Surgical vs. Nonsurgical Management for Humeral Shaft Fractures; Preference Among Orthopaedic Surgeons.

BACKGROUND: Determining trends in managing humeral shaft fractures may help identify variation in practice which might benefit design of clinical guidance. We aimed to determine the practice of members of the British Elbow and Shoulder Society (BESS) in managing humeral shaft fractures. METHODS AND MATERIALS: An electronic survey was sent to members of BESS. Questions related to preferred surgical and nonsurgical approaches for management of humeral shaft fractures. This was divided into management of proximal, middle and distal third diaphyseal fractures. RESULTS: 91 fully completed responses were analysed. Nonsurgical management was preferred by 90.1% (n=82) for middle-third and 80.2 % (n=73) for proximal third fractures, however 52.7% (n=48) favoured surgical treatment for distal third fractures. CONCLUSIONS: 1. The management preference for humeral shaft fractures amongst surgeons is highly variable. 2. This may be partly attributed to the sparsity of high-quality evidence. 3. Well-designed randomised trials or pro-spective cohort studies may help further guide management of these injuries.

Histological and chemical damage induced by microcystin-LR and microcystin-RR on land snail Helix aspersa tissues after acute exposure.

Microcystins (MCs) are the most common cyanotoxins with more than 200 variants. Among these cyanotoxins, microcystin-LR (MC-LR) and microcystin-RR (MC-RR) are the most studied congeners due to their high toxicity and frequent occurrence in surface waters. MC-LR has been detected in more than 75% of natural cyanobacteria bloom, along with other toxic and less toxic congeners. Accumulation of several microcystins variants (MC-LR and MC-RR) has been confirmed in aquatic snails exposed naturally or in the laboratory to toxic blooms. Thus, this paper aims to compare the biochemical and histological impact of both toxic variants (microcystin-LR and microcystin-RR) and their mixed form on a bioindicator, the land snail Helix aspersa. During experiments, snails were gavaged with a single acute dose (0.5 µg/g) of purified MC-LR, MC-RR, or mixed MC-LR + MC-RR (0.25 + 0.25 µg/g). After 96 h of exposure, effects on the hepatopancreas, kidney, intestine and lungs were assessed by histological observations and analysis of oxidative stress biomarkers. The results show that a small dose of MCs variants can increase the non-enzymatic antioxidant glutathione (GSH), inhibit glutathione-s-transferase (GST) level and trigger a defense system by activating glutathione peroxidase (GPx), catalase (CAT) and superoxide dismutase (SOD). Microcystin-RR causes serious anomalies in the hepatopancreas and kidney than Microcystin-LR. The organ most affected is the kidney. The damage caused by MC-LR + MC-RR is greater than that caused by single variants.

Blunt chest trauma: bony injury in the thorax.

The management of blunt chest trauma is an evolving concept with no clear current guidelines. This article explores the bony injuries associated with this, focusing on rib fractures and flail segments and the themes around investigation and best management.

Blunt chest trauma: soft tissue injury in the thorax.

The management of blunt chest trauma is evolving. This article discusses the soft tissue injuries associated with blunt chest trauma.

Significance of global versus segmental subclassification of class III and IV lupus nephritis: a single center experience.

INTRODUCTION: Class III and IV are the most ominous among the classes of lupus nephritis (LN) and there are contradictory reports on whether LN class IV-G (global) differs from LN class IV-S (segmental) as envisaged by the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) 2003 classification. These subcategories are not validated for LN class III. This study was designed to assess the differences between global and segmental subclasses in classes III and IV of LN. PATIENTS AND METHODS: In a retrospective analysis, the kidney biopsies of 84 patients with new-onset LN were analyzed. The Student's t-test and Mann-Whitney test were employed to compare differences between the means of continuous variables among the two groups. Fisher's exact test was used to compare the categorical variables. A p-value <0.05 was considered statitistically significant. RESULTS: Of 84 patients, 69 (82.1%) were females and 15 (17.9%) males, with the female to male ratio of 4.6:1. The mean age of all patients was 32.7±12.6 years. The mean serum creatinine at the time of biopsy was 1.5±0.94 mg/dl and the mean urinary protein excretion was 1.6±1.9 g/day. Among 84 biopsies, 26(30.95%) belonged to class III and 37 (44.05%) to class IV LN. In class IV LN, serum creatinine was significantly higher in global vs. segmental subcategory (2.4±1 vs. 1.1±0.5 mg/dl; p=0.034), while. 24-h proteinuria was not significantly different between the subcategories (2.7±1.2 vs. 3.1±1.0 g/d, p=0.56). In LN class III, the mean age, serum creatinine and 24-hour proteinuria did not show significant difference between the global and segmental subcategories (37±17 vs. 30±15 years, p=0.58; 1.2±0.2 vs. 1.25±0.6 mg/dl, p=0.66; 2.03±0.5 vs. 3.1±3.5 g/day, p=0.45, respectively). The proportion of glomeruli showing endocapillary proliferation was significantly higher in global than in segmental subclasses (94.25% vs. 5.72; p=0.026) in class IV LN. The activity and chronicity percent also revealed higher values in global subclass vs. segmental subclass of class IV LN (p=0.038 and p=0.045, respectively). These parameters were not significantly different among the global and segmental subcategories of class III LN (p>0.5 for all parameters). CONCLUSION: In conclusion, our study showed significant differences in renal function and some pathological features on renal biopsies among the global and segmental subclasses of class IV LN. There were no significant differences among these subclasses of class III LN. Further, and larger studies are needed on this subject to substantiate the above results.

Antioxidant activity and preventive effect of aqueous leaf extract of Aloe Vera on gentamicin-induced nephrotoxicity in male Wistar rats.

OBJECTIVE: In the present study, the nephroprotective and curative effects of aqueous extract of AV on gentamicin-induced tubular toxicity in male Wistar rats were investigated. Antioxidant activity, phenolic and flavonoid contents of AV were also determined. MATERIALS AND METHODS: In a preclinical study, 60 male Wistar rats were designated into 6 groups of 10 and treated as follows: Group I: Treated with vehicle (distilled water) and kept as control. Group II: Received 300 mg/kg/d AV for three days then, AV plus GM (80 mg/kg; intraperitoneally) for 7 more days and sacrificed. Group III: Received 300 mg/kg AV orally for 10 days, then sacrificed. Group IV: Received GM for 7 days and sacrificed. Group V: Received GM for 7 days and saline for ten days and sacrificed on 17th day. Group VI: Received GM for 7 days, then AV for 10 days and sacrificed. RESULTS: The levels of flavonoid and phenolic compounds in Aloe vera extract were 43 ± 3.8 mg/g (Rutin equivalent) and 80.1 ± 3.8 mg/g (Gallic acid equivalent), respectively. The antioxidant activity of the extract was 38%. The intensity of nephrotoxicity in group 2 that received AV 300 mg/kg/d as prophylaxis was not significantly different from the group I and from the group II which treated with 300 mg/kg/d AV without GM. This finding reveals that AV as prophylaxis could potentially attenuate the GM-induced nephrotoxicity. CONCLUSIONS: Aole vera significantly protects the renal cells and reduces the severity of tubular damage caused by gentamicin. However, it cannot regenerate tubular damage.

Significance of extracapillary proliferation in IgA-nephropathy patients with regard to clinical and histopathological variables.

BACKGROUND AND AIM: Extracapillary proliferation (crescent) was not included in the Oxford classification, although previous attempts to correlate the crescent with clinical outcomes have produced conflicting results. In this study, we investigated the clinical and morphological significance of extracapillary proliferation in a group of IgA nephropathy (IgAN) patients with regard to the Oxford classification. PATIENTS AND METHODS: In an observational study conducted on IgAN patients, we collected a total of 114 biopsies. We diagnosed IgAN by light and immunofluorescence for all patients. RESULTS: Of the 114 patients, 70.2% were male. The mean age of the patients was 37.7 ± 13.6 years. The mean proteinuria was 1742 ± 1324 mg/day. The mean serum creatinine was 1.6 ± 1.5 mg/dL. Twenty-five (21.9%) patient kidney biopsies had extracapillary proliferation. We found a significant positive correlation between the number of crescents and serum creatinine (p<0.001). Furthermore, we found a positive association between the nephrotic syndrome and the total number of crescents (p<0.05). Additionally, we observed a significant positive correlation between the amount of sclerosed glomeruli and extracapillary proliferation (p=0.028). CONCLUSION: Our findings confirm that extracapillary proliferation has a significant association with proteinuria and sclerotic glomeruli. We anticipate that extracapillary proliferation will be included in a revision of the Oxford classification of IgAN to widen the scope of the classification.

[Factors associated with graft reepithelialization after penetrating keratoplasty]. / Les facteurs intervenant dans la réépithélialisation cornéenne après kératoplastie transfixiante.

INTRODUCTION: To study graft reepithelialization time after penetrating keratoplasty and the factors influencing this reepithelialization. PATIENTS AND METHODS: In this retrospective study, 48 patients underwent penetrating keratoplasty (52 eyes) by the same surgeon between 1998 and 2006. Recipient pre- and postoperative variables, donor characteristics, and surgical variables were analyzed. Postoperative slit-lamp examination after fluorescein staining and graft reepithelialization time were recorded. Statistical analysis was done using SPSS version 11.5 (p<0.05). RESULTS: The average graft reepithelialization time was 8.02 +/- 6.87 days. Complete corneal epithelial healing was obtained in 2.2%, 38.3%, and 63% of patients in 1, 3, and 7 days, respectively. There was a statistical correlation between graft reepithelialization time and trephination size, death-to-storage time, and storage time (p<0.05). DISCUSSION: Postoperative epithelial defects are common after penetrating keratoplasty. Many factors influence this graft reepithelialization such as abnormal lid and surface dysfunction, recipient corneal epithelium, and surgical technique. A better understanding of these factors will prevent postoperative epithelial defects and complications.

The association between serum leptin and blood lymphocytes in hemodialysis patients.

AIMS: To find the association between serum leptin, blood lymphocytes and PMN percentages as markers of immune-system function, as well as nutritional status in long term hemodialysis patients. PATIENTS AND METHODS: In a group of long term hemodialysis patients, serum leptin, albumin, creatinine, BUN, and white-blood cell (WBC) count--[lymphocytes and polymorphonuclear (PMN) cells] were measured. RESULTS: A significant positive correlation between serum leptin and body-mass index and between serum leptin and lymphocyte percentage was found, as well as a significant negative correlation between serum leptin and PMN percentage. There was a weak negative correlation between WBC counts and the duration and dosage of dialysis, and also a near significant negative correlation between WBC counts and hemodialysis adequacy. There was also a significant negative correlation between WBC counts and serum albumin. CONCLUSION: Generally increased neutrophil coun and increased lymphocyte count markers of an increased mortality in hemodialysis patients. This study shows a positive association between serum leptin and lymphocytes, and a negative correlation between serum leptin and PMN. Leptin might have a protective role in decreasing mortality in hemodialysis patients by maintaining the function of the immune system (Tab. 1, Fig. 3, Ref 33).

Helicobacter pylori infection and its relationship to plasma magnesium in hemodialysis patients.

Dyspeptic symptoms are quite common in chronic hemodialysis patients, and Helicobacter pylori (cagA(+)) is thought to play an important role in the pathogenesis of the active gastritis and other upper gastrointestinal mucosal lesions in these patients. The aim of this study was to evaluate a probable association between plasma magnesium (Mg(2+)) and Helicobacter pylori infection in maintenance patients. Helicobacter pylori specific IgG antibody levels and plasma magnesium were measured in patients. Totally 44 patients consisted from 34 non diabetic hemodialysed patients and 10 diabetic hemodialysis patients. In this study, a significant positive correlation between anti-Helicobacter IgG antibody and plasma magnesium was found in all patients (r = 0.29, p = 0.050) (adjusted for dialysis sessions). The results of this study suggest the association of serum magnesium with the infection of Helicobacter pylori. Mg(2+) acquisition by CorA is essential for Helicobacter pylori in vitro. We concluded that high serum magnesium level and probably its higher concentration in gastric mucosa might facilitate the colonization of Helicobacter pylori in the stomach of hemodialysis patients, although more studies are needed to prove the clinical relevance of this finding (Tab. 1, Fig. 1, Ref: 23). Full Text (Free, PDF) www.bmj.sk.

Serum leptin concentration and left ventricular hypertrophy and function in maintenance hemodialysis patients.

AIM: The aim of the study was to investigate the potential relationship between left ventricular hypertrophy (LVH) and left ventricular ejection fraction with serum leptin in end-stage renal failure patients undergoing regular hemodialysis (HD) treatment. METHODS: A cross-sectional study was carried out on 41 patients (15 women, 26 men) with end-stage renal disease (ESRD), undergoing maintenance HD treatment with acetate basis dialysate and polysulfone membranes. Serum leptin, pre- and post-dialysis creatinine, predialysis BUN, calcium (Ca), phosphorus (P), serum albumin (Alb) and serum ferritin were monitorized; the patients were categorized into no LVH, mild , moderate and severe LVH, according to the performed echocardiographies. RESULTS: The mean patient's age was 46+/-17.6 years. The mean length of the time patients had received HD was 29.5+/-34 months (median: 18 months). The mean serum leptin was 9.5+/-13.8 ng/mL (median value 4.7 ng/mL). In this study no significant association between stages of LVH with serum leptin was seen. In this study a significant positive correlation between LV ejection fraction with logarithm of serum leptin (r=0.32, P=0.048) (adjusted for age, duration and doses of dialysis, BMI, diabetes mellitus, serum ferritin, Ca, P and serum Alb was observed). CONCLUSIONS: Leptin might not be an aggravator for LV hypertrophy. This behavior of leptin in maintenance HD patients which is in contrast to general population, especially in obese patients with normal renal function could be explained through its reverse epidemiology role in HD patients. Our results emphasize the importance of leptin in HD and clinical impact of these findings merit further investigation.

Linkage of elevated CaxPO4 product with inflammation in maintenance hemodialysis patients.

AIM: The aim of the paper was to elucidate whether and how, in end-stage renal disease (ESRD) patients on regular hemodialysis, the levels of C-reactive protein (CRP) correlate with CaxPO4 product; thus, a cross-sectional study was conducted on stable hemodialysis patients. METHODS: According to the severity of secondary hyperparathyroidism, each patient being treated for secondary hyperparathyroidism was given oral active vitamin D3, calcium carbonate capsule, and Rena-Gel tablet at various doses. Fasting serum 25-hydroxy, vitamin D and intact serum PTH and also serum blood urea nitrogen, serum CRP, albumin, serum calcium, phosphorus and alkaline phosphatase and also serum ferritin were measured using standard RESULTS: There was a total of 41 patients, consisting of 29 nondiabetic hemodialysis patients and 12 diabetic hemodialysis patients. The mean patient age was 46+/-17.6 years. The value of serum CRP of patients was 8.6+/-6.6 mg/L (median 6 mg/L). The value of CaxPO4 product was 50.5+/-15.5 mg(2)/dL(2) (median: 50 mg(2)dL(2)). The present study showed a significant inverse correlation between CaxPO4 product and the age of the patients and a significant positive correlation between logarithm of serum CRP with age and also significant inverse correlations of dialysis adequacy as determined by urea reduction rate (URR) with logarithm of serum CRP and with CaxPO4 product. Furthermore, significant positive correlation of logarithm of serum CRP with CaxPO4 product was found too. CONCLUSIONS: Our findings showed the need to pay further attention to hyperphosphatemia and uncontrolled secondary hyperparathyroidism in maintenance hemodialysis patients.

Association of serum lipoprotein(a) with ultrasonographically determined early atherosclerotic changes in the carotid and femoral arteries in kidney transplanted patients.

OBJECTIVES: To evaluate the association of serum lipoprotein(a) [Lp(a)] with carotid intimal media thickness (IMT) and carotid femoral plaque occurrence in kidney transplant patients. PATIENTS AND METHODS: Fifty-four subjects included 29 group 1 normal healthy persons and 25 group 2 kidney transplant patients underwent carotid IMT measurements and carotid femoral plaque assessment by B-mode ultrasonography. Also we measured cholesterol, triglyceride, HDL-C, LDL-C and Lp(a) as well as BUN and creatinine. RESULTS: There was a significant difference between Lp(a) in the two groups (P = .016). There was a significant difference between carotid IMT of the two groups (P < .001). Moreover there was a significant difference between the plaque scores of kidney transplant patients and the normal group (P = .05). There were no correlations between carotid IMT and plaque score in normal subjects or in kidney transplant patients (P > .05). There was a significant correlation between carotid IMT with age in Group 1 (P = .035). No correlation between carotid IMT and serum Lp(a) was seen in the two groups. No significant correlations between plaque score and serum Lp(a) were observed. There was no correlation between duration of transplant and thickening of intimal media complex in this group. In this group a positive correlation was demonstrated between carotid IMT with serum LDL-C (P < .001). CONCLUSIONS: Age was the most important factor associated with thickening of intimal media complex in normal subjects and in plaque formation in the renal transplant group. Serum LDL-C may be associated with thickening of intimal media complex in kidney transplant patients. Serum Lp(a) may not be a significant factor in thickening of the intimal media complex or plaque occurrence in kidney transplant patients.

Close association between parathyroid hormone and left ventricular function and structure in end-stage renal failure patients under maintenance hemodialysis.

OBJECTIVES: Cardiovascular risk factors are a significant burden in end-stage renal disease patients under hemodialysis and cardiovascular-related diseases are the leading cause of death among these patients and are responsible for almost half of all deaths in dialysis patients. In this study we aimed to consider the role of excess PTH in the development of left ventricilar hypertrophy (LVH) and LV ejection fraction in patients with end-stage renal disease under regular hemodialysis. PATIENTS AND METHODS: This study is cross-sectional, and was done in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis treatment. Calcium, Phosphorus, Alkalin phosphatase and Intact PTH (iPTH) were measured. Hypertensive patients were stratified into three stages. The total of 73 patients (F=28, M=45) consisted of 58 non-diabetic hemodialysis patients (F=22, M=36) and 15 diabetic hemodialysis patients (F=6, M=9). RESULTS: Significant inverse correlation of serum ALP with percent age of LV ejection fraction, marginal correlation of serum ALP with LVH and marginal correlation of serum iPTH with LVH were observed. Also significant inverse correlation of serum iPTH with percent age of LV ejection fraction in non diabetic HD patients was observed. CONCLUSIONS: Adverse effects of secondary hyperparathyroidism on LV function and structure in this study show the role of excess PTH in the development of left ventricilar (LV) hypertrophy as well as low LV ejection fraction in patients with end-stage renal disease under hemodialysis which needs more attention to control of secondary hyperparathyroidism to reduce the risk of cardiovascular morbidity and mortality in dialysis patients. (Tab. 5, Fig. 3, Ref: 29.)

Oestrogen and cortisol producing adrenal tumour.

A 14 year old boy is presented who was admitted to the psychiatric ward because of delirium. He also had gynaecomastia, facial oedema, striae, and hypertension. He was finally proved to have a mixed oestrogen and cortisol producing adrenal tumour which was removed surgically with complete improvement and no relapse.

Structure of (2,3,7,8,12,13,17,18-octaethylporphinato)dioxoosmium(VI).

[Os(C36H44N4)O2].C6H5Cl, Mr = 867.53, triclinic, P1, a = 8.177 (1), b = 10.668 (1), c = 11.791 (1) A, a = 73.91 (1), beta = 83.18 (1), gamma = 75.07 (1) degree, V = 953.6 A3, Z = 1, Dx = 1.51 g cm-3, Dm = 1.50 g cm-3, Mo K alpha, lambda = 0.71073 A, mu = 34.5 cm-1, F(000) = 438, T = 293 K, R = 0.048 for 5721 unique observed reflections. The Os atom is centered in the porphinato plane with an average Os-N = 2.052 (6) A and Os-O = 1.745 (5) A. The 24-atom porphyrin core is effectively planar with the largest deviation from the mean plane less than 0.02 A.