Ottawa versus Bernese: which is better?

PURPOSE: Trauma of the foot and ankle is commonly seen in the emergency service. For most patients, fractures cannot be ruled out without radiography. The aim of this study is to consider these injured patients in the light of the Ottawa ankle rules and the Bernese ankle rules. METHODS: Our study is a randomized, prospective clinical study. This study was performed during a 24-month period in the Süleyman Demirel University Emergency Medicine Service. A total of 962 adult patients with foot and ankle pain or tenderness following trauma incurring within the previous 10 days were included in the study. Patients were examined only by physicians who had been trained in the correct application of the Ottawa ankle rules and the Bernese ankle rules. All patients were X-rayed with standardized anterior-posterior and lateral radiographs of the ankle and foot, regardless of whether the Ottawa ankle rules and the Bernese ankle rules were positive or negative. The sensitivity and specificity of the Ottawa and Bernese ankle rules according to the study results regarding the correlation between physical examination and radiography were calculated. RESULTS: For the Ottawa ankle rules, the sensitivity was 74.8 %, specificity was 68.6 %, false-negative ratio was 15.1 %, and the false-positive ratio was 46.3 %. For the Bernese ankle rules, the sensitivity was 55.7 %, specificity was 79 %, false-negative was ratio 21.4 %, and the false-positive ratio was 43.7 %. CONCLUSION: These data suggest that the Ottawa ankle rules are more sensitive than the Bernese ankle rules to accurately identify the fracture, but they are still not 100 % reliable.

Hydatid disease: a rare cause of pelvic pain (2008: 5b).

We describe a case of hydatid disease as a rare cause of pelvic pain. Although the involvement of pelvic bones makes diagnosis challenging, characteristic imaging findings of the cysts in the other tissues highly suggest the diagnosis of hydatid disease.

Photovoltaic energy converter as a chipscale high efficiency power source for implanted active microelectronic devices.

We report the development of a microscale photovoltaic energy converter which has been designed and implemented to deliver power to CMOS-based microelectronic chips. The design targets the delivery of voltages on the order of 3V with power levels in excess of 10 mW. The geometry of the prototype device, which has been fabricated and tested, is specifically designed for coupling to an optical fiber, to facilitate remote power delivery in implantable component environment.

LC method for the analysis of acetylsalicylic acid, caffeine and codeine phosphate in pharmaceutical preparations.

An accurate, simple, reproducible and sensitive method for the determination of acetylsalicylic acid, caffeine and codeine phosphate has been developed and validated. Acetylsalicylic acid, caffeine and codeine phosphate were separated using a microBondapack C(8) column by isocratic elution with flow rate 1.0 ml/min. The mobile phase composition was 125/125/250/0.5 (v/v) isopropyl alcohol, acetonitrile, water and o-phosphoric acid. The samples were detected at 215 nm using photo-diode array detector. The linear range of detection for acetylsalicylic acid, caffeine and codeine phosphate were between 0.40 and 1000, 0.25 and 250, and 0.48 and 96 microg/ml, respectively. The linearity, range, selectivity, system performance parameters, precision, accuracy, and ruggedness for acetylsalicylic acid, caffeine and codeine phosphate were also shown to have acceptable values.

Clonal spread of imipenem-resistant Pseudomonas aeruginosa in the intensive care unit of a Turkish hospital.

Pseudomonas aeruginosa may cause life-threatening infections, especially in nosocomial settings. Although carbapenems are considered as one of the most effective alternatives in antipseudomonal therapy, resistance to the carbapenem group of antibacterials is a growing problem. In the first 6 months of 1997, P. aeruginosa isolates that were resistant to almost all antipseudomonal agents including imipenem were recovered from various specimens from intensive, care unit (ICU) patients. Isolates with the same antibiogram profile caused a small outbreak in May 1997. A retrospective case-control study revealed that the major risk factors for infection/colonization with multiresistant P. aeruginosa were prolonged stay in the ICU (p<0.001), previous and lengthy imipenem usage (p<0.001 and p<0.0001, respectively), and mechanical ventilation (p<0.001). Analytical isoelectric focusing of the sonicates prepared from the isolates showed that each isolate produced 1-5 beta-lactamases, enzymes with isoelectric points (pIs) of 5.1, 6.4, 8.5-8.7 being the most prevalent. DNA macrorestriction patterns of imipenem-resistant isolates were distinct from those of the imipenem-sensitive isolates recovered from ICU patients during the same interval and from the environmental isolates (controls). Thus, our results indicate that colonized patients appear to be the major source for cross-contamination of other patients and if imipenem is selected for empirical therapy, emergence of resistant strains should be anticipated and appropriate precautions taken.

Improvement of water solubility and in vitro dissolution rate of gliclazide by complexation with beta-cyclodextrin.

Inclusion complexes of gliclazide with beta-cyclodextrin were prepared using different two methods: neutralization and recrysstalization. Host-guest interactions were studied in the solid state by X-ray diffractometry and infrared spectroscopy. The stability constant between gliclazide and beta-cyclodextrin was calculated from the phase solubility diagram. It was found that the neutralization technique and a solid complex of gliclazide with beta-cyclodextrin in a molar ratio of 1.5:1 could be used to prepare the amorphous state of drug inclusion complexes. The dissolution rates of gliclazide from the inclusion complex made by neutralization was much faster than the pure drug, physical mixture of drug and cyclodextrin, recyristalization system and also comparable to the data reported in literature. Results of this report indicate that beta-cyclodextrin could be useful for the solid gliclazide formulations as it may results in a more rapid and uniform release of the drug.

Auditory event-related potentials (P300) in partial and generalized epileptic patients.

We evaluated the P300 components of event-related potentials (ERP) in 64 cryptogenic partial epilepsy (CPE) patients, and 52 idiopathic generalized epilepsy (IGE) patients as well as in their age-matched control groups. The P200, N200 and P300 latencies recorded from Cz were significantly longer in CPE patients compared with those of their control group (P = 0.0371, P = 0.0092 and P = 0.0405, respectively). The P200 and N200 latencies recorded from Fz were significantly longer than in their control group (P = 0.0448 and P = 0.0107) while the prolongation in the P300 latencies was not found to be statistically significant (P = 0.0733). All latencies were longer in IGE patients, and the amplitudes of the N200/P300 components of ERP were lower in both epileptic groups compared with their control groups, but these differences were not significant. The prolongation of the P300 latencies was not correlated with the type or serum level of antiepileptic drug or seizure control. Our findings suggest that the prolongation of the P300 latency of ERP is related to the type of epilepsy.

The effects of Azone and capsaicin on the permeation of naproxen through human skin.

The permeation of naproxen through excised human skin and isolated perfused rabbit ear skin has been determined. It was found that both Azone and capsaicin enhanced the permeation with an enhancement ratio of up to 4-fold. The magnitudes of the effect were similar in human and rabbit skin. The permeation of naproxen from a saturated solution of the drug through skin pre-treated with Azone was similar to that from a commercial preparation (Naprosyn). In the perfused rabbit ear experiments the presence of capsaicin had no effect on the vasodilatation of the blood vessels, inferring that the penetration enhancement was a direct result of capsaicin influencing the barrier function of the skin. Structural similarities between Azone and capsaicin were seen using molecular graphics.

Somatosensory evoked potentials and EEG findings in siblings of juvenile myoclonic epilepsy patients.

PURPOSE: In order to demonstrate cortical hyperexitability and to determine the efficacy of 'SEP of high amplitude (HASEP) in detecting asymptomatic relatives of JME patients, we evaluated the EEG findings and SEP in asymptomatic siblings of JME patients. METHODS: We analysed the EEG and SEP findings of 37 JME patients and 48 asymptomatic siblings of 27 patients and compared the results with healthy volunteers. RESULTS: Of 13 asymptomatic siblings with EEG abnormalities (27.1%), 5 had 4-6 Hz spike/polyspike and wave paroxysms (10.4%), 5 had slow wave paroxysms (10.4%), and the remaining 3 patients exhibited focal spike and wave activity during hyperventilation (6.25%). No significant difference was found between JME patients, asymptomatic siblings and control groups with respect to N20 latencies. N20/P25 amplitudes were significantly higher in both JME group and asymptomatic siblings than those of control cases. HASEP were observed in 8 out of 37 JME patients (21.6%), 10 out of 48 healthy siblings (20.8%) and none of the control cases. The consanguinity rate was higher in parents of patients who had at least one asymptomatic sibling with EEG and/or SEP abnormalities (68.7%) than in those of patients who had siblings with no EEG and SEP abnormalities (9.9%). We suggest that the high rate of SEP and EEG changes among offspring of consanguineous marriages might reflect the genetic heterogeneity of the disease.

Misdiagnosis and treatment in juvenile myoclonic epilepsy.

Of 1300 epileptic patients 76 (5.8%) were found to have juvenile myoclonic epilepsy (JME). These 76 patients were examined at the epilepsy outpatient clinic of Bakirköy State Hospital for Neurological and Psychiatric Diseases between 1991 and 1996 and data obtained were analysed retrospectively. Clinically typical absence seizures were reported in 40.8%, myoclonic jerks in 100%, and generalized tonic-clonic seizures in 82.9% of the patients. Neurological and mental examination was normal for all patients with the exception of three cases; two with essential tremor and one with minimal dysarthria. Precipitating factors were noted in 85.5% of cases. Abnormal EEG was recorded in 73 (6.1%) patients. Abnormalities mainly consisted of generalized discharges of spike/polyspike and slow-wave (86.6%) and generalized paroxysmal theta or delta (9.2%). Fifteen (19.7%) had focal abnormalities and 20 (26.4%) had photoconvulsive discharges. Of the 76 patients, 40 (52.6%) were not diagnosed at the initial interview; definite diagnosis was delayed by a mean of 5.9 years. As a result of misdiagnosis at the initial interview 40 patients had been administered AED except for valproate. After reassessment of clinical and EEG findings, the medication was changed to valproate therapy. As a result, 65 of our JME patients (85.5%) were seizure free after a one-year follow-up period.

Relationship of leukoaraiosis to vascular risk factors and lesion type in stroke patients.

Nonspecific periventricular white matter lucencies on computed tomograms (leukoaraiosis) were found in 49 (55%) of 89 stroke patients. We compared the vascular risk factors and the types of stroke with and without leukoaraiosis. Patients with leukoaraiosis were significantly older than those without it. The duration of hypertension was longer than those without leukoaraiosis. Mean diastolic blood pressure was associated with leukoaraiosis. No association was found with systolic blood pressure, diabetes mellitus, angina pectoris, myocardial infarction, heart failure, valvular disease and intermittent claudication. Patients with leukoaraiosis were significantly more likely to have lacunar infarcts on computed tomograms but were less likely to have cortical infarcts, subcortical infarcts or cerebral hemorrhage.