Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation.

PURPOSE: Elastic stable intramedullary nailing is increasingly used for surgical treatment of tibial shaft fractures, but frequently requires immobilization and delayed full weight-bearing. Therefore, external fixation remains interesting. The aim was to report clinico-radiological outcomes of monolateral external fixation for displaced and unstable tibial shaft fractures in children. METHODS: All tibial fractures consecutively treated by monolateral external fixation between 2008 and 2013 were followed. Inclusion criteria included skeletal immaturity and closed and open Gustilo I fractures caused by a direct impact. Patients were seen until two years postoperatively. Demographics, mechanism of injury, surgical data and complications were recorded. Anteroposterior and lateral side radiographs were performed at each visit. Full-limb 3D reconstructions using biplanar stereroradiography was performed for final limb length and alignment measures. RESULTS: A total of 45 patients (mean age 9.7 years ± 0.5) were included. In all, 17 were Gustilo I fractures, with no difference between open and closed fractures for any data. Mean time to full weight bearing was 18.2 days ± 0.7. After 15 days, 39 patients returned to school. Hardware removal (mean time to union 15.6 weeks ± 0.8) was performed during consultation under analgesic gas. There were no cases of nonunion. No fracture healed with > 10° of angulation (mean 5.1° ± 0.4°). Leg-length discrepancy > 10 mm was found for six patients. CONCLUSIONS: This procedure can be a safe and simple surgical treatment for children with tibial shaft fractures. Few complications and early return to school were reported, with the limitations of non-comparative study. LEVEL OF EVIDENCE: IV.

Endometrial cytopathology. An image analysis approach using the Ki-67 biomarker.

OBJECTIVE: To investigate the different identity and biological behaviour of endometrial benign epithelial and endometrial adenocarcinoma cell categories. METHODS: For this study, the imprint smears from three groups, 10 cases of disordered proliferative/benign hyperplastic endometrium, 21 cases of low-grade and eight cases of high-grade endometrial adenocarcinoma, were examined using image analysis and the Ki-67 biomarker. The plastic stem cell model was also applied. RESULTS: Among the examined groups, the nuclear area major axis ranged statistically different in the digitally measured Ki-67 positive endometrial epithelial and adenocarcinoma cells (P<.0001). Moreover, higher values of the cycling nuclear area major axis were observed in high-grade, as compared with the low-grade endometrial adenocarcinomas (P<.0001) and the cases of disordered/benign hyperplastic endometrium (P<.0001). Additionally, a Ki-67 increase pathway was observed in the benign endometrial lesions, and a relatively stable pathway was noticed in low- and high-grade endometrial adenocarcinomas. CONCLUSIONS: The different range of the nuclear area major axis among cycling endometrial epithelial and adenocarcinoma cells may correlate with their specific identity and biological behaviour. The different values of the cycling nuclear area major dimension may also be connected with the biological behaviour of the three examined groups. Moreover, the endometrial epithelial cells may follow a Ki-67 increase pathway, instead of the relatively stable pathway which the rapidly proliferating adenocarcinoma cells may use. Finally, the studied cell categories may exhibit different biology, because their stem cells may reside in different states of stemness.

[Technical note: iliac crest bone graft harvesting in children]. / Note technique: prélèvement osseux de crête iliaque chez l'enfant.

Harvesting iliac crest bone in children is special because of the presence of a thick cartilage. Constant pressure on the internal iliac fossa, ascends the skin, and moves the abdominal muscles away from the iliac crest. A single incision is then used for cutaneous and subcutaneous dissection. An internal piece of cartilage is then removed and the iliac muscle retracted in order to harvest cortical and spongy bone from the internal side of the iliac crest. That pièce of cartilage is then sutured at its initial place. During the harvesting, the surgeon needs to be careful to preserve the lateral femoral cutaneous nerve.

Cytodiagnosis of endometrial carcinoma and hyperplasia on imprint smears with additional immunocytochemistry using Ki-67 and p53 biomarkers.

OBJECTIVE: It is said to be difficult to interpret the different endometrial lesions by cytomorphology; however, evaluation of the microarchitecture of the cell clumps and application of immunocytochemistry can improve diagnostic accuracy. The aim of the present study was to evaluate cytolomorphological features and correlate them with the histological diagnosis of benign and malignant endometrial lesions, and to investigate certain immunocytochemical biomarkers to achieve a more accurate cytodiagnosis. METHODS: In the present study, we graded the cytomorphology on imprint smears of 35 low-grade endometrial endometrioid carcinomas compared with 23 cases of endometrium ranging from disordered proliferative to benign hyperplastic. Additionally, 10 cases of high-grade endometrial carcinoma and 11 cases of atrophic endometrium were evaluated. Ki-67 and p53 biomarkers were applied to the cytological smears. RESULTS: A total cytological score less than six, resulting from nuclear overlapping, nuclear/cytoplasmic ratio, the presence of a branched pattern, vesicular cytoplasm and loss of cohesiveness, distinguished all the cases of disordered proliferative and benign hyperplastic endometrium from low-grade endometrioid carcinomas of endometrium (P < 0.0001). The application of different cut-off values for Ki-67 and p53 helped differentiate certain endometrial lesions in our study. The integration of the immunocytochemical score of Ki-67 and p53 into the cytological score resulted in a final score that was also diagnostically useful. CONCLUSIONS: The results of the present study demonstrated that evaluation of certain cytological features along with specific immunocytochemical findings could improve the accuracy of endometrial cytodiagnosis but our findings need to be tested in a routine clinical situation, using pre-operative cytological samples, to ascertain whether the diagnostic criteria are reproducible.

Lamivudine treatment for acute severe hepatitis B: report of a case and review of the literature.

The oral nucleoside analogue lamivudine has been effectively used in the treatment of chronic hepatitis B. However, there is limited data concerning the efficacy and safety of lamivudine in patients with severe acute or fulminant hepatitis B. We report the use of lamivudine in a young woman with acute HBV infection and fulminant hepatic failure. Following lamivudine treatment, we noticed a prompt clinical, biochemical, serological and virological response as it was seen in the vast majority of, previously reported, cases. Lamivudine treatment was continued until HBsAg was cleared. Our case, as well as previously reported ones, suggests that lamivudine may have a beneficial effect in selected patients with acute severe or fulminant HBV infection.

Compulsory hospitalisation and optimal mental health care: A European perspective and the example of Greece.

Countries offering good psychiatric care which respects their clients' dignity and human rights can be expected to reflect this fact in their official health statistics. Given that European data on compulsory hospitalisation are currently inadequate, we propose that all Member States should collect at least a basic set of figures for calculating the rates or quotas of compulsory admissions and the rate of legally indefensible detentions; this will allow us to examine both the actual cost of freedom lost as well as the extent to which national mental health laws are delivered as prescribed. As shown here by the example of Greece, there is an urgent need to focus on possible infringements on the rights of the mentally ill, because Member States can nοt be compelled to accept international monitoring or to observe minimum standards of mental health care.

Advanced image fusion algorithms for Gamma Knife treatment planning. Evaluation and proposal for clinical use.

Image fusion is a process of combining information from multiple sensors. It is a useful tool implemented in the treatment planning programme of Gamma Knife Radiosurgery. In this paper we evaluate advanced image fusion algorithms for Matlab platform and head images. We develop nine level grayscale image fusion methods: average, principal component analysis (PCA), discrete wavelet transform (DWT) and Laplacian, filter - subtract - decimate (FSD), contrast, gradient, morphological pyramid and a shift invariant discrete wavelet transform (SIDWT) method in Matlab platform. We test these methods qualitatively and quantitatively. The quantitative criteria we use are the Root Mean Square Error (RMSE), the Mutual Information (MI), the Standard Deviation (STD), the Entropy (H), the Difference Entropy (DH) and the Cross Entropy (CEN). The qualitative are: natural appearance, brilliance contrast, presence of complementary features and enhancement of common features. Finally we make clinically useful suggestions.