Elaboration of Sterically Stabilized Liposomes for S-Nitrosoglutathione Targeting to Macrophages.

S-nitrosoglutathione (GSNO) is a potential therapeutic for infectious disease treatment because of its pivotal role in macrophage-mediated inflammatory responses and host defense in addition to direct antibacterial activities. In this study, sterically stabilized cationic liposomes (SSCL) and sterically stabilized anionic liposomes (SSAL) were developed as nanocarriers for macrophage targeting. Elaborated liposomes were characterized in terms of size, zeta potential, morphology, encapsulation efficiency, in vitro drug release behavior and cytotoxicity. Their versatility in targeting monocytes/macrophages was determined by confocal laser scanning microscopy and transmission electron microscopy. Flow cytometry revealed that cellular uptake of both SSCL and SSAL was governed by several endocytic clathrin- and caveolae-dependent mechanisms. Quantitative assessments of intracellular nitric oxide demonstrated highly efficient uptake of GSNO-loaded SSCL that was twenty-fold higher than that of GSNO-free molecules. GSNO-loaded SSCL displayed strong bacteriostatic effects on Staphylococcus aureus and Pseudomonas aeruginosa, which can be involved in pulmonary infectious diseases. These results reveal the potential of liposomal GSNO as an anti-infective therapeutic due to its macrophage targeting capacity and direct antibacterial effects.

[Severe pelvic injuries: indications and techniques of skeletal fixation]. / I traumi complessi del bacino: indicazioni e tecniche della stabilizzazione scheletrica.

The aim of this work is to assess the role of immediate Hoffmann's external fixation frame and delayed posterior internal fixation in the management of severe pelvic injuries. We have also analysed the role of selective arteriography and embolization for controlling pelvic fractures hemorrhage and the relationship between embolization and external fixation in the management of severe bleeding. We reviewed 112 patients with severe pelvic injuries admitted to our hospital from 1986 to 1998 (71 males, 41 females). The average age was 39.8 years, mean ISS 31.2. Unstable pelvic ring fracture was present in 59 (52.6%) patients at admission in the emergency room: hemorrhagic shock in 43 patients (38.3%). Fourteen (12.5%) patients died. Eight deaths (57%) were directly caused by hemorrhagic shock, two secondary to major caval lesion, three brain lesions and two respiratory failure. The last patient died secondary to MOF. Twenty-three patients (20.5%) with unstable fracture underwent pelvic fracture ring fixation surgery: eleven (9.8%) Hoffmann's anterior external fixation frame (hemorrhage control in all patients) and eight (7.1%) delayed internal posterior fixation. Six (5.3%) patients underwent arteriography and embolization: hemorrhage was stopped in all cases and no patient died in this group.

Preservation of detached fragments in open fractures of the limbs.

In open limb fractures, loss of bone fragments of considerable size, including portions of the joint surface, is a frequent finding. Although the authors routinely use common surgical methods of reconstruction, in this paper they present a method for preserving these fragments by storage in the abdominal wall, and using them for autografting once healing of the soft tissues in the site of fracture has occurred. This method, illustrated by an analysis of 3 cases, appears to be simple and effective and, when used in selected cases, may provide a solution for the treatment of severe post-traumatic loss of bone.

Quantification by dual photonabsorptiometry of local bone loss after fracture.

Total bone mineral and bone mineral density modifications were evaluated during fracture healing of long bones in patients with traumatic fractures of the lower limbs, using an experimental model based on the dual photonabsorptiometry technique. Seven patients (five males and two females; mean age, 19.5 years; range, 17-23 years) with tibia and fibula midshaft open fractures treated with osteosynthesis were studied. Dual energy gadolinium-153 photonabsorptiometry was used to measure distal leg bone loss at a skeletal segment distant from the fracture to exclude callus formation. Total bone mineral (TBM) and bone mineral density (BMD) of the tibia and fibula both in the fractured leg and in the healthy contralateral leg were measured on Days 10, 20, 30, 40, 60, and 120 after trauma. TBM and BMD of the healthy contralateral leg did not present any significant modifications at the different observation times. Both TBM and BMD of the fractured leg showed a progressive reduction that reached statistical significance starting on Day 30 with maximum reduction on Day 120 when TBM and BMD were reduced to almost one-half the initial value.

External fixation in the treatment of fractures of the distal forearm.

The authors present 12 cases of fractures of the lower forearm treated by Hoffmann external fixation. They discuss the indications for this method and its advantages over internal fixation and closed treatment by manipulation and plaster. The advantages are: simplicity and rapidity of treatment, good toleration of the instrumentation, constant control of the soft tissues, almost bloodless technique, complete freedom of joints not involved in the fracture, and the ability to adjust the position of the wrist and hand as union progresses so as to gradually restore the physiological position in the later stages.