Spontaneous spinal epidural haematomas with repeated remission and relapse

We present a case of spontaneous spinal epidural haematoma (SSEH) with a rare clinical course of repeated spontaneous recovery and relapse. The patient suffered three episodes of upper-back pain of sudden onset followed by sensory and motor dysfunction after weight lifting. In the first two episodes, the neurological deficits recovered spontaneously and completely. In the last episode, paraplegia persisted even after emergency surgery. Serial studies with computed tomographic (CT) myelography and magnetic resonance imaging (MRI) demonstrated the remitting and relapsing course of the SSEHs. The possible causes of the SSEHs and the mechanisms of spontaneous recovery are discussed.

Klebsiella meningitis in Taiwan: an overview

Klebsiella infection has been considered to be an uncommon cause of meningitis. To determine its incidence and clinical features, we reviewed the microbiologic records of cerebrospinal fluid (CSF) and blood cultures and the medical records of patients with bacterial meningitis admitted between 1981 and 1995. Klebsiella meningitis was diagnosed in 79 patients with 83 episodes. All patients had klebsiella isolated from CSF and/or blood and typical symptoms and signs of acute bacterial meningitis. Of these, 74 were over 16 years of age and 2 of the 5 children were infants. There was an increased prevalence rate of klebsiella meningitis after 1986. Of the 83 episodes, only 9 occurred between 1981 and 1986, accounting for 7.8% of 115 cases with CSF and/or blood culture-proven acute bacterial meningitis, whereas in 1987-95, there were 74 episodes accounting for 17.7% of 419 bacteriologically proven cases. K. pneumoniae accounted for 69 episodes, K. oxytoca, 11 episodes and K. ozaenae, 3 episodes. Male gender, diabetes mellitus and liver cirrhosis were commonly associated with K. pneumoniae meningitis. Neurosurgical procedures were frequently associated with K. oxytoca meningitis. All three patients with K. ozaenae meningitis had a primary disease of the nasopharyngeal pathway. The mortality rate due to K. pneumoniae was 48.5%, K. oxytoca, 10% and K. ozaenae, 0%. In patients with K. pneumoniae meningitis, poor prognostic factors included age over 60 years, diabetes mellitus, bacteremia and severe neurological deficits on the first day of treatment.

Severe rhabdomyolysis with good recovery in a patient with head injury: case report

OBJECTIVE AND IMPORTANCE

We report a case of head injury, in which a hyperosmolar state evolved during the course of treatment, complicated by severe rhabdomyolysis and acute renal failure, which subsequently resulted in a good recovery after intensive supportive treatment. To our knowledge, such high levels of creatine kinase in a patient with head injury and rhabdomyolysis have not been reported.

CLINICAL PRESENTATION AND INTERVENTION

A 19-year-old male patient with head injury sustained a compound fracture of the frontal region. He received a hyperosmolar agent to treat brain edema and developed a hyperosmolar state and diabetes insipidus 1 day after the accident. There were no obvious associated injuries at physical examination. After admission to the intensive care unit, the patient developed myoglobinuria and rhabdomyolysis; serum creatine kinase was elevated to a peak of 650,000 IU/L. Four days later, acute renal failure was noted. The patient's myoglobinuria and rhabdomyolysis gradually declined, and he eventually recovered from acute renal failure after supportive treatment and dialysis.

CONCLUSION

We postulate that the hyperosmolar state of the patient was the major cause of his severe rhabdomyolysis. Associated hypokalemia and hypophosphatemia are also predisposed to rhabdomyolysis. The most serious complication in rhabdomyolysis is acute renal failure, but most patients who receive supportive treatment and can survive despite the complications can expect to have normal renal function restored.

Endothelium-dependent higenamine-induced aortic relaxation in isolated rat aorta

The pharmacological action of higenamine in isolated rat aorta was investigated. Although the beta-adrenoceptor antagonist propranolol (1 x 10(-5) M) completely blocked the beta-adrenoceptor agonist higenamine in inducing a positive chronotropic activity in isolated mouse atria, the higenamine-induced aortic relaxation was not completely antagonized by this concentration of propranolol. The present data also demonstrate that the higenamine-induced aortic relaxation was attenuated in the absence of endothelium. These findings suggest that the beta-adrenoceptor specificity to higenamine in aorta is different from that of beta-1 in atria; moreover, the beta-adrenoceptors sensitive to higenamine are mainly located in the endothelial layer.

Breast mass due to alveolar soft part sarcoma of the pectoris major muscle

We present a case of alveolar soft part sarcoma (ASPS) of the pectoris major muscle in a 20-year-old female. She felt a mass in her right side breast for 7 years. The lesion was almost the same size with occasional throbbing pain and tenderness. Fine needle aspiration of the tumor was performed in the OPD and suspicious abnormal cells were reported. Ultrasound (US) examination of the breast revealed a large heterogeneously hypoechoic lesion contiguous to the pectoris major muscle. Profound color flow signals were evident in both central and peripheral regions of the mass. Spectral Doppler US showed high flow velocity in the tumor vessels with resistivity index of 0.73. Surgical intervention was performed and the histological examination yielded a diagnosis of ASPS.

A dynamic K-winners-take-all neural network

In this paper, a dynamic K-winners-take-all (KWTA) neural network, which can quickly identify the K-winning neurons whose activations are larger than the remaining ones, is proposed and analyzed. For N competitors, the proposed KWTA network is composed of N feedforward hardlimit neurons and three feedback neurons, which are used to determine the dynamic threshold. From theoretical analysis and simulation results, we found that the convergence of the proposed KWTA network, which requires Log(2)(N+1) iterations in average to complete a KWTA process, is independent of K, the number of the desired winners, and faster than that of the existing KWTA networks.

Pharmacokinetics of higenamine in rabbits

The pharmacokinetics of higenamine were investigated in rabbits by IV bolus, PO route, and IV infusion. Plasma higenamine concentration declined rapidly in a biexponential pattern, with a terminal half-life of 22 min. The AUC increased proportionally with increasing dose, whereas the percentage of unchanged higenamine excreted from urine remained constant when dose was increased. The means of total body clearance, mean residence time, volume of distribution at steady state, and fraction of urinary excretion were 127.7 mL min-1 kg-1, 9.28 min, 1.44 kg-1, and 5.48%, respectively. The mean percentage of protein binding of higenamine in plasma was 54.8% at steady state after IV infusion. The results from post-infusion also confirmed that higenamine followed a two-compartment open model in animals. After oral administration, higenamine was rapidly absorbed to reach peak concentration within 10 min. Interestingly, the plasma concentration-time profiles revealed two distinguishable groups with different Cmax, extent of absorption, and urinary excretion. The average absolute bioavailabilities of higenamine calculated by AUCs and accumulated urinary excretion were 21.86 and 2.84% versus 20.19 and 5.50% for the two groups, respectively. Upon hydrolysis of urine samples with beta-glucuronidase, urinary concentrations of higenamine were greatly enhanced in both groups.

Idiopathic hypereosinophilic syndrome with eosinophilic myositis, peripheral neuropathy and central nervous system involvement

Idiopathic hypereosinophilic syndrome (HES) is a rare disorder marked by a sustained overproduction of eosinophils and a predilection for damage to multiple organ systems. Its neurologic involvement ranges from the central to the peripheral nervous system, and can be associated with eosinophilic myositis. We report a 68-year-old woman who had eosinophilia, eosinophilic dermatitis and eosinophilic pneumonia. She also suffered from numbness and weakness of the lower limbs. Because of long-lasting (> 6 mo) eosinophilia (> 1.5 x 10(9)/L) in the peripheral blood and the fact that no other underlying causes of eosinophilia and neurologic involvement could be identified, a diagnosis of idiopathic hypereosinophilic syndrome was made. The muscle biopsy showed infiltration of inflammatory cells, including a few eosinophils (Liu's stain). Magnetic resonance images, motor evoked potentials, somatosensory evoked potentials and nerve conduction velocities also showed abnormalities in the central and peripheral nervous systems. The pathogenesis and treatments of HES are discussed in this report.

Determination of Z-butylidenephthalide in plasma by high-performance liquid chromatography

An HPLC assay is described for the determination of Z-butylidenephthalide (Z-Bdph) in plasma. Plasma samples were cleaned up by extraction with 2% chloroform in n-hexane. Z-Bdph was separated on a normal-phase silica column with a mobile phase of chloroform-n-hexane (1:1). The limit of quantitation with UV detection at 254 nm for Z-Bdph in plasma was 0.01 microgram/ml. The recovery of Z-Bdph by organic solvent extraction of plasma was 99.5%. The intra-day and inter-day coefficients of variation and relative errors for Z-Bdph determination in plasma were both less than 10%. The present method was applied to pharmacokinetic studies of Z-Bdph in plasma after intravenous administration to rabbits.

Vocal cord paralysis as an initial sign of multiple system atrophy in the central nervous system

Multiple system atrophy (MSA) of the central nervous system has been recognized as a rare cause of stridor secondary to vocal cord paralysis. This respiratory problem usually occurs in the later stages of the disease. We report the case of a 53-year-old man who presented with bilateral vocal cord paralysis accompanied by stridor and sleep apnea, which were relieved by a tracheostomy. Two years after the onset of stridor, he developed extrapyramidal and cerebellar signs combined with severe autonomic failure. Magnetic resonance imaging of the brain revealed atrophy of the brainstem and cerebellum. This clinical picture is consistent with the diagnosis of MSA. Vocal cord paralysis preceding any other neurologic and autonomic manifestations has been infrequently described. This case should remind clinicians that MSA should be considered in the differential diagnosis of vocal cord palsy of undetermined origin.

I-mf, a novel myogenic repressor, interacts with members of the MyoD family

During embryogenesis, cells from the ventral and dorsal parts of the somites give rise to sclerotome and dermomyotome, respectively. Dermomyotome contains skeletal muscle precursors that are determined by the MyoD family of myogenic factors. We have isolated a novel myogenic repressor, I-mf (Inhibitor of MyoD family), which is highly expressed in the sclerotome. In contrast, MyoD family members are concentrated in the dermomyotome. We demonstrate that I-mf inhibits the transactivation activity of the MyoD family and represses myogenesis. I-mf associates with MyoD family members and retains them in the cytoplasm by masking their nuclear localization signals. I-mf can also interfere with the DNA binding activity of MyoD family members. We postulate that I-mf plays an important role in the patterning of the somite early in development.

Squamous cell carcinoma of the ampulla of Vater: a case report

A wide variety of neoplastic lesions may involve the ampulla of Vater, but squamous cell carcinoma has not been reported. Here we report a case of squamous cell carcinoma of papilla Vater. A 72-year-old Chinese female was manifested by obstructive jaundice and biliary tract infection. Duodenoscopic study revealed a polypoid mass with deep and broad ulcer on the ampulla of Vater. Histological examination revealed a metastatic squamous cell carcinoma. The gynecologist had examined the patient carefully and revealed a negative tumor survey. Other sources were also intensively studied but which revealed nothing. The patient developed biliary tree infection after endoscopic retrograde cholangiopancreatic study so that percutaneous transhepatic cholangiography & drainage was performed. Pseudomonas aeruginosa and Enterococcus were cultured from the drainaged bile. Radiotherapy was used and the bleeding was halted temporarily but the patient later expired due to persistent bleeding.

Child malnutrition in China--present status and changing trend

Halving the malnutrition of under five of years has been set as one of the goals to be achieved by the year of 2000 by Chinese government. So it is important to know the present status of child malnutrition and its trend of changing, in order to predict the possible outcome of the achievement of the goal. According to the Child Survey carried out by the State Statistic Bureau (SSB) in 26 provinces and autonomous regions and 3 municipalities in 1992, the prevalence of malnutrition of under five was: moderate and severe underweight, stunting and wasting were 17.9%, 34.7% and 4.7% respectively. But there are significant differences among urban and rural children and between different provinces. The highest prevalence rate usually occurred in the second year of life of the children, and this may be the result of inadequate weaning food provided to the children. As compared with the data collected in 1987 by SSB in 9 provinces and autonomous regions, an impressive improvement in underweight has occurred within these 5 years. The average declined prevalence was 20.5%. It is specially true for urban children. To stunting, there was also improvement for urban children but not in the rural, resulting and over all increasing of prevalence by 5.9%. To wasting, the prevalence for urban children was low and remained at the same level while there was some what increase in the rural. So, according to these results, with constant economic development and more attempt made in areas and groups at risk, the goal to decrease malnutrition in half in terms of underweight could be reached by the year of 2000.

Nutrition status of the Chinese people

Based on the available data collected with national nutritional survey, nutrition surveillance and the child surveys since 1987, analysis on food consumption, dietary pattern and nutrition status of the Chinese people has been done. The data sets used for the analysis are as follows. (1) 1987 Child Survey in 9 Provinces-91,011 preschool children were sampled. (2) 1992 National Child Survey-570,704 children under the age of 15 were sampled, with anthropometric measurement of 185,965 children under the age of 5. (3) 1990 Nutrition Surveillance-State Statistic Bureau (SSB) household survey in selected 7 provinces (including Beijing Municipality) with 8629 household samples in the urban and 11,840 households in the rural covered 5341 children under the age of 6, among which 1487 were in the urban and 3854 in the rural. (4) 1992 Third National Nutritional Survey-All the provinces and municipalities were covered with 25,033 household samples, among which 8474 were in the urban and 16,559 in the rural. 99,749 residents were surveyed, among which 30,723 were in the urban and 69,026 in the rural. Dietary survey data is used for comparison on food consumption and nutrient intake with 1990 nutrition surveillance data.

Ender nail in unstable closed tibial fractures

BACKGROUND

This retrospective study aims to evaluate the effect of Ender nail in management of unstable closed tibial fractures.

METHODS

From January 1985 to May 1992, 99 cases of unstable closed tibial shaft fractures (with fibular fractures) were collected for retrospective study. All the 99 tibiae were fixed with Ender nails. The mean follow up period was 80 (26-115 months).

RESULTS

The clinical results were evaluated with special charts. The average blood loss was 126 ml. Operation time was 45 minutes. Hospital day was 10.2 days. Union time was 16.8 weeks for Winquist-Hansen (WH) type I-II fractures and 20.5 weeks for VVH type III-V fractures. Student t test revealed statistically significant differences between the clinical results of WH type I-II cases and those of WH type III-V cases. The postoperative complications included superficial infection in 1 case (1%), nail protrusion in 13 (13%), malunion in 10 (10%), aseptic nonunion in 2 (2%) and infected nonunion in 1 (1%) (overall 18% in the 99 cases).

CONCLUSIONS

Ender nail is no doubt effective in treatment of less comminuted unstable tibial shaft fractures, but should be used carefully for more comminuted unstable tibial shaft fractures.

Polychaetoid is required to restrict segregation of sensory organ precursors from proneural clusters in Drosophila

Reduction of wild-type activity of the polychaetoid (pyd) gene results in formation of extra mechanosensory bristles on the head and notum of adult Drosophila. Loss of pyd function results in decreased ability to restrict sensory organ precursor (SOP) formation to a single cell per proneural cluster. Although the initial proneural cluster pattern of achaete expression is not altered in pyd mutants, extra cells within proneural clusters express the high levels of achaete characteristic of SOPs. This observation suggests that pyd+ functions as a negative regulator of achaete-scute complex expression within the proneural cluster. Synergistic interactions between pyd and Notch, Delta and extramacrochaetae mutations support this model. We also demonstrate that pyd is required for normal eye development.

Pharmacological characteristics of BDTI, a new isoquinoline-derived beta 2-adrenoceptor agonist, in canine trachea and rat heart

The tracheal relaxing effects and beta 2-selectivity of BDTI (1-benzyl-6,7-dihydroxy-1,2,3,4-tetrahydroisoquinoline HBr) were investigated in canine trachea and rat heart by radioligand binding assay and pharmacological experiments in comparison with those of other beta-adrenoceptor agonists, salbutamol and isoprenaline. The potency of relaxing effect on carbachol-induced contraction in isolated canine trachea was in the order of isoprenaline (pD2 = 6.70 +/- 0.08) > BDTI (6.11 +/- 0.06) approximately salbutamol (6.14 +/- 0.08). ICI-118,551 (a selective beta 2-antagonist) and atenolol (a selective beta 1-antagonist) inhibited the relaxant action of BDTI with pKB values of 8.4 and 5.3, respectively, corresponding to high affinity for ICI-118,551 and low affinity for atenolol in antagonizing this response. The Kd values of radioligand ([3H]-CGP12177) were 453.3 +/- 30.8 and 563.4 +/- 96.7 pmol/l in cultured canine tracheal smooth muscle cells (TSMCs) and rat cardiomyocytes, respectively, and the Bmax values were 64.6 +/- 10.7 and 245.7 +/- 44.5 fmol/mg protein, respectively. BDTI, salbutamol and isoprenaline inhibited the binding of [3H]-CGP12177 in a concentration-dependent manner in cultured canine TSMCs (Ki 0.73 +/- 0.15, 0.75 +/- 0.21 and 0.24 +/- 0.05 mumol/l, respectively) and rat cardiomyocytes (Ki 2.76 +/- 0.36, 2.31 +/- 0.26 and 0.22 +/- 0.03 mumol/l, respectively). These results demonstrated that BDTI possessed moderate selectivity (3.8-fold) to beta 2-adrenoceptors as judged from the Ki (heart)/Ki (trachea) value (salbutamol 3.1-fold, isoprenaline 0.92-fold). BDTI and salbutamol also stimulated cAMP formation in a concentration-dependent manner in cultured canine TSMCs (EC50 0.5 +/- 0.2 and 0.4 +/- 0.1 mumol/l, respectively) and rat cardiomyocytes (EC50 6.2 +/- 0.5 and 5.7 +/- 0.6 mumol/l, respectively). The selectivity of BDTI and salbutamol for beta 2-adrenoceptors on the cAMP response were 12.4 and 14.3 times, respectively. It is concluded that BDTI is a beta 2-selective adrenoceptor agonist.

(+/-)-Govadine and (+/-)-THP, two tetrahydroprotoberberine alkaloids, as selective alpha 1-adrenoceptor antagonists in vascular smooth muscle cells

(+/-)-Govadine and (+/-)-THP ((+/-)-2,3,10,11-tetrahydroxytetrahydroprotoberberine HBr) have been shown to inhibit noradrenaline-induced contraction of rat thoracic aortae. The pharmacological activity of the compounds was determined in thoracic aortae and cardiac tissue isolated from the rat and in trachea isolated from the guinea-pig to determine the selectivity of the compounds towards different types of receptor. (+/-)-Govadine and (+/-)-THP were found to be alpha 1-adrenoceptor blocking agents in rat thoracic aorta as revealed by their competitive antagonism of vasoconstriction induced by noradrenaline (pA2 = 6.57 +/- 0.07 and 5.93 +/- 0.06, respectively) or phenylephrine (pA2 = 6.74 +/- 0.08 and 6.06 +/- 0.10, respectively). Removal of endothelium did not affect the antagonistic potencies of (+/-)-govadine (pA2 = 6.83 +/- 0.09) and (+/-)-THP (pA2 = 6.25 +/- 0.06) on phenylephrine-induced vasoconstriction. They were more potent than yohimbine (pA2 = 6.05 +/- 0.05), but less so than phentolamine (pA2 = 7.54 +/- 0.11) and prazosin (pA2 = 9.27 +/- 0.12). (+/-)-Govadine and (+/-)-THP, furthermore, inhibited [3H]inositol monophosphate formation caused by noradrenaline (3 microM) in rat thoracic aorta. (+/-)-Govadine and (+/-)-THP were also alpha 2-adrenoceptor blocking agents with pA2 values 5.50 +/- 0.13 and 5.41 +/- 0.11, respectively. A high concentration of (+/-)-govadine (30 microM) or (+/-)-THP (30 microM) did not, however, affect the contraction induced by the thromboxane receptor agonist U46619, prostaglandin F2 alpha (PGF2 alpha), 5-hydroxytryptamine (5-HT), angiotensin II, endothelin or high K+ in rat aorta denuded of endothelium. Neither the cyclic AMP nor cyclic GMP content of rat thoracic aorta was, furthermore, changed by (+/-)-govadine or (+/-)-THP. Contraction of guinea-pig trachea caused by carbachol, histamine, leukotriene C4 or neurokinin A was not affected by (+/-)-govadine or (+/-)-THP. (+/-)-Govadine or (+/-)-THP also did not block beta 1- or beta 2-adrenoceptor-mediated responses induced by isoprenaline in rat right atria and guinea-pig trachea. It is concluded that (+/-)-govadine and (+/-)-THP are selective alpha 1-adrenoceptor antagonists in vascular smooth muscle.

Unstable closed tibial shaft fractures: a prospective evaluation of surgical treatment

OBJECTIVE

To define the roles of the rigid interlocking nail and the semirigid Ender nail in the treatment of closed unstable tibia] shaft fractures.

DESIGN

Randomized, clinical, prospectively study with detailed comparison of parameters.

MATERIALS AND METHODS

Data on 116 unstable closed tibial shaft fractures were collected. Randomly, 60 tibiae were fixed with interlocking nails and 56 tibiae were fixed with Ender nails. The follow-up period was 24 (16-32) months.

MEASUREMENTS AND MAIN RESULTS

In the interlocking nail group, the average blood loss was 189 cc, operation time was 51 minutes, length of hospital stay was 7 days, and union time was 14.2 weeks. In the Ender nail group, the average blood loss was 95 cc, operation time was 30 minutes, length of hospital stay was 5.0 days, and union time was 16.9 weeks. Student's t test was used for statistical significance.

CONCLUSIONS

For more comminuted unstable tibial shaft fractures, an interlocking nail is undoubtedly a better choice, but an Ender nail still is effective in some aspects of treatment in the less comminuted unstable tibial shaft fractures.

Molecular analysis of cellular loci disrupted by papillomavirus 16 integration in cervical cancer: frequent viral integration in topologically destabilized and transcriptionally active chromosomal regions

To discern the structural features of cellular loci that are disrupted by type 16 human papillomavirus (HPV-16) integration in cervical cancer, a polymerase chain reaction (PCR)-based strategy was employed for direct amplification and sequence analysis of four such cellular loci in cancer biopsy samples. One of the HPV-16-disrupted loci was found to be the microtubule-associated protein (MAP-2) gene and the other three loci were uncharacterized and were designated PID-1 to -3 (for papillomavirus integration-disrupted). The junctional sequences of the viral integration sites in the four loci analyzed are bracketed by long tracts of homogeneous purine or pyrimidine or alternating purine-pyrimidine which are known to destabilize the B-form conformation of the DNA structure. Using a panel of human/hamster hybrid cell DNAs and PCR analysis, the four loci were assigned to chromosomes 2 (MAP-2), 9 (PID-1), 1 (PID-2) and 8 (PID-3), respectively. These chromosomes carry numerous other previously determined viral integration and chromosomal fragile sites and the myc oncogenes. The PID-1 locus was further found in Southern analysis to be rearranged and amplified in another cervical cancer biopsy and a cervical carcinoma cell line (CaSki). On Northern analysis, the PID-1 and -3 probes detected a 3.0- and a 3.6-kb transcript, respectively, in normal cervical cells and in cervical cancer cell lines. The findings suggest that HPV-16 genome integrates frequently into topologically destabilized and transcriptionally active chromosomal sites. It remains to be elucidated whether the MAP-2 and the PID loci contribute to the pathogenesis of cervical cancer.

Breast-conserving surgery and radiotherapy for early breast cancer

Breast conservation is not a commonly prescribed treatment option for breast cancer in Taiwan. We report 42 patients with 43 early-stage breast cancers who were treated with breast-conserving surgery and radiotherapy at the Koo Foundation Sun Yat-Sen Cancer Center from April 1990 to December 1994. Included in this study were 33 patients with stage I cancers and 10 with stage II. Breast-conserving surgery consisted of wide local excision and ipsilateral axillary lymph node dissection. Radiotherapy was given 2 to 6 weeks after surgery, with a dose of 46 to 50 Gy, 2 Gy per fraction per day, to the whole breast, and an additional 14 to 18 Gy to the original tumor site. Irradiation to the regional lymph nodes was not performed in patients with negative axillary lymph nodes. Sixteen out of 43 (37%) patients were treated with adjuvant chemotherapy. The local control rate 3 years after treatment was 97% and relapse-free survival was 91%. The cosmetic outcome in 41 treated breasts that were rendered relapse-free by conserving treatment were evaluated and graded by the physicians as excellent, good, fair or poor using a standardized scale. Forty breasts (98%) were scored as excellent or good for their cosmetic results. Breast-conserving surgery and radio-therapy offer Taiwanese women with early breast cancer excellent local control and a highly satisfactory cosmetic outcome.

Requirement for alpha-CaMKII in experience-dependent plasticity of the barrel cortex

The mammalian sensory neocortex exhibits experience-dependent plasticity such that neurons modify their response properties according to changes in sensory experience. The synaptic plasticity mechanism of long-term potentiation requiring calcium-calmodulin-dependent kinase type II (CaMKII) could underlie experience-dependent plasticity. Plasticity in adult mice can be induced by changes in the patterns of tactile input to the barrel cortex. This response is strongly depressed in adult mice that lack the gene encoding alpha-CaMKII, although adolescent animals are unaffected. Thus, alpha-CaMKII is necessary either for the induction or for the expression of plasticity in adult mice.

Treatment of open tibial fracture with Ender nail

BACKGROUND

This retrospective study aims to evaluate the effect of Ender nail in management of open type I and II unstable tibial fractures.

METHODS

From 1984 to 1993, 30 cases of open unstable tibial shaft fracture (with fibular fracture) were collected in the retrospective study. All were fixed with Ender nails. The followup period was 99 (24-135) months.

RESULTS

The average of blood loss was 140 cc, operation time 45 minutes, hospital day 10 days, and union time 20.5 weeks. Student t-test revealed statistically significant difference between open type I cases and type II cases in some parameters described above.

CONCLUSIONS

Ender nail is effective in the treatment of open type I and II unstable tibial shaft fractures, but it should be used carefully, especially in cases with more comminution.