Size of interlocking nails used in the treatment of diaphyseal femoral fractures.

Fracture of the femur is most commonly treated with interlocking nailing. We conducted this study to describe and analyze the size of femoral interlocking nails used in our local population. This is a retrospective study on reamed intramedullary interlocking nailing procedures performed between 1st July 1998 and 30th June 2003. Demographic data, the diameter and length of femoral nails used were obtained from patient's medical record. A total of 267 procedures were included. The most common diameter used was 10 mm (56.9%), followed by 11 mm (27.0%) and 12 mm (13.1%). Only 2.6% of the nails were less than 10 mm in diameter. The most common nail length was 38 cm (31.1%), followed by 36 cm (24.9%) and 40 cm (19.5%). The longest nail used was 46 cm while the shortest 32 cm. The most commonly used femoral nails were of 10 mm diameter with the length ranging from 36 to 40 cm, which is smaller than those reported in the English literature. Nails with diameter smaller than 10 mm were required in 2.6% of patients.

Cytostatic and antiestrogenic effects of 2-(indol-3-ylmethyl)-3,3'-diindolylmethane, a major in vivo product of dietary indole-3-carbinol.

Under acidic conditions, indole-3-carbinol (13C) is converted to a series of oligomeric products thought to be responsible for the biological effects of dietary 13C. Chromatographic separation of the crude acid mixture of 13C, guided by cell proliferation assay in human MCF-7 cells, resulted in the isolation of 2-(indol-3-ylmethyl)-3,3'-diindolylmethane (LTr-1) as a major antiproliferative component. LTr-1 inhibited the growth of both estrogen-dependent (MCF-7) and -independent (MDA-MB-231) breast cancer cells by approximately 60% at a non-lethal concentration of 25 microM. LTr-1 had no apparent effect on the proliferation of MCF-7 cells in the absence of estrogen. LTr-1 was a weak ligand for the estrogen receptor (ER) (IC50 70 microM) and efficiently inhibited the estradiol (E2)-induced binding of the ER to its cognate DNA responsive element. The antagonist effects of LTr-1 also were exhibited in assays of endogenous pS2 gene expression and in cells transiently transfected with an estrogen-responsive reporter construct (pERE-vit-CAT). LTr-1 activated both binding of the aryl hydrocarbon (Ah) receptor to its cognate DNA responsive element and expression of the Ah receptor-responsive gene CYP1A1. LTr-1 was a competitive inhibitor of CYP1A1-dependent ethoxyresorufin-O-deethylase (EROD) activity. In summary, these results demonstrated that LTr-1, a major in vivo product of I3C, could inhibit the proliferation of both estrogen-dependent and -independent breast tumor cells and that LTr-1 is an antagonist of estrogen receptor function and a weak agonist of Ah receptor function.

The cofactor effect: varicocele and infertility.

The varicocele may be a cofactor that, when potentiated by other cofactors (i.e., gonadotoxins), causes male infertility. This hypothesis could explain the unpredictable effects of the varicocele on fertility. Male rats with experimental varicoceles, sham surgery, or no surgery were treated for 30 days with the known gonadotoxins cyclophosphamide or nicotine. Spermatogenesis was assessed by flow cytometry. Cyclophosphamide alone caused gonadotoxicity, and its effect was accentuated by sham or varicocele surgery. Nicotine and the presence of a varicocele were more gonadotoxic than either the varicocele or nicotine by itself. This data would lend support to the cofactor hypothesis of the pathophysiology of the varicocele.

Ileocecocystoplasty for the management of refractory neurogenic bladder: surgical technique and urodynamic findings.

A total of 21 incontinent adults with a neurogenic bladder who were refractory to conservative management underwent a modified technique of ileocecocystoplasty. Followup ranged from 1 to 6 years (mean 3.1 years). To ensure a wide anastomosis the augmentation was accomplished by suturing a detubularized ileocecal patch to a large posterior based bladder flap anchored to the psoas muscles. Postoperatively 20 of 21 patients were continent. The remaining woman was cured after surgical correction of sphincteric incontinence. Mean bladder capacity increased from 185 +/- 17 to 595 +/- 43 ml. (standard error). Mean maximum detrusor pressure decreased from 53 +/- 6.3 to 16 +/- 2.3 cm. water (p less than 0.0001). Followup revealed a persistently large capacity, low pressure reservoir in all patients. No patient required anticholinergic medication. None experienced acid-base imbalance, tumors in the augmented bladder or upper tract deterioration. We conclude that this technique of ileocecocystoplasty is suitable for the management of patients with a refractory neurogenic bladder.

Cystic adrenal masses in the neonate associated with hemihypertrophy and the relation to the Beckwith-Wiedemann syndrome.

We report 2 cases of unilateral, multilocular, cystic adrenal masses in neonates. Both patients demonstrated somatic hemihypertrophy, which is considered to have the same implications as the Beckwith-Wiedemann syndrome in terms of tumor risk. Pathological examination showed multiple, adrenal cysts without evidence of tumor or routine adrenal hemorrhage. This finding appears to represent a previously unreported association between the spectrum of hemihypertrophy/Beckwith-Wiedemann syndrome and benign cystic adrenal disease.