Description of the anterior cerebral artery and its cortical branches: Variation in presence, origin, and size.

OBJECTIVE: Certain aspects of the anterior cerebral artery (ACA) cortical branches tend to vary, including absent or additional arteries, variation in origin, and changes to diameter and length. Knowledge of these factors can be crucial in aneurysm and arteriovenous malformation surgery. Few studies report on these aspects and a South African study have not been completed. Therefore, the aim of this study is to report absent or additional arteries, the origin, diameter and length of ACA cortical branches in a Western Cape population. METHODS: A coloured silicone was injected into the ACA of 121 hemispheres (60 right, 61 left), consisting of 83 males and 38 females. Specimens were divided in groups younger than 34 (n=36), between 35 and 48 (n=35), older than 49 (n=40), and unknown (n=10). There were three population groups; coloured (n=72), black (n=37), white (n=10), and unknown (n=2). Any absent or additional arteries were noted, as well as the origins. External diameter and lengths were measured using a digital micrometre, string and a ruler. RESULTS: The diameter and lengths indicated significant differences between right and left, sex, age and population groups. Most commonly absent (callosomarginal artery) and additional (paracentral lobule artery) arteries were noted. Origins were similar to the literature; however, previously unreported origins and common trunks were also observed. CONCLUSION: The aspects reported have been neglected in previous work and neurosurgeons should be aware of these variations and anomalies to avoid complications. Studies should continue to assess the cerebral vasculature since undocumented variations are still being reported.

Detailed description of the anterior cerebral artery anomalies observed in a cadaver population.

Anomalies of the anterior cerebral artery (ACA) include the median ACA (MedACA), bihemispheric ACA (BihemACA) and the azygos ACA. Knowledge of these anomalies can be crucial to clinicians and neurosurgeons, especially during surgeries involving the interhemispheric region and in the interpretation of the clinical signs of a stroke. Since few reports exist on the origin, area supplied, diameter and length of the ACA anomalies, the aim of this study is to give a detailed description on the anatomy of the ACA anomalies. The ACAs of 60 brains were injected with a colored silicone. When an anomaly was observed, a detailed illustration of the course and pattern of the ACA and cortical branches were made. The origins and the areas supplied by the anomalous arteries were noted. The external diameter was measured using a digital micrometer and the length was measured using string and a ruler. There were seven cases (11.7%) of a MedACA and 12 cases (20.0%) of a BihemACA. The MedACA originated mostly from the anterior communicating artery, and from the A2 segment in one case. The MedACA was bilateral in four cases and unilateral in three cases. Excluding Cases 5 and 9, the BihemACA cases can be divided into two groups; one branch to the left hemisphere (n=3), and one branch to the right hemisphere (n=7). The average diameter of both the BihemACA and MedACA was 1.8mm. Studies rarely provide additional information on these anomalies. Therefore, the present study elaborated on the origin, diameter, length and the area supplied by these anomalies. The definitions are described in the literature, although additional criteria were still lacking and this was provided in the present study. Since information on these aspects of the ACA anomalies is scarce, future research should give detailed descriptions on the ACA anomalies.

A survey of lung cancer in rural and remote Aboriginal and Torres Strait Islander communities in Queensland: health views that impact on early diagnosis and treatment.

BACKGROUND: Lung cancer incidence, mortality and hospitalisation rates are higher for Indigenous Australians compared with non-Indigenous Australians and increase again when living in more remote areas. If Indigenous Australians are made more aware of lung cancer through better access to health services and programmes, lung cancer outcomes might improve. AIM: We aimed to survey the level of lung cancer awareness in rural and remote Aboriginal and Torres Strait Islander communities and discover perceived barriers to timely diagnosis and treatment of lung cancer. METHODS: Interviews were conducted in three discrete outer regional and remote Aboriginal communities and one urban setting in Queensland. Participants included Aboriginal and Torres Strait Islander peoples from three target population groups: patients referred for medical treatment with symptoms suspicious of lung cancer or confirmed lung cancer; Indigenous health workers; community members aged 18 years and over. Participants gave written, informed consent. RESULTS: Of 51 community members and 14 Indigenous health workers, 32 reflected they knew very little about lung cancer, 60 cited smoking as the cause of lung cancer and 54 recognised warning symptoms as a prompt to seek healthcare. Indigenous health workers were not able to describe a healthcare pathway that would apply to a patient with suspected lung cancer. CONCLUSION: The two main barriers identified as impacting on quality healthcare were communication and follow-up processes. These could be addressed by service improvement activities.

An in vitro assessment of the effect of Athrixia phylicoides DC. aqueous extract on glucose metabolism.

Athrixia phylicoides DC. is an aromatic shrub indigenous to the eastern parts of Southern Africa. Indigenous communities brew "bush tea" from dried twigs and leaves of A. phylicoides, which is consumed as a beverage and used for its medicinal properties. Plant polyphenols have been shown to be beneficial to Type 2 diabetes mellitus (T2D) and obesity. Aqueous extracts of the plant have been shown to be rich in polyphenols, in particular phenolic acids, which may enhance glucose uptake and metabolism. The aim of this study was to determine the phenolic composition of a hot water A. phylicoides extract and assess its in vitro effect on cellular glucose utilisation. The most abundant phenolic compounds in the extract were 6-hydroxyluteolin-7-O-glucoside, chlorogenic acid, protocatechuic acid, a di-caffeoylquinic acid and a methoxy-flavonol derivative. The extract increased glucose uptake in C2C12, Chang and 3T3-L1 cells, respectively. Intracellular glucose was utilised by both oxidation (C2C12 myocytes and Chang cells; p < 0.01 and p < 0.05, respectively) and by increased glycogen storage (Chang cells; p < 0.05). No cytotoxicity was observed in Chang cells at the concentrations tested. The effects of the extract were not dose-dependent. A. phylicoides aqueous extract stimulated in vitro glucose uptake and metabolism, suggesting that consumption of this phenolic-rich extract could potentially ameliorate metabolic disorders related to obesity and T2D.

An in vitro evaluation of the cell toxicity of honey and silver dressings.

OBJECTIVE: To establish whether honey and silver-impregnated dressings used by wound-healing practitioners are cytotoxic in vitro to human skin keratinocytes and dermal fibroblasts. METHOD: Human keratinocyte and fibroblast tissue cultures were established in vitro. Untreated cultures served as controls (group I). Small dressing implants of monofloral, medicinal honey (L-Mesitran) (group 2) and nanocrystalline silver (Acticoat) (group 3) were placed in test wells and co-cultured with each of the two cell lines. Morphological changes, including cell toxicity, were assessed using inverted microscopy, trypan blue staining and the Rosdy and Clauss cell toxicity scoring system. RESULTS: Untreated cultures consisting of both keratinocytes and fibroblasts (group 1) were established in 90% of all cases. In group 2, cultures with honey-impregnated implants, cell proliferation remained present at two and four months. Cell viability remained intact and cell toxicity was not evident at four months after continuous tissue culture. In group 3, marked toxicity was observed with high non-viability staining and cell-scoring counts compared with groups 1 and 2 (p<0.05). This demonstrates that the silver interfered with epidermal cell proliferation and migration, implying that it contains cytotoxic material. CONCLUSION: The honey-based product showed excellent cytocompatibility with tissue cell cultures compared with the silver dressing, which demonstrated consistent culture and cell toxicity. Further studies are needed to assess if these comparative in-vitro findings should influence a clinician's choice of wound dressing.

The safety of pedicles in breast reduction and mastopexy procedures.

Nipple necrosis is a potential complication of breast reduction and mastopexy procedures that can be prevented if the surgeon is acquainted with the arterial blood supply to the breast, particularly the nipple-areolar complex (NAC). A review of the latest research on this with its clinical application is given.

An immunocytochemical profile of the endocrine pancreas using an occlusive duct ligation model.

CONTEXT: Ligation of the pancreatic duct, distally to its confluence into the bile duct has been shown to induce endocrine tissue regeneration. The surplus endocrine tissue formed is presumed to be able to replace pathologically and/or experimentally compromised tissue. OBJECTIVE: This is a quantitative study on the histology of duct ligated pancreas employing immunocytochemistry and computerised morphometry. INTERVENTIONS: Pancreatic duct ligation was performed on 25 groups of six normal Sprague-Dawley rats. Experimental animals were sacrificed at 12-hour intervals from day one to ten post-duct ligation and every 24 hours thereafter to day 14, the pancreas removed, fixed and processed. Six consecutive 3-6 micron serial sections were cut on a rotary hand microtome, floated onto 3-aminopropyl-trimethoxysilan coated slides and alternatively immunocytochemically stained for insulin, glucagon, pancreatic polypeptide and somatostatin. RESULTS: Pancreas transformation between days 1/2 and 3 1/2 was characterised by acinar deletion and the appearance of immunoreactive cells for the primary endocrine hormones. Transdifferentiation of existing endocrine tissue saw islet insulin core cells replaced by pancreatic polypeptide- and somatostatin positive cells, glucagon deletion and random appearance of all endocrine cell types within the inter-islet interstitium by day 3 1/2. Days 4 to 14 were characterised by cellular migration and islet reconstruction. CONCLUSIONS: To date our laboratory has investigated transplantation of foetal tissue beneath the renal capsule in syngeneic, isogeneic and allogeneic normal and diabetic rats. As pancreatic duct ligation induces the development of surplus endocrine tissue our next step would be to investigate the use of ligated pancreas as a replacement for foetal tissue.

Bipolar hemiarthroplasty for primary osteoarthritis of the hip.

One hundred twenty-five bipolar hemiarthroplasties of the hip were performed at the authors' hospital. Although the procedure was performed for acute femoral neck fractures, rheumatoid arthritis, revision hemiarthroplasty, and primary osteoarthritis, only the latter is the subject of this review. A modified Harris hip score (HHS) was used to evaluate the patients both preoperatively and postoperatively. Radiographs were taken preoperatively as well as postoperatively at 2-, 4-, 6-, and 24-month intervals. A total of 68 patients underwent bipolar hemiarthroplasty for primary hip osteoarthritis. The mean preoperative HHS was 35.5 (SEM = 1.86); the mean postoperative score was 81.2 (SEM = 1.64) with an average improvement of 45.7 (SEM = 2.03). The results of this review were compared to a control group of conventional total hip arthroplasties performed at the same institution. The mean postoperative HHS for the group of conventional arthroplasties was 87.2 (SEM = 1.07). The results of this review indicate a good clinical result from bipolar hemiarthroplasty, but significantly less postoperative function when compared to conventional total hip arthroplasty.

Component motion in bipolar hip arthroplasty: an evaluation of reamed and non-reamed acetabula.

Sixty-four patients with 67 bipolar arthroplasties of the hip were reviewed for a mean follow up of 3.1 years. The study group consisted of 46 hemiarthroplasties secondary to primary osteoarthritis of the hip and 21 hemiarthroplasties secondary to displaced subcapital hip fractures. Reaming of the acetabulum was performed in 47 of the hips studied. The Harris hip scores were not significantly affected by acetabular reaming. Total motion decreased when hips were loaded in the standing position. Reaming of the acetabulum resulted in a decrease in percent outer component motion and an increase in percent inner component motion. The non-reamed acetabula had the largest percent inner motion decrease when taken from the supine to the standing position. The reamed acetabula had significantly higher average percentage of inner component motion in both standing and supine positions. There was no patient with postoperative acetabular protrusion.

Fracture of the neck of the talus associated with a trimalleolar ankle fracture and ruptured tibialis posterior tendon.

A rare case of a fracture through the neck of the talus with a trimalleolar ankle fracture and ruptured tibialis posterior tendon is presented and the literature reviewed. Management consisted of open-reduction internal fixation of the fractures and repair of the tibialis posterior tendon. At 40 months after injury, the patient had tibiotalar range of motion at 5 degrees of dorsiflexion and 38 degrees of plantar flexion. While avascular necrosis of the talus did not occur, significant degenerative arthritis of the ankle was noted.

Analysis of therapeutic efficacy, cost, and safety of gentamicin lavage solution in orthopaedic surgery prophylaxis.

Prophylactic antibiotic irrigation solutions are used quite commonly during total joint arthroplasty; however, scientific data regarding their efficacy are inconclusive. In a retrospective review of 100 total joint replacements (53 total hips and 47 total knees) that substituted gentamicin for kanamycin as an intraoperative irrigant, no apparent variation from the incidence of infection reported to the literature occurred, and no evidence of drug-induced side effects presented. Antibiotic irrigation solutions are probably noncontributory to infection prevention when used concomitantly with systemic prophylaxis. Most orthopaedic surgeons will continue to utilize them, however, owing to the catastrophic nature of a deep infection and the prevailing medicolegal atmosphere. Gentamicin is therefore a cost-effective antibiotic for intraoperative lavage--it has a sound microbiologic and safety profile, despite its lack of proven efficacy.

Unilateral versus bilateral simultaneous arthroplasties of the lower extremities.

We reviewed retrospectively 26 replacement arthroplasties performed as bilateral simultaneous procedures in 12 patients at an osteopathic community hospital during a 52-month period. One patient had two bilateral operations. Surgical time, estimated blood loss, units of blood transfused, perioperative morbidity, number of days hospitalized, and hospital costs were compared with data from randomly selected patients who underwent unilateral procedures during the same time period. The bilateral group had an average length of stay of 12 days (vs 10.3 days), an average surgical time of 2 hours 37 minutes (vs 1 hour 55 minutes), an average blood loss of 419 mL (vs 277 mL), and average hospital costs of $12,315 (vs $10,272) in comparison with the unilateral group. Perioperative morbidity was similar for both groups. Our findings indicate that bilateral simultaneous procedures offer a reasonable approach and a savings of time and money for selected patients who require multiple joint replacements for improved functional status.

Treatment of phalangeal fractures of the hand with intraosseous wire fixation.

Most phalangeal fractures of the hand can usually be treated by closed methods; however, those fractures that require open reduction may be effectively treated by the intraosseous wire-fixation technique. Twenty-five unreducible or unstable phalangeal fractures were treated with open reduction and intraosseous wire fixation. Functional results are reported in terms of total active motion and flexion to distal palmar crease of the involved fingers. Acceptable union was achieved in all cases, whereas functional assessment revealed 11 excellent and 14 fair results. Our operative technique and postoperative regimen are reported. A closely supervised postoperative therapy program appears to be critical in achieving a satisfactory end result.

Use of the Clyburn External Fixator in fractures of the distal radius.

A study was organized to evaluate the use of a one-plane external fixation device to treat comminuted fractures of the distal radius. Clinical and roentgenographic data were obtained in 20 patients with a followup ranging from 12 to 20 months. The results were graded 14 excellent, 4 good, 2 fair, and none poor. The use of the Clyburn External Fixation Device with supplemental radial styloid Kirschner wire fixation achieved acceptable results in the treatment of comminuted distal radius fractures and proved to be easily applied.

Medial unicompartmental arthroplasty of the knee. Use of the L-cut and comparison with the tibial inset method.

Forty-four medial unicompartmental arthroplasties were performed between August 1982 and August 1985 using the L-cut resection and guides. These were compared with 19 medial unicompartmental arthroplasties performed between September 1974 and August 1982 in which the tibial plateau was prepared by the conventional tibial inset method. The L-cut was more precise due to the use of guides. This method allowed the tibial component to be seated directly on the cortical rim of the medial proximal tibial plateau for better support. There was a direct relationship between the placement of the tibial component and the clinical results. In both groups, those patients approaching a tibial prosthesis placement of 90 degrees in the coronal plane and 80 degrees in the sagittal plane had the best clinical results.

Flexor digitorum profundus avulsions with associated distal phalanx fractures. A report of four cases and review of the literature.

A review of the current literature reveals that avulsions of the flexor digitorum profundus tendon, with a separate and concomitant intraarticular fracture of the distal phalanx, is an uncommon and easily misdiagnosed injury that has been infrequently described. This report encompasses a review of four patients with such an injury, and includes treatment recommendations for this complex injurious pattern. A classification system for flexor digitorum profundus avulsions is reviewed and it is proposed that the avulsion of the flexor digitorum profundus tendon with concomitant and separate intraarticular fracture of the distal phalanx, be added to the classification as a Type IV injury.

Transcuneiform fracture--cuboid dislocation of the midfoot.

Complete dislocation of the tarsal cuboid is presented along with regional anatomic considerations. Thorough literature search revealed only three other reported cases of dislocation of the tarsal cuboid. The operative procedure described encompasses an interesting method of reduction of this dislocation. It should be emphasized that A-P, lateral, and oblique X-rays should be obtained for injuries of the mid and forefoot. The rarity of such a dislocation is attributed to the structural integrity of the supporting ligamentous elements.