Results of the operative treatment in Madelung's deformity]

Nine wrists in eight patients were treated surgically between 1988 and 2003 for symptomatic Madelung's deformity. The pain of involved wrist followed by forearm deformation fulfilled criteria for surgery. Closing wedge osteotomy of the distal radius were carried out eight times accompanied by shortening of the ulna (four patients), excision of the distal ulna (one patient), and no ulnar surgery (three patients). Pain relieved after surgery. The follow up period ranged from 1 to 9.5 years. No pour results were stated in subjective patient's estimation during final check up. Wrist appearance were stated to be satisfactory. Limitation of the range of motion concerning supination and pronation of the forearm were stated invariably. X-ray retrospective assessment of the inclination angle, lunate coverage and presence of arthritic changes were conducted. Time and method of surgical treatment for Madelung's deformity should be considered individually.     

Experimental evaluation of three osteosynthesis devices used for stabilizing condylar fractures of the mandible.

INTRODUCTION: The purpose of the study is to evaluate experimentally the quality of the primary stability achieved in treating low subcondylar fractures by means of three different osteosynthesis devices. MATERIAL AND METHODS: The devices, a standard four-hole plate, an axial lag screw and a three-dimensional rectangular plate were tested on fresh isolated human mandibles. Testing was done on a test bench by reproducing static biting exercises between the first molars on the side of the fracture. The quality of the osteosynthesis was assessed by measuring the macroscopic amount of fragment displacement and on the device's ability to diffuse the mechanical strain within the fractured area by photoelastic stress analysis. RESULTS: The straight plates provided the worst restoration. This was explained by the unfavourable position of the plate along compression lines. The axial lag screws allowed average stability. This was due to the difficulty of intra-medullary positioning of the screw, and by the compression of the fracture line. Rectangular plates allowed good stability associated with rather good restitution of the strains. These good results were assigned to the shape of the plate, one of its arms approximating the tensile strain lines. CONCLUSION: Positioning and shape of the osteosynthesis device are of prime importance for condylar fracture stabilization. None of the three tested devices was optimal but the three-dimensional plate was the best. There is a need to develop the geometry of new plates.     

Prenatal diagnosis of an infratentorial subdural hemorrhage: case report.

We report a case of a prenatally diagnosed infratentorial subdural hemorrhage. The hematoma located in the posterior cerebral fossa was detected by conventional ultrasound at 24 weeks of gestation. Intrauterine magnetic resonance imaging confirmed the diagnosis. Autopsy of the fetus revealed a well-circumscribed subdural hematoma. The prenatal findings of intracranial bleeding located in the posterior fossa and the prognosis of such cases are discussed.     

Conventional MRA and contrast- enhanced MRA of extracranial vessel segments

Summary The introduction of fast gradient systems allows a reliable visualization of the extracranial carotid vessels by the magnetic resonance angiography (MRA) which meanwhile is implemented into clinical routine. By the mainly applied time-of-flight (TOF) technique, vessels can be imaged without contrast agent (CA). Due to the application of ultra-fast gradient-echo-sequences, the first-pass evaluation of an intravenous bolus-injection of Gadolinium in the carotids from the aortic arch up to the skull base can be performed in less than 30 s. In this study, advantages and disadvantages of both techniques are discussed. For a qualitatively optimal contrast enhanced MRA (CE-MRA) timing parameters like injection delay, flow rate and the adjustment of sequence parameters have to be considered in relation to the fast venous return from the sinus to the jugular veins. First, the optimal time point of the data acquisition have been determined at a model and with a computer simulation in reference to the presence of CA in the arteries. As a result, 90 % of the contrast contribution is defined by 16 % of the symmetrically acquired central k-space lines. A measuring protocol for clinical use was obtained by a gradual variation of spacial resolution, measuring time and CA-injection parameters and was proved in normal volunteers and patients. An exact determination of the bolus-arrival-time by means of a test-bolus injection was acquired. The best qualitative results were achieved by a double-dose injection at 2 ml/s injection rate. The temporal reserves of ultra-fast sequences should be invested in the improvement of the spatial resolution. To date, further investigations related to the problem of optimal CA-application may improve the potentials of CE-MRA procedures.      

Deep dermal burn injury results in scarless wound healing in the ovine fetus

Early to mid-term fetuses heal cutaneous incisional wounds without scars; however, fetal response to burn injury has not been ascertained. We present a fetal model of thermal injury and subsequent analysis of fetal and lamb response to burn injury. A reproducible deep dermal burn injury was created in the fetus by application of water at 66 degrees C for 7 seconds, and at 82 degrees C for 10 seconds to the lamb. Macroscopically, the area of fetal scald was undetectable from day 7 post injury, while all lamb scalds were readily identified and eventually healed with scarring. Using a five-point histopathology scoring system for alteration in tissue morphology, differences were detected between control and scalded skin at all stages in lamb postburn, but no difference was detected in the fetal model after day 7. There were also large differences in content of alpha-smooth muscle actin and transforming growth factor-beta1 between control and scalded lamb and these differences were statistically significant at day 14 (P < 0.01). This novel model of fetal and lamb response to deep dermal injury indicates that the fetus heals a deep burn injury in a scarless fashion. Further elucidation of this specific fetal process of burn injury repair may lead to improved outcome for patients with burn injury.     

Is bacterial osteomyelitis of the spine spondylitis or spondylodiscitis?

This is a retrospective study of 43 patients with pyogenic vertebral osteomyelitis. Results obtained with several diagnostic methods, including myelography and CT are described and the usefulness of the different methods is assessed. The frequency of occurrence of the pathogenic bacteria, the focal localization, and the interval between early symptoms and diagnosis are determined. Involvement of intervertebral disc and adjacent vertebrae indicates the development of spondylodiscitis. There are several reasons to characterize the vertebral osteomyelitis as spondylodiscitis too.