The use of circular external fixators in the management of lower limb trauma in Dublin: a single surgeon's 20-year experience.

INTRODUCTION: It has been estimated that approximately 520,000 injury presentations are made to Irish accident and emergency departments each year. Fractures account for 20 % of these injuries. Circular external fixators (frames) have been shown to be a safe and effective method of treatment for long bone fractures where internal fixation is impossible or in-advisable. We present the outcomes of all frames applied at our institution for stabilisation of acute fractures over a 20-year period. METHODS AND METHODS: We retrospectively reviewed a prospectively compiled database of all frames applied in our institution and identified all frames which were applied for acute lower limb trauma. RESULTS: We identified 68 fractures in 63 patients. There were 11 femoral fractures and 57 tibial fractures. All fractures were classified using the AO Classification system, and most fractures were Type C fractures. We used an Ilizarov frame for 53 fractures and a Taylor Spatial Frame for 15 fractures. The mean time in frame was 365 days for a femoral fracture and 230 days for a tibial fracture. There were five tibial non-unions giving an overall union rate of 93 %. Factors associated with non-union included high-energy trauma and cigarette smoking. CONCLUSION: The vast majority of lower limb fractures can be treated using 'conventional' methods. Complex fractures which are not amenable to open reduction and internal fixation or cast immobilisation can be treated in a frame with excellent results. The paucity of published reports regarding the use of frames for complex trauma reflects the under-utilisation of the technique.

The epidemiology of multiple sclerosis in Devon: a comparison of the new and old classification criteria.

OBJECTIVES: To determine the prevalence of multiple sclerosis in Devon and compare the new McDonald classification guidelines with the Poser criteria currently used. METHODS: All patients known to have multiple sclerosis and alive and resident within the chosen area on 1 June 2001 were included in the study. Seven sources of case ascertainment were used and each patient was classified according to both the Poser criteria and the McDonald guidelines. RESULTS: The prevalence of multiple sclerosis in Devon was 118 per 100,000 (definite and probable cases, Poser criteria) in a population of 341,796, on the prevalence day. The prevalence of definite and possible cases, as classified by the new McDonald guidelines, was slightly lower at 117 per 100,000. Clinical demographics of the prevalent population were similar to those of other studies in the United Kingdom. CONCLUSIONS: This is first survey to use the new recommended guidelines and compare these criteria with the Poser classification. The difficulties encountered with applying the new criteria in research are highlighted, as are the differences between the new and old criteria. This study reports one of the highest prevalences in the south of the UK, adding support for a north-south divide being a step effect rather than a latitudinal gradient.

Neuroprotective effects of GDNF against 6-OHDA in young and aged rats.

In young adult rats, glial cell line-derived neurotrophic factor (GDNF) can completely protect against 6-hydroxydopamine-induced loss of nigral dopamine neurons when administered 6 h prior to the 6-hydroxydopamine. The present study was undertaken to determine if GDNF would provide similar protective effects in aged rats. Male, Fischer 344 x Brown Norway hybrid rats of 3, 18 and 24 months of age were given an intranigral injection of GDNF or vehicle followed 6 h later with an intranigral injection of 6-hydroxydopamine. Nigral dopamine neuron cell survival, and striatal and nigral dopamine and DOPAC levels, were evaluated 2 weeks after the lesions. In vehicle treated animals cell survival on the lesioned side ranged from 15 to 27%. GDNF promoted significant cell survival in the nigra of all three age groups; however, the percent survival was lowest in the 24-month-old animals (85% at 3 months, 75% at 18 months, 56% at 24 months). Similarly, dopamine levels in the striatum and substantia nigra on the lesioned side remained significantly greater in the GDNF treated animals compared to the vehicle treated animals. As with the cell survival experiment, the protective effects of GDNF on dopamine levels were less in the 24-month-old animals. GDNF pretreatment also protected against 6-hydroxydopamine-induced reductions in striatal DOPAC levels in all age groups. Overall, these results indicate that GDNF can protect nigrostriatal dopamine neurons against the effects of 6-hydroxydopamine in aged as well as young adult rats. However, the extent of protection is less in the aged (24-month-old) animals.

Maturational Constraints on Functional Specializations for Language Processing: ERP and Behavioral Evidence in Bilingual Speakers.

Changes in several postnatal maturational processes during neural development have been implicated as potential mechanisms underlying critical period phenomena. Lenneberg hypothesized that maturational processes similar to those that govern sensory and motor development may also constrain capabilities for normal language acquisition. Our goal, using a bilingual model, was to investigate the hypothesis that maturational constraints may have different effects upon the development of the functional specializations of distinct sub within language. Subjects were 61 adult Chinese/English bilinguals who were exposed to English at different points in development: 1-3, 4-6, 7-10, 11-13, and after 16 years of age. Event-related brain potentials (ERPs) and behavioral responses were obtained as subjects read sentences that included semantic anomalies, three types of syntactic violations (phrase structure, specificity constraint, and subjacency constraint), and their controls. The accuracy in judging the grammaticality for the different types of syntactic rules and their associated ERPs was affected by delays in second language exposure as short as 1-3 years. By comparison the N400 response and the judgment accuracies in detecting semantic anomalies were altered only in subjects who were exposed to English after 11-13 and 16 years of age, respectively. Further, the type of changes occurring in ERPs with delays in exposure were qualitatively different for semantic and syntactic processing. All groups displayed a significant N400 effect in response to semantic anomalies, however, the peak latencies of the N400 elicited in bilinguals who were exposed to English between 11-13 and >16 years occurred later, suggesting a slight slowing in processing. For syntactic processing. the ERP differences associated with delays in exposure to English were observed in the morphology and distribution of components. Our findings are consistent with the view that maturational changes significantly constrain the development of the neural systems that are relevant for language and, further, that subsystems specialized for processing different aspects of language display different sensitive periods.

Loneliness, emotional repression, marital quality, and major life events in women who develop breast cancer.

Women awaiting mammograms at a breast clinic were given questionnaires to investigate the role of psychosocial variables in the development of breast cancer while controlling for established breast cancer risk factors. Questionnaires to determine loneliness, emotional repression, marital quality, and major life changes were completed by 826 female volunteers who were later classified into groups according to their diagnoses. The total emotional repression score showed a hierarchy of most repression to least repression for the most-diseased to the most-healthy subjects. A breakdown of the emotional repression scale revealed that each group was significantly different from the other in suppression of anger and unhappiness. Women in the new cancer group showed significantly more loneliness than the women in the fibrocystic and normal groups. The newly diagnosed cancer group also had a higher proportion of women who experienced the death of a spouse or close family member within the past two years compared to the other groups.

A comparison of three methods for predicting hearing loss from acoustic reflex thresholds.

Previously reported acoustic reflex threshold data from normal and hearing-impaired subjects indicate that the effect of stimulus bandwidth on reflex thresholds is altered by sensorineural hearing loss. It is this change in the "bandwidth effect" that forms the basis for predicting hearing loss from reflex threshold data. Three predictive procedures were compared for 17 normal and 60 hearing-impaired ears. All methods correctly identified most hearing losses but none of the methods accurately estimated magnitude of hearing loss. Two methods were characterized by a high rate of false positives. The third was tailored to minimize false positives (6%) and maintain a high rate (93%) of predicting hearing losses greater than 32 dB while making no attempt to make finer discriminations. This more conservative approach minimizes serious predictive errors while identifying a high proportion of clinically significant hearing losses.