Biomedical subjects
Publications and source records attributed to D Hardy.
Subcapital stress fracture occurring after a previously healed intertrochanteric fracture is a rare event. One further case is reported. A new etiology and different ways of preventing such a complication are proposed.
We have studied the interest of an original radiological incidence ("Plantar hyperflexion") allowing to demonstrate a possible hyperlaxity of medio-tarsal joints. We discovered a significant difference of mobility between patients with unstable feet and the control group. The existence of a medio-tarsal hyperlaxity should be taken into account before starting any treatment.
A total of 112 consecutive cases of fractures of the distal radius managed conservatively were graded according to radiological criteria using the first radiograph. These criteria, as well as age over 60 years, were considered as gravity factors. A strong correlation was found between these criteria and the risk of secondary displacement, despite a correct initial reduction.
Twenty patients, victims of a first luxation of the patella, were the object of a retrospective study. They were all subjected to arthroscopic examination during which, in 7 of the patients, the liquid injected under pressure massively escaped into the subcutaneous layer of the medial side of the knee. The patients were divided into 2 groups according to the integrity of the capsule of their knees. Group I consisted of 7 patients, group II of 13 patients. The treatments, the majority of which were conservative, were quite varied, but the post-traumatic functional recuperation was much slower and more variable for the group I patients. These patients presented more significant tissue lesions which certainly contributed to the functional prognosis of the traumatized joint. Seventy two percent of the patients, equally distributed between the 2 groups, presented trochleo-patellar dysplasia. With the exception of age, different clinical parameters (sex, circumstances of the accident, clinical examination) and radiological criteria (external displacement of the patella, detached bony fragment at the interior border of the patella, value of the patellar and trochlear angles, patella alta) did not permit a distinction between the two groups. Because of our results and those in the existing literature we recommend arthroscopy, which is the only examination capable of establishing a complete picture of the lesions and which, in addition, permits rising of the joint and sometimes allows extraction of free osteo-cartilaginous fragments. The younger patients may then benefit from immediate functional reeducation. For older patients, where the tissue lesions are more important, conservative treatment is associated with a slower and sometimes variable functional recuperation. It remains to be determined, whether surgical treatment, adapted to each case, would permit us to obtain better results more rapidly.
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Is an increase in medio-plantar strain the common denominator in Köhler disease and in stress fractures of the tarsal navicular? This hypothesis is illustrated by the present observation where the increase in strain is provoked by constitutional articular laxity.
One-hundred-sixty-seven consecutive cases of distal radius fracture have been treated in our department from October 1985 until November 1987. All cases were rated according to anatomical criteria defined on the first radiogram. These criteria were the presence of a dorsal tilt greater than 20 degrees, dorsal comminution, intra-articular radiocarpal involvement, an associated fracture of the ulna and comminution of the distal radius. Age greater than 60 years was also considered as a factor in determining severity. With regard to fractures treated conservatively (from which comminuted fractures were excluded), a strong correlation was found between the sum of these factors and the risk of secondary displacement. This complication occurs despite a satisfactory initial reduction. Although the surgically treated cases were more severe, significantly better radiological results were observed following surgical management. This mode of classification of distal radius fractures is helpful for determining prognosis and evaluating the risk of secondary displacement and in the course, should help in the selection, perhaps earlier of the most appropriate treatment.
We examined three patients with AIDS who had large, sharply demarcated areas of thinned retina consistent with inactive cytomegalovirus retinitis and who were not treated with ganciclovir. These lesions appeared identical to clinically inactive areas of cytomegalovirus retinitis after effective antiviral treatment. All patients were receiving azidothymidine or ribavirin, or both, which have activity against the human immunodeficiency virus and which may improve immune function. All patients also received oral acyclovir at doses ineffective against cytomegalovirus retinitis.
Ganciclovir is an experimental antiviral drug with activity against human cytomegalovirus (CMV). Forty patients with acquired immune deficiency syndrome (AIDS) and CMV retinopathy were treated with ganciclovir on a compassionate protocol basis. Initial treatment doses ranged from 5.0 to 14.0 mg/kg/day for 9 to 26 days. Signs of drug response were a halt to enlargement of lesions, decreased opacification of retinal tissue, and resolution of hemorrhage and vasculitis. Complete response was seen in 88% of patients and incomplete response was seen in 9%. Vision improved or remained stable in 88% of patients. Initial treatment did not eradicate live virus from the eye. To prevent reactivation of disease, 26 patients received low-dose maintenance therapy ranging from 1.5 to 7.5 mg/kg/day, once or twice daily, 3 to 7 days per week. Reactivation of disease developed for unknown reasons in 50% of patients on continuous, uninterrupted maintenance therapy for longer than 3 weeks. Reversible neutropenia, requiring cessation of treatment, developed in 30% of patients on initial treatment and in 38% of patients on maintenance therapy. Rhegmatogenous retinal detachment was a late complication in seven patients. By reducing or delaying visual loss, ganciclovir appears to be useful in the management of CMV retinopathy in patients with AIDS.
There is poor correlation between the MICs and zone sizes obtained for erythromycin against Haemophilus influenzae. The effect of two media, Mueller-Hinton medium supplemented with 3% lysed horse blood and 10 micrograms of NAD per ml (MHA + LYHB) and Mueller-Hinton agar supplemented with 1% bovine hemoglobin and 1% IsoVitaleX (MHA + HGB), on the MICs and zone sizes of erythromycin against H. influenzae was determined. The effect of three different methods for inoculum preparation on the susceptibility of H. influenzae was also determined. The MICs were independent of the method of inoculum preparation, but the zone sizes were smaller if the inoculum was carefully adjusted to contain approximately 10(8) CFU/ml. MICs were higher and zone sizes were smaller when MHA + HGB was used instead of MHA + LYHB. Good correlation was found when MHA + LYHB was used for determining the MIC and MHA + HGB was used for determining susceptibility by the disk method. When the inoculum was adjusted to match a McFarland 0.5 standard, the viable counts had to be approximately 10(8) CFU/ml for good correlation between MICs and zone sizes. A-56268, a new macrolide antibiotic, was tested against H. influenzae, and its MICs and tentative breakpoints against this organism were determined. The MICs obtained by various methods were correlated with in vivo efficacy by using a mouse septicemia model. MICs obtained on MHA + HGB or MHA + LYHB incubated without a 5% CO2 atmosphere showed the best correlation with in vivo efficacy.
Of 163 human breast cancers examined, 68% contained detectable aneuploid populations, whilst 32% had apparently normal DNA distributions. A slightly higher incidence of aneuploidy was observed in pre-menopausal patients (83%) than in post-menopausal patients (66%). Also, pre-menopausal patients had slightly higher proportions of S-phase or cycling (S + G2 + M) cells. Estradiol receptor negative (ER-) tumours from post-menopausal patients were found to have the lowest incidence of aneuploidy (59%) and ER- tumours from pre-menopausal patients the highest (91%). There were no significant differences in the proportions of cycling nuclei when receptor status and menopausal status were considered. A weak relationship is shown to exist between flow cytometric data and two common prognostic indicators of breast cancer, namely receptor status and menopausal status.
Syringomyelia is known to occur secondary to compression of the spinal cord. We report the case of a female patient who underwent removal of a spinal meningioma. She re-presented 30 years later with multiple meningiomas causing cord compression. After a 4 year interval she was found to have developed a syrinx proximal to the site of compression. Comparison with previous case reports suggest that the causation of syringomyelia is multi-factorial.
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Cytomegalovirus (CMV) retinopathy, a relentlessly progressive disease that results in permanent blindness, is the most common opportunistic infection of the eye in patients with the acquired immunodeficiency syndrome. Twenty patients with the acquired immunodeficiency syndrome with CMV retinopathy were treated with a new, experimental, antiviral drug, 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine (BW B759U), in dosages ranging from 5.0 to 14.0 mg/kg/d for a ten- to 20-day course. In 19 patients (95%), treatment halted the progression of infection and decreased retinal opacification, hemorrhage, and vasculitis. Vision remained stable in most cases. Six patients received no additional treatment. Fourteen patients received continued treatment with a lower maintenance dosage. Retinal disease reactivated in all patients who did not receive maintenance therapy immediately after initial treatment, indicating persistence of live virus despite drug therapy. Reactivation of disease also developed in four (40%) of ten patients receiving continuous, uninterrupted maintenance therapy for longer than three weeks. Reversible neutropenia, requiring cessation of treatment, developed in five (25%) of 20 patients on initial treatment and five (36%) of 14 patients receiving maintenance therapy. Rhegmatogenous retinal detachment was a late complication in four patients. BW B759U appears to be useful in the management of CMV retinopathy by reducing or delaying visual loss.
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