Screw fixation of the olecranon after fracture or osteotomy

For 10 years prior to the availability of the Olecranon Screw described in this article, oblique fixation using a regular Sherman bone screw was employed for displaced fractures (with a suitable fragment) by engaging the anterior ulnar cortex. Internal fixation was supplemented by a split for 3 weeks. The reason for a special olecranon screw is to eliminate the necessity for additional fixation and permit early motion. No instance of non-union or important restriction of motion or serious complication has been encountered.     

Computed tomography in the postoperative patient

Nine cases of patients in whom intracranial infection was suspected after operation are presented. Lesions with ring enhancement were seen in all of these patients. The differentiation of enhancement, seen as a normal postoperative phenomenon, from residual neoplasia and cerebral abscess can be difficult. This can be resolved by serial and sequential-delayed CT, and thus unnecessary re-exploration may be prevented.     

A staging system for forelimb regeneration in the axolotl, Ambystoma mexicanum

A staging system has been devised for normal regeneration from the upper arm in the mature axolotl. It consists of seven externally definable stages: (1) Wound healing (WH): (2) Dedifferentiation (DD); (3) Early bud (EB); (4) Medium bud (MB); (5) Late bud (LB); (6) Palette (Pal), and (7) Digital outgrowth (DO). Serial histological sections of 38 regenerating limbs were used to correlate gross stages with microscopic events in the regenerative process.     

Increased ubiquitin expression suppresses the cell cycle defect associated with the yeast ubiquitin conjugating enzyme, CDC34 (UBC3). Evidence for a noncovalent interaction between CDC34 and ubiquitin

The yeast ubiquitin (Ub) conjugating enzyme CDC34 plays a crucial role in the progression of the cell cycle from the G1 to S phase. In an effort to identify proteins that interact with CDC34 we undertook a genetic screen to isolate genes whose increased expression suppressed the cell cycle defect associated with the cdc34-2 temperature-sensitive allele. From this screen, the poly-Ub gene UBI4 was identified as a moderately strong suppressor. The fact that the overexpression of a gene encoding a single Ub protein could also suppress the cdc34-2 allele indicated that suppression was related to the increased abundance of Ub. Ub overexpression was found to suppress two other structurally unrelated cdc34 mutations, in addition to the cdc34-2 allele. In all three cases, suppression depended on the expression of Ub with an intact carboxyl terminus. Only the cdc34-2 allele, however, could be suppressed by Ub with an amino acid substitution at lysine 48 which is known to be involved in multi-Ub chain assembly. Genetic results showing allele specific suppression of cdc34 mutations by various Ub derivatives suggested a specific noncovalent interaction between Ub and CDC34. Consistent with this prediction, we have shown by chemical cross-linking the existence of a specific noncovalent Ub binding site on CDC34. Together, these genetic and biochemical experiments indicate that Ub suppression of these cdc34 mutations results from the combined contributions of Ub-CDC34 thiol ester formation and a noncovalent interaction between Ub and CDC34 and therefore suggest that the correct positioning of Ub on a surface of the ubiquitin conjugating enzyme is a requirement of enzyme function.     

A microbiological validation and criteria for the efficacy of the use of CO2 and YAG lasers in the surgical treatment of cholecystitis

A considerable frequency of infected bed of the gallbladder in different forms of cholecystitis was established, the anaerobic microflora being inoculated more often. A direct dependence of the frequency of infecting the bile and gallbladder bed on the patient's age and duration of having chronic cholecystitis was shown. The sterilization and prevention of reinfection of the gallbladder bed after the removal of it can be achieved by the laser irradiation of the total bed surface inspite of the absence of clear symptoms of acute inflammation of the bladder and the surrounding tissues, and the cleansing should be performed after the manipulations on extrahepatic bile ducts are completed.     

Initial and follow-up brain MRI findings and correlation with the clinical course in Wilson's disease

We performed pretreatment brain MRIs in 25 patients with neurologically symptomatic Wilson's disease (WD) and clinical and MRI follow-up in 16 of them. All 25 pretreatment MRIs revealed abnormalities, with abnormal high-signal intensity (HSI) in bilateral thalami being the most common (92%). HSI lesions in the brainstem (84%) and the basal ganglia (72%) were also common. Brain atrophy was present in 88% of the 25 patients. In the follow-up period of 5 to 24 months, during which the patients were treated with D-penicillamine, both HSI lesions and neurologic symptoms improved in 88% of the 16 patients, but the brain atrophy did not change.     

A date with death: management of time-based and contingent suicidal intent

OBJECTIVE: The patient who voices suicidal intent in terms of the future or in terms of certain life contingencies presents special difficulties for the therapist. The authors outline the challenges posed by this problem for assessment, clinical management, and risk management. METHOD: The authors examined and analyzed case examples from both clinical and risk-management aspects. RESULTS: Problematic cases can be grouped into categories that offer insight as to management. The authors discuss this area and offer suggestions for appropriate clinical responses to this challenge. CONCLUSIONS: The authors recommend that therapists 1) treat the expressed "date with death" as a communication to be explored, 2) explore the problem of helplessness while monitoring their own countertransference responses, 3) assess the patient's competence to inform clinicians about suicidal state, and 4) readily use involuntary commitment.     

Arterial remodeling after balloon angioplasty of the coronary artery: an intravascular ultrasound study. PICTURE Investigators. PostTreatment IntraCoronary Transluminal Ultrasound Result Evaluation

OBJECTIVE: Before balloon dilation, failure of compensatory enlargement and even arterial shrinkage are frequently observed at the lesion site in response to plaque accumulation. Balloon angioplasty may be regarded as artificial remodeling to enlarge the artery. The prevalence of the different types of arterial wall remodeling after applied stretch by balloon angioplasty is unknown. METHODS AND RESULTS: In 181 patients an intravascular ultrasound study was performed after coronary balloon angioplasty (n = 200 lesions). The vessel area was measured at a proximal and distal reference site and at the lesion site. Subsequently, the relative vessel area [(Vessel area lesion site)/Vessel area reference site) x 100] was calculated. Lesions were classified in three groups on the basis of their relative vessel areas: > or =105%, <105% but >95%, and < or =95%. A relative vessel area > or =105%, indicating enlargement compared with the reference site, was observed in 84 (44%) lesions. A relative vessel area <105% but >95% was observed in 43 (22%) lesions. A relative vessel area < or =95%, indicating "shrinkage" compared with the reference site, was observed in 66 (34%) lesions. CONCLUSIONS: After balloon angioplasty, the vessel area was found to be smaller compared with the reference site in 34% of the lesions. This small vessel area at the lesion site compared with a reference site may be a reflection of insufficient stretch by balloon angioplasty.