Use of minimally invasive (percutaneous) Fassier-Duval telescopic rod on an 8 year old patient with Lobstein disease.

Lobstein disease is a severe disease characterized primarily by bone fragility which causes numerous fractures, especially in long bones. Multiple fracture of a bone will cause in time a deformity with consecutive functional impotence. The treatment for Lobstein disease in children must take into account both increasing bone strength and fracture prevention and treatment of possible fractures. Regarding the choice of synthesis material, in children, there are many constraints related to the small size of the bones, presence of growth plate and the risk of periosteal blood supply infringement. Currently, for the long-term fixation of long bone fractures in children, telescopic Fassier Duval rods are used, allowing reinforcement throughout growth. In this article we present an 8 years old patient, with a femoral fracture and Lobstein disease, who underwent initial intramedullar fixation with a Kirschner pin which was subsequently replaced by a Fassier Duval telescopic rod. Mounting the telescopic rod was performed minimally invasively through a technique improved in our service. We believe that this method can be applied in all cases where other types of fracture stabilization was used, and to ensure straightness of the medullar canal.

Neurovascular abnormalities in Gartland III supracondylar fractures in children.

The most common elbow injuries in pediatric trauma practice are supracondylar fractures of the humerus. Posteriorly displaced fractures may be angulated or displaced medially or laterally with associated internal or external rotation. We compared two groups of patients, each with grade III supracondylar fractures after Gartland. The goal of this study was to see if reduction and pinning maneuvers create neurovascular abnormalities and if there are any differences in terms of neurovascular consequences for reducing grade III Gartland supracondylar fractures of the humerus using reduction in supination or pronation of the forearm. We formed two study groups based on the reduction method used. Concretely: patients who needed reduction in pronation were included in the first group and patients who needed reduction in supination were included in the second group. Patients were added to each group until every group reached 40, to have equal and comparable groups. No statistically significant differences on clinical outcome and neurovascular complications appeared between the two methods of closed reduction. We can say that both methods used are correct.

New approach for regulation of the internal recirculation flow rate by fuzzy logic in biological wastewater treatments.

The internal recirculation plays an important role on the different biological processes of wastewater treatment plants because it has a great influence on the concentration of pollutants, especially nutrients. Usually, the internal recirculation flow rate is kept fixed or manipulated by control techniques to maintain a fixed nitrate set-point in the last anoxic tank. This work proposes a new control strategy to manipulate the internal recirculation flow rate by applying a fuzzy controller. The proposed controller takes into account the effects of the internal recirculation flow rate on the inlet of the biological treatment and on the denitrification and nitrification processes with the aim of reducing violations of legally established limits of nitrogen and ammonia and also reducing operational costs. The proposed fuzzy controller is tested by simulation with the internationally known benchmark simulation model no. 2. The objective is to apply the proposed fuzzy controller in any control strategy, only replacing the manipulation of the internal recirculation flow rate, to improve the plant operation.Therefore, it has been implemented in five operation strategies from the literature, replacing their original internal recirculation flow rate control, and simulation results are compared with those of the original strategies. Results show improvements with the application of the proposed fuzzy controller of between 2.25 and 57.94% in reduction of total nitrogen limit violations, between 55.22 and 79.69% in reduction of ammonia limit violations and between 0.84 and 38.06% in cost reduction of pumping energy.

Fuzzy logic for plant-wide control of biological wastewater treatment process including greenhouse gas emissions.

The application of control strategies is increasingly used in wastewater treatment plants with the aim of improving effluent quality and reducing operating costs. Due to concerns about the progressive growth of greenhouse gas emissions (GHG), these are also currently being evaluated in wastewater treatment plants. The present article proposes a fuzzy controller for plant-wide control of the biological wastewater treatment process. Its design is based on 14 inputs and 6 outputs in order to reduce GHG emissions, nutrient concentration in the effluent and operational costs. The article explains and shows the effect of each one of the inputs and outputs of the fuzzy controller, as well as the relationship between them. Benchmark Simulation Model no 2 Gas is used for testing the proposed control strategy. The results of simulation results show that the fuzzy controller is able to reduce GHG emissions while improving, at the same time, the common criteria of effluent quality and operational costs.

Control strategies for nitrous oxide emissions reduction on wastewater treatment plants operation.

The present paper focused on reducing greenhouse gases emissions in wastewater treatment plants operation by application of suitable control strategies. Specifically, the objective is to reduce nitrous oxide emissions during the nitrification process. Incomplete nitrification in the aerobic tanks can lead to an accumulation of nitrite that triggers the nitrous oxide emissions. In order to avoid the peaks of nitrous oxide emissions, this paper proposes a cascade control configuration by manipulating the dissolved oxygen set-points in the aerobic tanks. This control strategy is combined with ammonia cascade control already applied in the literature. This is performed with the objective to take also into account effluent pollutants and operational costs. In addition, other greenhouse gases emissions sources are also evaluated. Results have been obtained by simulation, using a modified version of Benchmark Simulation Model no. 2, which takes into account greenhouse gases emissions. This is called Benchmark Simulation Model no. 2 Gas. The results show that the proposed control strategies are able to reduce by 29.86% of nitrous oxide emissions compared to the default control strategy, while maintaining a satisfactory trade-off between water quality and costs.

[Contact tracing in a case of tuberculosis in a health care worker]. / Investigations autour d'un cas de tuberculose d'un soignant.

INTRODUCTION: Tuberculosis is a public health problem, of which the nosocomial transmission from a health care worker to patients has not been well documented. OBSERVATIONS: A Senegalese surgeon aged 32 was admitted to hospital on account of deterioration in his general health. He was found to have sputum positive tuberculosis and received standard treatment. We report the strategy employed for tracing the contacts of this health care worker. Of a total of 185 members of staff (permanent and temporary) and 91 patients who had been in contact with the index case, 180 (97.3%) and 71 (78%) respectively were screened. Of the 251 subjects screened, 5 staff (2.8%) and 11 patients (15.4%) showed evidence of latent tuberculous infection and 6 were treated. In total 97.3% of staff exposed were screened at the beginning of the study and 63% were reviewed at 3 months as opposed to 78% and 53% for the patients. CONCLUSION: This study shows poor compliance with the visit 3 months after exposure and the need to standardise the procedures in order to improve the screening and follow up of contacts.

Early telescopic rod osteosynthesis for Osteogenesis Imperfecta patients.

Osteogenesis imperfecta is a genetically determined pathology that implies bone variability and osteoporosis with early onset of fractures after low energy trauma. For a better understanding of the clinical problems, Sillence and Danks created a classification. The study group consisted of 12 patients both males and females, with ages ranging from 2 years and 3 months to 12 years. All of them came to the hospital late, after walking, after several fractures occurred and the only treatment they underwent was with prolonged cast immobilization that caused rapid bone demineralization, axial deformations of the affected bones, increased number of fractures and eventually loss of ambulation. Following the discharged patients, we appreciated that the open bone alignment and Fassier Duval osteosynthesis were the best way to treat a patient with Lobstein disease. The results showed that by using these two techniques a lot of time is saved on a long term because all the great complications associated with older techniques are gone and a rapid ambulation is possible due to the soft tissue damage that is kept to a minimum.

Phase I and pharmacokinetic study of brequinar (DUP 785; NSC 368390) in cancer patients.

Brequinar (DUP 785, NSC 368390) is a 4-quinoline carboxylic acid derivative with broad spectrum antitumour activity in experimental models that acts as an antimetabolite by specific inhibition of de novo pyrimidine synthesis. We performed a phase I study of brequinar administered as a 10 min intravenous (i.v.) infusion for 5 consecutive days, every 4 weeks. 67 evaluable patients were entered in this study and a total of 130 courses were administered at doses ranging from 2 to 350 mg/m2. The dose-limiting toxicity was myelosuppression with predominant thrombocytopenia. Myelosuppression was dose-related and non-cumulative, with considerable interpatient variability depending on haematological risk factors. The maximum tolerated dose of brequinar was 210 mg/m2/day in poor risk patients whereas patients with good risk haematological profile tolerated higher doses (up to 350 mg/m2/day). Other non-limiting toxicities included nausea and vomiting, mucositis and skin reactions. Brequinar plasma pharmacokinetic profiles were biphasic with alpha half-life ranging from 0.1 to 0.7 h, and beta half-life ranging from 1.5 to 8.2 h. Increase in brequinar area under the plasma concentration versus time curves (AUC) was nonlinear. Day 5 brequinar pharmacokinetics obtained in 21 patients indicated a significant increase in AUC (47%) and half-life beta (133%) compared to day 1 pharmacokinetics in the same patient. Brequinar plasma AUC and the per cent change in platelet count at nadir were correlated (P < 0.001). Although no objective response was observed in this study, one minor response was noted in cervical lymph nodes of a Hodgkin's disease patient.

99m Technetium labelled heparin: potential value as a tracer of heparin activity in pharmacokinetic and biodistribution studies.

Pharmacokinetics and biodistribution of 99m Technetium (99mTc) labelled heparin were studies to assess its value as a tracer of heparin kinetics in comparison with unlabelled heparin. In vitro, the stability and labelling efficiency (98%) of the labelled drug were excellent and elution was minimal. In vivo, after I.V. infusion of the drug, there was no difference in the same animal between anticoagulant activity measurements and radioactive countings, both displaying a plasmatic biexponential pattern (T1 = 2.9 minutes, T2 = 76 minutes). Biodistribution studies showed primarily liver, spleen and kidney accumulation, with no thyroid uptake. The advantages of this technetium labelling may therefore be used for the heparin drug in various experimental and pathological situations even in humans.

Investigation of the results obtained following repeated boosters with Di-Te vaccine in HIV positive children.

The paper is an attempt to study the effect of repeated boosters with Di-Te vaccine in positive children. The efficacy of their administration (vaccinal coverage degree, level of secreted antitoxins, the persistency of the immune response) and their influence upon the subsequent evolution of HIV infection are investigated.

The modern treatment of the simple bone cysts.

This study was performed between 2007-2012 and encompasses 94 patients. The patients were divided in two groups. The first group included the patients who have benefited from surgical treatment (42 cases) and the second one included patients who benefited from conservative treatment. Out of the total number of cases, 63 cases showed an intact simple bone cyst that was most of the time an accidental discovery. 31 patients presented with fracture sustained on a simple bone cyst. There were 63 boys and 31 girls. Their mean age was 9.9 +/- 2.34 years. Single injection was performed for 49 patients; the rest had double or triple injections. The mean follow-up was 34.5 +/- 6.6 months. The procedure succeeded in obtaining healing in 77 cysts (82%). Cyst index of more than five and cortical index of less than 1 mm were significantly prone to pathological fractures and had significant poor results after treatment. Our results suggested that an autogenous bone marrow injection is a safe and effective treatment method for simple bone cysts, when compared with the surgical management, but sometimes-repeated injections are necessary. Cyst index and cortical width are good indicators for treatment outcome.

A new case of lower extremity glomus tumor up-to date review and case report.

Glomus tumor (glomus cell tumor) is a rare, hamartomatous, usually benign neoplasm, whose cells resemble the modified smooth muscle cells of the normal glomus body. The diagnosis of a lower extremity is often delayed, due to the lack of awareness and low level of suspicion, by the treating physician. The glomus tumor (GT) often involves the nail beds. The unusual location of the lower extremity often leads to missed or delayed diagnosis and management. There is a paucy of information about GT in general, especially among orthopedic surgeons. The aim of this article is to make the surgical community more aware of this disease.

Molecular cloning of cDNAs that encode the chicken P0 protein: evidence for early expression in avians.

As the major transbilayer glycoprotein of peripheral myelin, P0 is believed to play a prominent role in the formation of this structure by Schwann cells. The amino acid sequence of the chicken P0 molecule, deduced from the nucleotide sequence of cDNA clones, is reported here. Comparison with the mammalian molecule reveals an extensive overall homology, thus underlining the importance both of the cytoplasmic and of the extracellular domains of this protein in the establishment and preservation of peripheral myelin structure. Unexpectedly, an avian P0 cDNA probe was found to hybridise with several mRNA species, present exclusively in peripheral nerve and in proportions that varied according to the developmental stage. The expression of these transcripts was detected significantly earlier than that of P0 mRNA in mammals.

[Jaundice with indirect bilirubinemia via the mother's milk]. / Icter cu bilirubinemie indirecta prin lapte matern.

Among the clinical entities included in the differential diagnosis of the prolonged jaundice at the end of neonatal period and in the small infant is the jaundice due to mother's milk, whose incidence is of 0.5-2% in the naturally fed infants. The authors present two cases in which the diagnosis was reached by exclusion and confirmed by the therapeutically positive test. Physiopathologic considerations are made on the basis of the literature data, and the nosologic background of the affection is presented. This clinical entity, considered to have an excellent prognosis, presented a special evolution in one of the cases.

Technetium 99m autoradiography of labelled white cells.

The cellular uptake of technetium 99m was determined on white blood cells (WBC) by autoradiography, after 'cold' tin pyrophosphate prelabelling followed by pertechnetate labelling. The autoradiographic method gave visible tracks of 99mTc internal conversion and Auger electrons. 75 +/- 5% of the treated WBC were labelled but none of the control WBC. The number and length of tracks per cell varied greatly. This was perhaps due to imaging conditions as well as to variations in cell uptake.

Expression of GlN1-immunoreactive glycoproteins during development and regeneration in avian peripheral nerve.

Reactivity of the monoclonal antibody GlN1 was examined by immunocytochemistry and immunoblotting in quail and chick developing and regenerating wing nerves; its distribution is compared to that of HNK-1 which detects a carbohydrate epitope widely distributed in the nervous system. Reactivity was detected by immunofluorescence in cryostat sections, by a postembedding electron-microscopic immunogold technique and in immunoblots of nerve homogenates. From E11-E16, reactivity was detected in several large (120-260 kD) glycoprotein bands; and thereafter, principally, in 3 myelin-related glycoproteins (100, 26.5, and 21.5/ 19.5 kD). The HNK-1 carbohydrate epitope was detected in all these and in other bands permitting identification of the 100-kD moiety as the myelin-associated glycoprotein and the 26.5-kD protein as the P0 protein; the myelin-related 21.5/19.5-kD doublet appears as distinct, probable adhesion molecule(s). During development and regeneration, GlN1 reactivity detected by immunogold labeling of sections appeared first over the extracellular matrix, and later over thicker myelin sheaths. After transection, immunoreactivity in immunoblots was lost in distal stumps but reappeared with time; first in the larger (greater than 120 kD) moieties and then in the myelin-related bands, the same sequence observed in development. Electron-microscopic detection of both GlN1 and HNK-1 carbohydrate epitopes by immunogold labeling of resin-embedded sections is localized most consistently in the thicker (greater than 0.3 microns) myelin sheaths of nerves from chicks at or after hatching. Immunoblots of mature fowl nerve tissues homogenized at various stages of preparation for electron microscopy (after fixation or after fixation and dehydration) show sustained immunoreactivity in the 21.5/19.5-kD bands, reduction or complete suppression in others, and evidence of immunoreactivity in high molecular weight, presumably cross-linked, constituents that remain in the stacking gel portion of the blots.

Phenotypic plasticity of avian embryonic sympathetic neurons grown in a chemically defined medium: direct evidence for noradrenergic and cholinergic properties in the same neurons.

Avian embryonic sympathetic ganglia possess both catecholaminergic and cholinergic features and can synthesize noradrenaline (NAd) and acetylcholine (ACh) simultaneously. In the present study we sought to determine (1) whether or not this coproduction of NAd and ACh corresponds to the existence of two non-overlapping populations, and (2) to what extent the levels of synthesis are influenced by non-neuronal ganglion cells. We have focused on the correlation between the immunocytochemically demonstrable presence of the noradrenergic and cholinergic enzymes tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT), respectively, and the synthesis of the corresponding neurotransmitters in embryonic quail sympathetic neuronal and non-neuronal cells purified by fluorescence-activated cell sorting. We show that (1) freshly sorted neurons synthesize both NAd and ACh, whereas non-neuronal cells produce neither; (2) the overwhelming majority of the sympathetic neurons display TH immunoreactivity; (3) about half of the TH-positive neurons are recognized by an anti-ChAT antibody in an artificial medium that selectively enhances synthesis and/or accumulation of ACh; (4) the non-neuronal cells are important for survival of the neurons and potentiate their synthesis of ACh in this medium, and (5) finally, we present evidence that expression of TH in noradrenergic neurons and in small intensely fluorescent cells of sympathetic ganglia is differentially regulated.

[Illumination in schools, a health problem for the developing body]. / Iluminatul în scoli, problema de sanatate pentru organismul în dezvoltare.

The relationship between lightening degree in schools and vision problems was investigated in a series of 500 pupils (aged between 11 and 14 years) from both rural and urban areas, schooled in 21 different classrooms. The tests revealed that natural lightening is observing the health standards in a percentage of 100% in the urban classrooms and is deficient with 16.64% in the rural ones. Artificial lightening is inappropriate in all investigated classrooms (both rural and urban). Vision, estimated by visual acuity test, proved to be more affected in the rural areas (14% of the children) where lightening conditions are more deficient, than in the urban pupils (12.8%). It was also noticed that the active detection index of vision disturbances is lower in the rural as compared to urban pupils (5.7% and 28.12%, respectively). School lightening should be a priority in the public health programs.

Five leucocyte labelling techniques: a comparative in-vitro study.

During the past years, several authors have used labelled leucocytes to detect inflammatory foci. However, before routine use in man. It is necessary to control the viability of labelled cells. Five leucocyte labelling techniques (111In-oxine, 111In-oxine without extraction, 99mTc oxine, pyrophosphate 99mTc, 51Cr) were compared using the same separation methods, conservation medium, viability assays and migration studies. Electron microscopic studies allowed the assessment of cellular damage induced by the labelling techniques as well as the calculation of the percentage of cells disrupted during preparation. Results obtained in vitro using 111In-oxine were not satisfactory and in fact appeared contradictory to those published by the authors using this technique in vivo. Even the best method, pyrophosphate 99mTc labelling, was not completely atoxic, but the functional behaviour of the leucocytes did not seem affected. While in vitro studies offer much information concerning labelled cells, they cannot predict the in vivo behaviour of these cells.