Comparative clinical study of locking screws versus smooth locking pegs in volar plating of distal radius fractures.

The present study was performed to test the null hypothesis on no difference in stability of fixation after volar plating of intra-articular distal radius fractures (AO C2-C3) with either locking smooth pegs or locking screws in a clinical setting. A retrospective evaluation included adult patients with C2-C3 AO fractures treated with a volar plate with locking smooth pegs or locking screws. Radiographic assessment was performed to evaluate extra- and intra-articular parameters in the early postoperative period and after bone union. Twenty-seven consecutive patients were included. Thirteen cases had fixation with locking screws and 14 had fixation with locking smooth pegs. Both groups had bone fragment displacement after fixation. However, there were no significant differences between the groups either in extra- or intra-articular parameters defined by Kreder et al. (1996). Our study shows that, in a clinical setting, there is no difference in stability fixation between locking screws or smooth locking pegs in C2-C3 distal radius fractures.

Bilateral rupture of the extensor pollicis longus tendon. A case report.

Bilateral rupture of the extensor pollicis longus (EPL) is a rare entity and the few cases that have been reported were associated with an underlying systemic condition such as rheumatoid arthritis or following an injury. We present the case of a patient who was referred to us with a spontaneous rupture of the EPL tendon of the right wrist and that of the left side observed 2 months after tenosynovectomy. The patient had not any pathologic condition or evidence of trauma in both wrists. In the left side, he was operated on and a tenolysis and subcutaneous tendon transposition was performed. Despite this preventive surgery, the patient suffered from a tendon rupture. The possible causes of surgery failure are discussed.

Taq I polymorphism of the vitamin D receptor and risk of severe diabetic retinopathy.

AIMS/HYPOTHESIS: Vitamin D, a molecule with antiproliferative, antiangiogenic, antioxidant and immunosuppressive effects, could play a role in the pathogenesis of severe diabetic retinopathy. We examined whether Taq I polymorphism of the vitamin D receptor is involved in the development of severe diabetic retinopathy. METHODS: 200 unrelated C-peptide-negative French Type I diabetic patients were randomly selected (male:female, 103:97, age 44.4 +/- 12.4 years, diabetes duration: 27.7 +/- 10.0 years, BMI: 24.3 +/- 3.4 kg/m(2), HbA(1c): 8.6 +/- 1.3 %). The Taq I site was analysed by PCR followed by digestion with Taq I enzyme. Diabetic retinopathy was assessed by retinal angiography and classified as presence (n = 101) or absence (n = 99) of severe (preproliferative or proliferative) diabetic retinopathy. RESULTS: Frequency of wild-type genotype TT was lower in patients with severe diabetic retinopathy (n = 27) when compared with control subjects (n = 42, OR = 0.5, p = 0.028). Allele frequencies were not different between patients (T: n = 112 and t: n = 90) and control subjects (T: n = 128, and t: n = 70, p = 0.075). Global chi(2) (df = 2): p = 0.064. In subjects with diabetes duration of more than 25 years, TT was lower in severe diabetic retinopathy (n = 14) than control subjects (n = 18, OR = 0.3, p = 0.01). Allele frequencies were different between patients (T: n = 68 and t: n = 66) and control subjects (T: n = 52, OR = 0.5, and t: n = 26, OR = 1.9, p = 0.034). Global chi(2) (df = 2): p = 0.024. In subjects with HbA(1c) over 9 %, Tt was higher in patients (n = 28) than control subjects (n = 15, OR = 3.1, p = 0.019). Allele frequencies were not different between patients (T: n = 52 and t: n = 38) and control subjects (T: n = 57, and t: n = 29, p = 0.31). Global chi(2) (df = 2): p = 0.035. CONCLUSION/INTERPRETATION: In French Type I (insulin-dependent) diabetic patients, we demonstrate an association between TT form (VDR) and low risk for severe diabetic retinopathy, especially in patients with long duration, and between Tt variant and high risk for severe diabetic retinopathy in subjects with poor glycaemic control.

eNOS4 polymorphism of the endothelial nitric oxide synthase predicts risk for severe diabetic retinopathy.

BACKGROUND: Genetic factors may be involved in the development, and particularly in the severity, of diabetic retinopathy (DR), in addition to chronic hyperglycaemia. Increased nitric oxide generation has been suggested to play a significant role in the pathogenesis of DR. AIMS AND METHODS: To examine whether the eNOS4 is involved in the risk of severe DR, 200 unrelated Caucasian Type 1 diabetic patients of long duration were randomly selected (M/F 103/97, age 44.4 +/- 12.4 years, diabetes duration 27.7 +/- 10.0 years, body mass index 24.3 +/- 3.4 kg/m2, HbA1c 8.6 +/- 1.3%). The eNOS4 polymorphism was analysed by polymerase chain reaction, and DR by retinal angiography and classified as presence (n = 101) or absence (n = 99) of severe (proliferative or pre-proliferative) DR. RESULTS: The genotype distribution of eNOS4b/b (wild-type), eNOS4b/a (heterozygous) and eNOS4a/a (homozygous) was 72%, 24.5% and 3.5%, respectively. Frequency of eNOS4a/a was significantly lower in patients with severe DR (n = 0) when compared with controls (n = 7, odds ratio (OR) = 0 (95% confidence interval (CI) = 0.5-0.74), P = 0.02). eNOS4b/b was more frequent in patients with severe DR (n = 80) when compared with controls (n = 64, OR = 2.1 (95% CI = 1.1-4.12), P = 0.032). Frequency of eNOS4b/a was not different between the study (n = 21) and control groups (n = 28, ns). The allelic frequencies between the study and control groups were different (4b: n = 181 vs. n = 156, respectively, OR = 2.3 (95% CI = 1.27-4.25), P = 0.005; 4a: n = 21 vs. n = 42, respectively, OR = 0.4 (95% CI = 0.24-0.79), P = 0.005). CONCLUSIONS: We demonstrate in Caucasians with Type 1 diabetes that (i) eNOS4a/a is associated with absent or non-severe DR, and (ii) eNOS4b/b is associated with severe DR.

Beta-cell function evaluated by HOMA as a predictor of secondary sulphonylurea failure in Type 2 diabetes.

BACKGROUND AND AIMS: Secondary failure to oral hypoglycaemic agents, a common evolution of long-standing Type 2 diabetes, is usually assessed by non-standardized indices requiring fine clinical assessment, including hyperglycaemia resistant to maximum doses of sulphonylureas despite appropriate diet and follow-up. The goal of this study was to evaluate if HOMA, a modelized plasma insulin/glucose ratio allowing simple evaluation of residual insulin secretion and sensitivity, is a better predictor of the insulin requiring stage than clinical indices. MATERIALS AND METHODS: HOMA was measured in 84 Type 2 diabetic patients aged 58 +/- SD 6 years, with diabetes duration 11 +/- 4 years, hospitalized because of hyperglycaemia resistant to maximal doses of sulphonylureas (e.g. glibenclamide > or = 15 mg/day), with no apparent external reason for hyperglycaemia. Despite reinforced appropriate diet recommendations, 62 of these patients remained hyperglycaemic (insulin-requiring group). RESULTS: Age, duration of diabetes, body mass index (BMI) and HOMA value for insulin sensitivity (71 +/- 6% vs. 76 +/- 7%, normal values 59-161%) were comparable in the two groups. HbA(1c) was higher (10.0 +/- 0.2% vs. 8.3 +/- 0.3%, P < 0.001) and HOMA insulin secretion values lower (25 +/- 2% vs. 43 +/- 6%, normal values 70-150%, P < 0.01) in the insulin-requiring group. Of the following potential predictors: HbA(1c) > 8%, duration of diabetes > or = 10 years, HbA(1c) combined with diabetes duration, insulin sensitivity < or = 40%, insulin secretion < or = 20%, the latter showed the best positive predictivity (86% patients with low insulin secretion were insulin-requiring). CONCLUSIONS: (i) HOMA is a simple and good predictor of the insulin-requiring stage in Type 2 diabetes mellitus; (ii) this stage of diabetes is characterized by a further decline of insulin secretion rather than of insulin sensitivity. Diabet. Med. 18, 584-588 (2001)

Chronic consumption of fresh but not heated yogurt improves breath-hydrogen status and short-chain fatty acid profiles: a controlled study in healthy men with or without lactose maldigestion.

BACKGROUND: Ingestion of fermented dairy products induces changes in the equilibrium and metabolism of the intestinal microflora and may thus have beneficial effects on the host. OBJECTIVE: We compared the effects of chronic consumption of yogurt with (fresh) or without (heated) live bacterial cultures (Lactobacillus bulgaricus and Streptococcus thermophilus) on plasma glucose, insulin, triacylglycerols, cholesterol, fatty acids, and short-chain fatty acids. DESIGN: Two groups of 12 healthy men with or without lactose malabsorption were selected with use of a breath-hydrogen test after a 30-g lactose load. Subjects were randomly assigned in a crossover design to 500 g/d of either fresh or heated yogurt for 2 periods of 15 d each, separated by a 15-d washout interval. RESULTS: Chronic consumption of fresh or heated yogurt had no detrimental effects on plasma glucose, insulin, or fatty acid areas under the curve in response to acute ingestion of 500 g yogurt in healthy men with or without lactose malabsorption. There were also no detectable changes in fasting plasma glucose, insulin, fatty acid, triacylglycerol, or cholesterol concentrations. In contrast, plasma butyrate was higher (P: < 0.03) and plasma propionate tended to be higher (P: = 0.059) in subjects without lactose malabsorption after fresh yogurt consumption than after heated yogurt consumption. There were no significant changes in plasma acetate. In subjects with lactose malabsorption, 15 d of fresh yogurt consumption also increased propionate production compared with values at baseline (P: < 0.04). In the same group, the production of breath hydrogen was lower after fresh yogurt consumption than after heated yogurt consumption (P: < 0.01). CONCLUSIONS: In men with lactose malabsorption, chronic consumption of yogurt containing live bacterial cultures ameliorated the malabsorption, as evidenced by lower breath-hydrogen excretion, but increased propionate concentrations. In subjects without lactose malabsorption, such yogurt tended to increase propionate and increased butyrate.

Euglycemic hyperinsulinemic clamp to assess posthepatic glucose appearance after carbohydrate loading. 2. Evaluation of corn and mung bean starches in healthy men.

BACKGROUND: The rate of absorption of glucose from carbohydrates is important in several aspects of health. We recently validated a noninvasive technique in pigs, euglycemic hyperinsulinemic clamp plus oral carbohydrate loading (OC-Clamp), to quantify the rate of net posthepatic appearance of glucose after ingestion of carbohydrates. OBJECTIVE: The OC-Clamp procedure was performed in 8 healthy men to compare the net posthepatic appearance of glucose after ingestion of 1 of 3 carbohydrates. DESIGN: Human volunteers underwent the OC-Clamp procedure at an insulin infusion rate of 1.5 mU x kg(-1) x min(-1) (n = 5). The oral carbohydrate load (1 g/kg) consisted of glucose, cornstarch, or mung bean starch. During the OC-Clamp procedure, the glucose infusion rate decreased during absorption to maintain plasma glucose steady state and the decrease reflected the net posthepatic appearance of glucose. In addition, carbohydrates were loaded without insulin infusion (n = 6) and glycemic indexes were calculated (with glucose as the reference). RESULTS: The mean (+/-SEM) glycemic index of cornstarch was higher (95 +/- 18) than that of mung bean starch (51 +/- 13). In the OC-Clamp experiments, the posthepatic appearance of glucose and cornstarch did not differ significantly and represented 79.4 +/- 5.0% and 72.6 +/- 4.0%, respectively, of the load after complete absorption (within 3 h). In contrast, the net posthepatic appearance of glucose from mung bean starch was significantly lower (35.6 +/- 4.6% of the load, P < 0.001) than that from glucose and cornstarch, even 4.5 h postprandially. CONCLUSIONS: The OC-Clamp technique allows a continuous assessment of net posthepatic appearance of glucose after ingestion of carbohydrates and significant discrimination between corn and mung bean starches.

Structural analysis of gene marker loci on chromosomes 10 and 11 in primary and secondary uraemic hyperparathyroidism.

BACKGROUND: The genetic molecular anomalies in patients with primary (I degree) and secondary (II degree) hyperparathyroidism (HPTH) are still largely unknown. In particular, the changes underlying monoclonal growth in the parathyroids of patients with II degree HPTH are not well understood. METHODS: We screened genomic DNA from a total of 30 patients with I degree HPTH and 29 patients with II degree uraemic HPTH for possible rearrangements or allelic losses of several gene markers located on chromosome 11p near the PTH gene, namely Ha-ras, IGF-2, WT1, and the PTH gene itself. In addition, two other gene markers, PRAD1 (localized on 11q13) and RET (localized on 10q11) were examined for possible structural alterations. Moreover, we used fluorescence in situ hybridization (FISH) which is another technique to detect numerical alterations of chromosome 11. RESULTS: The results show that one of 13 patients with I degree HPTH (8%) exhibited a rearrangement for the PRAD-1 gene. Loss of heterozygosity of Ha-ras locus was observed in one of 11 uraemic patients with II degree HPTH (9%). Three of 10 patients with I degree HPTH (30%) and one of 7 patients with II degree HPTH (14%) showed an allelic loss of the WT1 gene. No evidence of rearrangement or allelic loss was detected for the IGF-2, PTH or RET genes respectively. Using FISH method, three normal parathyroid gland, six I degree HPTH adenomas and eight II degree HPTH hyperplastic glands from uraemic patients were studied with centromeric probe for chromosome 11. Monosomy 11 was observed in one case of I degree HPTH and in one other case of II degree HPTH. CONCLUSION: Evidence of loss of heterozygosity for several genes located on human chromosome 11p has been found in a series of parathyroid glands from several patients with I degree and II degree uraemic HPTH, corresponding to monosomy of chromosome 11 in some cases.