH 18,894 and its expression in Escherichia coli was attempted by the use of both two-cistron and fusion protein-expression systems. Whereas the former resulted in low intracellular expression level of recombinant alpha-sarcin (r-Sar), the latter allowed high-level expression of the fusion protein in the culture supernatant. A variant form of alpha-sarcin with an additional threonine residue in position 1 (Thr-Sar) was obtained by proteolytic processing of the fusion protein with a final yield after purification of 40 mg/L of culture. Both recombinant proteins r-Sar and Thr-Sar were identical to native a-sarcin with respect to the biochemical properties and to the in vitro biological activity.     

Ultrastructural studies of bones from patients with osteogenesis imperfecta

Bone samples from patients suffering from osteogenesis imperfecta (OI) types I, II, III and IV, as well as normal controls, were studied by scanning (SEM) and transmission electron microscopy (TEM). SEM views of normal bone at low magnification show coherent structure, with regular striations due to a lamellar plywood-like arrangement of the mineralized collagen fibrils. Compact lamellar bone was also found in various OI specimens, but in limited disconnected regions separated by open spaces. Furthermore, some OI, but not normal, bones have regions of loose unconnected fibers and others of apparently abnormally dense mineral deposition. High resolution TEM studies of OI bone fragments have served to elucidate the structures of these different textures. There appears to be a substantial, though reduced, proportion of normal lamellar bone even in quite severe OI. However, the regions of loose fibers are largely unmineralized and probably contain abnormal collagen. Other regions are overmineralized, with generally small unorganized apatite crystals deposited onto fibril surfaces or in separate clusters. These structural abnormalities, together with the paucity of normal bone, may explain the fragility of OI bones.