Percutaneous fluoroscopic screw fixation of acetabular fractures

Over a 2-year period eight patients underwent percutaneous fluoroscopic fixation of their acetabular fractures. Average patient age was 43 and mean ISS was 27. Mean blood loss was less than 100 ml. There were five transverse fractures, one affecting both columns, one anterior column-posterior hemitransverse and one T-type fracture. There were two ipsilateral femoral and two ipsilateral tibial fractures. Mean follow-up was 15 months. Three broad patient groups were identified. One patient died, one was lost to follow-up, four had full range of motion of the affected hip, one had good range with Brooker II heterotopic ossification and one was wheelchair-bound with Brooker IV heterotopic ossification. The technique, which requires only cannulated screws and fluoroscopy, is described.     

Open compared with laparoscopic approach to Burch colposuspension: a cost analysis

OBJECTIVE: To compare postoperative course and hospital charges of an open versus laparoscopic approach to Burch colposuspension for the treatment of genuine stress urinary incontinence. METHODS: A retrospective chart review was performed to identify all patients undergoing open or laparoscopic Burch colposuspension by the same surgeon over a 2-year period. Patients undergoing additional surgical procedures at the time of colposuspension were excluded from the study. Twenty-one patients underwent open Burch colposuspension and 17 patients underwent laparoscopic colposuspension. Demographic data including age, parity, height, and weight were collected for each group. Both groups also were compared with regard to operative time, operating room charges, estimated blood loss, intraoperative complications, change in postoperative hematocrit, time required to resume normal voiding, length of hospital stay, and total hospital charges. RESULTS: The laparoscopic colposuspension group had significantly longer operative times (110 versus 66 minutes, P < .01) and increased operating room charges ($3479 versus $2138, P < .001). There was no statistical difference in estimated blood loss or change in postoperative hematocrit between the two groups. No major intraoperative complications occurred in either group. Mean length of hospital stay was 1.3 days for the laparoscopic group and 2.1 days for the open group (P < .005). However, total hospital charges for the laparoscopic group were significantly higher ($4960 versus $4079, P < .01). CONCLUSION: Laparoscopic colposuspension has been described as a minimally invasive, cost-effective technique for the surgical correction of stress urinary incontinence. Although the laparoscopic approach was found to be associated with a reduction in length of hospital stay, it had significantly higher total hospital charges than the traditional open approach because of expenses associated with increased operative time and use of laparoscopic equipment.     

Value of imaging in the assessment of malignant fibrous histiocytoma of the soft tissues

Malignant fibrous histiocytoma (MFH) is a rare and potentially highly malignant sarcoma. The authors report 6 cases of MFH in various sites: two in the chest wall, one in the pelvis, two in the gluteal zones and one on the scalp. Ultrasonography and computed tomography were the main imaging methods used in the assessment of the structure and extension of the tumor. A poor prognosis was noted in four cases: death within a few months in the two thoracic sites, recurrence in the pelvic and scalp lesions, radical surgery allowed recovery in two cases. A review of the literature showed that MRI and CT are complementary in the initial staging and follow-up of these patients.     

Percutaneous in situ pin fixation in superior femoral epiphysiolysis]

OBJECTIVES: This study determined the effect of alginate adhesive on various bond strengths of alginate to stainless steel. METHODS: Three test assemblies were designed and machined in stainless steel for tension, shear and cleavage tests. Alginate adhesive (Fix) was applied thinly and dried for 5 min. Alginate (Blueprint) was then loaded and allowed to set for 5 min before testing. The force at failure was measured by an Instron machine with a cross-head speed of 50 mm min(-1). RESULTS: Breaking stresses of alginate without adhesive were found to be 65 kPa (tension), 31 kPa (shear) and 10 kPa (cleavage). The bond strengths of Blueprint with Fix were 100 kPa (tension), 42 kPa (shear) and 37 kPa (cleavage) giving improvements of 53%, 37% and 270% respectively (p < 0.05). CONCLUSIONS: Alginate adhesive increases the bond strength of alginate, particularly cleavage, to stainless steel.     

Attending to color with proper fixation

In contemporary theorizing, there is a controversy about the role of spatial location in the selection of visual information; some theories postulate that position plays a unique role, whereas other theories hold that position is just one selection dimension that is not different from other dimensions, such as color and shape. In this context, a paradigm introduced by Tsal and Lavie (1988) promised to be of fundamental importance. With that paradigm, Tsal and Lavie found that, after reporting a first letter of a prespecified color, subjects preferred to switch their reporting to letters from array positions adjacent to that letter over continuing to report letters of the same color as that of the first letter. This switch from color to position provided firm evidence in favor of the position-special views as opposed to the all-attributes-are-equal views. In the present study, six experiments, employing Tsal and Lavie's paradigm and variations of that paradigm, are reported. Experiments 1,2,4, and 5 show that evidence for a switch from selection on the basis of color to selection on the basis of position is not obtained when subjects are forced to fixate the fixation point and possibly also not under normal contrast conditions without fixation controls. Experiment 3 shows that switching from color to position is difficult. Experiments 2, 5, and 6 show that evidence for a switch is obtained only under low-contrast conditions when subjects are not forced to fixate the fixation point. It is concluded that the Tsal and Lavie paradigm is an asymmetric paradigm. The results reported by Tsal and Lavie constituted a major threat for the all-attributes-are-equal theories and provided firm support for the position-special theories. The results reported in the present study are compatible with the all-attributes-are-equal theories, but, at the same time, do not constitute a major threat for the contemporary position-special theories.     

Morphogenesis and origin of fibrous long-spacing collagen fibers in collagenase-treated mouse skin tissues

Morphogenesis and origin of fibrous long-spacing collagen (FLS) fibers in newborn mouse skin tissues treated with collagenase were examined using ultrastructural observation, morphometry, histochemical methods, and immunoelectron microscopy. The enzyme caused both the partial destruction of basal laminae and the formation of abundant FLS fibers in the dermal matrix. The fibers were usually distributed in the vicinity of basal laminae in the capillaries or basal layer cells. The fibers were characterized by the cross-striated dark bands with about 91 nm periodicity and longitudinally aligned filaments with a diameter of about 6.5 nm. The dark bands of FLS fibers were often continuous with the basal laminae. Histochemical results showed that the dark bands contained the similar mucopolysaccharides which were involved in the basal laminae. Immunoelectron microscopic results showed that laminin was present in the dark bands as well as in the basal laminae, and that type VI collagen was located in the filaments of FLS fibers. These results suggest that the dark bands are formed by products similar to basal laminae and that the products were precipitated on type VI collagen-contained filaments with periodic intervals of about 91 nm. Morphometric examination revealed that there was no differences in ultrastructure between FLS fibers of a collagenase-treated mouse and those of a human neural tumor.     

Thermal cycling-induced deformation of fibrous composites with particular reference to the tungsten-copper system

Dimensional stability of fibrous composites under conditions of elevated temperature cycling has been examined with reference to the familiar model system, tungsten wirereinforced copper. Preferential growth of the matrix in the direction parallel to the reinforcing fibers, the amount of which increased with the number of cycles, was observed in specimens subjected to hundreds of repctitive thermal cycles in the temperature range between 0.35 and 0.8 of the matrix homologous temperature. The amount of growth per unit length after a given number of cycles was found to increase with increasing the holding time at the upper cycling temperature; it was also dependent on such composite variables as the fiber length, fiber diameter, and fiber volume fraction. This observation strongly suggests that interface sliding plays an important role in elevated temperature deformation of this class of material. On the basis of a model which assumes a viscous nature of the phase boundaries, the phenomenon observed is theoretically explained in terms of interfacial sliding-induced relaxation of the internal stress built up in the composite due to differential thermal expansion of the composite constituents. Formerly Graduate Student.     

Clinical and instrumental evaluation after Burch's colposuspension in patients with stress urinary incontinence

The authors performed a retrospective study of 29 patients undergoing Burch's anterior colposuspension to treat stress incontinence. Patients were aged between 32 and 71 years old and before surgery presented a urodynamic picture with low mictional pressure, normal filling and Max P of lower closing at 40 mm. Follow-up monitoring ranged from a minimum of 6 months to a maximum of 5 years (mean length 33 months) and was carried out using a urodynamic examination and transvaginal scan to evaluate the distance of the bladder neck from the posterior face of the pubic symphysis. Seventeen women (65.5%) were fully cured after surgery, whereas 27% improved. In "dry" patients the urodynamic examination showed increased significantly of the functional length of the urethra and the transvaginal scan showed that mean values of the distance between bladder neck and pubic symphysis were lover than those in those patients who still presented symptoms. The authors also used ultrasonography to evaluate the efficacy of the latter in the study of urinary incontinence. As reported in other studies, they affirm that intracavitary ultrasonography using a linea probe is equivalent to radiography using cystography with metallic repere, making the examination less invasive and easily repeatable; in addition, it is also important for studying the dynamics of the pelvic floor to establish effective rehabilitative treatment.     

A prospective randomized controlled trial comparing suprapubic with urethral catheterization in rectal surgery

BACKGROUND: Bladder drainage is necessary for several days following rectal surgery. Urethral catheterization has long been known to be associated with significant morbidity. Therefore a prospective randomized trial was performed to determine if this morbidity could be decreased by suprapubic catheterization. METHODS: One hundred and thirty-seven patients undergoing rectal surgery were prospectively randomized to either suprapubic or urethral catheterization. RESULTS: After exclusions, 108 patients were analysed. Of the 49 patients with suprapubic catheters there was 14% morbidity, and of the 59 patients with urethral catheters there was 32% morbidity. Significant bacteriuria was halved with suprapubic catheterization. Patient acceptability of suprapubic catheterization was high, and there was no increased morbidity in any of the areas studied. CONCLUSIONS: This study suggests that suprapubic catheterization has advantages over urethral catheterization with decreased bacteriuria, and greater patient acceptability. However, the significance of decreased bacteriuria is not clear and therefore we can only say suprapubic catheter drainage is comparable to urethral catheter drainage.     

One-stage hypospadias repair with stent or suprapubic diversion: which is better?

PURPOSE: The authors report on 105 consecutive patients who underwent one-stage hypospadias repair based on use of suprapubic diversion or transurethral drainage with stenting. METHODS: The surgical procedures included 52 metal-based flap urethroplasty (Mathieu) for coronal, subcoronal, and distal shaft hypospadias; 32 transverse island pedicle graft (Duckett) for mid and proximal shaft hypospadias; 21 transverse island pedicle (Duckett) plus rolled midline tube (Thierchs) for penoscrotal and scrotal hypospadias. To accomplish urinary drainage, suprapubic diversion (cystofix) was used in 28 of 52 Mathieu operations, in 17 of 32 Duckett operations, and in 11 of 21 transverse island pedicle graft plus rolled midline tube operations. In the rest of the cases, transurethral drainage with stenting was used. RESULTS: All children had excellent cosmetic and functional outcomes. But the rates of complications such as fistula and meatal stenosis were significantly different between the groups in which suprapubic tube or urethral stent was used. In 56 of the 105 patients in whom suprapubic diversion was used, four (7.14%) had fistulas and three (5.35%) had meatal stenosis, in contrast to a fistula rate of 14.28% and meatal stenosis rate of 12.24% in patients that urethral stent is used for urinary drainage. CONCLUSION: The authors believe that the use of suprapubic diversion is advantageous for the outcome of one-stage hypospadias repair in relation to fistula occurrence and meatal stenosis.     

Experiences in the use of suprapubic bladder drainage after gynecologic surgery

Suprapubic catheterisation using a lately available puncture set for single use has been performed by us after major gynecologic surgery. Very favorable results of 48 suprapubic catheterisations performed under systematic control are reported.     

Cell biological analysis with respect to cause of fibrous opacification of the anterior capsule after cataract extraction

To assess whether juvenile-onset epilepsy or motor disability is complicated by an increased number of mental health disorders or experience of psychosomatic symptoms in young adulthood, we studied 81 subjects with epilepsy and 52 with motor disabilities at the age of 19 to 25 years and compared them with 211 controls. The main diagnostic tool, the Present State Examination, was administered to those attending the interviews in person who were of normal intelligence; there were 62, 38, and 123 subjects in the three categories, respectively. Compared with the controls, the subjects with epilepsy showed an equal prevalence of psychiatric disorders whereas those with motor disabilities had a significantly higher prevalence, particularly of depressive disorders. The reported prevalence of psychosomatic symptoms confirmed this main result. Psychological illness affected everyday life of two out of five subjects with motor disabilities, but only half of those in the other two groups. It is concluded that motor disability since childhood, but not epilepsy, could be a factor that increases susceptibility to psychiatric morbidity, especially depression, and causes a large number of psychosomatic symptoms. The results challenge staff of clinics working with such adolescents to find individual approaches in preventing the negative influence of psychological disorders on social life.     

纤维状WC晶粒硬质合金的制备

以高能球磨方法处理制备的纳米晶复合粉末为原料，通过真空烧结制备硬质合金块体，研究该纳米晶复合粉末的烧结致密化行为和显微结构特征。结果表明：该纳米晶粉末的烧结致密化可依烧结温度从低至高分为、3个阶段，而在高于1250℃的液相烧结阶段，将温度提高至1375℃烧结30min，可获得密度为14．46g／cm^3、烧结收缩率为27．2％的致密硬质合金。此时，WC晶粒呈纤维状，随机分布在烧结体中，其长度约为1．2μm，径向尺寸约为100nm；采用高能球磨处理工艺可以获得原位生成的纤维状WC晶粒增强的硬质合金。     

Porous-coated acetabular components with screw fixation. Five to ten-year results

The results of 136 consecutive primary total hip arthroplasties performed by one surgeon with the Harris-Galante-I porous-coated acetabular component were reviewed at a mean of seven years (range, five to ten years). In all hips, the outer diameter of the acetabular component was the same as the diameter of the final reamer used in the preparation of the acetabulum. However, this reamer was used only briefly at the rim of the acetabulum, and therefore the components had so-called press-fit stability. A mean of four screws (range, three to six screws) were used for additional fixation of the component. The clinical evaluation was performed with use of the Harris hip score. Standardized anteroposterior radiographs of the pelvis were assessed for migration of the component, radiolucent and radiodense lines, linear wear of the polyethylene, and osteolysis. No acetabular component had been revised for loosening and none were radiographically loose at the time of the most recent follow-up evaluation. There were no complications related to the use of the screws, and no screw had bent or broken. A non-progressive radiolucent line was seen in one acetabular zone in thirty-four hips (25 per cent) and in two acetabular zones in six hips (4 per cent). No hip had a radiolucent line in all three acetabular zones. The mean rate of linear wear of the polyethylene was 0.1 millimeter per year. There was no dissociation of the acetabular liner from the metal shell. Two hips (1 per cent) had asymptomatic osteolysis in the ischium and adjacent to the rim of the acetabular component; this was treated with grafting at the site of the lesion and exchange of the femoral head and the worn polyethylene liner. Five femoral components inserted without cement and one inserted with cement were revised because of loosening. The data suggest that, at a mean of seven years, fixation of this porous-coated component was uniformly excellent. The low prevalence of radiolucent lines and the absence of loosening are probably related, in part, to the technique of implantation. The low prevalence of polyethylene wear and pelvic osteolysis is a notable improvement compared with the results of arthroplasty with other porous-coated acetabular components. Although the results of the present study are encouraging, longer follow-up is necessary to determine the prevalence of late loosening and osteolysis.     

Unilateral femoral deformity due to a focal fibrous tether

Metacercariae of Clonorchis sinensis were collected from freshwater fish (Pseudorasbora parva) after storage in a freezer at -12 degrees C for 10-20 days, in a freezer at -20 degrees for 3-7 days, or treating with heavy salt (fish/salt = 10 gm/3 gm) at 26 degrees for 5-15 days. The metacercariae from the frozen fish were inoculated into 30 rats and eight rabbits, and those from the salted fish into 33 rats. Metacercariae from freshwater fish stored at -12 degrees for 10-18 days or -20 degrees for 3-7 remained viable and infective. Moreover, those kept at the heavy salt concentration for 5-7 days remained viable and infective. These findings indicate that freezing or storing infected freshwater fish in heavy salt may not be effective in the prevention of clonorchiasis. However, it appears that refrigeration, or keeping the fish in salt for longer periods, may be suitable for prevention of the infection.     

Stress urinary incontinence. Our experience with its treatment using the transvaginal colposuspension technique (Raz I and II)

Presentation of our experience in the surgical treatment of urinary stress incontinence, with transvaginal colposuspension techniques, specifically those described by S. Raz and known as Raz I and Raz II. Over a 24-month period, 25 transvaginal colposuspensions (22 Raz I and 3 Raz II) were performed. The results achieved were 21 patients (84%) have recovered, while 4 (16%) remain incontinent, 3 of them referring improvement and 1 without improvement, after a follow-up of 12 to 36 months. With regard to complications, there has been 5 cases (20%) of postoperative retention, one vesical perforation while passing the needles, and a vesicle perforation during vaginal dissection of the retropubic space.