New insight into the diagnostic cut-off value of serum anti-Toxocara IgG for ocular toxocariasis in uveitis patients.

Uveitis is one of the commonest causes of vision loss worldwide and its exact etiology is still not clarified in most patients. The current study is a trial to assess the efficacy of serum anti-Toxocara immunoglobulin G (IgG) by enzyme-linked immunosorbent assay (ELISA) as a diagnostic tool for ocular toxocariasis (OT) and to detect OT prevalence and the associated ocular manifestations in sera of patients with uveitis. One hundred and twelve patients (62 females and 50 males) with uveitis were diagnosed by ophthalmologists, radiologists and rheumatologists according to ocular manifestations, laboratory and radiological investigations. Serum anti-Toxocara IgG titers were determined by ELISA in sera of all patients. Our results revealed that OT is highly associated with intermediate and posterior uveitis. Children and young adult females, especially those residing in rural areas, complained mainly of diminution of vision in the left eye, with strabismus and leukocoria. At a cut-off value of 0.258, the sensitivity and specificity of IgG ELISA were 93.3% and 100%, respectively. In conclusion, at a novel cut-off value of 0.258 the serum anti-Toxocara IgG ELISA is predicted to be a diagnostic tool for OT regarding sensitivity and specificity. Also, it has potential importance in the interpretation and differential diagnosis of OT. Thus, serum anti-Toxocara IgG ELISA should be a routine test for screening of suspected cases.

Macrophage recruitment and activation: a model for comparing resistance to Salmonella enteritidis in different broiler breeds.

A model for comparing resistance to Salmonella Enteritidis was evaluated in different broiler breeds. The recruitment and phagocytic activity of peritoneal macrophages were assessed in three different broiler breeds (A, B and C) which are farmed world-wide. Assessment was performed after three days of intraperitoneal (i.p.) administration of 3% Sephadex G-200 (10 ml), initiated at twenty-one days of age, followed by contact with i.p. live S. Enteritidis (10 ml, 1.2 x 10(8) colony forming units/ml) for 45 min. Assessment included determination of the number of i.p. macrophages recruited, the number of i.p. phagocytized S. Enteritidis cells per macrophage, the levels of degranulated i.p. beta-glucuronidase and beta-galactosidase, and the count of surviving S. Enteritidis cells. Confirmation of the significance of the model was obtained by comparing resistance to field infection by S. Enteritidis in the three broiler breeds. The recruitment of i.p. macrophages in response to challenge with Sephadex and S. Enteritidis was significantly higher (P < 0.05) in birds of breed A (mean cumulative i.p. macrophage count, in 10 fields of microscopic slide smear magnified at x1,000, was equal to 81.7), compared to recruitment in birds of breed B (33.3) or breed C (41.2). The mean number of phagocytized S. Enteritidis cells per i.p. macrophage in birds of breed A (2.68) was significantly higher (P < 0.05) than in breed B (0.83) and insignificantly higher (P > 0.05) than in breed C (2.35). In addition, the highest level of recruitment and phagocytic activity of macrophages, in birds of breed A, was associated with a higher significant mean i.p. beta-glucuronidase activity (10,425.5 units/ml) than in breed B (3,438.2 units/ml) or breed C (3,356.94 units/ml) (P < 0.05). Moreover, birds of breed A demonstrated a higher mean i.p. beta-galactosidase activity (2.225 units/ml) than birds of breed B (0.852 units/ml) or breed C (1.852 units/ml) (P > 0.05). The higher level of recruitment and activity of i.p. macrophages and the higher rate of degranulation of i.p. enzymes in breed A were associated with a greater number of surviving i.p. S. Enteritidis cells. In response to outbreaks of S. Enteritidis in the field, the average mortality was significantly higher in flocks of breed A (3.2%) than in flocks of breed B (1.2%) or breed C (0.96%) (P < 0.05). These data provide an indication of the significance of the model in reflecting the differences in resistance of S. Enteritidis of broiler breeds reared in a farm environment.

Acute haematogenous osteomyelitis and ABO blood groups and secretor status.

A correlation was found between the incidence of acute haematogenous osteomyelitis (AHO) and ABO blood groups but not between AHO and the secretory function of the saliva. AHO is more common among children of blood group O and, to a lesser extent, group A. Although it was found to occur more commonly among secretors than non-secretors, the difference from a control group was not statistically significant. At present this possibility can only be taken as a tentative suggestion for further research in this field.

Fractures of the pelvis.

Pelvic fractures in this series constituted 3.3% of all traumatic admissions and 5.7% of all fractures. A classification of pelvic fractures was adopted in which five types were identified. Type I (24.2%) comprised fractures without a break in the pelvic ring. Type II (17.7%) comprised those with a single break in the pelvic ring. Fractures with a double break of the pelvic ring constituted Type III (23.6%). Multiple fractures of the pelvis were identified as Type IV (10.8%). Fractures of the acetabulum were grouped separately as Type V (23.7%). On the basis of blood loss, mortality and potential disability, Types I and II constituted the 'minor' fractures of the pelvis. Types III, IV and V were the 'major' fractures of the pelvis, of which Type IV were the worst. The commonest fracture encountered was that of a single pubic ramus. The pubic area was involved in 43.0% of the cases. Associated injuries were common (2.19 per patient). Some of these lesions were the result of the causative trauma. Some others, however, were related to certain types of pelvic fractures.

Early urinary complications of fractures of the pelvis.

The occurrence, relation to a particular type of fracture of the pelvis and the possible mechanism of early urinary complications were studied in 186 consecutive patients with fracture of the pelvis. Eighty-eight patients (47.3%) showed early urinary complications. These complications were minor in 73 patients (83.0%; 32.9% of all pelvic features) and major in 15 (17.0%; 8.1% of all pelvic fractures). The former comprised retention of urine in 41 patients (33.0%; 15.6% of all pelvic fractures), haematuria in 29 patients (33.0%; 15.6% of all pelvic fractures), and oliguria in three (3.4%; 1.6% of all pelvic fractures). The latter comprised rupture of the posterior urethra in nine patients (10.2%; 4.8% of all pelvic fractures), rupture of the bladder in five (5.7%; 2.7; of all pelvic fractures), and combined injury to the bladder and posterior urethra in one (1.1%; 0.5% of all pelvic fractures). These complications were common in relation to run-over and collision accidents. The common pelvic fracture encountered in these patients was the Type III and the individual pelvic fracture was that of both pubic rami on one or both sides; fractures of the acetabulum and posterior segment of the pelvis were next in frequency. On the other hand, fractures of a single ischial ramus or wing of the ilium were not commonly encountered. Fractures with intact pelvic ring were associated with only 9.1% of these complications; all were minor.

Aetiological factors in non-union following Küntscher intramedullary nailing of the femur.

One hundred and three consecutive patients who underwent Küntscher intramedullary nailing for recent non-pathological single fracture of the femoral shaft showed 13.6% incidence of non-union. The latter complication was not significantly influenced by the type, site, and cause of the fracture nor by sex, timing of the operation, and reaming of the medullary cavity. Conversely, non-union was more common in older patients and in those who were in bad general condition prior to and at the time of operation. Similarly, non-union increased significantly when the nail was too thin, or its lower end did not reach the optimum level (2 cm higher than the joint line), when weight-bearing was started 6 weeks or less after operation and in the presence of post-operative knee stiffness. Two patients presented with broken nails and four with angulated nails in the presence of non-union. Three patients with segmental fracture of the femur showed non-union of the fracture nearer to the middle of the shaft.

Some immunological aspects of staphylococcal haematogenous osteomyelitis.

Patients with primary (haematogenous) staphylococcal osteomyelitis have been suspected for being deficient in their immune response. Serum levels of the three major circulating immunoglobulins (IgG, IgA, and IgM) have been determined in 90 patients with this disease of varying duration and activity and in 100 control subjects. Of 270 measurements in the patient group, 80% fell within or below the normal (control) range. A small group of eight patients, however, were found to have sufficiently large increases in IgM levels to raise the mean value of the whole series to a statistically significnat level. Similarly IgA production was increased in chronic infection. These findings, on the whole, indicate that a majority of patients suffering from primary osteomyelitis may have depression of their normal immune response to infection.

Osteomalacia as a contributing factor in fracture of the femoral neck in the elderly in Quatar.

Eighty-seven patients with femoral neck fractures were investigated for possible evidence of osteomalacia. Eighteen patients were under the age of 50, or had sustained the fracture following severe injury. No evidence of osteomalacia was demonstrated in this group. In the remaining 69 patients the fracture was associated with a trivial injury, and in some patients no history of injury could be obtained. Only 16 (23.2%) of these showed evidence of osteomalacia; in 7 (10.1%) the disease was suspected. This occurred more often in women than men, and in trochanteric rather than cervical fractures.

Reduction of displaced supracondylar fracture of the humerus in children by manipulation in flexion.

Sixty-one children with posteriourly displaced supracondylar fractures of the humerus were treated by minipulation with the elbow flexed 40 degrees-60 degrees. This method proved to be safe, easy to apply and was followed by a high rate of success. The elbow was immobilized using a collar-and-cuff or a broad sling and binding of the arm to the forearm with zinc oxide adhesive plaster. In difficult children, the limb was put under the child's clothing to avoid its being used. Redisplacement occurred in only 8.2 per cent of the patients and in none of these was it severe enough to justify remanipulation.

Treatment of chronic haematogenous osteomyelitis of the os calcis.

Twenty-five patients suffering from chronic haematogenous osteomyelitis of the os calcis were studied. The disease often presents in a subacute or chronic form, and the pathological process is well established in the majority of the cases by the time treatment is begun. For this reason, conservative treatment was found to be ineffective. Similarly, limited surgical procedures, such as curettage, sequestrectomy or partial excision, were also inadequate because of the wide-spread nature of the infection. Complete excision of the os calcis and stitching of the Achilles tendon to the plantar fascia was followed by a high rate of success, provided the other tarsal bones were not involved in the infective process. The infection was cured and reasonably normal function was obtained in 14 out of 19 patients (73.7 per cent). A "new heel" is often formed after the operation by the laying down of plaques of calcification within the toughened scar tissue of the heel pad.