[Treatment of calcaneal fractures with a locking nail (C-Nail)]. / Versorgung des Fersenbeinbruchs mit einem Verriegelungsnagel (C-Nail).

OBJECTIVE: Anatomic reconstruction of the posterior facet by primary stabilization of the calcaneal fracture with a locking nail. INDICATIONS: All intraarticular calcaneal fractures and unstable two-part fractures independent of the degree of closed/open soft tissue trauma. CONTRAINDICATIONS: High perioperative risk, soft tissue infection, beak fracture (type II fracture) and still open apophysis. SURGICAL TECHNIQUE: Anatomic reduction of the posterior facet using a sinus tarsi approach. Reduction and temporary fixation of the sustentacular, tuberosity, and anterior process fragments with 1.8-2.0 mm Kirschner wires. Thereafter, the C-Nail (calcaneus nail) is introduced with its guiding device stabilizing the sustentacular, tuberostity, and anterior process fragments through its three guiding arms with 6 or 7 locking screws. POSTOPERATIVE MANAGEMENT: Passive and active motion starts on postoperative day 2. Lymph drains help reduce swelling. Partial weightbearing with 20 kg for 6-8 weeks in the patient's own shoes is recommended. X­ray controls are done at 4 and 8 weeks as well as after 6 and 12 months. RESULTS: A total of 107 calcaneal fractures treated with the C-Nail between 2011 and 2014 were evaluated according to the AOFAS score 6 months and 1 year after surgery. The measured values were on average 93.0 (range 65-100) points at 6 months and 94.1 (range 75-100) points 12 months after the surgery. Böhler's angle with initial traumatic values of 6.2° (-30 to +13°) improved postoperatively to 31.8°, after 3 months slightly decreased to 29.6°, and after 12 months to 28.3°. There were 2 cases of superficial wound necrosis (1.9 %) and 1 case a deep infection (0.93 %) with need of early C-Nail removal.

Synthesis and biological evaluation as microtubule-active agents of several tetrahydrofuran and spiroacetal derivatives.

The stereoselective preparation of several molecules containing structural fragments of the tetrahydrofuran and spiroacetal type is described. Their degree of cytotoxicity and their interactions with tubulin have been investigated. It has been confirmed that the tetrahydrofuran derivatives are cytotoxic but, in contrast to previous reports, it has been found that the cytoxicity is not due to interactions with the microtubule network. Furthermore, and also in contrast to a previous report on closely related compounds, the spiroacetal derivatives do show interactions with tubulin, even though the precise mechanism and the binding site still remain to be established.

The high affinity dopamine uptake inhibitor, JHW 007, blocks cocaine-induced reward, locomotor stimulation and sensitization.

The discovery and evaluation of high affinity dopamine transport inhibitors with low abuse liability is an important step toward the development of efficacious medications for cocaine addiction. We examined in mice the behavioural effects of (N-(n-butyl)-3alpha-[bis(4'-fluorophenyl)methoxy]-tropane) (JHW 007), a benztropine (BZT) analogue that blocks dopamine uptake, and assessed its potential to influence the actions of cocaine in clinically-relevant models of cocaine addiction. In the conditioned place preference (CPP) paradigm, JHW 007 exposure did not produce place conditioning within an ample dose range but effectively blocked the CPP induced by cocaine administration. Similarly, in the CPP apparatus JHW 007 treatment failed to stimulate locomotor activity at any dose but dose-dependently suppressed the hyperactivity evoked by cocaine treatment. In locomotor sensitization assays performed in the open field, JHW 007 did not produce sensitized locomotor behaviour when given alone, but it prevented the sensitized component of the locomotor response elicited by subchronic (8-day) cocaine exposure. In the elevated plus maze (EPM), acute treatment with JHW 007, cocaine and combinations of the BZT analogue and cocaine produced an anxiogenic-like profile. Re-test in the EPM following subchronic (8-day) exposure enhanced the anxiogenic-like effect of the same drug treatments. The present findings indicate that JHW 007 exposure counteracts some critical behavioural correlates of cocaine treatment, including conditioned reward, locomotor stimulation and sensitization, and lend support to the further development of BZT analogues as potential replacement medications in cocaine addiction.

[Open vs. percutaneous suture repair of the subcutaneous Achilles tendon rupture]. / Perkutánni vs. otevrená sutura subkutánní ruptury Achillovy slachy.

INTRODUCTION: The authors assess and compare results of percutaneous and open repair of closed Achilles tendon rupture METHOD AND CLINICAL MATERIAL: The authors retrospectively examined 115 patients with subcutaneous Achilles tendon rupture who were treated in the Regional Hospital of Pardubice during the years 2000-2005. They used the 100 point Hannover Achilles Tendon Score. 42 patients were operated on exclusively with percutaneous technique and 73 patients with open repair of Achilles tendon. Duration of the rehabilitation, post-operative complications and using of alternative fixation system in a post-operative treatment of Achilles tendon rupture were also assessed. RESULTS: 62 % of evaluated patients achieved good or excellent results. There was no significant difference between the open and percutaneous repair. In a case of percutaneous repair there was achieved a shortening of post-fixation rehabilitation time in compare with open repair about two weeks. Eighteen postoperative complications were identified after open Achilles tendon repair, resulting in institutional complication rate of 24.7 %. The complications included 6 (8.2%) superficial wound infections. 7 (9.6%) deep crural flebothromboses, 4 (5.5%) re-ruptures and 1 (1.4%) sural nerve injury. Seven postoperative complications were identified after percuaneous Achilles tendon repair, resulting in institutional complication rate of 11.8%. The complications included 3 (7.1%) sural nerve injury and 2 (4.7%) deep crural flebothromboses. The vacuum brace system VacoAchill was used in 23 patients and involved in shortening of duration of rehabilitation about 20%. CONCLUSION: Percutaneous suture of Achilles tendon rupture is a simple and safety method, that brings comparable functional results to open repair with the same time of post-operative fixation and with a significantly lower rate of complications. The vacuum brace system VacoAchill is an alternative method of post-operative fixation allowing earlier mobilization and shortening patient's disability.

[When should surgery be performed in traumatic hemoperitoneum ]. / Kdy operujeme úrazové hemoperitoneum.

Authors in their theoretical report discuss problems of traumatic haemoperitoneum resulting from blunt abdominal injury including diagnostics and therapy. They put the stress on diagnostic-therapeutic algorithm. It is emphasized the necessity of immediate US of the abdomen and at the haemodynamically stable patients helical CT scan. Classification of injured certain abdominal cavity organs is mention and suggested unification of these classifications. It is highlighted conservative treatment of traumatic haemoperitoneum with regular monitoring including monitoring of intralpha abdominal pressure and abdominal compartment syndrome. Damage Control Surgery System, as a new strategy, is discussed in a part regarding operative management.

[Multiorgan failure in pulmonary embolism]. / Multiorgánové selhání na podklade embolizace do plic.

The case-history presents a case of unexpected pulmonary embolization manifestated in a middle-aged patient closely before operation (classical cholecystectomy). The severe respiratory insufficiency was the consequence, which proceeded to a metabolic dysbalance and the state of disseminated intravascular coagulation. The prognosis was very serious, but the patient recovered after 4 weeks of complete resuscitative care. The authors would like to initiate the discussion about the way and timing of antithrombic preoperative preparation in elderly patients and in those with a high risk of thromboembolic complications.

Chlorodicyclohexylborane-mediated aldol additions of alpha,alpha'-dioxygenated ketones.

Boron aldol additions of variously O-protected alpha,alpha'-dioxygenated ketones using dicyclohexylboron chloride and a tertiary amine have been investigated. The stereoselectivity of the process was dependent on the protecting group on the alpha-oxygen atoms. Notably, ketones with bulky silyloxy groups gave syn aldols, most likely via Z enolates. This rules out the participation of chelates during the enolization process, at least in the presence of such sterically crowded protecting groups. An alternative explanation is offered.

Stereoselective 1,3-dipolar cycloadditions of a chiral nitrone derived from erythrulose. An experimental and DFT theoretical study

We have investigated several 1,3-dipolar cycloadditions of a chiral nitrone prepared from L-erythrulose. While cycloadditions to carbon-carbon multiple bonds of dipolarophiles such as ethyl acrylate, ethyl propiolate, or dimethyl acetylenedicarboxylate were poorly stereoselective, reaction with acrylonitrile provided predominantly one diastereomeric adduct. Furthermore, the regioselectivity exhibited by the two structurally similar dipolarophiles ethyl acrylate and ethyl propiolate was found to be opposite. The molecular mechanisms of these cycloadditions have thus been investigated by means of density functional theory (DFT) methods with the B3LYP functional and the 6-31G and 6-31+G basis sets. A simplified achiral version of nitrone 1 as the dipole, and methyl propiolate or acrylonitrile as the dipolarophiles, were chosen as computational models. The cycloadditions have been shown to take place through one-step pathways in which the C-C and C-O sigma bonds are formed in a nonsynchronous way. For the reaction with methyl propiolate, DFT calculations predict the experimentally observed meta regioselectivity. For the reaction with acrylonitrile, however, the predicted regioselectivity has been found to depend on the computational level used. The calculations further indicate the exo approach to be energetically favored in the case of the latter dipolarophile, in agreement with experimental findings. The main reason for this is the steric repulsion between the nitrile function and one of the methyl groups on the nitrone that progressively develops in the alternative endo approach.

A new technique for culturing rat embryos between gestation days 14 and 15.

A method for culturing rat embryos between days 14 and 15 has been developed. On gestation day 14 (morning of sperm and plug = day 0), laparotomies were performed on time-mated rats that had been anaesthetized with halothane. The embryos, with open attached yolk sacs and placentas, were cultured in 650-ml plastic flasks with 120 ml medium (0.7% bovine serum albumin in Earle's balanced salt solution with antibiotics, prewarmed to 37 degrees C and continuously flushed with water-saturated 95% O(2)/5% CO(2), pH 7.4) in a Dubnoff metabolic shaker with gentle agitation. Viability and morphology were assessed after 26 hr in culture. On day 15, embryonic growth and development were similar to that in in vivo controls, and viability was high (55%).

Studies of the role of ischemia/reperfusion and superoxide anion radical production in the teratogenicity of cocaine.

The administration of multiple doses of cocaine on a single day during late gestation is teratogenic in rats in which hind limb ectrodactyly is a major finding (Webster and Brown-Woodman, '90). We have previously hypothesized that these limb malformations result from the generation of reactive oxygen species during the process of ischemia/reperfusion in vivo. In order to study the direct effects of cocaine versus the aberrant oxygenation it may induce, we have developed a system for culturing rat embryos between days 14 and 15 of gestation. Growth and development of cultured embryos are comparable to that of in vivo controls. Exposure to normoxia (95% O2) with or without cocaine failed to induce limb malformations and exposure to a single long period of hypoxia (20% O2) only reduced limb growth in the anterior-posterior axis. By contrast, embryos receiving multiple brief exposures to hypoxia developed a significant incidence of hind limb ectrodactyly that appeared indistinguishable from that induced by cocaine in vivo. By incubating day 14 embryos in a nitroblue tetrazolium derivative, 1-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT), it was shown that superoxide anion radical appears in the digital rays following two episodes of reperfusion. Little reaction product was seen under the other conditions. Finally, mitochondrial electron transport particles prepared from teratogenically sensitive limb buds spontaneously "leak" electrons to form superoxide anion radical whereas those from insensitive heart fail to do so. We propose that cocaine and other exposures that can transiently reduce conceptual oxygenation during late gestation are teratogenic by virtue of their capacity to induce ischemia/reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)