Urine congophilia associated with preeclampsia does not persist 6-months postpartum

INTRODUCTION

Preeclampsia is a common hypertensive disorder of pregnancy. Several studies have demonstrated that protein aggregates, detected through urine congophilia, is associated with preeclampsia; however, it has yet to be investigated whether urine congophilia remains postpartum in these women. In this study, we aimed to augment prior studies and determine whether urine congophilia is present postpartum.

METHODS

Women were recruited from Lyell McEwin Hospital, South Australia. Urine samples were collected during pregnancy and 6-months postpartum from women with non-preeclampsia pregnancies (n = 48) and women with pregnancies complicated by preeclampsia (n = 42). A Congo Red Dot blot test, total protein and creatinine levels from urine, as well as serum Soluble fms-like tyrosine kinase 1 to placental growth factor ratio (sFlt-1:PlGF), were assessed and correlated.

RESULTS

Preeclamptic women exhibited increased urine congophilia (P < 0.01), sFlt-1:PlGF ratio (P < 0.0001) and total protein (P < 0.01) during pregnancy; with a positive correlation between urine congophilia and total protein across the entire cohort (P < 0.0001). Although urine congophilia was no longer detected 6-months postpartum in preeclamptic women, total protein remained elevated (P < 0.05). sFlt-1:PlGF ratio during pregnancy was positively correlated with congophilia across the cohort (P = 0.0007). Serum creatinine was also higher in preeclamptic women during pregnancy (P < 0.001).

DISCUSSION

These results support that urine congophilia is significantly elevated in pregnancies complicated with preeclampsia and show that it does not continue postpartum, although larger cohort studies are needed to determine its feasibility as a diagnostic marker.

P1778 Preeclampsia is associated with reduced myocardial work efficiency during pregnancy

Methods

We evaluated 41 pregnant women, aged between 18-40, at 28.4-40 (Mean 35) weeks of gestation and within one week of the diagnosis of PrE. 49 normotensive pregnant women (control) were matched for age and gestation. These patients were reassessed after six months postpartum. All patients underwent echocardiography for left ventricular indices and assessment with speckle tracking for global longitudinal strain (GLS%) and myocardial work indices - performed at both time points.

Result

PrE had a mean LV mass index (LVMi) of 14.53g.m2 higher than control (P value = 0.000) during pregnancy which normalised at six-months postpartum. There was a reduction in GLS between PrE and controls during pregnancy (p = 0.002) and this remained significant postpartum (p = 0.001). (Fig1) However, there was no change over time within each group. During pregnancy, peak global myocardial work efficiency (GWE%) in PrE was significantly lower than controls (p = 0.001) and no different six months postpartum (p = 0.169) (Fig2). In contrast, during pregnancy, myocardial work index (GWI mmHg) was significantly higher in PrE (p &lt; 000) compared to control, but not in postpartum (p = 0.165) There was a significant change over time of GWI in both groups (p &lt; 0.05) (Fig3).

Conclusion

During pregnancy and post-partum PrE patients show a reduction in GLS when compared to matched normotensive pregnant women. This finding is consistent with previous studies which suggests subclinical LV dysfunction in PrE. However, the GWI was significantly increased but reduced in efficiency (GWE). The GWI increase is likely a result of an increase in LV mass index. The hypertrophied LV allows the increase in work at the cost of a reduction in efficiency but normalises when the hypertrophy improves post-partum. Our study is the first to use myocardial work in PrE patients, which we believe provides a better assessment of cardiac adaptation post-partum and does not suggest long term subclinical LV dysfunction.

Abstract P1778 Figure.

Antibiotic management of acute pharyngitis in primary care

The Centre for Health Protection of the Department of Health has convened the Advisory Group on Antibiotic Stewardship Programme in Primary Care (the Advisory Group) to formulate guidance notes and strategies for optimising judicious use of antibiotics and enhancing the Antibiotic Stewardship Programme in Primary Care. Acute pharyngitis is one of the most common conditions among out-patients in primary care in Hong Kong. Practical recommendations on the diagnosis and antibiotic treatment of acute streptococcal pharyngitis are made by the Advisory Group based on the best available clinical evidence, local prevalence of pathogens and associated antibiotic susceptibility profiles, and common local practice.

Hazmat Emergency Preparedness in Hong Kong: What are the Dangerous Goods in Kowloon?

Introduction

Hazmat emergency preparedness is critical, especially as Hong Kong prepares for major international events, such as the 2008 Olympic Equestrian Games. No published medical study has described the identities and quantities of dangerous goods (DG) in the Kowloon area and listed what antidotes are needed for these DG. This study describes what hazardous materials are most common in Kowloon to prioritise emergency preparedness and training.

Materials & methods

Design A descriptive, cross-sectional study. Setting The Hong Kong Special Administrative Region, specifically Kowloon. Sample The Hong Kong Fire Services Department (HKFSD) Dangerous Goods Database (DGD). Interventions Descriptive statistical analyses with Stata 9.2. Chief outcome Identifying and quantifying dangerous goods in the HKFSD DGD.

Results

Most DG do not have antidotes. The most common DG with recognised antidotes are carbon monoxide, methylene chloride, fluorine, fluorides, fluoroboric acid, cyanides, nitriles, methanol, nitrobenzene, nitrites, and nitrates. The most common categories of DG are substances giving off inflammable vapours, compressed gases, and corrosive and poisonous substances.

Conclusions

Hazmat emergency preparedness and training should emphasize these most common categories of DG. Disaster planning should ensure adequate antidotes for DG with recognised antidotes, i.e., oxygen for carbon monoxide and methylene chloride; calcium gluconate or calcium chloride for fluorine, fluorides, and fluoroboric acid; hydroxocobalamin for cyanides and nitriles; ethanol for methanol; and methylene blue for methaemoglobinaemia produced by nitrobenzene, nitrites, and nitrates. Supportive care is essential for patients exposed to hazardous materials because most dangerous goods do not have antidotes.

A cross-sectional analysis of the relationships of FAM components and their effects on quality of life in Chinese patients with chronic musculoskeletal pain

Introduction

A body of evidence has accrued supporting the Fear-Avoidance Model (FAM) of chronic pain which postulated the mediating role of pain-related fear in the relationships between pain catastrophizing and pain anxiety in affecting pain-related outcomes. Yet, relatively little data points to the extent to which the FAM be extended to understand chronic pain in Chinese population and its impact on quality of life (QoL).

Objective

This study explored the relationships between FAM components and their effects on QoL in a Chinese sample.

Methods

A total of 401 Chinese patients with chronic musculoskeletal pain completed measures of three core FAM components (pain catastrophizing, pain-related fear, and pain anxiety) and QoL. Cross-sectional structural equation modeling (SEM) assessed the goodness of fit of the FAM for two QoL outcomes, Physical (Model 1) and Mental (Model 2). In both models, pain catastrophizing was hypothesized to underpin pain-related fear, thereby influencing pain anxiety and subsequently QoL outcomes.

Results

Results of SEM evidenced adequate data-model fit (CFI30.90) for the two models tested (Model 1: CFI = 0.93; Model 2: CFI = 0.94). Specifically, pain catastrophizing significantly predicted pain-related fear (Model 1: stdb = 0.90; Model 2: stdb = 0.91), which in turn significantly predicted pain anxiety (Model 1: stdb = 0.92; Model 2: stdb = 0.929) and QoL outcomes in a negative direction (Model 1: stdb = −0.391; Model 2: stdb = −0.651) (all P < 0.001) (Table 1, Fig. 1).

Conclusion

Our data substantiated the existing FAM literature and offered evidence for the cross-cultural validity of the FAM in the Chinese population with chronic pain.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The net suppression effect of pain catastrophic cognition on anxiety sensitivity

Introduction

The existing literature on chronic pain points to the effects anxiety sensitivity, pain hypervigilance, and pain catastrophizing on pain-related fear; however, the nature of the relationships remains unclear. The three dispositional factors may affect one another in the prediction of pain adjustment outcomes. The addition of one disposition may increase the association between another disposition and outcomes, a consequence known as suppressor effects in statistical terms.

Objective

This study examined the possible statistical suppressor effects of anxiety sensitivity, pain hypervigilance and pain catastrophizing in predicting pain-related fear and adjustment outcomes (disability and depression).

Methods

Chinese patients with chronic musculoskeletal pain (n = 401) completed a battery of assessments on pain intensity, depression, anxiety sensitivity, pain vigilance, pain catastrophizing, and pain-related fear. Multiple regression analyses assessed the mediating/moderating role of pain hypervigilance. Structural equation modeling (SEM) was used to evaluate suppression effects.

Results

Our results evidenced pain hypervigilance mediated the effects of anxiety sensitivity (Model 1: Sobel z = 4.86) and pain catastrophizing (Model 3: Sobel z = 5.08) on pain-related fear. Net suppression effect of pain catastrophizing on anxiety sensitivity was found in SEM where both anxiety sensitivity and pain catastrophizing were included in the same full model to predict disability (Model 9: CFI = 0.95) and depression (Model 10: CFI = 0.93) (all P < 0.001) (see Figs. 3 and 4, Figs. 1 and 2).

Conclusions

Our findings evidenced that pain hypervigilance mediated the relationship of two dispositional factors, pain catastrophic cognition and anxiety sensitivity, with pain-related fear. The net suppression effects of pain catastrophizing suggest that anxiety sensitivity enhanced the effect of pain catastrophic cognition on pain hypervigilance.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Structure prediction of nanoclusters; a direct or a pre-screened search on the DFT energy landscape?

Atomic structure prediction, using KLMC (Lamarckian evolutionary algorithm search), and properties comparison of (KF)_n, (MgO)_n, (ZnO)_n and (CdSe)_n nanoclusters.

Frequency of developmental dysplasia of the hip in breech-presented Chinese neonates in Hong Kong

OBJECTIVES. To clarify the use of ultrasonography by determining the frequency of developmental dysplasia of the hip among breech-presented Chinese neonates in Hong Kong. DESIGN. Prospective case series. SETTING. Regional hospital, Hong Kong. PATIENTS. All breech-presented Chinese neonates born during January 2008 to June 2009 were included (except premature neonates). They were examined clinically from birth till the age of 1 year. Ultrasound of the hips was performed at the age of 2 weeks, and X-ray of the pelvis at the age of 1 year. RESULTS. A total of 209 breech-presented neonates were born during the study period; 110 neonates completed all necessary investigations and follow-up. Among the latter, there were three neonates with developmental dysplasia of the hip warranting treatment, which amounted to a frequency of 2.7%. CONCLUSION. Developmental dysplasia of the hip among breech-presented Chinese babies is only slightly less common than in corresponding populations in other regions in the world. Since early diagnosis is important, ultrasonography screening in high-risk cases such as those with breech presentation may be useful.

Mesenchymal stem cells derived from human induced pluripotent stem cells modulate T-cell phenotypes in allergic rhinitis

BACKGROUND

Human induced pluripotent stem cells (iPSCs) possess remarkable self-renewal capacity and the potential to differentiate into novel cell types, such as mesenchymal stem cells (MSCs). iPSC-MSCs have been shown to enhance tissue regeneration and attenuate tissue ischaemia; however, their contribution to the immune regulation of Th2-skewed allergic rhinitis (AR) and asthma remains unclear.

OBJECTIVE

This study compared the immunomodulatory effects of iPSC-MSCs and bone marrow-derived MSCs (BM-MSCs) on lymphocyte proliferation, T-cell phenotypes and cytokine production in peripheral blood mononuclear cells (PBMCs) in patients with AR, and investigated the possible molecular mechanisms underlying the immunomodulatory properties of iPSC-MSCs.

METHODS

In co-cultures of PBMCs with iPSC-MSCs or BM-MSCs, lymphocyte proliferation was evaluated using 3H-thymidine (3H-TdR) uptake, carboxyfluorescein diacetate, succinimidyl ester (CFDA-SE) assays; the regulatory T-cell (Treg) phenotype was determined by flow cytometry, and cytokine levels were measured using an enzyme-linked immunosorbent assay. The immunomodulatory properties of both MSCs were further evaluated using NS398 and transwell experiments.

RESULTS

Similar to BM-MSCs, we determined that iPSC-MSCs significantly inhibit lymphocyte proliferation and promote Treg response in PBMCs (P < 0.05). Accordingly, the cytokine milieu (IFN-γ, IL-4, IL-5, IL-10 and IL-13) in the supernatants of PBMCs changed significantly (P < 0.05). The immunomodulatory properties of iPSC-MSCs and BM-MSCs were associated with prostaglandin E2 (PGE2) production and cell-cell contact.

CONCLUSIONS

These data demonstrate that iPSC-MSCs are capable of modulating T-cell phenotypes towards Th2 suppression through inducing Treg expansion, suggesting that iPSC-MSCs can be used as an alternative candidate to adult MSCs to treat allergic airway diseases.

Mesenchymal stem cells derived from human induced pluripotent stem cells modulate T-cell phenotypes in allergic rhinitis

Background

Human induced pluripotent stem cells (iPSCs) possess remarkable self-renewal capacity and the potential to differentiate into novel cell types, such as mesenchymal stem cells (MSCs). iPSC-MSCs have been shown to enhance tissue regeneration and attenuate tissue ischaemia; however, their contribution to the immune regulation of Th2-skewed allergic rhinitis (AR) and asthma remains unclear.

Objective

This study compared the immunomodulatory effects of iPSC-MSCs and bone marrow-derived MSCs (BM-MSCs) on lymphocyte proliferation, T-cell phenotypes and cytokine production in peripheral blood mononuclear cells (PBMCs) in patients with AR, and investigated the possible molecular mechanisms underlying the immunomodulatory properties of iPSC-MSCs.

Methods

In co-cultures of PBMCs with iPSC-MSCs or BM-MSCs, lymphocyte proliferation was evaluated using 3H-thymidine (3H-TdR) uptake, carboxyfluorescein diacetate, succinimidyl ester (CFDA-SE) assays; the regulatory T-cell (Treg) phenotype was determined by flow cytometry, and cytokine levels were measured using an enzyme-linked immunosorbent assay. The immunomodulatory properties of both MSCs were further evaluated using NS398 and transwell experiments.

Results

Similar to BM-MSCs, we determined that iPSC-MSCs significantly inhibit lymphocyte proliferation and promote Treg response in PBMCs (P < 0.05). Accordingly, the cytokine milieu (IFN-γ, IL-4, IL-5, IL-10 and IL-13) in the supernatants of PBMCs changed significantly (P < 0.05). The immunomodulatory properties of iPSC-MSCs and BM-MSCs were associated with prostaglandin E2 (PGE2) production and cell–cell contact.

Conclusions

These data demonstrate that iPSC-MSCs are capable of modulating T-cell phenotypes towards Th2 suppression through inducing Treg expansion, suggesting that iPSC-MSCs can be used as an alternative candidate to adult MSCs to treat allergic airway diseases.

Assessing whole body vibration exposure for use in epidemiological studies of back injuries: measurements, observations and self-reports

Improved assessment of whole body vibration exposure is needed for epidemiological studies investigating the causes of low back disorders. Vibration was measured on 54 worker-days in five heavy industries, with data collected on observed and self-reported driving conditions, demographics, and vehicle characteristics. Variables significant at p < 0.1 in simple linear regressions (20 of 34) were retained for mixed effects multiple regressions to determine the best prediction of rms vibration level and 8-h equivalent vibration exposure. Vibration was measured, on average, for 205 min per work shift (SD 105). Means and standard deviations in m · s⁻² were: x-axis 0.35 (0.19); y-axis 0.34 (0.28); z-axis 0.54 (0.23); vector sum 0.90 (0.49); and 8-h equivalent vector sum 0.70 (0.37). The final three regression models retained only 2 or 3 of the 34 variables (driving speed (<20 km/h and/or 20-40 km/h) and industry and/or vehicle type and explained up to 60% of the variance (R² = 0.26-0.6).

PRACTITIONER SUMMARY

The purpose of the project was to create a model that can predict whole body vibration exposure from a number of observed or self-reported variables. This could eliminate the need for costly and time-consuming field measurements of WBV in epidemiological studies. Despite a large number of variables included in the model (34) and 54 worker-days of WBV measurement, the final models contained only two or three variables, and explained 60% of the variance. While this is an improvement over use of job title in epidemiological studies, it still leaves a considerable amount of WBV variance unexplained.

Metacarpophalangeal joint arthroscopy: indications revisited

Arthroscopic surgery has become the gold standard for the diagnosis and treatment of major joint disorders. With advancement in arthroscopic technique, arthroscopy has become feasible in most human joints, even those as small as the finger joints. The metacarpophalangeal joint (MCPJ) can become spacious with simple traction, the intra-articular anatomy is simple, and its major structures can be easily visualized and identified. However, MCPJ arthroscopy has never been popular. This article describes our experience with MCPJ arthroscopy and seeks to establish its role in clinical practice.

Development and evaluation of an observational Back-Exposure Sampling Tool (Back-EST) for work-related back injury risk factors

We developed and evaluated an observational Back-Exposure Sampling Tool. A literature review suggested 53 exposure variables; these were reduced to 20 following field trials. Kappas for agreement beyond chance between six observers assessing exposures in 72 photos ranged from 0.21 to 1.0, with the highest values for posture type, trunk angle, manual materials handling, hands on item, and load weight. Intraclass correlations for agreement between pairs observing 17 workers once per minute for a full-shift were >0.74 for most postural, trunk angle, and manual materials handling variables. In validity testing, the proportions of shifts in flexion/extension and lateral bending observed for 169 full-shifts were compared to inclinometer measurements. Pearson correlations were 0.42 for 45-60 degrees flexion and 0.9 for >60 degrees flexion, but only 0.11-0.19 for lateral bending and trunk flexion less than 45 degrees . When lower flexion angles were collapsed to include trunk extension, correlations increased to >0.5.

Contact with livestock--a protective effect against allergies and asthma?

BACKGROUND

A 'protective farm factor' possibly related to livestock exposure is hypothesized to reduce the risk for allergic sensitization.

OBJECTIVE

The purpose of this study was to determine whether 4-H club youth, who have opportunities for contact with livestock through club activities, have reduced risks of respiratory and allergic symptoms according to residence on a farm or exposure to livestock.

METHODS

A cross-sectional postal survey was completed by British Columbia 4-H members 8-20 years of age; a subset underwent skin prick testing as well. The association of farm residence and livestock exposure variables with symptoms were evaluated using logistic regression with adjustment for age, sex, cat and/or dog ownership, parental history of allergic disease, parental education, number of older siblings and exposure to smokers at home.

RESULTS

Questionnaires were completed by 1158 participants (response rate 50.3%); of these, a subset of 317 had skin prick tests (SPTs) (response rate 64.4%). Current residence on a farm was associated with a lower prevalence of ever having wheeze and asthma, as well as symptoms of atopic dermatitis. Variables relating to residence in a farm or rural area with livestock were more strongly associated with respiratory and allergic symptoms than were the livestock exposure variables such as frequency of contact and hours of barn use. The adjusted odds ratios for living in a farm residence in comparison with a rural non-livestock area were 0.49 (95% confidence interval (CI) 0.27-0.89) for diagnosed asthma, 0.51 (95% CI 0.30-0.85) for allergic rhinitis and 0.45 (95% CI 0.24-0.84) for atopic dermatitis.

CONCLUSION

Our findings suggest that some aspects of the farm environment, not just attributable to contact with livestock, were protective for respiratory and allergic conditions among 4-H youth.

Structured data entry of clinical information for documentation and data collection

Routine databases containing large amounts of clinical data represent a tremendous opportunity for the evaluation of health care practices and outcomes. However, data collected for administrative purposes has limitations in content, accuracy and completeness. Routine entry of clinical information directly into clinical information systems by care providers is one strategy to address this problem. We developed a structured data entry method, the Clinical Data Framework (CDF), which has been used to support the capture of clinical information by clinicians in the normal process of care delivery. A study of the CDF over a two month period showed that it improved the accuracy of completeness of data collection over a coding method which was based on selection of ICD-9-CM codes.

Spatial and temporal distribution of airborne Bacillus thuringiensis var. kurstaki during an aerial spray program for gypsy moth eradication

We measured airborne exposures to the biological insecticide Bacillus thuringiensis var. kurstaki (Btk) during an aerial spray program to eradicate gypsy moths on the west coast of Canada. We aimed to determine whether staying indoors during spraying reduced exposures, to determine the rate of temporal decay of airborne concentrations, and to determine whether drift occurred outside the spray zone. During spraying, the average culturable airborne Btk concentration measured outdoors within the spray zone was 739 colony-forming units (CFU)/m3 of air. Outdoor air concentrations decreased over time, quickly in an initial phase with a half time of 3.3 hr, and then more slowly over the following 9 days, with an overall half-time of about 2.4 days. Inside residences during spraying, average concentrations were initially 2-5 times lower than outdoors, but at 5-6 hr after spraying began, indoor concentrations exceeded those outdoors, with an average of 244 CFU/m3 vs. 77 CFU/m3 outdoors, suggesting that the initial benefits of remaining indoors during spraying may not persist as outside air moves indoors with normal daily activities. There was drift of culturable Btk throughout a 125- to 1,000-meter band outside the spray zone where measurements were made, a consequence of the fine aerosol sizes that remained airborne (count median diameters of 4.3 to 7.2 microm). Btk concentrations outside the spray zone were related to wind speed and direction, but not to distance from the spray zone.

The measurement of volatile constituents in Foray 48B, an insecticide prepared from Bacillus thuringiensis var. kurstaki

Foray 48B, an insecticide prepared from Bacillus thuringiensis var. kurstaki (Btk), has been used for many years to combat infestations of Gypsy moths. Foray 48B also contains a large number of 'inert ingredients' which are not disclosed by the manufacturer. Gypsy moths usually enter the country through marine- and airports in close proximity to urban areas, which consequently need to be sprayed. The population affected often demands more detailed information than what is available including the potential presence of volatile organic agents which could be released during spraying, posing a potential health hazard. Four different methods were investigated using GC/mass spectrometry regarding their ability to capture volatile agents associated with Foray 48B. It was found that solid phase micro-extraction was most efficient in capturing volatile agents from the head-space of Foray 48B. Separate trials using 95:5% ethanol/isopropanol mixture and toluene in an impinger configuration were much less efficient. Standard techniques using activated charcoal tubes in the laboratory setting as well as in a field trial did not capture any compounds. It was concluded that the volatile agents associated with Foray 48B did not appear to constitute a significant health hazard and no one agent was a likely candidate to serve as a tracer for Foray 48B exposure.

Cord compression due to extramedullary hemopoiesis in a patient with thalassemia

STUDY DESIGN

This is a case report of a patient with thalassemia who had acute spinal cord compression at the T3 to T8 level and presented for treatment.

METHODS

Magnetic resonance imaging and surgical decompression and transfusion therapy was chosen as the preferred treatment modality.

RESULTS

Neurologic recovery was satisfactory from the immediate postoperative period, and full recovery was observed 2 months after surgery.

CONCLUSION

Clinical awareness is important for early diagnosis. Documentation with an imaging technique, such as magnetic resonance imaging, is mandatory. Optimal treatment is tailor-made and depends on the clinical situation and the expertise available.

Choledochocholecystojejunostomy: a quick, effective method of biliary decompression for carcinoma of the pancreas

The frequency of pancreatic carcinoma appears to be increasing. Effective treatment is essential for most patients whose tumours are unresectable. Definitive treatment by stenting techniques are currently limited to those patients who are high surgical risks, elderly, present with metastatic disease or refuse the surgical option. Surgical bypass offers the best palliation and should reliably decompress the biliary obstruction caused by the tumour with the least surgical trauma. Roux-en-Y choledochojejunostomy (CDJ), with or without a gastroenterostomy, is usually the preferred method of bypass; however, for patients with a distended gallbladder this procedure is often made easier by its removal. Even then providing a proximal, tension-free anastomosis can be challenging. In 13 consecutive patients who still had a gallbladder and required a biliary bypass for carcinoma of the pancreas, the authors interposed the gallbladder between the proximal bile ducts and a Roux-en-Y loop. This procedure could be done more quickly than CDJ and performed well.

Surgery for neglected congenital torticollis

Nineteen patients were operated on for congenital muscular torticollis after the age of 1 year. Tenotomy gave good results below 5 years of age and resection of the sternocleidomastoid muscle was satisfactory in most of the older children.

The place of the dynamic compression plate in femoral shaft fractures

A retrospective study of 32 adult patients with fractures of the femoral shaft treated with the AO dynamic compression plate in one centre was carried out. Pathological fractures, transverse and short oblique fractures in the middle third of the femur were excluded from this study. The average follow-up was 3.5 years. The complications were failure of the implant in 6.3 per cent of cases, loosened screws in 3 per cent, refracture in 3 per cent and non-union in 3 per cent. No instance of deep infection was encountered. The average time taken for union was 5.5 months. The overall objective assessment showed excellent or good results in 90.6 per cent of cases. There is a definite place for the AO dynamic compression plate in well-selected cases of fracture of the femoral shaft, provided that close attention to technical details is observed. Timing of the operation and the postoperative care also affect the results.

Closed medullary nailing for fractured shaft of the femur--a comparison between the Küntscher and the AO techniques

A retrospective review was made of 97 cases of fractured shaft of the femur treated with closed medullary nailing. A comparison was made between the Küntscher and the AO techniques with respect to union of the fracture, rehabilitation, complication and functional results. Patients treated with AO nails enjoyed more rapid recovery: 88 per cent of the fractures united in 12 weeks, 62 per cent walked with full weight bearing in 8 weeks and 78 per cent returned to work within 6 months. However, the functional results in both groups were comparable. The special technical considerations and complications in each group are discussed.

Reconstruction of proximal femoral defects with a vascular-pedicled graft

A new method of treating large bony defects of the proximal femur is described. The defect is filled with a large vascular-pedicled bone graft from the iliac crest. The graft, being nourished by the deep circumflex iliac vessels, remains viable and therefore induces rapid healing of the bone. This method of bony replacement encourages adequate excision of potentially malignant bone lesions and provides sufficient mechanical support to allow early walking. Six clinical cases are presented to illustrate its application.

Treatment of burned hands

One hundred and thirty-five cases of burned hands were reviewed retrospectively. These consisted of 80 acutely burned hands, and 55 burned contractures. Treatment for the acutely burned hands included initial plastic-bag coverage and early tangential excisions and skin graftings. No skin grafting was required for all the first-degree and some second-degree superficial burns while some second-degree, all third-degree and deep superficial burns required early tangential excisions and skin resurfacing. The results were invariable satisfactory. The burned contractures were classified into four categories: the mild type; the claw type; the severely distorted type and the mutilated type. Treatment for the mild types consisted of release and different forms of skin grafting, Z-plasties and local flap repairs. Distant flaps were required for the claw and severely distorted types whilst the mutilated type was treated by amputation. The operative techniques to achieve satisfactory functional restorations were discussed.