Treatment of midclavicular nonunion: Comparison of dynamic compression plating and low-contact dynamic compression plating techniques

In this study a comparison of patients with midclovicular nonunion, treated by a combination of internal fixation with dynamic compression plate (DCP) or lowcontact DCP (LC-DCP) and application of autogenous corticocancellous chips or sculptured graft on nonunion areas, was performed. Time to union in the patients treated with LC-DCP fixation was shorter than in those treated with DCP fixation (P < .001). Union was obtained in oil patients treated with LC-DCP fixation and in 87.5% of those treated with DCP fixation. All of those treated with LC-DCP fixation returned to their original jobs, whereas two patients treated with DCP fixation had to change jobs. According to the Disabilities of the Arm, Shoulder, and Hand functional score, at the lost follow-up visit, functional outcomes of the patients treated with LC-DCP fixation were more satisfactory (P < .001). The addition of internal fixation of the clavicle with DCP or LC-DCP to application of autogenous corticocancellous chips, or sculptured graft on nonunion areas in patients with miciclavicular nonunion, shortens the time to union, increases union rates, and provides satisfactory functional outcomes

A rare complication of chlorine gas inhalation: pneumomediastinum

Chlorine gas is a potent pulmonary irritant that causes acute damage in both the upper and lower respiratory tract

Acute amitraz poisoning in adults: Clinical features, laboratory findings, and management

Background . Amitraz is a formamidine pesticide widely used in agriculture and veterinary medicine as an insecticide and acaricide. Reports on amitraz poisoning in humans are not as prevalent as those in animals. Of human intoxications in the medical literature, the majority of intoxications are in children. The number of adult intoxications with amitraz is limited. Methods . In this study, we discuss the clinical features, laboratory findings, and management of 23 adults with amitraz poisoning cared for in our center. Data were extracted from the charts retrospectively, and included age, gender, mode of poisoning, initial symptoms, time to appearance of initial symptoms, clinical and laboratory findings, management, and prognosis. Results . Fourteen of 23 patients were female (61%). Ages ranged from 16 and 78 years (mean 38.6 19.8 years). Twenty-one patients ingested amitraz orally while one was exposed through skin contact and one probably through skin contact and/or inhalation. Seven patients ingested amitraz with intent to commit suicide and 11 patients accidentally. Vomiting, altered consciousness, and drowsiness were the predominant initial symptoms. Initially, hypotension was present in seven patients (30%), bradycardia in two (8.7%), myosis in six (26%), and mydriasis (without atropine administration) in three (13%). Time to appearance of the initial symptoms ranged from 5 to 120 minutes. Laboratory findings included an initial blood glucose level higher than 120 mg/dL in 62% of patients (mean 191 70 mg/dL) and elevations in AST levels in four patients (81 28 U/L) and ALT levels in three (60 14 U/L). Ten patients had central nervous system depression, which resolved spontaneously. Five patients required mechanical ventilation for respiratory depression (mean duration of mechanical ventilatory support: 50 16 hours). Six patients were thought to have been poisoned with an organophosphate and three with a carbamate pesticide due to confusing clinical picture; four of these nine patients received pralidoxim. Conclusions . In spite of a rapidly progressing and life-threatening clinical picture, amitraz intoxication in humans carries a low morbidity and mortality when appropriate supportive treatment is given. No antidote has been developed for use in more serious cases. To prevent accidental ingestions, prominent and clear warning labels should be placed on its containers

Functional outcome of open reduction and internal fixation for completely unstable pelvic ring fractures (Type C) - A report of 40 cases

Objectives: To evaluate functional outcomes, morbidity and mortality rates, and psychological and psychosomatic status in patients treated for completely unstable pelvic injuries (Tile class C)

Role of oxygen free radical scavengers in acute renal failure complicating obstructive jaundice

Obstructive jaundice is associated with high morbidity and mortality. Major complications such as pulmonary dysfunction, renal failure and sepsis are frequently encountered. Recent studies and observations suggest that the free oxygen radicals (FORs) produced in obstructive jaundice may play a significant role in the etiopathogenesis of acute renal failure ARF). Thirty rats were divided into three groups, as sham, control and treatment groups containing 10 rats each. Laparatomy was performed on each animal in the control and treatment groups and common bile ducts were ligated. Common bile duct was observed but was not ligated for the rats in the sham group. Saline solution injection was begun on the first day of surgical procedure and repeated once a day during the following 5 days. The same procedure was performed with oxygen radical scavenger dimethyl sulfoxide (1.5 mg/kg/day i.p.) instead of saline in the treatment group. The rats were sacrificed on the 7th postoperative day. On the 7th postoperative day, the bilirubin, urea and creatinine levels of the control and treatment groups were significantly higher in comparison with the sham group (p 0.05), the urea and creatinine levels in the treatment group were significantly lower (p 0.05), renal and erythrocyte MDA levels of the treatment group were significantly lower than those of the control group (p 0.05). FORs seem to play a significant role in the etiopathogenesis of renal failure in obstructive jaundice. Antioxidant treatment may decrease oxidative damage due to FORs and may prevent renal failure. Copyright (C) 2003 S. Karger AG, Basel

Effect of interleukin-10 on pancreatic damage caused by organophosphate poisoning

Organophosphate poisoning is a common cause of severe morbidity and mortality in emergency departments. Acute pancreatitis is a frequently reported consequence of organophosphate poisoning, but preventing this potentially severe complication has not been the subject of much research. We tested whether interleukin-10, a cytoprotective agent, could prevent or diminish pathological signs of acute pancreatitis caused by organophosphate poisoning. Thirty rats were divided into three equal groups. Group 1 did not receive any agent during the experiment. Group 2 received 0.8 g/kg fenthion intraperitoneally, followed by 6 ml/kg intraperitoneal normal saline 30 min and 3 h later. Group 3 received 0.8 g/kg fenthion intraperitoneally, followed by 2 mu g/kg of interleukin-10 intraperitoneally 30 min and 3 h later. All rats underwent laparotomy and thoracotomy while still under anesthesia at 6 h, and tissue samples were obtained from the pancreas. After blood samples were taken by cardiac puncture, the animals were sacrificed. Organophosphate poisoning resulted in significant elevations of serum amylase and glucose. Interleukin-10 significantly reduced pancreatic damage as determined by pathologic scoring, but not by enzyme elevations. Interleukin-10 should be considered for larger studies in other animal models to confirm its ability to decrease pancreatic damage after organophosphate poisoning treatment with interleukin-10. (C) 2005 Elsevier Inc. All rights reserved