Range of motion and complications after postburn heterotopic bone excision about the elbow

OBJECTIVE: To review the results of surgical management of heterotopic ossification about the elbow in burned patients. DESIGN: Retrospective analysis with long-term patient follow-up. MATERIALS AND METHODS: Eleven patients with 16 elbows requiring surgery were admitted between January 1, 1982 and December 31, 1993. A posterior approach to the elbow with release of the encased ulnar nerve +/- anterior transposition and transolecranon osteotomy to access extensive bone formation in the olecranon fossa was employed. Eight patients (11 elbows) were available for long-term follow-up conducted at mean 50 +/- 13 months after surgery. Long-term follow-up consisted of measurement of range of elbow motion, as well as clinical assessment of ulnar nerve function. MAIN RESULTS: For the 11 elbows examined postoperatively, the mean range of motion preoperatively in flexion-extension was 11 degrees +/- 5 degrees compared to 89 degrees +/- 12 degrees postoperatively (p < 0.001). Three patients with poor long-term results had ankylosis of the joint preoperatively. Of four patients with ulnar nerve paresis preoperatively, none had ulnar nerve dysfunction at follow-up. Of 16 elbows operated on, four (25%) had postoperative complications. Two suffered soft-tissue breakdown with hardware exposure requiring abdominal flap closure, one early failure of olecranon fixation, and one late infected hardware. CONCLUSIONS: Surgery for both limited range of motion as well as ulnar nerve compression is effective in cases of heterotopic ossification about the elbows of burned patients. Early operative intervention is indicated in progressive disease, particularly ulnar nerve palsy, if soft-tissue quality is adequate. Complications with 25% of elbows suggest that use of olecranon osteotomy for joint access may warrant review.     

Inhibition of expression of the lysine-rich 30 kDa surface antigen of Entamoeba dispar by the transcription of its antisense RNA

The gene coding for the 30 kDa lysine rich surface antigen (Ed-Ag) that is present on membrane surfaces of Entamoeba dispar trophozoites has been characterized. A specific monoclonal antibody MAb 318-28 prepared against this antigen reacts with all E. dispar strains tested, but not with any of the antigens of E. histolytica. In order to understand the function of this antigen, we constructed two plasmids, pEdA-9 and pEdA-Rev, in which the antigen-coding sequence was introduced into the pEhAct-Neo shuttle vector in the direct and opposite orientation, respectively. When E. dispar trophozoites were transfected with pEdA-9, only a slight increase was observed in the expression of the antigen. However, when E. dispar trophozoites were transfected with pEdA-Rev, the expression of the native 30 kDa antigen was significantly inhibited. This inhibition was proportional to the level of resistance of the E. dispar culture to the neomycin derivative G418. Cytopathic assays detected only a slight difference between untransfected, pEdA-9 transfected and pEdA-Rev transfected trophozoites.     

The Imbrication Model for the integration of social services in a community

An innovative model for organising social services in a community, the Imbrication Model, is contrasted with two traditional models, the Entrepreneurial and the Umbrella Agency. The structural characteristics and dynamics of the three models are illustrated with actual case histories. Imbrication Model calls for the interlocking of personnel from several agencies, with the purpose of redirecting the dysfunctional interagency rivalry prevalent in the traditional models. Imbrications at all organisational levels--Board of Directors, Administrators and Staff--facilitate adoption of the superordinate goal of providing clients with the best services available, regardless of which particular agency delivers the service. Few observers of the current social service scene would challenge the statement that needs for service are unlimited and resources limited. In the USA the imbalance between needs and resources persists despite a decade of massive governmental programmes intended to alleviate social ills. Recent substantial cutbacks in federal funds, moreover are not likely to improve the situation. The resource shortage involves more than a limitation of funds. Deliverers of service and competent programme administrators are also on critically short supply. These shortages are more often than not exacerbated by a chronic spirit of competition among agencies and programmes at the local level. Three organizational models for the delivery and administration of social services, two conventional and one of more recent date, are examined in this article. The innovative model, which has been named the Imbrication Model, explicitly calls for redirecting interagency rivalry and competition. Its ambitious goal is to integrate the efforts of those attempting to meet a community's social service needs.     

Bile secretion in dogs after intravenous administration of glucose

The effect of drop infusions of 10% glucose solution for parenteral nutrition, in a dose of 2 g/kg, on bile secretion was studied in experiments on dogs with chronic gallbladder-duodenal fistulas. It was demonstrated that the infusion of hypertonic glucose solution inhibits bile production quantitatively and qualitatively.