El uso de artroscopia no aumenta la incidencia de complicaciones en el manejo de fracturas de mesetas tibiales Schatzker IV-VI / The use of arthroscopy does not increase the incidence of complications in the management of Schatzker IV-VI tibial plateau fractures

Antecedentes y objetivo: El uso de asistencia artroscopica en fracturas de mesetas tibiales tipos I-III según la clasificación de Schatzker se ha popularizado; sin embargo aún existe controversia con respecto a su uso en fracturas Schatzker IV-VI por el potencial riesgo de complicaciones. El objetivo de este trabajo es comparar la tasa de complicaciones intra o postoperatorias entre pacientes con fracturas de mesetas tibiales de este tipo tratados con y sin artroscopia al momento de la reducción y osteosíntesis definitiva. Materiales y métodos: Estudio de cohortes retrospectivo. Se incluyeron pacientes con diagnóstico de fractura de mesetas tibiales Schatzker IV-VI, sometidos a reducción y osteosíntesis definitiva, y al manejo de lesiones asociadas con o sin el uso de artroscopia evaluando la aparición de síndrome compartimental, trombosis venosa profunda e infección relacionada a fractura con seguimiento mínimo de 12 meses posterior a la cirugía definitiva. Resultados: Se incluyeron 288 pacientes: 86 operados con asistencia artroscópica y 202 sin asistencia artroscópica. La tasa de complicaciones total en el grupo con y sin asistencia artroscópica fue del 18,60 y 26,73%, respectivamente (p=0,141). No hubo asociación estadísticamente significativa entre el uso de asistencia artroscópica y el desarrollo de las complicaciones analizadas. Discusión y conclusiones: El uso de artroscopia de rodilla como apoyo de la reducción o como adyuvancia para el tratamiento simultáneo de lesiones intraarticulares concomitantes no aumentó el riesgo de complicaciones en el postoperatorio inmediato ni tras 12 meses de seguimiento.(AU)

Background and objective: The use of arthroscopy for tibial plateau fractures type I, II and III according to Schatzker classification has increased, yet its employment for tibial plateau fractures Schatzker IV, V and VI is controversial due to the potential risk of compartment syndrome, deep vein thrombosis and infection. We aimed to compare the rate of operative and postoperative complications among patients with these types of tibial plateau fractures treated with and without arthroscopy at the time of definitive reduction and osteosynthesis. Methods: Retrospective cohort study. Patients with diagnosis of tibial plateau fracture Schatzker IV, V or VI who underwent reduction and definitive osteosynthesis with or without the use of arthroscopy were included. The development of compartment syndrome, deep vein thrombosis, and fracture-related infection was evaluated up to 12 months after the definitive surgery. Results: Two hundred eighty-eight patients were included: 86 with arthroscopic assistance and 202 without it. The overall complication rate in the group with and without arthroscopic assistance was 18.60% and 26.73%, respectively (P=.141). No statistical association was found between the use of arthroscopic assistance and the development of the analyzed complications. Discussion and conclusion: The use of arthroscopy to support reduction or addressing concomitant intra-articular injuries did not increase the risk of complications in patients with high-energy tibial plateau fractures at 12 months of follow up.(AU)

[Translated article] The use of arthroscopy does not increase the incidence of complications in the management of Schatzker IV–VI tibial plateau fractures / El uso de artroscopia no aumenta la incidencia de complicaciones en el manejo de fracturas de mesetas tibiales Schatzker IV-VI

Antecedentes y objetivo: El uso de asistencia artroscopica en fracturas de mesetas tibiales tipos I-III según la clasificación de Schatzker se ha popularizado; sin embargo aún existe controversia con respecto a su uso en fracturas Schatzker IV-VI por el potencial riesgo de complicaciones. El objetivo de este trabajo es comparar la tasa de complicaciones intra o postoperatorias entre pacientes con fracturas de mesetas tibiales de este tipo tratados con y sin artroscopia al momento de la reducción y osteosíntesis definitiva. Materiales y métodos: Estudio de cohortes retrospectivo. Se incluyeron pacientes con diagnóstico de fractura de mesetas tibiales Schatzker IV-VI, sometidos a reducción y osteosíntesis definitiva, y al manejo de lesiones asociadas con o sin el uso de artroscopia evaluando la aparición de síndrome compartimental, trombosis venosa profunda e infección relacionada a fractura con seguimiento mínimo de 12 meses posterior a la cirugía definitiva. Resultados: Se incluyeron 288 pacientes: 86 operados con asistencia artroscópica y 202 sin asistencia artroscópica. La tasa de complicaciones total en el grupo con y sin asistencia artroscópica fue del 18,60 y 26,73%, respectivamente (p=0,141). No hubo asociación estadísticamente significativa entre el uso de asistencia artroscópica y el desarrollo de las complicaciones analizadas. Discusión y conclusiones: El uso de artroscopia de rodilla como apoyo de la reducción o como adyuvancia para el tratamiento simultáneo de lesiones intraarticulares concomitantes no aumentó el riesgo de complicaciones en el postoperatorio inmediato ni tras 12 meses de seguimiento.(AU)

Background and objective: The use of arthroscopy for tibial plateau fractures type I, II and III according to Schatzker classification has increased, yet its employment for tibial plateau fractures Schatzker IV, V and VI is controversial due to the potential risk of compartment syndrome, deep vein thrombosis and infection. We aimed to compare the rate of operative and postoperative complications among patients with these types of tibial plateau fractures treated with and without arthroscopy at the time of definitive reduction and osteosynthesis. Methods: Retrospective cohort study. Patients with diagnosis of tibial plateau fracture Schatzker IV, V or VI who underwent reduction and definitive osteosynthesis with or without the use of arthroscopy were included. The development of compartment syndrome, deep vein thrombosis, and fracture-related infection was evaluated up to 12 months after the definitive surgery. Results: Two hundred eighty-eight patients were included: 86 with arthroscopic assistance and 202 without it. The overall complication rate in the group with and without arthroscopic assistance was 18.60% and 26.73%, respectively (P=.141). No statistical association was found between the use of arthroscopic assistance and the development of the analyzed complications. Discussion and conclusion: The use of arthroscopy to support reduction or addressing concomitant intra-articular injuries did not increase the risk of complications in patients with high-energy tibial plateau fractures at 12 months of follow up.(AU)

[Translated article] The use of arthroscopy does not increase the incidence of complications in the management of Schatzker IV-VI tibial plateau fractures.

BACKGROUND AND OBJECTIVE: The use of arthroscopy for tibial plateau fractures type I, II and III according to Schatzker classification has increased, yet its employment for tibial plateau fractures Schatzker IV, V and VI is controversial due to the potential risk of compartment syndrome, deep vein thrombosis and infection. We aimed to compare the rate of operative and postoperative complications among patients with these types of tibial plateau fractures treated with and without arthroscopy at the time of definitive reduction and osteosynthesis. METHODS: Retrospective cohort study. Patients with diagnosis of tibial plateau fracture Schatzker IV, V or VI who underwent reduction and definitive osteosynthesis with or without the use of arthroscopy were included. The development of compartment syndrome, deep vein thrombosis, and fracture-related infection was evaluated up to 12 months after the definitive surgery. RESULTS: Two hundred eighty-eight patients were included: 86 with arthroscopic assistance and 202 without it. The overall complication rate in the group with and without arthroscopic assistance was 18.60% and 26.73%, respectively (p=.141). No statistical association was found between the use of arthroscopic assistance and the development of the analysed complications. DISCUSSION AND CONCLUSION: The use of arthroscopy to support reduction or addressing concomitant intra-articular injuries did not increase the risk of complications in patients with high-energy tibial plateau fractures at 12 months of follow up.

The use of arthroscopy does not increase the incidence of complications in the management of Schatzker IV-VI tibial plateau fractures. / El uso de artroscopia no aumenta la incidencia de complicaciones en el manejo de fracturas de mesetas tibiales Schatzker IV-VI.

BACKGROUND AND OBJECTIVE: The use of arthroscopy for tibial plateau fractures type I, II and III according to Schatzker classification has increased, yet its employment for tibial plateau fractures Schatzker IV, V and VI is controversial due to the potential risk of compartment syndrome, deep vein thrombosis and infection. We aimed to compare the rate of operative and postoperative complications among patients with these types of tibial plateau fractures treated with and without arthroscopy at the time of definitive reduction and osteosynthesis. METHODS: Retrospective cohort study. Patients with diagnosis of tibial plateau fracture Schatzker IV, V or VI who underwent reduction and definitive osteosynthesis with or without the use of arthroscopy were included. The development of compartment syndrome, deep vein thrombosis, and fracture-related infection was evaluated up to 12 months after the definitive surgery. RESULTS: Two hundred eighty-eight patients were included: 86 with arthroscopic assistance and 202 without it. The overall complication rate in the group with and without arthroscopic assistance was 18.60% and 26.73%, respectively (P=.141). No statistical association was found between the use of arthroscopic assistance and the development of the analyzed complications. DISCUSSION AND CONCLUSION: The use of arthroscopy to support reduction or addressing concomitant intra-articular injuries did not increase the risk of complications in patients with high-energy tibial plateau fractures at 12 months of follow up.

Age-dependent seroprevalence of Toscana virus in central Italy and correlation with the clinical profile.

In order to estimate the antibody prevalence rates for Toscana virus (TOSV) among children and adults, we evaluated the seroprevalence of TOSV in a population (n = 2,737) living in Tuscany during the period of 1999 to 2006. The seroprevalence rate was 19.8% in adults and 5.8% in children, showing an age-dependent increase in TOSV-specific immunity. Meningitis due to TOSV infection was more frequent in adults than in children.

Docetaxel pharmacokinetics with pre- and post-dialysis administration in a hemodyalized patient.

BACKGROUND: Docetaxel has a proven significant activity against breast, non-small cell lung, ovarian, head and neck, and hormone refractory prostate cancer. Preclinical pharmacokinetic studies have shown that hepatobiliary extraction is the major route of elimination. We conducted this study to elucidate the feasibility and safety of the use of docetaxel in hemodialysis patients. PATIENT AND METHODS: In a 72-year-old hormone refractory prostate cancer patient on hemodialysis for diabetic nephropathy for 3 years, a first dose (35 mg/m(2) iv) of docetaxel was completed 30 min before starting dialysis, while a second dose was administered 30 min after completion of a different hemodialysis session. Pharmacokinetic analysis was performed following both infusions. RESULTS: No apparent differences could be seen in the plasma concentration-time curves of docetaxel administered before or after dialysis. The patient experienced no significant toxicity after either administration of docetaxel. CONCLUSIONS: Docetaxel is safe in dialysis patients and does not require dose reduction. Dialysis does not remove this drug from blood.

Pain management documenting the decision making process.

From patient admission to discharge, pain is a critical symptom of concern to the nurse case manager. This descriptive study examined nurses' decision-making regarding pain management as documented in clinical records of patients after orthopedic surgery. Using a Nurses' Pain Management Audit Tool, data analysis revealed that during the first 24 hours after emergence from the Post-Anesthesia Care Unit, these patients received less than 50% of the narcotic doses available for their pain relief. Nurses documented less than 25% of the "ideal occurrences" possible for pain assessment, as described in the Agency for Health Care Policy and Research Guidelines. Incomplete databases for guiding patient outcomes of effective pain management were perpetuated by insufficient documentation. Nurse case managers could stimulate increased commitment and quality improvement in pain management as a crucial aspect of patient care.

Helicobacter pylori cytotoxin: importance of native conformation for induction of neutralizing antibodies.

We have attempted to express the Helicobacter pylori vacuolating cytotoxin in Escherichia coli. Although the 95-kDa VacA polypeptide was expressed abundantly, it completely lacked any biological activity. In addition, this material failed to induce neutralizing antibodies after immunization of rabbits. In contrast, highly purified high-molecular-mass cytotoxin from the supernatant of H. pylori cultures was active in a HeLa cell assay and effectively induced a neutralizing response in rabbits. Neutralizing sera were shown to contain a high proportion of antibodies which recognized conformational epitopes found only on the native toxin. The data indicate that toxin-neutralizing epitopes are conformational and that potential vaccines based on the cytotoxin may benefit from the use of the intact molecule.

Cyclodextrins for growth of Helicobacter pylori and production of vacuolating cytotoxin.

Growth of Helicobacter pylori in liquid culture requires the addition of media supplements that often interfere with subsequent purification of bacterial antigens. In order to determine whether cyclodextrins can substitute for conventional H. pylori growth supplements, we cultured H. pylori in the presence of five commercially available cyclodextrins. The effect of these compounds on the production of the vacuolating cytotoxin antigen was evaluated. Several cyclodextrins supported flourishing growth and permitted the consistent production of vacuolating cytotoxin. These data suggest that Brucella broth supplemented with cyclodextrins is an improved medium for bacterial culture and industrial production of H. pylori antigens.

Construction of nontoxic derivatives of cholera toxin and characterization of the immunological response against the A subunit.

Using computer modelling, we have identified some of the residues of the A subunit of cholera toxin (CT) and heat-labile toxin that are involved in NAD binding, catalysis, and toxicity. Here we describe the site-directed mutagenesis of the CT gene and the construction of CT mutants. Nine mutations of the A subunit gene were generated. Six of them encoded proteins that were fully assembled in the AB5 structure and were nontoxic; these proteins were CT-D53 (Val-53-->Asp), CT-K63 (Ser-63-->Lys), CT-K97 (Val-97-->Lys), CT-K104 (Tyr-104-->Lys), CT-S106 (Pro-106-->Ser), and the double mutant CT-D53/K63 (Val-53-->Asp, Ser-63-->Lys). Two of the mutations encoded proteins that were assembled into the AB5 structure but were still toxic; these proteins were CT-H54 (Arg-54-->His) and CT-N107 (His-107-->Asn). Finally, one of the mutant proteins, CT-E114 (Ser-114-->Glu), was unable to assemble the A and the B subunits and produced only the B oligomer. The six nontoxic mutants were purified from the culture supernatants of recombinant Vibrio cholerae strains and further characterized. The CT-K63 mutant, which was the most efficient in assembly of the AB5 structure, was used to immunize rabbits and was shown to be able to induce neutralizing antibodies against both the A and B subunits. This molecule may be useful for the construction of improved vaccines against cholera.

Optimized conditions for the fermentation of Helicobacter pylori and production of vacuolating cytotoxin.

We report here improvements to the growth media and fermentation conditions which result in a substantial increase of Helicobacter pylori growth and in the enhanced production of vacuolating cytotoxin. Addition of glucose to the medium resulted in the increase of cell yield, cell viability and a significant improvement in the production of vacuolating cytotoxin.

Ultrasound therapy of chronic arm lymphedema after surgical treatment of breast cancer.

The treatment of chronic arm lymphedema following axillary dissection for breast cancer is still a therapeutic challenge. To examine other treatment options, we undertook a pilot study on the efficacy of ultrasound therapy (UST) in management of these patients. Fifty patients with post-surgical arm lymphedema and without regional irradiation underwent ultrasound treatment (2 cycles at 4 month intervals) and the results were compared up to 1 year with 100 other patients treated by standardized mechanical pressure therapy (MPT) using a pneumatic pump. In this report we evaluate 96 patients who have been followed after 1 year, 31 of whom belong to UST group and 65 to the MPT group. UST did not show a statistically significant difference in whole arm reduction of lymphedema although there was initially a greater reduction in size after the first 4 months of treatment. The addition of an elastic sleeve did not improve lymphedema in either group. Advantages of UST were an overall shorter length of treatment, a tendency to greater softening of the arm, patient satisfaction by avoidance of an uncomfortable and constrictive device and better relief of osteomyofascial pain, greater scapulohumeral motion, and less intercostobrachial pain-dysesthesia.

Growth of Helicobacter pylori in media containing cyclodextrins.

We show that solid and liquid media, supplemented only with cyclodextrins and free of blood and its derivatives, support the growth of Helicobacter pylori. These media can be used for primary isolation of the bacteria from biopsy samples, routine laboratory growth, and large-scale industrial fermentation.

Cellular pertussis vaccine containing a Bordetella pertussis strain that produces a nontoxic pertussis toxin molecule.

Bordetella pertussis 165-9K/129G, which produces a nontoxic form of pertussis toxin (PT), was used to prepare a whole-cell diphtheria-tetanus-pertussis (DTP) vaccine. The in vivo potency and the serological response induced by this vaccine were comparable to those of the conventional DTP vaccine which contains active PT. The toxic activities induced by PT such as leukocytosis, histamine sensitivity, and potentiation of anaphylactic reactions, which are present in the conventional DTP vaccine, were absent in the new vaccine. These results suggest that the introduction of a whole-cell vaccine containing B. pertussis 165-9K/129G would induce the same immunity as the conventional vaccine and would avoid the administration of a harmful toxin to children.

A strategy for introducing diagnostic reasoning: hypothesis testing using a simulation approach.

The ability to generate a number of hypotheses, so all possibilities in a situation are recognized, is a vital component in arriving at a correct nursing diagnosis. Students need learning experiences in this aspect of the diagnostic reasoning process. The authors discuss the four phase simulation method of teaching, which provides a useful model for developing beginning skills in hypothesis generation.