Intraspinal penetrating stab injury to the middle thoracic spinal cord with no neurologic deficit.

The annual incidence of traumatic spinal cord injury worldwide is estimated to be 35 patients per million. Nonmissile penetrating spinal injuries most commonly occur in the thoracic region, and the majority has neurologic deficits on admission. The management of patients who lack neurologic deficits is controversial due to the risk of neurologic status alteration intraoperatively. However, failure to intervene increases the risk of infection, delayed onset of neurologic deficits, and worsening functional outcome.A 17-year-old boy presented with an intradural T7-T8 knife penetration injury to the spinal cord with no neurologic deficit. Rapid surgical intervention was critical because the knife was lodged between the 2 hemispheres of the spinal cord. The patient was intubated in the lateral position, transferred to the prone position on a Jackson table, and underwent surgical decompression with laminectomy 1 level above and below the injury site, removal of the knife blade in the original path of trajectory, and repair of the dural tear with a collagen matrix. The patient sustained no neurologic sequelae from the penetrating knife injury. He was able to ambulate at discharge and had no complications. To our knowledge, this is the only report of a patient with intradural spinal cord penetration by a foreign object (knife blade) presenting with a normal neurologic preoperative examination that persisted throughout the course of postoperative care.

Future directions in knee replacement.

The use of artificial joints for the treatment of osteoarthritis is expected to expand considerably over the next decade. While newer technologies can offer yet further improvements in total knee systems, implementation will be strongly affected by the need to satisfy apparently competing requirements. Patients expect quicker rehabilitation, improved performance, and lifelong durability; on the other hand, economic constraints require a reduction in cost for each procedure, as well as early intervention and preventative measures, while there is increased pressure from health care systems to use evidence-based medicine as the standard of choice for implants and techniques. The success of a knee replacement depends on the design itself, the surgical technique, the rehabilitation, and, not least, the patient. The major goal of the implant design can be redefined as a restoration of normal knee mechanics, whether by maximum preservation of tissues, or by guiding surfaces that replace their function. Surgical technique needs to be less invasive but achieve optimal patient-specific alignment and soft tissue balancing. Rehabilitation procedures must achieve the expectations of realistic patients. Testing and evaluation methods need to be upgraded for enhanced predictability. This paper discusses current trends and future possibilities to address this expansive scope of design criteria.

Preparation and functionalization of multilayer fullerenes (carbon nano-onions).

Carbon nano-onions (CNOs) represent a still largely unexplored carbon allotrope. Promising properties of these unique carbon structures are driving the research efforts in this area, but many technical problems remain in their preparation, derivatization, separation and characterization. In this article, we report the preparation, partial purification, and multiple functionalization and solubilization of CNOs. With only one priorly published short communication describing CNO functionalization, the present work is the most comprehensive description of CNO functionalization and characterization to date.

Preparation and stability of lipid-coated nanocapsules of cisplatin: anionic phospholipid specificity.

Cisplatin nanocapsules represent a novel lipid formulation of the anti-cancer drug cis-diamminedichloroplatinum(II) (cisplatin), in which nanoprecipitates of cisplatin are coated by a phospholipid bilayer consisting of a 1:1 mixture of zwitterionic phosphatidylcholine (PC) and negatively charged phosphatidylserine (PS). Cisplatin nanocapsules are characterized by an unprecedented cisplatin-to-lipid ratio and exhibit increased in vitro cytotoxicity compared to the free drug [Nat. Med. 8, (2002) 81]. In the present study, the stability of the cisplatin nanocapsules was optimized by varying the lipid composition of the bilayer coat and monitoring in vitro cytotoxicity and the release of contents during incubations in water and in mouse serum. The release of cisplatin from the PC/PS (1:1) nanocapsules in water increased with increasing temperature with a t(1/2) of 6.5 h at 37 degrees C. At 4 degrees C, cisplatin was retained in the nanocapsules for well over 8 days. Replacement of PS by either phosphatidylglycerol or phosphatidic acid revealed that nanocapsules prepared of PS were more stable, which was found to be due to the ability of PS to form a stable cisplatin-PS coordination complex. Mouse serum had a strong destabilizing effect on the cisplatin nanocapsules. The PC/PS formulation lost over 80% of cisplatin within minutes after resuspension in serum. Incorporation of poly(ethylene glycol 2000) (PEG)-derivatized phosphatidylethanolamine and cholesterol in the bilayer coat extended the lifetime of the cisplatin nanocapsules in mouse serum to almost an hour. The results demonstrate that specificity in the interaction of cisplatin with anionic phospholipids is an important criterium for the formation and stability of cisplatin nanocapsules.

Azomethine Imines in Four- and Five-Membered Rings: Stable Cyclic Valence Isomers of an α-(Phenyldiazenyl)ketocarbene.

The expected Wolff rearrangement of the ketocarbene intermediate 2, formed upon rhodium(II)-catalyzed elimination of nitrogen from diazoketone 1, does not occur. Instead, by incorporation of the neighboring diazene group the surprisingly stable, crystalline azomethine imines 3 and 4 are formed as cyclic valence isomers of 2. Compound 4, which contains a five-membered ring, is the first representative of a carba-sydnone and can also be obtained by acid-catalyzed isomerization of 3 at 50-70°C.

A group for "wandering" institutionalized clients with primary degenerative dementia.

The authors implemented a group in a state psychiatric institution for women with primary degeneration dementia. The group provided scheduled opportunity in a nonrestrictive environment for structured movement and sensory stimulation. Over a period of nine sessions, small but significant changes were noted in the members' behavior. This type of therapy can benefit such limited clients by enhancing the quality of their life in the institution.

The a angle: a quantitative measurement of patella alignment and realignment.

This case study introduces a clinical measurement of patellar glide, tin, and rotation, and defines a quantitative measurement called the A angle. An 11-year-old female with patellofemoral pain is treated using a protocol that includes a technique to align the patella through taping, stretching the lateral structures, and strengthening using functional training and isokinetics, with emphasis on the vastus medialis obliquus. The A angle may be a sensitive clinical indicator of patellofemoral pathomechanics. J Orthop Sports Phys Ther 1990;12(6):237-242.