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Subtrochanteric missile fractures of the femur.

The treatment results of subtrochanteric missile fractures of the femur in 41 casualties are analyzed. The wounds were inflicted by infantry weapon missiles in 29 (70.7%) and by fragments of mine or explosive devices in 12 (29.3%) casualties. The associated neurovascular bundle injuries were present in 11 (26.8%) patients. Fracture stabilization was done by external fixation in 25 (62.5%): group A; and by plaster of Paris in 15 (37.5%) patients: group B. The postoperative period was uneventful in 14 (35.0%) and early or late complications occurred in 26 (65.0%) patients. Bone infection developed in six (15.0%) and fractures did not heal in four (10.0%) patients. Complications were present in 13 (52.0%) patients from group A and in 13 (86.7%) patients from group B. Delayed fracture healing and fracture nonunion were present in group A and contractures of large joints in group B. Subtrochanteric missile fractures of the femur present very severe injuries where the treatment is followed by a very high percentage of complications. External fracture fixation in this region facilitates the care, stability, early covering of soft tissue defects and early physical therapy.

Adult↗

Primary surgical treatment of war injuries of the foot.

Presented are the results of primary surgical treatment of war injuries of the foot in 250 patients wounded in the territory of former Yugoslavia in the period June 1991-October 1995. Total number of feet treated was 275. Aetiologically, the most frequent injuries were those inflicted by the effect of mine blasts (65.2%) and by bullets from firearms (30.8%). Injuries to a single foot were present in 140 (56.0%), combined injuries in 107 (42.8%) and associated with burn injuries in three (1.2%) patients. Soft tissue injuries were present in 25 (9.1%) and injuries to bone structures and joints in 250 (90.9%) feet. Injuries resulting from solid blasts were found in nine (3.2%) feet. Postoperative bone fragment stabilization was required in 115 (41.8%) feet. Stabilization was by plaster of Paris in 87 (75.6%) and by external fixation in 23 (20. 0%) feet. Amputations were performed in 73 (26.5%) feet. Covering of soft tissue and bone defects was required in 84 (33.6%) patients.

Adolescent↗

Identification of lipid binders in paintings by gas chromatography. Influence of the pigments.

The influence of the presence and the type of pigments in the lipid binding media of paintings were studied by gas chromatography with flame ionization detector. The drying oils were linseed stand oil, poppy oil and sunflower oil, and the pigments studied were cadmium red, cobalt blue, tin white, lead white, chalk and plaster of Paris, commonly used in paintings. The results indicate that the stearic/palmitic ratio and the presence of pigments are quite stable during ageing. However, some differences in the oleic acid/palmitic acid ratio were found, depending on the type of pigment present in the lipid binding media. These variations are related to the drying effect of the pigments. The proposed method has been applied to the identification of drying oils in two samples from baroque paintings in the "Basilica de la Virgen de los Desamparados" of Valencia, Spain.

Art↗

The role of stress waves and cavitation in stone comminution in shock wave lithotripsy.

Using an experimental system that mimics stone fragmentation in the renal pelvis, we have investigated the role of stress waves and cavitation in stone comminution in shock-wave lithotripsy (SWL). Spherical plaster-of-Paris stone phantoms (D = 10 mm) were exposed to 25, 50, 100, 200, 300 and 500 shocks at the beam focus of a Dornier HM-3 lithotripter operated at 20 kV and a pulse repetition rate of 1 Hz. The stone phantoms were immersed either in degassed water or in castor oil to delineate the contribution of stress waves and cavitation to stone comminution. It was found that, while in degassed water there is a progressive disintegration of the stone phantoms into small pieces, the fragments produced in castor oil are fairly sizable. From 25 to 500 shocks, clinically passable fragments (< 2 mm) produced in degassed water increases from 3% to 66%, whereas, in castor oil, the corresponding values are from 2% to 11%. Similar observations were confirmed using kidney stones with a primary composition of calcium oxalate monohydrate. After 200 shocks, 89% of the fragments of the kidney stones treated in degassed water became passable, but only 22% of the fragments of the kidney stones treated in castor oil were less than 2 mm in size. This apparent size limitation of the stone fragments produced primarily by stress waves (in castor oil) is likely caused by the destructive superposition of the stress waves reverberating inside the fragments, when their sizes are less than half of the compressive wavelength in the stone material. On the other hand, if a stone is only exposed to cavitation bubbles induced in SWL, the resultant fragmentation is much less effective than that produced by the combination of stress waves and cavitation. It is concluded that, although stress wave-induced fracture is important for the initial disintegration of kidney stones, cavitation is necessary to produce fine passable fragments, which are most critical for the success of clinical SWL. Stress waves and cavitation work synergistically, rather than independently, to produce effective and successful disintegration of renal calculi in SWL

Calcium Oxalate↗

Movement-related glutamate levels in rat hippocampus, striatum, and sensorimotor cortex.

Changes in brain extracellular glutamate during movement stress were studied using in vivo microdialysis. Male Long-Evans rats were placed in a clear cylinder designed to elicit behavioral activation while undergoing microdialysis sampling from either the hippocampus, striatum or sensorimotor cortex. Glutamate levels were determined by high performance liquid chromatography with fluorescence detection in the dialysates taken before, during, and after exposure to the cylinder. Animals were in a behaviorally quiescent state before exposure to the cylinder, but they demonstrated increases in rearing, locomotion, and turning while in the cylinder. Dialysate glutamate levels were significantly enhanced in the samples taken while the rat was in the cylinder compared with samples taken before or after exposure to the cylinder. In a second study, rats were implanted with bilateral probes in the forelimb sensorimotor cortex, and one forelimb was immobilized by means of a plaster of paris cast. Glutamate, aspartate, serine, and taurine levels were quantified in casted animals. In casted animals, dialysate glutamate levels were lower on the side contralateral to the immobilized limb during both quiescence and movement stress. Aspartate and taurine, but not serine levels increased during movement stress in both the side contralateral and the side ipsilateral to the immobilized limb. These results suggest that there is extracellular overflow of glutamate and other neuroactive amino acids during spontaneous movement, and chronic disuse can suppress extracellular glutamate levels.

Amino Acids↗

Correction of post burns contracture of wrist with Ilizarov method.

A case of severe post burns contracture of the wrist, of 43 years duration resulting in recurrent ulceration of the skin was successfully treated by gradual distraction using the Ilizarov method. This method is superior to plaster of Paris cast and is more versatile than other forms of external fixation.

Adult↗

[Effects of halothane on the electrical activity of respiratory muscles in rats].

This study was designed to investigate the effects of halothane on the electrical activity of the respiratory muscles in rats. Indeed, halothane is known to reduce end-expiratory lung volume, both in man and in animal; this may be due to altered activity in the respiratory muscles. The electrical activity of the diaphragm, parasternal, intercostal and abdominal muscles were recorded using intramuscular electrodes in ten rats weighing between 400 and 450 g each. The rats were prepared under light halothane anaesthesia (tracheostomy, laparotomy, electrode positioning, plaster of Paris cast to impede leg movements). They were placed prone in a 20 1 plexiglass chamber, and allowed to awake. Thereafter halothane was vaporized in this chamber at a known concentration, until the animals no longer reacted to tail pinching. The measurements were carried out during the awake state, and under 2 vol % halothane. Muscle tone was assessed by the thickness of baseline inspiratory muscle activity at the end of expiration (maximally amplified raw electromyographic signals). The measurement of phasic electrical activity was carried out using peak inspiratory integrated electromyographic signals. Under halothane, phasic activity of the diaphragm was slightly reduced (p less than 0.05), whereas tonic activity remained unchanged. Parasternal intercostal muscle activity, both tonic and phasic, was also decreased during halothane anaesthesia (p less than 0.001). No phasic activity occurred in the abdominal muscles, but muscle tone was reduced during halothane administration (p less than 0.01). In rats, the decrease in intercostal muscle tone under halothane anaesthesia could play a major part in the fall in functional residual capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Fusidic acid in bone and joint infections.

The prominence of staphylococci as the causative agent in bone and joint infections suggests that fusidic acid (FA) has a potentially important role in their treatment. FA has been studied in a broad range of orthopaedic infections, mostly in combination with other antimicrobials. For susceptible organisms, particularly Staphylococcus aureus, it has demonstrable efficacy in acute osteomyelitis, chronic osteomyelitis, specialised forms of osteomyelitis such as calcaneal and vertebral infection, septic arthritis, prosthetic and other device-related infections. A small number of studies have also examined the use of FA alone for the treatment of bone infections, with evidence of good efficacy, as well as the local application of FA in plaster-of-Paris (POP) beads, or incorporated into bone cement, again with promising results. Further studies are required to confirm the efficacy of FA in the treatment of orthopaedic infections caused by methicillin-resistant strains of S. aureus.

Animals↗

A five year review of anaerobic, necrotizing soft tissue infections: a nursing perspective.

Anaerobic necrotizing soft tissue infections are known for their devastating effects of tissue destruction and death. These infections may occur as a result of trauma, surgical intervention or occur spontaneously in predisposed individuals. They are caused by a wide range of anaerobic organisms and may be categorised according to the tissue involvement as Necrotizing Fasciitis and Myonecrosis. A five year review of patients admitted for hyperbaric oxygen (HBO) therapy and requiring intensive care revealed a patient group numbering 25, roughly equally divided between the two classifications of tissue involvement. Trauma was an aetiological factor in 5 of these cases. Cancer and diabetes mellitus were also prominent aetiological factors. Treatment consisted of the triad of early selective/aggressive surgery, high dose antibiotic therapy and HBO therapy. The mortality of the group was 25%. Delay in treatment was associated with increased mortality. Nursing care, for this particular patient group is demanding, requiring particular attention to wound care, analgesia, transport, psychosocial care of patient with mutilating wounds, nutrition and temperature homeostasis. It is a cause for concern that two cases occurred after elective orthopaedic procedures requiring the application of plaster of paris (POP) cast over a leg.

Adolescent↗

Electrical impedance tomography of human brain function using reconstruction algorithms based on the finite element method.

Electrical impedance tomography (EIT) is a recently developed technique which enables the internal conductivity of an object to be imaged using rings of external electrodes. In a recent study, EIT during cortical evoked responses showed encouraging changes in the raw impedance measurements, but reconstructed images were noisy. A simplified reconstruction algorithm was used which modelled the head as a homogeneous sphere. In the current study, the development and validation of an improved reconstruction algorithm are described in which realistic geometry and conductivity distributions have been incorporated using the finite element method. Data from computer simulations and spherical or head-shaped saline-filled tank phantoms, in which the skull was represented by a concentric shell of plaster of Paris or a real human skull, have been reconstructed into images. There were significant improvements in image quality as a result of the incorporation of accurate geometry and extracerebral layers in the reconstruction algorithm. Image quality, assessed by blinded subjective expert observers, also improved significantly when data from the previous evoked response study were reanalysed with the new algorithm. In preliminary images collected during epileptic seizures, the new algorithm generated EIT conductivity changes which were consistent with the electrographic ictal activity. Incorporation of realistic geometry and conductivity into the reconstruction algorithm significantly improves the quality of EIT images and lends encouragement to the belief that EIT may provide a low-cost, portable functional neuroimaging system in the foreseeable future.

Adult↗

Pseudocyst of the auricle: a new method of treatment.

Pseudocyst of the auricle is a condition where spontaneous serous fluid collection is seen on the lateral surface of the pinna. The aetiology of this condition is not known. Several methods of treatment have been advocated in the past. We report 10 cases of unilateral pseudocyst who were treated with aspiration and pressure dressing by a plaster of Paris cast over the pinna for two weeks.

Casts, Surgical↗

Volumetry of simulated bone grafts in the edentulous maxilla by computed tomography: an experimental study.

OBJECTIVE: To determine the precision of CT for calculating the volume of bone grafts to the maxilla. METHODS: Plaster of Paris was used to simulate bone as onlay and inlay grafts to the maxillary alveolus and sinus in a dry skull. Two mm thick axial CT scans were obtained. The area of the graft on each slice was measured and volumes calculated according to the formula V(graft)=Sigma of areas x the thickness of each section. Scans were repeated with the skull at approximately +5 degrees and -5 degrees to the horizontal plane and the calculations repeated. The real volume was calculated by the displaced water technique. Precision was estimated as reliability coefficient. RESULTS: The reliability coefficients for the right and left inlay and the onlay grafts were 0.97, 0.6 and 0.96 respectively. CONCLUSION: Calculations of the volume of both inlay and onlay grafts to the maxilla from axial CT is precise.

Algorithms↗

Efficacy of external fixation following nasal manipulation under local anaesthesia.

Nasal fractures are one of the commonest reasons for patients being referred to ENT departments, but few studies have been published about the management of this condition. In particular, the efficacy of external splintage following manipulation has not been assessed. This was a prospective randomized study, which examined the results of manipulation under local anaesthetic and the benefit to be gained from external fixation with Plaster of Paris (POP) following this procedure. Accurate measurements of the degree of deviation of the nose pre- and post-manipulation were obtained using a camera mounted on a specially designed frame. Thirty-three out of 241 consecutive patients seen at a research clinic over the course of 12 months were included in the study. The mean deviation of the nasal bridge at presentation was 4.12 mm. Manipulation under local anaesthetic significantly improved the degree of deviation (mean 2.47 mm, P = 0.0011, 90% CI, 1-2 mm). Randomization of the patients, following manipulation, into POP/none-POP groups showed that external splintage of the nose appeared to be of little practical benefit.

Anesthesia, Local↗

Sealing ability of composite resin placed over calcium hydroxide and calcium sulphate plugs in the repair of furcation perforations in mandibular molars: a study in vitro.

The purpose of this study was to evaluate in vitro the sealing ability of various materials in the repair of furcation perforations in mandibular molars by measuring coronal microleakage with Indian ink. Ninety extracted mandibular molars were embedded individually into a plaster of Paris block, with the roots surrounded by a simulated periodontal ligament of silicone. Subsequently, a standard coronal access opening was prepared, the root canal orifices were located and a perforation was made with a size 012 round bur in a water-cooled high-speed handpiece directly into the centre of the floor of the pulp chamber. The perforations were repaired with amalgam, composite resin, calcium sulphate under composite resin and calcium hydroxide under composite resin. The teeth were coated with two layers of nail polish, leaving the access opening area uncovered, and immersed in Indian ink for 4 days at 37 degrees C. The teeth were sectioned longitudinally and dye penetration measured from the coronal level of the repair material to the apical end of the perforation. All experimental groups revealed dye penetration in varying degrees, but there was no significant difference amongst them (Kruskal-Wallis test P < 0.05). Calcium sulphate and calcium hydroxide prevented overextrusion of composite resin when used under this repair material.

Analysis of Variance↗

Evaluation of healing with use of an internal matrix to repair furcation perforations.

AIM: The purpose of this study was to evaluate healing responses following repair of furcation perforations, with and without an internal matrix. Two matrix materials, HAPSET (65% non-resorbable hydroxyapatite and 35% plaster of paris) and hydroxyapatite were compared. METHODOLOGY: Four adult female baboons (Papio anubis) served as experimental models. Furcation perforations were made in the molar and premolar teeth, which were then randomly assigned to one of the five groups, according to the method of perforation repair: 1 Experimental group 1 (16 teeth): The matrix material was HAPSET and the sealing material, amalgam. 2 Experimental group 2 (16 teeth): The matrix material was hydroxyapatite and the sealing material, amalgam. 3 Experimental group 3 (16 teeth): No matrix was placed. The sealing material was amalgam. 4 Positive control group (16 teeth): The perforation was not sealed. 5 Negative control group (16 teeth): No perforation was made. The animals were sacrificed at 1 week and 1, 3 and 7 months. Specimens were prepared for examination with light microscopy. RESULTS: The data revealed that when amalgam was used alone without a matrix, there was marked extrusion of the material into the underlying bone with an associated severe inflammatory response, which continued throughout the observational period. When an internal matrix was used, there was an initial acute inflammatory response that diminished with time such that at 7 months, 75% of these specimens were free of inflammation. There was no difference in the tissue response to the different matrix materials. HAPSET and hydroxyapatite underwent connective tissue encapsulation in the early stages followed by new bone deposition in direct contact with the materials. CONCLUSIONS: Within this animal model healing responses are better when an internal matrix, whether HAPSET or hydroxyapatite, is used in the repair of furcation perforations.

Alveolar Process↗

The advantages and disadvantages of Bier's blocks and haematoma blocks for Colles' fractures in A&E.

In the author's current area of practice the use of either the Bier's block or haematoma block for manipulating distal radial fractures seems to have been based mostly on the A&E consultant's preference. The purpose of this literature review was to determine if there was sufficient evidence on the advantages and disadvantages of each method of regional anaesthesia to advocate the general use of one and the exclusion of the other. When reviewing the literature the author specifically looked in to three key areas to answer this question: 1) the patient's perception of pain experienced during and after the manipulation; 2) patient safety i.e. the documented risks of the anaesthetic type used; and 3) the success of the manipulation as determined by repeat radiographs immediately after the application of a plaster of Paris cast.

Anesthesia, Local↗

Management of the radial composite donor site: an orthopaedic opinion.

Maxillofacial and plastic surgeons have reported on the management of radial composite flap donor sites, but little reference is made to orthopaedic advice. Orthopaedic surgeons manage forearm injuries more often than other specialties and we thought that an orthopaedic consensus was long overdue. The composite radial donor site subsequently fractures in up to 43% of cases. There is no agreement on the optimal management of these difficult injuries and the patient is often referred for orthopaedic advice. Options include plaster-cast immobilization, internal fixation with either a plate or intramedullary nail, and external fixation. Bone grafting may also be required. A postal questionnaire, using two case histories including radiographs, was sent to 100 consultant orthopaedic surgeons in the UK asking how they would manage the donor site primarily and how they would manage a fracture at this site. Fifty-nine adequate replies were received. Generally, six weeks of immobilization in a plaster of Paris (POP) cast was considered sufficient for the initial management of the donor site. In the event of a fracture, internal fixation with a dynamic compression plate with or without a cancellous bone graft was the most common choice.

Bone Transplantation↗

Splinting tips.

Both plaster of Paris and fiberglass can be used for temporary or definitive treatment of acute extremity fractures, sprains, and strains. Longitudinal slab splints are appropriate for immobilizing inflamed tendons or joints of the wrist, elbow, and knee. "Sugar-tong" splints work well for humerus, forearm, and ankle fractures or sprains.

Arm Injuries↗