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At least 775 records · Page 43Linked to original sources
PubMed2007

Iontophoretic drug delivery across human nail.

Topical trans-nail delivery of antifungal drugs is limited by several physicochemical and physiological factors. Use of chemical permeation enhancers has been a common approach for enhancing trans-nail delivery of drugs. The potential of physical permeation enhancement techniques has been found to be higher than the potential of chemical permeation enhancers in transdermal delivery of hydrophilic drugs and macromolecular therapeutic agents. However, application of physical permeation enhancement techniques has not been explored for trans-nail drug delivery. In the current work, iontophoresis was applied across human nail in vitro to assess its efficiency in enhancing drug delivery. Salicylic acid (SA) was used as test diffusant. The influence of pH, ionic strength, and current density was studied. Obviously, increase in current density increased the trans-nail transport flux. It appears that about 50-100 mM ionic strength is required for optimal conduction of electric current across nail. The flux enhancement factor (iontophoretic flux/passive flux) also increased with increase in pH due to increased ionization of SA. This study demonstrates the efficacy of iontophoresis in enhancing the trans-nail delivery of drugs.

Administration, Topical↗
PubMed1984

[Automatic retroversion of the femur neck during fasciculated nailing of pertrochanteric fractures by the Ender method].

The shape of the standard Ender nail may result in malunion in external rotation in intertrochanteric fractures treated with this device. The nail is curved in one plane, and is usually introduced into the femur without making allowance for the bowing of the diaphysis and the anteversion present in the neck. We have measured radiographically the anteversion of the femoral neck in three groups of patients after operation using Ender nails, and also assessed the anteversion of the unoperated hip for comparison. In Group I normal Ender nails were used. The operated hip showed an average of 12 degrees of retroversion compared with the opposite side. In Group II the nails were bent anteriorly at their upper end, but an average retroversion of 14 degrees was produced compared with the other hip. In Group III the nails were bent to produce anterior bowing as well as proximal anteversion. The group showed retroversion of only 1 degree compared with the normal side. We therefore recommend that Ender nails be bent in this manner in order to reduce rotatory malunion when used for intertrochanteric fractures of the neck of the femur.

Aged↗
PubMed1992

Biomechanical analysis of the mechanism of interlocking nail failure.

From December 1986 to May 1989, 412 patients with 274 femoral and 144 tibial fractures were treated with Grosse-Kempf interlocking nails at our hospital. 324 cases (78.6%) were followed-up for at least 1 year (average 23 months). There were 13 breakages in the locking nails in femora and none in tibiae. The recorded incidence of breakage in the femur is therefore 4.7% (13/274). The mechanisms of locking nail failure are stress concentration around screw hole and nail slot, nicking of the nail during drilling of the screw holes, too close proximity of the screw hole to the fracture, and larger loading over the proximal femur. The incidence of failure is 4.9% in the upper third, 1.9% in the mid-third, and 8.2% in the distal third (P greater than 0.05, chi 2 test). The site most at risk is the first screw hole of the distal third, especially if it is near the fracture site. Prevention of failure involves using a nail of larger diameter and sufficient length, improving the surgical drilling technique, and allowing only protected weight bearing. Management of nail breakage by insertion of a new implant and supplementary cancellous bone grafting can gain satisfactory results.

Adolescent↗
PubMed1989

Quantitative trace element analysis of human nails with external beam PIXE.

External beam PIXE (Particle Induced X-ray Emission) analysis with a proton beam of 2.4 MeV was used to study trace element concentrations in human nails. The suitability of PIXE analysis regarding nail samples without any pretreatment besides washing was investigated. The main emphasis has been on the ability to obtain absolute concentration values and a new accurate method for nail sample standardization has been developed. Concentration values for the elements Ca, Cr, Mn, Fe, Ni, Cu, Zn, Se, Br, and Pb were determined from human nail samples. A comparison was made with nail samples taken from different fingers and toes to monitor intraindividual variation, and nails of different healthy individuals to get a view of the interindividual differences. The concentrations were also measured in relation to time in order to observe any possible short-term changes. The results are compared with the previous studies reported in the literature. The nail analysis is also compared to hair analysis in terms of detection limits, number of elements determinable, and standardization of the results.

Humans↗
PubMed2003

[Mechanical borderline indications in the treatment of unreamed tibial nailing].

The extended usage of unreamed tibial nailing resulted in reports of an increased rate of complications, especially for the distal portion of the tibia. The goal was to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bone in a fractured tibia, and to identify borderline indications due to biomechanical factors. In finite element analyses of a human tibia, horizontal defects were modeled using unreamed nailing for five different fracture locations, including proximal and distal borderline indications for this treatment method. The findings of this study show that with all muscle and joint contact forces included, nailing leads to considerable unloading of the interlocked bone segments. Unreamed nailing of the distal defect results in an extremely low axial and high shear strain between the fragments. Apart from biological reasons, clinical problems reported for distal fractures may be due to the less favorable mechanical conditions in unreamed nailing. From a biomechanical perspective, the treatment of distal tibial shaft fractures with unreamed nailing without additional fragment contact or without stabilizing the fibula should be carefully reconsidered.

Biomechanical Phenomena↗
PubMed2007

[The AO/ASIF Flexnail : A flexible intramedullary nail for the treatment of humeral shaft fractures].

BACKGROUND: The use of conventional implants for intramedullary nailing of humeral shaft fractures is associated with specific difficulties. During antegrade implantation structures of the rotator cuff can be affected leading to a reduced functional result of the shoulder. If the nail is implanted in a retrograde manner problems arise due to a relatively large hole close to or within the olecranon fossa, which is necessary for insertion of the nail. Supracondylar fractures as well as persistent elbow pain and loss of function are reported in the literature. To overcome these disadvantages a flexible nail has been developed that can be stiffened and locked after implantation. METHOD: Between October 2000 and February 2002, 34 patients were treated with the flexible nail at our institution; 29 were available for follow-up. Fracture healing was documented on radiographs and clinical outcome was evaluated with use of the Constant as well as the Kwasny score. RESULTS: Median duration until fracture consolidation was 10 weeks. In two patients fracture union was not achieved within the follow-up period. The median outcome measured with the Constant score was 93 points and 2.5 with the Kwasny score. Both values correspond to a very good functional outcome. CONCLUSION: We conclude that the flexible humeral nail is an excellent treatment option for humeral shaft fractures. Damage to the rotator cuff and the distal humerus can be avoided due to its unique flexible construction, improving the functional outcome of intramedullary nailing for the treatment of humeral shaft fractures.

Adolescent↗
PubMed2003

Difficulties in removing ACE tibial intramedullary nail.

We experienced three cases of refracture and two cases of failure to remove the nail while trying to take out ACE tibial nails from healed tibial fractures. In order to determine the risk factors associated with difficulties in nail removal, these five patients were compared in the parameters of age, gender, duration of nail in situ, nail diameter, nail length, and level of fracture with 30 patients who had uneventful removal. Younger age of the patient was significantly associated with the difficulty in nail removal.

Adolescent↗
PubMed1998

Treatment of intertrochanteric fracture with the Gamma AP locking nail or by a compression hip screw--a randomised prospective trial.

The Gamma AP (Asia-Pacific) locking nail (GAPN) is a modification of the standard Gamma locking nail made especially for use in Oriental patients. We made a randomised prospective comparison of the compression hip screw (CHS) and the Gamma AP locking nail for the internal fixation of 60 intertrochanteric fractures of the hip in elderly patients by comparing perioperative details and analysing the radiographic and clinical results. The operation time for the GAPN group was shorter than for the CHS group and the intraoperative blood loss was lower. The Gamma AP nail enabled earlier mobilisation. We found no significant difference in the time to union and the length of sliding of the lag screw between the two groups. The decrease in the neck shaft angle in the Gamma nail group was significantly smaller than in the CHS patients. There were no significant mechanical complications, such as fracture of the femoral shaft or failure of fixation in the Gamma nail group. On the basis of our observations we conclude that the Gamma AP locking nail is more efficient than the CHS in the treatment of intertrochanteric fractures in geriatric patients.

Aged↗
PubMed2005

Tibial lengthening over an intramedullary nail.

BACKGROUND: Long-term application of an external fixator to treat leg-length discrepancy and short stature often causes complications, such as pin-tract infection or loss of range of motion at the knee or ankle (or both). Prolonged fixator use also interferes with the activities of daily living. To minimize such problems, we have combined intramedullary nailing with external fixation. Using this technique, the external fixator can be removed more quickly after completing the lengthening. METHODS: We combined intramedullary nailing with lengthening in 13 tibias (8 patients) and then compared these cases with 17 standard tibial lengthenings (16 patients) using an external fixator alone. In both groups we excluded patients who had a history of previous bone infection, open fracture, immature bone, soft tissue compromise, antineoplastic chemotherapy, or bone deformity of a severity that required gradual deformity correction. We also excluded cases with lengthening of less than 3 cm. RESULTS: The mean external fixation index differed significantly between the two groups, but the consolidation index did not. Mean operating time for lengthening combined with intramedullary nail placement was approximately 60 min longer than for standard lengthening without nail placement; intraoperative blood loss was not greater in the nailing group. Complications related to the external fixator were far fewer in the combined intramedullary nailing and lengthening group compared with the control group, and callus formation was satisfactory for both groups. CONCLUSIONS: A combination of intramedullary nailing and external fixation produces callus formation as good as that obtained by the standard Ilizarov method of lengthening. Furthermore, this combined procedure decreases the external fixation time and is associated with fewer complications.

Adolescent↗
PubMed2004

Nail psoriasis: combined therapy with systemic cyclosporin and topical calcipotriol.

BACKGROUND: Nail psoriasis is a common problem in psoriatic patients and often it is difficult to cure. Several treatments have been proposed in the last decade using new molecules like vitamin-D analog and/or immunosoppressive drugs both systemically and locally. OBJECTIVE: Our goal was to evaluate a combination of cyclosporin and topical calcipotriol cream versus cyclosporin alone in a matched group of patients treated with cyclosporin alone. METHOD: Fifty-four patients affected by severe psoriasis and nail involvement were selected and matched for severity of nail involvement, sex, age, and cyclosporin dosage. Group A included 21 patients treated with cyclosporin alone (3.5 mg/kg/day) for three months. Group B included 33 patients treated with the same cyclosporin dosage plus, for the same time, topical application of calcipotriol cream twice a day. Evaluation for clinical improvement was the personal feeling of the patient after three months, while clinical appearance of the lesions was evaluated by the same dermatologist using digital pictures and who was blind as to the treatment of the patient. A score ranging from + to +++ was used in order to evaluate the improvement, and data were statistically evaluated with the Wilcoxon test. RESULTS: Both cyclosporin alone and a combination of cyclosporin with topical calcipotriol twice a day were useful for treating nail psoriasis after three months of therapy although the combined therapy showed a better overall result in both mild and severe nail psoriasis. Improvement of the clinical appearance of the nail lesions was seen in about 79% of patients in group B (p < or = 0.0004) versus about 47% of patients in group A (p < or = 0.15). CONCLUSIONS: In patients with severe involvement of nail psoriasis we suggest the use of a combination of topical calcipotriol twice a day with systemic treatment such as cyclosporine.

Administration, Oral↗
PubMed2006

The half-and-half nail: a new sign of Crohn's disease? Report of four cases.

Systemic disease can produce changes in the nails. Perhaps the best known example of this is koilonychia as a sequale of iron deficiency anemia. "Half and half nail" is a type of pseudoleuconychia that can be caused by chronic renal disease, Kawasaki's disease, cirrhosis, and zinc deficiency. It has not been described in patients with Crohn's disease yet. Four male patients with Crohn's disease were observed. None of them had extraintestinal manifestations of Crohn's disease. The average duration of the disease was 5.25 (range, 1-10) years. The nail alterations were defined with a portion of the nail being as much as 15 to 40 percent of normal color distally, whereas the rest of the nail was white. The contrast between the two zones remains sharply demarcated even after constricting venous return. Histologic examination was not performed. Every patient had zinc deficiency but not hypalbuminaemia or sideropenia. After review of relevant literature (MEDLINE, PubMed, etc.), we found that half-and-half nail had not been described in Crohn's disease. This study was designed to highlight the fact that the half-and-half nail, which was thought to be a sign of chronic renal failure, also occurs in patients with Crohn's disease. The relationship of this symptom to clinical activity cannot yet be assessed and has only been observed in four cases.

Adult↗
PubMed1990

Yellow nail syndrome.

The yellow nail syndrome is characterized by yellow, slow-growing nails in association with lymphedema, idiopathic pleural effusions, chronic bronchiectasis, and chronic sinusitis. We report two patients with yellow nail syndrome in whom spontaneous clearing of the nail changes occurred without resolution of the respiratory involvement. This observation suggests that nail changes may not result from the systemic manifestations. We also report for the first time the histopathologic findings of the nail matrix and bed, which demonstrate dense, fibrous tissue replacing subungual stroma with numerous ectatic, endothelium-lined vessels that are similar to that in the pleura in yellow nail syndrome. We hypothesize that primary stromal sclerosis may lead to lymphatic obstruction, thus explaining the clinical manifestations.

Chronic Disease↗
PubMed1989

Bacterial carriage by artificial versus natural nails.

Although health care workers are following fashion trends when they wear artificial nails, the implications of these nails for infection control is unknown. Cultures were obtained before and after handwashing from the fingertips of 56 nurses with artificial nails and 56 nurses with natural nails. After handwashing there were higher numbers of colony-forming units of gram-negative rods cultured from the fingertips of nurses with artificial nails than from nurses with natural nails. There were no significant differences in carriage of gram-positive cocci or normal flora. Because of the number of nosocomial infections caused by gram-negative rods, health care workers who wear artificial nails should consider the potential risk of increased carriage of gram-negative rods.

Adult↗
PubMed1991

Treatment of subungual hematomas with nail trephination: a prospective study.

Subungual hematoma is a commonly encountered problem in the emergency department. We designed a prospective, observational study to determine if treatment of simple subungual hematomas (SUH) by nail trephination alone is without cosmetic or infectious complications. Over a 2-year study period, 48 patients met inclusion criteria. Radiographs of all digits were taken to detect distal phalangeal fracture and SUH size was measured. Nail trephination was performed using electrocautery, and all patients reported relief of pain after the procedure. Follow-up was achieved in 45 of 48 patients with a total of 47 SUH. Average follow-up period was 10.3 +/- 4.3 months. By patient history, average time for the nail to grow back was 4.0 +/- 2.6 months. No complications of infection, osteomyelitis, or major nail deformities occurred in any patients treated by nail trephination, regardless of SUH size or presence of fracture. In simple SUH, regardless of size, nail removal with suture repair of the nail bed, as suggested in previous studies, is unnecessary.

Adolescent↗
PubMed2006

Drug-induced nail diseases.

Although many nail disorders have been associated with drug intake, most reports are anecdotal. Most nail changes caused by drugs are the outcome of acute toxicity to the nail epithelia; nail symptoms depend on which nail structure is damaged. The most com-mon symptoms include Beau's lines/onychomadesis, melanonychia, onycholysis, and periungual pyogenic granulomas. Drug-induced nail abnormalities are usually transitory and disappear with drug withdrawal, but sometimes persist over time. This article reviews drugs that have been consistently associated with nail abnormalities.

Adrenergic beta-Antagonists↗
PubMed2005

Infection resistance of unreamed solid, hollow slotted and cannulated intramedullary nails: an in-vivo experimental comparison.

Infection continues to be a problematic complication of fracture treatment, particularly in severe open fractures. The implant design and material as well as implantation technique play an important role in the pathogenesis of local infection. The aim of our study was to determine if the local resistance to infection of a cannulated IM nail is less than that of a solid nail and more similar to that of a hollow nail. In 65 female White Zealand rabbits, the intramedullary cavity was inoculated with matching concentrations of Staphylococcus aureus, and one of the three nails was inserted. The solid nail had a greater than twofold higher resistance to infection (23%) compared to that of the other two nails (hollow, 65%; cannulated, 61%) which was statistically significant (p<0.02). No difference in infection resistance was detected between the hollow slotted and cannulated nail designs (p=1). Although these experimental results may be clinically considered, direct extrapolation to clinical infection rates is ill advised.

Animals↗
PubMed2006

Effect of nail polish on oxygen saturation determined by pulse oximetry in critically ill patients.

INTRODUCTION: Nail polish of different colours may alter accuracy and precision of pulse oximetry as previous data in healthy volunteers suggest. This trial evaluates the oxygen saturation determined by pulse oximetry and haematoximetry with nail polish of nine different colours applied. MATERIAL AND METHODS: Fifty critically ill and mechanically ventilated patients in an ICU were investigated in a prospective clinical-experimental trial. On nine finger nails polish of different colours was applied in a predetermined consecutive order. Functional oxygen saturation was determined by pulse oximetry (SpO2) on each finger for each colour with the finger sensor probe both in the normal position and at a 90 degrees rotation. Simultaneously oxygen saturation was determined by haematoximetry (SaO2). Accuracy (bias, DeltaS = SaO2-SpO2) and precision (standard deviation, S.D.) of pulse oximetry were analyzed with the t-test. A value of P < 0.05 was considered significant. RESULTS: While black (DeltaS = +1.6+/-3.0%), purple (DeltaS = +1.2+/-2.6%) and dark blue nail polish (DeltaS = +1.1+/-3.5%, each N = 50) had the greatest effect (P < 0.05), all other colours, including colourless nail polish, had a smaller effect (mean bias +0.2 to +0.9%). A rotation of 90 degrees reduced the bias from +2.8 to +1.3% (N = 10, n.s.). CONCLUSION: Nail polish does not alter pulse oximetry readings in mechanically ventilated patients to a clinically relevant extent. The mean error of measurement for all colours was within the manufacturers' specified range of +/-2%. A 90 degrees rotation of the sensor probe does not eliminate errors in measurement. To remove nail polish might be helpful to decrease the error of measurement in some cases.

Adult↗
PubMed2001

Tibial intramedullary nail distal interlocking screw placement: comparison of the free-hand versus distally-based targeting device techniques.

Intramedullary nailing is the standard treatment for closed and some open unstable diaphyseal tibia fractures. Fluoroscopy, while essential for proper nail placement can subject the surgical team and patient to substantial radiation. A new targeting system for tibia nail distal interlocking was developed by Orthofix to limit fluoroscopy. This prospective clinical study compares the Orthofix targeting system versus a free-hand technique for the tibial nail distal interlocking. Fifty eight consecutive patients with sixty tibial fractures amenable for nail fixation were randomly assigned into two equal groups: Group 1: Orthofix distally based distal targeting device and Group 2: a free-hand technique. In all the cases stabilization was achieved with a reamed statically locked tibial nail. Recorded data included accuracy of screw placement, duration of surgery prior to and during distal interlocking, and the fluoroscopy time prior to and during distal interlocking. Both groups revealed comparable fracture patterns. In all fractures the technical aspects of the surgical treatment were performed without complications. There was no statistically significant difference between the groups in the mean time of surgery prior to (62.02 vs. 61.01 min, P=0.92) and during distal interlocking (17.06 vs. 19.08 min, P=0.55), or in the total surgical time (81 vs. 85 min), respectively. Neither was there a statistically significant difference in the mean fluoroscopy time prior to distal interlocking (69 vs. 81 s, p=0.22) nor in the total fluoroscopy time (84 vs. 117 s). There was however, a statistically significant difference between the Orthofix and free-hand groups with regards to the mean fluoroscopy time during distal interlocking (15 vs. 36 s, P=0.01, respectively). This study demonstrates that the distally based distal targeting device by Orthofix for tibial nailing can significantly decrease the mean fluoroscopy time necessary to complete distal interlocking versus free-hand technique.

Adolescent↗