Description of new sign of integral (∫) for rotational deformity of distal femur.

PURPOSE: Femur shaft fractures commonly occur due to high velocity trauma and most of them are fixed with nailing. Malrotation is common after fixation. A rotational malalignment more than 30° is a deformity which requires correction. Various techniques described for rotational deformities are: the 'cable techniques' for the determination of varus-valgus malalignment; the 'hyperextension test', 'radiographic recurvatum sign', 'tibial plateau sign', and 'meterstick technique' for length analysis; and the 'hip rotation test', 'lesser trochanter shape sign', 'cortical step sign', and 'diameter difference sign' for rotational analysis. We describe integration sign at the medial or lateral aspect of notch of femur in fixed internal or external rotation due to condensation of trabeculae. METHODS: This is a prospective observational study. Informed consent was taken, and this study was approved by institutional review board. C arm imaging study of 50 knees was done at our institution in which rotational profile of distal femur was analyzed In 3 different views -AP , Internal and external rotation views. The rotation views were taken sequentially and each observer was asked to identify the sign at its appearance and at rotation when it was best seen. All the observers were asked to draw the sign on linear line diagram of distal femur. The data was analysed statistically. RESULTS: Sign of integral (∫) for rotational deformity was seen at Mean external rotation of  22±1.71 with a range of 19 degree to 25 degree and  Mean internal rotation of 15.78±1.21 with a range of 14 degree to 18 degree. CONCLUSION: The integration sign can be used as intraoperative C arm sign to understand the rotational deformity of distal fragment of femur. This helps the surgeon to understand the alignment and revise if needed intraoperatively. If combined with position of lesser trochanter, this will give alignment for both proximal as well as distal fragment of femur.

Spectrum of Factors Triggering Endothelial Dysfunction in PIH.

INTRODUCTION: Pre-eclampsia (PE) is a major cause of maternal and fetal/neonatal mortality and morbidity. The aetiology and pathogenesis of PE is yet to be completely understood. Evidence shows that, Endothelial Dysfunction (ED) plays a pivotal role in the genesis of this multi-system disorder that develops in PE and eclampsia. AIM: To determine the circulating levels of factors Malondialdehyde (MDA), Ferric Reducing Ability of Plasma-α (FRAP), Tumour Necrosis Factor (TNF-α), sFlt-1, VEGF, PlGF, Nitric Oxide (NO) that influence the ED. MATERIALS AND METHODS: Study groups consisted of Normotensive pregnant women (N), preeclamptic women (PE) and eclamptic women (E) with 100 subjects in each group in the 3rd trimester of pregnancy. They were investigated for MDA, FRAP, TNF-α, sFlt-1, VEGF, PlGF, NO. Statistical analysis was done using Analysis of Variance (ANOVA). RESULTS: When compared to controls MDA, TNF-α, sFlt-1 levels were found to be significantly high and FRAP, VEGF, PIGF and NO levels were significantly low in PE and E group. E showed a significantly high level of MDA, TNF-α, sFlt-1 and low levels of FRAP, VEGF, PIGF, NO when compared to PE group. CONCLUSION: Our study substantiated the fact, that oxidative stress, imbalance between anti-angiogenic factors and pro- angiogenic factors exists in Pregnancy Induced Hypertension (PIH) condition. This imbalance is directly related to the ED, the hallmark of PE. So oxidative stress, VEGF, PlGF and sFlt-1 can be used as markers to analyze the onset and progression of the disease.

A Study on the Level of Oxidative Stress and Inflammatory Markers in Type 2 Diabetes Mellitus Patients with Different Treatment Modalities.

INTRODUCTION: The prevalence of type 2 diabetes mellitus is increasing worldwide in all the age group. UKPDS study had shown that good glycaemic control is maintained by the administration of insulin in addition to hypoglycaemic drugs. But, hyperinsulinemia might cause vascular complications in T2DM. Oxidative stress and inflammation are common in diabetes and plays an important role in vascular complications. AIM: The study has been designed to estimate and compare the level of oxidative stress and inflammation in type 2 diabetic patients under different treatment modalities. MATERIALS AND METHODS: Sixty Type 2 diabetic subjects undergoing treatment were selected from Government Hospital and VMKV Medical College & Hospital at Salem. The subjects were divided into two groups based on treatment modalities, hypoglycaemic drugs subjects as Group-I (30) and hypoglycaemic drugs & Insulin subjects in Group-II (30). BMI was calculated by standard formula and Fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated haemoglobin (HbA1c), Lipid profile, oxidative stress (MDA) and inflammatory markers were measured by well established methods. SPSS 16.0 version was used for statistical analysis. RESULT: In our study we have found significantly high levels of BMI, MDA and hsCRP (25.5±2.79, 2.73±1.65, 1.98±0.85) in Group II subjects when compared to Group I subjects (23.4±3.09, 2.23±1.76, 1.168±1.124). CONCLUSION: Since risk factors like BMI, MDA and hsCRP were high in Diabetes mellitus patients on both oral hypoglycaemic drugs and insulin, they are more susceptible to cardiovascular diseases. Evaluation of these markers at regular interval can reduce the incidence of vascular complications in Type 2 DM patients.