The accessory soleus muscle as a cause of persistent equinus in clubfeet treated by the Ponseti method : A report of 16 cases

Encountering an accessory soleus muscle in children undergoing surgical release for clubfeet is not a frequent occurrence and only a few reports could be traced in literature. The purpose of this study is to report a series of 20 observations in 16 patients with idiopathic clubfeet treated by the Ponseti technique where the accessory soleus muscle was responsible in preventing full ankle dorsiflexion after Achilles tendon tenotomy. Following its division, adequate dorsiflexion could be achieved. To our knowledge this is the largest series published to date on this topic. In addition, we discuss the frequency and epidemiology, as well as the anatomy of the accessory soleus muscle, its innervation and embryology. The mean age at presentation was 40.7 days (range : 6 to 210 days). The accessory soleus tendon was observed in 6 right and 6 left feet, 4 feet had bilateral involvement. The average ankle dorsiflexion after complete tendo Achilles tenotomy was 2.50 (SD: 638), and after sectioning of the accessory soleus tendon, it was 19.50 (SD: 559) (p < 0.001). Correction was obtained in all patients, after 3 to 10 casts. In conclusion, the recognition of an accessory soleus muscle, in patients with clubfeet, is important, and its release is necessary to fully correct the deformity. Failure to recognize this muscle may lead to persistent hindfoot deformity.

Pain and anxiety with burn dressing changes: patient self-report

Pain and anxiety are integral parts of burn dressing care. Descriptions of pain and anxiety from the patients' perspectives enhance our understanding of their experiences. This descriptive study measured relationships between self-reported pain and anxiety. Twenty-four patients who had an uncomplicated flame or scald wound reported scores immediately before, immediately after, and 1/2 hour after dressing changes. Results indicated that pain and anxiety increased until day 4. Pain correlated with anxiety. Self-report scores showed that pain and anxiety are perceived by patients in a similar manner. Self-report scores are of great value because they indicate the degree of relief achieved with medication. Through the descriptive study, we found that the pain score immediately after dressing changes was greater than 3 on all study days. This finding indicates a need to further examine the way pain is managed with dressing changes.

Toxicity of crude extracellular products of Aeromonas hydrophila in tilapia, Tilapia nilotica

Extracellular products (ECP) secreted from Aeromonas hydrophila with haemolytic and proteolytic activity were studied with respect to temperature and time of incubation as well as the lethal toxicity on tilapia, Tilapia nilotica. The highest production of the haemolysin product was achieved when Aer. hydrophila was grown at 35 degrees C for 30 h. Tilapia erythrocyte was found to be more susceptible than sheep erythrocyte for determining the haemolytic activity. The haemolytic activity against tilapia erythrocyte was completely inactivated after heating the ECP at 60 degrees C for 10 min or 55 degrees C for 15 min. The proteolytic activity was maximized when the bacterium was grown at 30 degrees C for 36 h. Complete inactivation of the protease enzyme was performed after heating the ECP at 80 degrees C for 10 min or 70 degrees C for 15 min. Aeromonas hydrophila was found to produce haemolytic and proteolytic exotoxin lethal to tilapia (LD50 2.1 x 10(4) cell/fish), as well as heat stable unknown virulent factors that were responsible for 20% mortality. The lethality of ECP was decreased by heating and completely inactivated by boiling at 100 degrees C for 10 min.

Biological and chemical evaluation of chick pea seed proteins as affected by germination, extraction and alpha-amylase treatment

The effects of germination, extraction (double extraction with 70% ethanol and water at isoelectric point) and alpha-amylase treatments of chick pea seed flours on crude protein, total carbohydrate, protein efficiency ratio (PER), biological value (BV), true digestibility (TD), net protein utilization (NPU), essential amino acid composition, in-vitro protein digestibility (IVPD) and actual amino acid indices (essential amino acid index or amino acid score) were evaluated. Crude protein content was increased (8-149%), while total carbohydrate was decreased (11-62%) by germination, extraction and alpha-amylase treatments. Alpha-amylase treatment was more efficient in reducing total carbohydrate and increasing the protein content than that of extraction treatment. The protein quality of chick pea flours as measured by PER, BV, TD, NPU, IVPD and corrected amino acid indices (actual amino acid indices x IVPD) was significantly improved by these treatments. The protein quality of germinated-alpha-amylase treatment was comparable with casein, while germinated-alpha-amylase treaded seeds appeared nutritionally superior to casein. The results indicate that the germinated-alpha-amylase and germinated-alpha-amylase-extracted treatments could be used successfully as a source of concentrated high quality protein for baby food production. The corrected amino acid indices gave better prediction of PER, BV, TD and NPU (r = 93 to 97) than actual amino acid indices (r = 45 to 71). PER was highly correlated with corrected amino acid score (r = 0.93). The PER could be predicted from the following simple regression equation: PER = -1.827 + 0.0561 x corrected amino acid score.

Hypermetabolic low triiodothyronine syndrome of burn injury

The free tetraiodothyronine index (FT4I) and free triiodothyronine index (FT3I) in burn patients represented the serum levels of free (dialyzable) T4 and free T3, respectively. FT4I and FT3I were lower with greater burn size and were lower in nonsurvivors than expected for the burn size. there was no compensatory elevation of basal or releasing hormone-stimulated thyrotrophin (TSH) concentrations. Reverse T3 was higher with greater burn size. T3 treatment restored FT3I but did not affect mortality or resting metabolic rate (MR) measured in survivors, compared with placebo therapy. Whereas the hypermetabolic response to burn injury appeared t be independent of thyroid hormones, MR was correlated positively with burn size and with elevated plasma norepinephrine and epinephrine concentrations for several weeks after injury. Lack of augmented TSH concentrations, absence of low plasma reverse T3, and presence of hypermetabolism suggest that the reduced plasma free T3 does not indicate functional hypothyroidism, but may represent an adaptation to the assumption of metabolic control by the sympathetic nervous system.