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[Experience with surgical treatment of ruptures of the symphysis pubis].

Ten patients with symphyseal rupture and dehiscence of more than 10 mm who underwent different surgical procedures were reexamined between 8 and 59 months after surgery. In case of treatment within 3 weeks after the accident (n = 7) banding with completely absorbable Polydioxanon (PDS) cord (n = 4), PDS cord and crossing K-wires (n = 1), PDS-banding and plate-fixation for concomitant pubic fractures (n = 1), and wire banding (n = 1) were performed. In case of delayed operation (9 till 12 weeks after the injury n = 3) autologous bone grafts from the iliac crest were placed into the symphyseal split after removal of fibrous tissue, and double plate fixation (n = 2) respectively plate fixation and wirebanding (n = 1) were performed. There were no intraoperative and only 2 minor postoperative complications. The follow up revealed good and satisfactory results in 9 patients, and failure in one case. These results are better than to be expected from conservative management of this kind of injury. Banding with cord is a noteworthy alternative to wire banding and plate fixation.

Adult↗

Effects of an acidic, lactate-based peritoneal dialysis solution and its euhydric, bicarbonate-based counterpart on neutrophilic intracellular pH.

An exposure of human neutrophils to an acidic (pH 5.2), lactate-based incubation mixture containing a conventional, acidic, lactate-based peritoneal dialysis solution (PDS) resulted in the development of a prompt and substantial intracellular acidosis. A comparable exposure to a euhydric, bicarbonate-based incubation mixture containing a euhydric, bicarbonate-based PDS did not bring about similar changes in intracellular pH. The absence of an intracellular acidosis in the instance of the euhydric, bicarbonate-based PDS may be the reason why this solution is more biocompatible than its acidic, lactate-based counterpart.

Bicarbonates↗

Suitability of biodegradable polydioxanone materials for the internal fixation of fractures.

A distal femoral osteotomy in 46 rabbits was fixed either with biodegradable polydioxanone (PDS) thread and pins (group A, 31 animals) or with metallic Kirschner wire and pins (group B, 15 animals). Postoperatively, the distal part of each femur was removed and evaluated, and bone sections were evaluated by histology and histomorphometry. Macroscopic studies showed complete PDS absorption in all cases 24 weeks postoperatively. The histologic studies revealed new bone surrounding the area of the implant 3 weeks postoperatively, and at 24 weeks postoperatively, there was thinning or disappearance of the new bone around the implant. On the basis of the present study, PDS thread and pins show promise for the fixation of osteotomies or fractures of cancellous metaphyses of small long bones, such as metacarpals and phalanges.

Animals↗

Labeling of cysteine 231 in acetylcholinesterase from Torpedo nobiliana by the active-site directed reagent, 1-bromo-2-[14C] pinacolone. Effects of 2,2'-dipyridyl disulfide and other sulfhydryl reagents.

Acetylcholinesterase (AcChE, EC 3.1.1.7) was isolated from the electric organ of T. nobiliana and treated with the active-site-directed alkylating agent 1-bromo-2-[14C]pinacolone ([14C]BrPin), or with BrPin, which acts initially as a competitive inhibitor, Ki = 0.18 mM, and then inactivates the enzyme, k2 = 1.8 x 10(-4) s-1. AcChE aliquots were digested with trypsin and fractionated by reversed phase high performance liquid chromatography. Inactivation caused a decrease in one absorption peak and an increase in another, identified as the peptide beginning at Ala-222 and extending to Arg-242. 5-Trimethylammonio-2-pentanone, a competitive inhibitor, isosteric with acetylcholine, retarded the inactivation and decreased the quantity of labeled peptide. On sequencing, the 14C label was found associated with Cys-231. This was confirmed by comparison with synthesized S-pinacolonylcysteine, by study of effects of blocking the sequencing by o-phthalaldehyde, and by inactivation by 2,2'-dipyridyl disulfide (2-PDS), a thiol-specific reagent that acts initially as a competitive inhibitor, Ki = 0.042 mM, and then inactivates the enzyme, k2 = 5.0 x 10(-4) s-1. This is retarded by 5-trimethylammonio-2-pentanone, and prior inactivation by 2-PDS prevents subsequent reaction of [14C]BrPin in the active site. BrPin inactivates AcChEs from Electrophorus electricus and from human erythrocyte, but 2-PDS does not. Neither reagent inactivates butyrylcholinesterases from human and horse serum.

2,2'-Dipyridyl↗

Perceptions associated with dentists' decisions to report hypothetical cases of child maltreatment.

The purpose of this study was to examine case-specific perceptions associated with dentists' decisions to report hypothetical cases suggestive of child maltreatment. Surveys were mailed to 500 general dentists (GDs) in Georgia and all 200 pediatric dentists (PDs) in Georgia and Florida. The GDs were chosen from a pool of 1500 by a stratified randomization scheme. Each survey contained two brief vignettes suggestive of, but not conclusive for, child neglect and abuse. Identical questions followed each vignette that were designed to assess five perceptions of the incident and whether the respondent would be likely to report the case. Responses were received from 185 GDs (37%) and 103 PDs (51.5%), for a total of 288 (41.1%). A majority of respondents considered each vignette to be serious, but only a minority believed that they were required to report the neglect (7.3%) and the abuse (33.7%) vignettes. The percentages of likely reporters of the neglect (n = 28) and abuse (N = 103) vignettes were 9.7 and 36%, respectively. No significant differences were noted in the response patterns of GDs and PDs. Decisions to report child maltreatment described in the vignettes were associated with perceptions of 1) the seriousness of the incident, 2) the incident being defined as neglect or abuse, and 3) a requirement to report. The possibility that a maltreatment report would have a negative impact on the child was associated with a decision not to report. The perception that a report would have a negative impact on the family was common among likely reporters and nonreporters.

Attitude of Health Personnel↗

The effect of amantadine on arousal and EEG patterns in Creutzfeldt-Jakob disease.

In recent years, Creutzfeldt-Jakob disease (CJD) has been supposed to be of viral origin, and amantadine hydrochloride has been suggested as therapy because of its proved antiviral action. We studied nine patients with CJD (confirmed at autopsy in seven). Four were treated with amantadine hydrochloride, in dosages ranging from 3.5 to 15 mg/kg/day for an average period of 32 days. The clinical evolution of their disease was compared with that in five patients receiving only supportive maintenance therapy. The length of survival from the onset of clinical care did not differ significantly between the two groups. Nevertheless, a transient improvement in wakefulness and mentation was observed in three patients treated with amantadine, and EEG changes were observed in two, consisting above all of a reduction in the slow-wave activity and the periodic discharges (PDs). Amantadine administered intravenously did not induce any short-term changes in the PDs or the cyclic alternating pattern.

Aged↗

Diagnosing personality disorder in depressed patients. A comparison of patient and informant interviews.

Personality disorder (PD) diagnosis were made in 66 depressed patients based on independent interviews of the patient and a close informant. The patients and informants markedly differed in their descriptions of the patients' normal personality. The kappa coefficient of agreement for the diagnosis of any PD was .13, and all kappa values for the individual PD diagnoses were below .35. Informants reported more pathologic conditions than the patients, such that PDs were diagnosed in 57.6% (38/66) of the patients, based on the informant interview, and in 36.4% (24/66), based on the patient interview. We also examined dimensional scores. In general, we found only modest correlations between the patient and informant dimensional scores and that the ratings based on the informant interviews were higher. These results varied by specific PD diagnoses. Consensus ratings, which were based on both sources of information, were sometimes more strongly associated with patient information and sometimes with informant information, and this, too, varied among the different PDs.

Adult↗

Detecting personality disorders in a nonclinical population. Application of a 2-stage procedure for case identification.

BACKGROUND: There is no epidemiology of personality disorders (PDs) comparable with that currently available for most other mental disorders. One reason for this is that an Axis II diagnosis usually requires considerable clinical sophistication and it is expensive to deploy clinicians rather than trained laypersons to examine large community samples. This study explores the feasibility of using a 2-stage method in which only subjects who were screened as positive for PD would be interviewed by clinicians. METHODS: University students were screened with a self-administered Axis II inventory and subsequently interviewed by clinicians with the use of the International Personality Disorder Examination. RESULTS: The screen detected all individuals who subsequently received a definite diagnosis on the interview, and a specificity rate of detection was 61%. The point-prevalence estimate for diagnosable PD in this nonclinical population was 11.01% (95% confidence interval, 7.57%-14.52%). CONCLUSION: If these results can be replicated in a more representative community sample, this 2-stage method might substantially reduce the number of persons who needed to be interviewed in a major epidemiological study of PDs, with little or no loss in diagnostic accuracy, while presumably lowering the cost of such an investigation.

Adolescent↗

Childhood depression and adult personality disorder: alternative pathways of continuity.

BACKGROUND: This study extends previous findings of the risks posed by childhood major depressive disorder and other psychopathological features for later personality disorder (PD) in a random sample of 551 youths. METHODS: Self-reports and mother reports were used to evaluate DSM-III-R (Axes I and II) psychiatric disorders at mean ages of 12.7, 15.2, and 21.1 years. Logistic regression was used to examine the independent effects of major depressive disorder in childhood or adolescence on 10 PDs in young adulthood. RESULTS: Odds of dependent, antisocial, passive-aggressive, and histrionic PDs increased by more than 13, 10, 7, and 3 times, respectively, given prior major depressive disorder. Those effects were independent of age, sex, disadvantaged socioeconomic status, a history of child maltreatment, nonintact family status, parental conflict, preexisting PD in adolescence, and other childhood or adolescent Axis I psychopathological features, including disruptive and anxiety disorders. In addition, odds of schizoid and narcissistic PD increased by almost 6 times and odds of antisocial PD increased by almost 5 times given a prior disruptive disorder, and odds of paranoid PD increased by 4 times given a prior anxiety disorder. CONCLUSION: Personality disorders may represent alternative pathways of continuity for major depressive disorder and other Axis I disorders across the child-adult transition.

Adolescent↗

The effect of new monofilament absorbable sutures on the healing of musculoaponeurotic incisions, gastrotomies, and colonic anastomoses.

The purpose of this study was to quantitate the effect of two new synthetic monofilament absorbable sutures, Maxon and PDS, on the healing of musculoaponeurotic incisions, gastrotomies, and colonic anastomoses. Wound healing was assessed by measuring the resistance of the closed wound to leak or burst with controlled infusion of fluid. Bursting strength measurements of these incisions were compared with those undertaken in age-weight matched controls without wounds to determine the rate of gain of wound strength. The bursting strength measurements of unwounded tissue was found to vary according to the age, weight, and specific tissue. As the animals gained weight over 42 days, the bursting strength of their colons and musculoaponeurotic tissues significantly increased. In general, the regain of prewounding bursting strength was inversely proportional to the bursting strength of the unwounded tissue. The bursting strength of abdominal musculoaponeurotic tissue was the highest, followed by the stomach and then the colon. The time intervals in which the wounded musculoaponeurotic tissues, gastrotomies, and colonic anastomoses regained the strength of the unwounded tissue was 42, 14, and 7 days, respectively. The performance of Maxon and PDS sutures in the musculoaponeurotic tissues, gastrotomies, and colonic anastomoses was similar.

Abdominal Muscles↗

Physeal response to absorbable polydioxanone bone pins in growing rabbits.

Absorbable fixation materials would seem especially useful for treating transphyseal fractures in growing children, but their degradation products may affect physeal growth. The histologic response of an open physis to placement of transphyseal, polydioxanone (PDS), bioabsorbable pins was studied in skeletally immature New Zealand White rabbits. A 1.3-mm PDS pin was inserted across the right femoral physis, and a 1.3-mm empty drill hole across the left femoral physis served as a control. The animals were sacrificed at 3, 6, 9, and 12 weeks postsurgery. Biplanar radiographs, bone length measurements, and histology sections of the physis and adjacent bone were made. Three independent observers graded the histologic response of the physis to the drilling and implant. There was no evidence of inflammation, foreign body reaction, or distortion of the growth plate during the entire growth period. This suggests bioabsorbable pins do not cause any appreciable inflammatory response or adverse effect on physeal function during active longitudinal growth of the bone.

Animals↗

The role of superoxide ions in the degradation of synthetic absorbable sutures.

The objective of this study was to examine the effect of superoxide ion-induced degradation on synthetic absorbable biomaterials. Synthetic absorbable sutures were used as the model compounds. Inflammatory cells, particularly leukocytes and macrophages, are able to produce highly reactive oxygen species, such as superoxide (. O(2)(-)), during inflammatory reactions to foreign materials. Superoxide ions may act as oxygen nucleophile agents to attack biomaterials. In this study, the changes in tensile breaking force, thermal properties, and the surface morphology of five commercial (2/0 in size) synthetic absorbable sutures (Dexon, Vicryl, PDS II, Maxon, and Monocryl) as a function of superoxide ion concentration at 25 degrees C for 24 h were studied. Among the five absorbable sutures and over the concentration range of this study, the monofilament Monocryl suture was the most sensitive toward superoxide ion-induced degradation, followed by Maxon, Vicryl, Dexon, and PDS II sutures. The amount of tensile breaking force loss over a 24 h period ranged from as low as 3% to as high as 80%, depending on the type of absorbable sutures, the reaction time, and the superoxide ion concentration. All five absorbable sutures showed significant reductions in both the T(m) and T(g). Unlike the surface morphological changes of absorbable sutures in conventional buffer solutions, the effect of superoxide ion-induced degradation on the surface morphologies of these five absorbable sutures was unique, particularly the moon-crater-shaped impressions of various sizes and depths found in Monocryl and Maxon sutures, which defied the anisotropic characteristics of fibers.

Absorption↗

Comorbidity of DSM-IV personality disorders in a nonclinical sample.

The issue of comorbidity within the Axis II personality disorders was explored using a large sample of university students who were administered the Coolidge Axis II Inventory (CATI). Comorbidity patterns with this normal sample were compared with recent clinical data reported by several other researchers. The results confirm the high degree of comorbidity within Axis II and the similarity in the comorbidity patterns with clinical and nonclinical samples. With the CATI, a 30.4% comorbidity rate was obtained for Histrionic and Narcissistic Personality disorders (Pd). The paranoid, passive-aggressive and borderline personality disorder traits were comorbid with several other Pds. For Cluster A, there was low comorbidity except for Paranoid Pd and Schizotypal Pd. With Cluster B, the co-occurrence was moderate to strong. A moderate amount of interrelationship was obtained for the Cluster C Pds. The DSM-IV clusters were also strongly interrelated. An additional finding was the similarity between self-report and structured interview methodology in obtained personality disorder comorbidity.

Adolescent↗

Clinical and histological findings in guided bone regeneration (GBR) around titanium dental implants with autogeneous bone chips using a new resorbable membrane.

The aim of this study was to test the value of a polydioxanon-membrane (PDS(R), Ethicon, Norderstedt, Germany) in combination with autogenous bone as a spacer for guided bone regeneration of denuded implant surfaces in comparison to simple augmentation. Altogether, in 8 Beagle dogs of 12 months, the three mandibular premolars were extracted on both sides and, after an uneventful healing of the extraction sockets in each mandibular site, two seize defined bone defects were produced. The defects were 7 mm long, had a vertical extension of 7 mm, and were 7 mm deep. These also included, therefore, the resection of the lingual cortical bone wall. In the center of all these 32 bone defects, Brânemark fixtures with a diameter of 3 mm and a length of 10 mm were implanted. Every implant was primarily stable due to the fixation in the native bone under the created defects. In each mandible site, one bone defect was filled with autologous bone resulting from the previous defect preparation. Half of the defects were covered with a PDS membrane, and the other half were covered only by the relocation of the mucoperiosteal flap. During the observation period of 90-180 days, continuous clinical and radiological controls were executed. Aside from the observed clinical healing problems in the test sites, such as exposure of the membranes and serious inflammatory reactions, the histological and radiological results of the control group regarding bone regeneration were superior to these of the test group, which were valid also for the subgroups with or without autologous bone fillings.

Animals↗

A factorial study of personal development of unmarried mothers, college, alcoholic, and schizophrenic populations.

Reported the results of a factor analytic study of the Personal Development Study (PDS). The PDS was administered for research purposes to four diagnostic groups, which included 89 institutionalized alcoholics, 336 unmarried mothers, 159 college students, and 388 chronic schizophrenics. A principal component factor analysis with Varimax rotation performed on the combined populations (N = 972) yielded five main factors labeled as projection, optimism-responsibility, reaction and symptom formation, repressive-compulsive, and intropunitiveness-guilt. Analysis of base rates of responding to the individual items revealed that the four populations ranged along a continuum, with the normals at one extreme and the institutionalized schizophrenics at the other extreme of greater pathological responding.

Adolescent↗

The factorial structure of personal development mechanisms in unmarried mothers, college, alcoholic, and schizophrenic populations.

The Personal Development Study (PDS) was administered to four diagnostic groups, which included 89 hospitalized alcoholics, 336 unmarried mothers, 159 college students, and 387 chronic institutionalized schizophrenics. The PDS data from the four groups were factor analyzed separately by Varimax rotation of principal component factors. Cluster analysis methods were used to compare the separate diagnostic group factors with the overall factors previously reported by Pishkin and Thorne (1977). Only a few close fits of the diagnostic group factors showed large differences in item composition, order of emergence of factors and size of loadings between groups. Because many items and factors could be interpreted in terms of several alternative theoretical systems, interpretations were based on the clinical meanings of items and clusters in terms of integration theory (Thorne, 1976).

Adolescent↗

Bad or Mad? Personality disorders and legal responsibility-the German situation.

Criminal offenders have a high rate of personality disorders (PDS), especially Antisocial Personality Disorders and psychopathy, but criminal acts are not necessarily the result of PD. Findings from psychiatric research suggest that the development of PD is influenced by genetic factors, that can result in deviant traits in temper, emotionality and cognitive style. There is general agreement that those peculiarities and vulnerabilities find their expression and structure only under a complex interplay of stimulating or impairing environmental influences. Do these genetic factors-or other factors-diminish a person's criminal responsibility? There is no difficulty in diagnosing PDs, but the challenging questions arise in forensic assessments of defendants for criminal responsibility who have a PD. This article discusses the German legal situation and special problems created by the term of "diminished" criminal responsibility. In contrast to the Anglo-American legal situation, the German criminal law obliges the court to order an indeterminate forensic - psychiatric confinement, in addition to punishment, if the offender had acted under diminished criminal responsibility and is now still considered to be dangerous. The convicted offender remains under the control of the criminal court during psychiatric hospitalization. The change from handling the personality disordered offender as a criminal to handling him as someone with a mental disorder creates a social option for extended state interventions, including indeterminate hospitalization.

Antisocial Personality Disorder↗

Migration of porcine endothelial and smooth muscle cells in response to platelet-associated factors.

A NeuroProbe multiwell microchemotaxis assembly has been used to study the migration of porcine aortic endothelial and smooth muscle cells in vitro in response to serum factors. Whole pig serum was found to be chemokinetic for endothelial cells but not smooth muscle cells. Chemokinetic activity was higher in platelet-enriched, plasma-derived serum (PDS) than in platelet-free PDS. The supernatant from washed, lysed pig platelets also showed chemokinetic activity both for endothelial and smooth muscle cells. Chromatography on Sephadex G-200 showed that the lysate contained a number of activities that act independently on the two cell types. The chemokinetic activity that we have detected appears to be distinct from the chemotactic effect of platelet-derived growth factor and platelet factor 4 on the basis of insensitivity to protamine sulfate and molecular size. The role of these platelet factors in pathological changes in vascular structure is currently under study.

Animals↗