Vanadium pentoxide inhalation provokes germinal center hyperplasia and suppressed humoral immune responses.

Vanadium, an important air pollutant derived from fuel product combustion, aggravates respiratory diseases and impairs cardiovascular function. In contrast, its effects on immune response are conflicting. The aim of our work was to determine if spleens of vanadium-exposed CD1 mice showed histological lesions that might result in immune response malfunction. One hundred and twelve CD-1 male mice were placed in an acrylic box and inhaled 0.02 M vanadium pentoxide (V2O5); actual concentration in chamber approximately 1.4 mg V2O5/m(3)) for 1 hr/d, twice a week, for 12 wk. Control mice inhaled only vehicle. Eight mice were sacrificed prior to the exposures. Eight control and eight V2O5-exposed mice were sacrificed 24 hr after the second exposure of each week until the 12-wk study was over. Another 8 mice that completed the 12-wk regimen were immunized with recombinant Hepatitis B surface antigen (HBsAg; three times over an 8-wk period) before sacrifice and analyses of their levels of anti-HBsAg antibody (HBSAb) using ELISA. In all studies, at sacrifice, blood samples were obtained by direct heart puncture and the spleen was removed, weighed and processed for H-E staining and quantitation of CD19 cells. The results indicated that the spleen weight of V2O5-exposed animals peaked at 9 wk (546 +/- 45 vs. 274 +/- 27 mg, p < 0.0001) and thereafter progressively decreased (321 +/- 39 mg at 12 wk, p < 0.001; control spleen = 298 +/- 35 mg). Spleens of V2O5-exposed animals showed an increased number of very large and non-clearly delimited germinal centers (that contained more lymphocytes and megakaryocytes) compared to those of control mice. In addition, their red pulp was poorly delimited and had an increase in CD19+ cells within hyperplasic germinal nodes. The mean HBsAb levels in immunized control mice were greater than that in the exposed hosts (i.e., OD = 0.39 +/- 0.03 vs. 0.11 +/- 0.05, p < 0.01). HBsAb avidity dropped to a value of 40 in V2O5-exposed animals vs. 86 in controls (p < 0.0001). We conclude that the chronic inhalation of V2O5, a frequent particle (PM(2.5)) component, induces histological changes and functional damage to the spleen, each of which appear to result in severe effects on the humoral immune response.

Intertrochanteric-subtrochanteric fractures: treatment with the long Gamma nail.

OBJECTIVE: To evaluate the outcome of the treatment of intertrochanteric-subtrochanteric fractures (subtrochanteric fractures with extension into the greater trochanter and the piriformis fossa) using the long Gamma nail. DESIGN: Prospective, consecutive. SETTING: Multicenter (private clinics). PATIENTS: Fifty-two closed intertrochanteric-subtrochanteric fractures in nonpathologic bone in fifty-two consecutive patients with a mean age of forty-five years (range, 18 to 91 years). INTERVENTION: Closed reduction and internal fixation with the long Gamma nail. MAIN OUTCOME MEASUREMENTS: Analysis of clinical and radiologic results with emphasis on the incidence of complications. Outcome assessment comparing the preinjury status of every patient with the status at a minimum follow-up of twelve months. RESULTS: At one year, seven patients had died and two other patients were lost to follow-up. Thus, forty-three of the fifty-two patients completed a prospective follow-up averaging sixteen months (range, 12 to 31 months). All fractures united within an average of 4.3 months (range, 3 to 6.5 months). Mechanical complications (breakage of the distal locking bolts) occurred in one fracture. Two patients had more than 5 degrees but less than 10 degrees of deformity in varus and more than one but less than 2.5 centimeters of shortening; two had more than 5 degrees of deformity in varus; and two had up to one centimeter of shortening. Two patients had other severe injuries that influenced the end result. Thirty-four of the remaining forty-one patients (82.9 percent) were restored to their preinjury status. There was no direct relationship between the radiologic and the functional results: an excellent radiologic result was not uniformly associated with an excellent functional outcome. CONCLUSIONS: Closed reduction and long Gamma nailing of intertrochanteric-subtrochanteric fractures enables the orthopaedic surgeon to treat these fractures with a minimally invasive procedure and a negligible rate of mechanical complications. The rate of union was 100 percent in this series. The rate of restitution to the preinjury status was high.

Occult severe hyperflexion sprain of the lower cervical spine.

Three patients with occult severe hyperflexion sprain of the lower cervical spine are described. Because the spine radiographs obtained at the time of trauma were physiologically normal, the complete instability was initially overlooked. The authors recommend an algorithm for adequate diagnosis of this condition. Posterior cervical fusion is the treatment of choice.

Slow, gradual external fixation distraction for treatment of postburn knee flexion contracture.

Although surgical release and reconstruction have been used extensively to treat severe postburn knee flexion contractures, the degree of correction is sometimes unsatisfactory, and the procedure is not exempt from significant complications. Based on the principle of slow, gradual external fixation distraction, we have designed a triangular articulated frame to be mounted with the ASIF-BM fixator to deal with joint flexion contractures. One successfully treated patient is reported. This is a percutaneous surgery, with very mild aggression to the patient and very low iatrogenic risks. The technique is easy, the degree of correction may be almost complete, and the hospital stay is very short because it is an ambulatory surgery.

Anterolateral dislocation of the lumbosacral junction.

An unusual case of anterolateral fracture-dislocation of the lumbosacral junction is reported, and seven additional cases from the literature are discussed. The mechanism of injury is forced hyperflexion and shear. The prevalence of neurologic involvement is high, as is the number of fractures of the adjacent spinal elements and the occurrence of disk fragments in the spinal canal. The value of plain radiography and computed tomography in diagnosis and planning treatment is illustrated.

The dynamic ASIF-BM tubular external fixator in the treatment of open fractures of the shaft of the tibia.

The dynamic ASIF-BM external fixator incorporates telescopic tubes for axial dynamization and angled bayonet screws to keep the tubes parallel to the bone axis, that is essential for gliding, and adjustment of rotation. The results after treatment of 70 type II and III open tibial fractures with static ASIF and dynamic ASIF-BM frames were analysed. Of the fractures, 32 were treated with the delta ASIF static frame, the other 38 with delta and uniplanar dynamic ASIF-BM frames. The groups were found to be comparable. The results of the study confirm that tubular external fixation is a safe method for treating the bone and soft tissue lesions in such fractures. The comparative study shows that axial compression, using the ASIF-BM device, with early weight bearing, gave a higher rate of union (97 per cent against 87 per cent with the ASIF frame), a shorter healing time (19 weeks against 29 weeks with the ASIF frame) and a decreased need for bone grafting (21 per cent against 84 per cent with the ASIF frame). The incidence of pin track infection was also decreased in dynamic frames. Thus it seems that the ASIF-BM dynamic fixator has a valuable part to play as a definitive mode of therapy for severe open fractures of the tibial shaft.

Ipsilateral open fracture of the femur and tibia treated using the dynamic ASIF-BM tubular external fixator: case reports.

Two cases of ipsilateral open fracture of the femur and tibia treated using the dynamic ASIF-BM tubular external fixator are described. Results were very good, with short periods of occupational disability. These cases support primary stable osteosynthesis of these simultaneous fractures and the value of dynamic axial external fixation as a definitive treatment of open fractures of the femur and tibia shaft, either isolated or simultaneous.

Laboratory verification

Laboratory analysis is needed for verification of suspected pesticide poisoning. Analytical methods for an extensive number of pesticides and their metabolities have been developed (AU)

A combined therapeutic protocol for aseptic nonunion of the humeral shaft: a report of 25 cases.

Twenty-five patients with aseptic nonunion of the humeral shaft, treated by a combined therapeutic procedure, are reported. The initial treatment of these 21 closed and four open fractures had been nonoperative in 21 patients and surgical in four. Seven further open procedures had been performed in four of these patients, also undergoing failure. The time period between the fracture and our treatment averaged 13 months (range, 6-46 months). A uniform therapeutic protocol, consisting of decortication, internal fixation with a broad, straight DCP ASIF plate and autologous cancellous bone grafting, was performed in all cases, supplemented with the use of surgical cement in one. Radiologic healing was achieved primarily in 24 patients in periods averaging 6 months and after renewal of the protocol in one patient. Followup averaged 35 months (range, 8-69 months): results were good in 21 patients.

The AO tubular external fixator in the treatment of open fractures and infected non-unions of the shaft of the femur.

A series of 14 cases of open fractures of the shaft of the femur and another group of 13 cases of infected non-union of the shaft of the femur are reported. They were treated with the AO tubular external fixator. The complications and results are assessed and it is concluded that the AO external fixator system has a valuable part to play in these difficult cases.

Large segmental necrosis of the tibia with deep infection after open fracture.

Fifteen patients with large segmental necrosis of the tibia with deep infection, following open fractures, were treated according to the Burri-Papineau protocol. After radical debridement, the segmental bone defects averaged 8.4 (5-15) cm. Necrectomy, external fixation, and open cancellous grafting, in a two-stage procedure, gave infection control in 14 cases and bone healing in 12. Additional procedures, i.e., plating and posterolateral bone grafting, provided union in another 2 cases. One patient underwent amputation. Functional results in the other 14, after a follow-up averaging 4 years, were good in 9 cases, fair in 3, and poor in 2.

Dislocation of the shoulder with fracture of the ipsilateral shaft of the humerus.

Three cases of dislocation of the shoulder and ipsilateral fracture of the shaft of the humerus are reported. The literature is reviewed. It is suggested that X-ray films should be taken of the shoulder and elbow in all patients with fractures of the shaft of the humerus.

Simultaneous ipsilateral trochanteric and femoral shaft fracture.

Thirteen cases of concomitant trochanteric and shaft fracture of the same femur are reported. The hip fracture was initially missed in two cases. Osteosynthesis of both fractures was performed in ten cases. Both fractures healed in the 12 cases followed for 6 months or more. Osteosynthesis of both fractures is recommended, preferably by fixation with angled or straight plates, and Ender nailing in selected cases.

Posterior dislocation of the ulna at the elbow with associated fracture of the radial shaft.

An exceptional case of posterior dislocation of the ulna at the elbow, associated with fracture of the radial shaft, is reported. Diagnosis was established with anteroposterior and lateral radiographs of the forearm, elbow and wrist. Treatment consisted of closed reduction of the ulnar dislocation and open reduction and internal fixation of the radius with an AO plate. A long arm cast was applied for 3 weeks with the elbow held at 90 degrees. Six months later full function of the limb had been achieved.

Traumatic dislocation of the hip with separation of the proximal femoral epiphysis. Report of two cases and review of the literature.

Traumatic hip dislocation with separation of the proximal femoral epiphysis is a rare injury. Twenty-six observations collected from the literature, together with two further cases presented in this paper, were statistically evaluated. Two types of injury were considered: T1, dislocation with complete separation and displacement of the epiphysis; and T2, dislocation with incomplete separation of the epiphysis. Two main therapeutic protocols had been carried out: restoration of anatomy, supplemented by different means of stabilization; and removal of the epiphysis with or without complementary procedures. Fifteen patients had been followed up for 2 years or more and avascular necrosis had been found in all of them. Leg-length discrepancy also had significant incidence. Eleven patients with T1 injury had been followed up to skeletal maturity: results were fair in four patients and poor in seven. Early surgical restoration of the proximal extremity of the femur, stabilized with Kirschner wires and cast, is the recommended treatment.

Lindane poisonings.

One percent lindane, widely used to treat scabies and pediculosis, presents toxicologic problems when used excessively. A 16-year-old mentally retarded boy accidentally ingested approximately 392 g of 1% lindane shampoo and recovered. A 2-month-old, 4.5-kg, male infant was found dead in his crib after excessive application of a 1% lindane lotion. In the former patient, initial serum levels of lindane were 206 parts per billion (ppb) declining to 1.0 ppb after 25 days. In the latter, lindane was identified in the brain at a concentration of 110 ppb. Brain levels of lindane were three times greater than the levels found in the blood. Although the relationship of this pesticide exposure to the fatal outcome in the second case was conjectural, it was illustrative of the problem of interpreting CNS events that occur shortly after excessive exposure to this insecticide.

Fracture-dislocation of the femoral head with associated ipsilateral trochanteric and shaft fracture of the femur.

An exceptional fracture-dislocation of the femoral head with associated trochanteric and shaft fracture of the same femur in a severely multi-injured 25-year-old man has been treated by open reduction of the dislocation and internal fixation of the trochanteric and shaft fractures, with a 130 degrees and a straight plate, respectively. At the 27-months follow-up examination the patient showed good evidence of fracture healing, and avascular necrosis of the femoral head had not developed, even though there had been a 5-day delay in reduction of the dislocation. The reported observation not only illustrates this extremely rare combination of injuries, but also shows that this therapeutic plan, which is able to provide the basis for eventual and further reconstructive procedures, may also offer unpredictable and gratifying outcomes in certain instances.

A vascular necrosis following traumatic hip dislocation in childhood: factors of influence.

An evaluation was made of the factors possibly influencing the incidence of vascular necrosis in a collected series of 412 traumatic hip dislocations in children. This series consisted of 145 cases with necrosis, and 267 dislocations in which this complication had not developed after a follow-up period of 2 years or more. The age of the patient, the severity of the injury, the type of dislocation and the interval before reduction proved to be influencing factors. The reduction procedure appeared to play a similar role, but this could not be definitely assessed. The post-reduction immobilization and the interval before weight-bearing had no influence. Therapeutic principles are indicated.