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Background: Periprosthetic fractures are increasing in frequency. Classification: A treatment-oriented classification is the Vancouver classification. Therapy: Type A fractures will usually be treated conservatively, type C fractures are treated in the same way as shaft fractures, type B1 fractures are the domain of plate fixation and type B2 and B3 fractures require an exchange of the prosthesis possibly with bone augmentation. [ABSTRACT FROM AUTHOR]

Reinforcement corrosion is major reason for concrete structures deterioration. Chlorides from external sources such as seawater and de-icing salts penetrate in the concrete and as soon as a critical threshold reaches the reinforcement level corrosion processes start. Therefore, the characterization of the chloride ingress resistance in form of the rapid chloride migration (RCM) coefficient, DRCM is crucial to classify concretes for given applications and to enable full probabilistic service life prediction. To measure DRCM of chloride-contaminated concrete, a rapid iodide migration test was developed using iodide as penetration ion and an iodine–starch reaction for penetration depth indication. This indicator mixture has the disadvantage that it is not applicable on sulfide containing concretes such as ground granulated blast furnace slag concretes. In this paper, the reason for the unsuitability of this indicator is examined and alternative oxidation agents are found and validated to overcome this problem. The new indicator mixtures with hydrogen peroxide (H2O2) or/and potassium persulfate (K2S2O8) as oxidation agents are not only insensitive to sulfide contamination but are also applicable to common concrete compositions and could replace the existing indicator universally. [ABSTRACT FROM AUTHOR]

Purpose: The rise of computed tomography (CT) use in trauma has become the subject of concern given the harms of CT including radiation, cost, over diagnosis and identification of incidental lesions. We developed a novel metric, the Negative CT Score, (∑CT−) which quantifies how often CT imaging identifies important injuries. Our objective was to describe the pattern of CT utilization in trauma at an urban academic level one trauma center using this novel metric.Methods: This was a retrospective study of intermediate level trauma patients who received CT imaging over a 1-year study period at an urban level one trauma center. We applied the Negative CT Score, (∑CT−) to quantify the results of CT imaging. ∑CT− is computed by subtracting the number of non-extremity body regions (maximum four: head, neck, chest, abdomen) with an important positive CT finding (defined by a priori criteria) from the total number of non-extremity body regions scanned.Results: Of the 552 cases reviewed during the study period, 410 (74.3%) were male and the mean age was 40.3 years [SD ± 21.2]. Four hundred eighty-six patients (88.0%) suffered blunt trauma; 66 (12.0%) suffered penetrating trauma. The average injury severity score for admitted patients was seven. Four hundred ninety-five cases had at least one CT performed. The average number of regions per patient that received CT imaging was 2.36 (SD ± 1.3), and the average ∑CT− was 2.10 (SD ± 1.2). Three hundred and sixty-seven (74.3%) patients had no important findings on CT imaging.Conclusions: In a consecutive series of 552 intermediate trauma patients at our urban trauma center, 2.36 body regions were scanned per patient; of these, 2.10 regions revealed no important CT findings. We hope that these results and the Negative CT Score can be used to identify trends, variations in practice, and outliers within and across departments so that CT utilization can be optimized. [ABSTRACT FROM AUTHOR]

Social complexity is argued to be a driving factor in the evolution of communicative complexity. Complex social systems require individuals to form relationships with many conspecifics and interact in a wide variety of contexts over time, thus selecting for acoustic communication systems complex enough to facilitate these relationships. To better understand the evolution of such social and communicative complexity, we investigated a nocturnal, solitary forager, Garnett's bushbaby ( Otolemur garnettii), as a lorisoid model for the ancestral primate social systems from which more complex systems evolved. We hypothesized that it would be advantageous for solitary foragers to have individual differences in long-distance calls, as this could be crucial to the maintenance of their dispersed social networks. We tested for individual differences in the long distance bark vocalization. We measured 6 frequency and temporal parameters for 120 barks (15 barks from each of 8 individuals housed at the University of Southern Mississippi). Principal component and discriminant function analyses assigned the calls to the respective individuals at a rate that was moderately accurate and higher than chance (binomial test: 54.2% correct, P < 0.001, chance = 12.5%). This pilot work provides moderate evidence for individual differences and is the first such study to be conducted on lorisoids. Because individual differences have been documented in the vocalizations of solitary foraging lemuroids, we suggest that moderate individual differences may have been present in ancestral primates and contributed to the dispersed social system that is thought to have been the foundation from which increased social complexity evolved in primates. [ABSTRACT FROM AUTHOR]

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Many factors can influence the parasite load of animal hosts, but integrative studies that simultaneously investigate several factors are still rare in many taxonomic groups. This study investigates the influence of host species, host population density, parasite transmission mode, sex, and two temporal (month, year) factors on gastrointestinal parasite prevalence and fecal egg counts of two endemic primate species from Madagascar, Microcebus ravelobensis and Microcebus murinus. A total of 646 fecal samples were available and analyzed from three dry seasons. Six different helminth egg morphotypes were found, and these were Subulura sp. (14.51 % prevalence), strongyle eggs (12.95 %), Ascaris sp. (7.94 %), Lemuricola sp. (0.17 %), and two forms of tapeworms ( Hymenolepis spp.) (1.73 and 0.69 %). Coinfection with more than one egg type was observed in 21.22 % of the samples containing eggs. Multivariate analyses revealed that host species and sex did neither explain significant variation in the prevalence and fecal egg counts of parasites with direct life cycles ( Ascaris sp., strongyle egg type, Lemuricola sp.) nor of arthropod-transmitted parasites ( Subulura sp.). However, fecal egg counts of Subulura sp. differed significantly between study sites, and the prevalence of Subulura sp. and of parasites with direct life cycles was influenced by temporal parameters, mainly by differences between study years and partly between months. When comparing the findings with the yearly and seasonal rainfall patterns in the area, most results are in accordance with the hypothesis of an increased vulnerability of the host toward infection under some sort of environmental challenge. [ABSTRACT FROM AUTHOR]

Bone necrosis secondary to avascularity may not only delay or inhibit consolidation of a fracture, it may also be a cause of refracture. Both initial trauma und surgical insult will determine the extent of necrosis. Only the latter is under the surgeon's control; it can be reduced by gentle soft tissue handling and by minimizing periosteal stripping. While the impact of avascular necrosis on fracture healing is well recognized, its role in the pathogenesis of refractures has received less attention. Cortical necrosis delays bridging of gaps; these gaps act as stress risers which, following resumption of full activity or after implant removal, can lead to refracture. Evaluation of 28 refractures in 25 patients, with biopsies in 14 patients, suggests that the duration of fracture immobilization through external or internal means must be sufficiently long to allow vascular invasion of necrotic areas, their substitution by new bone and bridging of the fracture. These processes must be followed by radiographic studies prior to implant removal. Special attention needs to be paid to adequate visualization of the fracture gap on successive radiographs. [ABSTRACT FROM AUTHOR]

Background: Periprosthetic fractures are increasing in frequency. Classification: A treatment-oriented classification is the Vancouver classification. Therapy: Type A fractures will usually be treated conservatively, type C fractures are treated in the same way as shaft fractures, type B1 fractures are the domain of plate fixation and type B2 and B3 fractures require an exchange of the prosthesis possibly with bone augmentation. [ABSTRACT FROM AUTHOR]

Study design:Multi-center, prospective, cohort study.Objectives:To assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III) in measuring functional ability in persons with spinal cord injury (SCI).Setting:Inpatient rehabilitation hospitals in the United States (US).Methods:Functional ability was measured with the SCIM III during the first week of admittance into inpatient acute rehabilitation and within one week of discharge from the same rehabilitation program. Motor and sensory neurologic impairment was measured with the American Spinal Injury Association Impairment Scale. The Functional Independence Measure (FIM), the default functional measure currently used in most US hospitals, was used as a comparison standard for the SCIM III. Statistical analyses were used to test the validity and reliability of the SCIM III.Results:Total agreement between raters was above 70% on most SCIM III tasks and all κ-coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.81 and intraclass correlation coefficients were above 0.81. Cronbach's-α was above 0.7, with the exception of the respiration task. The coefficient of Pearson correlation between the FIM and SCIM III was 0.8 (P<0.001). For the respiration and sphincter management subscale, the SCIM III was more responsive to change, than the FIM (P<0.0001).Conclusion:Overall, the SCIM III is a reliable and valid measure of functional change in SCI. However, improved scoring instructions and a few modifications to the scoring categories may reduce variability between raters and enhance clinical utility. [ABSTRACT FROM AUTHOR]

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Zusammenfassung  Infektionen am diabetisch neuropathischen Fuß sind die typischen Komplikationen der Fußulzera. Sie stellen ein erhebliches Risiko zum Verlust des Fußes bzw. zur Sepsis dar, deshalb sind umfangreiche konservative und operative Maßnahmen zur Vermeidung und zur Heilung der Ulzera erforderlich. Wenn Infektionen eingetreten sind, erfordern sie ein gezieltes Vorgehen zunächst mit Entlastung und Antibiotikagabe. Abszesse und Phlegmonen lassen sich durch klinischen Befund, Sonographie, Röntgenaufnahme, Computer- (CT) und Magnetresonanztomographie (MRT) lokalisieren. Sie müssen durch Inzisionen drainiert werden. Nach Abklingen des akuten Stadiums werden die infizierten Nekrosen an Knochen und Weichteilen durch Débridements entfernt. Die Hautdefekte sind durch geeignete Verfahren zu verschließen. Störende Fehlstellungen und Instabilitäten sind durch Korrekturen an den Sehnen, durch Knochenresektionen oder durch Fusionsoperationen zu beseitigen. Auf diese Weise lässt sich eine Vielzahl von Amputationen verhindern bzw. das Ausmaß der Amputation deutlich einschränken. [ABSTRACT FROM AUTHOR]

We investigate the dynamics of microcapsules in linear shear flow within a reduced model with two degrees of freedom. In previous work for steady shear flow, the dynamic phases of this model, i.e. swinging, tumbling and intermittent behaviour, have been identified using numerical methods. In this paper, we integrate the equations of motion in the quasi-spherical limit analytically for time-constant and time-dependent shear flow using matched asymptotic expansions. Using this method, we find analytical expressions for the mean tumbling rate in general time-dependent shear flow. The capsule dynamics is studied in more detail when the inverse shear rate is harmonically modulated around a constant mean value for which a dynamic phase diagram is constructed. By a judicious choice of both modulation frequency and phase, tumbling motion can be induced even if the mean shear rate corresponds to the swinging regime. We derive expressions for the amplitude and width of the resonance peaks as a function of the modulation frequency. [ABSTRACT FROM AUTHOR]

The disease activity score of 28 joints (DAS28) is now commonly used for the guidance of treatment decisions in rheumatoid arthritis (RA). The goal of this work was to determine whether patients with DAS28 > 3.2 but less than 2 swollen and 2 tender joints respond differently to treatment than patients with a higher number of active joints. One hundred and ninety two patients with active RA treated in a rheumatology hospital as in-patients were studied prospectively. At admission (T1), release (T2) and 3 months after release (T3) disease activity (DAS28-CRP at T1 + 2, RADAI at T1 + 3), pain (numeric scale at T1 − 3) and function (FFbH at T1 + 3) were measured. A total of 148 patients had two or more (group 1) and 44 less than 2 swollen and tender joints at admission (group 2) but both groups had similar over all DAS28-scores. The groups significantly differed in their outcome after 3 months: group 1 had a significant better reduction of disease activity, pain and functional deficit ( p < 0.001 for the fulfilment of defined response criteria and p < 0.05 for comparison of the mean values for pain and function) in comparison to group 2. Although the numbers were small sub-analysis suggested that the differences might be due to a better response to newly administered DMARD and TNF-alpha-inhibitor therapy in group 1. Active RA patients with less than 2 swollen and 2 tender joints represent a subgroup with lower response to treatment with DMARD or TNF-alpha-inhibitors. This has to be taken into account in the management of these patients. [ABSTRACT FROM AUTHOR]

The aim of our study was to assess the utility and reliability of magnetic resonance imaging (MRI) in antenatal diagnosis of craniosynostosis. We retrospectively reviewed the MRI examinations of the head of 15 fetuses requested over a period of 11 years on the basis of sonographic suspicion of craniosynostosis. The postnatal diagnosis was available for 14 neonates. No termination of pregnancy was performed. There were four neonates with sporadic multisuture craniosynostoses, three of which were syndromic, including one Crouzon and one Pfeiffer syndrome. Eight neonates were normal, two showed cranial vault deformities without synostosis, and one was lost to follow-up. MRI showed a high predictive value for craniosynostosis, as there were no false-negative or false-positive diagnoses. However, the severity of the abnormalities were underestimated in two neonates. We suggest that prenatal MRI has diagnostic value when synostosis is suspected on ultrasonography. Moreover, MRI is accurate in the detection of associated brain abnormalities, which is an important prognostic issue in this diagnosis. Prenatal diagnosis of craniosynostosis is difficult and could benefit from three-dimensional ultrasonography and three-dimensional CT. [ABSTRACT FROM AUTHOR]

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Introduction: It was the purpose of this study to investigate how bone morphogenetic protein 2 (BMP-2) influences remodelling and the biomechanics of solvent- dehydrated bone in the long run. Furthermore, the early influence of this growth factor on the substitute was investigated. Materials and methods: Using a weight-bearing animal model, solvent-dehydrated bone was implanted in the tibial head of merino sheep (n= 12) after being loaded with BMP-2 (100 μg/100 μl). At 4 weeks (n=6) and 9 months (n=6) after surgery, histomorphological, histomorphometrical and biomechanical investigations were performed. Results: At 9 months after implantation of BMP-2-loaded specimens, the bone per tissue volume was high, with levels above those of physiological cancellous bone. The amount of remaining solvent-dehydrated bone was markedly decreased, and in contrast, the amount of newly formed bone was extremely high. The specimen degradation had already occurred within the first 4 weeks after implantation, showing no further impact throughout the 9-month period. Biomechanical investigations at 9 months after implantation demonstrated a yield strength which achieved levels at least equivalent to physiological cancellous bone. BMP-2 showed no significant impact on the biomechanical properties after 4 weeks, compared to specimens prior to im- plantation. Conclusion: BMP-2 predominantly has an impact on the early implant degradation as well as bone formation, which leads to an almost completed bone remodelling of the solvent-dehydrated specimen within the study period of 9 months. [ABSTRACT FROM AUTHOR]

Differences in the aetiology of osteoarthritis (OA) of the first carpometacarpal joints (CMC-1) and the interphalangeal joints (IP) have been reported. It was the purpose of this investigation to evaluate whether isolated OA of the first carpometacarpal joints and the interphalangeal joints differs in its aetiology, considering potential risk factors such as age, gender, body mass index, occupational history, OA in the hip or knee joints, hypertension and diabetes in patients with advanced hip or knee OA. Included in this investigation were 639 patients scheduled for either hip or knee replacement because of advanced OA. As well as a standardised interview and clinical examination, bilateral radiographs of both hands were obtained. According to the presence or absence of radiographic OA, participants were categorised as having CMC-1 OA (= 1 joint) or IP OA (= 2 joints), either isolated or in combination. Odds ratios (OR) and their 95% confidence intervals (CI) for potential determinants of OA were estimated using multivariable logistic regression.Of the total number of patients, 184 had CMC-1 OA and 424 IP OA. Patients with CMC-1 OA were more likely to be female (77.2%), and to have knee OA (62.5%) and hypertension (63.0%), than patients without CMC-1 OA. No differences between CMC-1 OA and IP OA were observed for the role of age, body mass index and diabetes. Age was associated with both CMC and IP OA. Female gender was independently associated with CMC-1 OA (OR=1.79; 95% CI: 1.16–2.74) but not with IP OA. Our data suggest a possible impact of age and female gender on the aetiology of CMC-1 OA and of age on IP-OA, at least in patients with advanced hip or knee OA. [ABSTRACT FROM AUTHOR]

It was the purpose of this investigation to prove the biomechanical properties, the osteoconductive capacity and the degradation rate of α tricalcium phosphate (α TCP), a neutralized glass ceramics (GB9N) and a composite material (GB9N+copolymers). In a weight-bearing animal model six substitutes each were implanted in the medial tibial head of the right lower leg of adult Merino-sheep in a standardized surgical technique. After nine months the implants were harvested and prepared for histomorphological and histomorphometrical investigations (undecalcified Masson Goldner staining). For additional biomechanical testing of the specimens, non-operated bone blocks from the contralateral tibia as well as native implants served as controls. No significant differences for the maximum fracture load as well as for the yield strength were detected between harvested specimens and bone blocks from the contralateral tibia. However there were marked differences to ceramics that were not implanted. All substitutes showed osteoconduction, leading to a continuous ingrowth of new formed bone. However in the composite material soft tissue could be identified within the scaffold and there were signs of ongoing bone remodeling, nine months after implantation. The bone per tissue volume of α-TCP in conjunction to new bone (=percentage of trabecular bone volume plus percentage of residual substitute) was higher than for GB9N and the composite material. Nine months after implantation the percentage of residual α-TCP was 48%, it was 32% for GB9N and 28% for the composite. The intention of further studies should be to accelerate the degradation rates of substitutes and to improve biomechanical properties of implants by either modifying the chemical composition or combining materials with agents as, e.g. growth factors. [ABSTRACT FROM AUTHOR]

Cancellous bone is routinely used in human surgery to fill skeletal defects. The availabilty of autogenous and allogenous grafts is limited, however. The aim of this in vivo study was therefore to determine the in-growth behaviour and biomechanical properties of solvent dehydrated human bone as an alternative to the use of autografts. In a weight-bearing experimental model, solvent dehydrated bone transplants were implanted subchondrally in the medial proximal tibia of merino sheep. After 9 months, explants as well as controls from the contralateral leg were harvested and prepared for histomorphological, histomorphometrical and biomechanical examination. A smaller, but statistically insignificant difference was found for the yield strength after 9 months for harvested specimens in comparison with untreated controls. Regarding the histomorphological results, we found a homogenous ingrowth of new bone trabeculae throughout the transplants. The degradation of the solvent dehydrated bone was not complete within the study period as shown by persistent bone remodelling. The bone per tissue volume of remaining solvent dehydrated graft particles together with newly formed bone was significantly higher than for controls. Our observation period was not long enough to document complete remodelling, but good osteointegration and reasonable biomechanical properties in this weight-bearing large animal model support the application of solvent dehydrated bone in cancellous defects of clinical relevance. [ABSTRACT FROM AUTHOR]

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In clinical and epidemiological studies the Kellgren & Lawrence (K&L) scale was mainly used in the past to determine the radiological prevalence and severity of gonarthritis. The dependency of this scoring system on the presence of osteophytes has been criticised, and owing to its varying reliability, its appropriateness in cross-sectional and longitudinal studies is questioned. It was the purpose of this study to test whether the dependency of the K&L scale on the presence of osteophytes is reflected in a higher correlation of the overall score with a separate scoring of ‘osteophytes’ than with other radiological features. Furthermore we compared the inter- and intrarater reliability with the reliability of individual radiological features. Knee radiographs of 40 patients were graded according to the K&L scale and for the presence and severity of five separate radiological features of osteoarthritis. We found a moderate correlation of the K&L scale with the radiological features of ‘osteophytes’, ‘joint space narrowing’ and ‘flattening of condyles’. The intra- and inter-rater reliability of the K&L scale was higher than the reliability of the individual radiological features. The K&L scale seems not to be strongly dependent on the presence of osteophytes, i.e. there is not a higher correlation of the overall score with that feature than with other radiological features. [ABSTRACT FROM AUTHOR]

It is not uncommon for sarcomatous transformation of giant cell tumor (GCT) of bone to occur after radiation, but rarely does malignant transformation occur spontaneously, with less than 15 cases reported up to 1995. Only four of these cases have been documented in detail. We report two additional cases of GCT of bone spontaneously transforming or "dedifferentiating" into osteosarcoma without radiation therapy. The first case is absolutely unique and most interesting in that the dedifferentiation process occurred in one of multiple GCT lung metastases 6 years after successful eradication of a primary tibial tumor. The right lung was resected due to development of a large tumor, and at pathologic examination, demonstrated several small nodules of conventional GCT and a much larger, 14-cm mass composed of a mixture of GCT and high-grade osteosarcoma. The second case involved a physician, who had a large tumor in the sacrum with vague symptoms for 8 years. Open biopsy revealed conventional, benign GCT of bone with a secondary aneurysmal bone cyst. Complete curettage 2 weeks later revealed, in addition to areas of conventional, benign GCT a second component of very high grade osteosarcoma. Both patients died less than 1.5 years from diagnosis. This report of osteosarcomatous transformation of a conventional GCT of bone strengthens the theory that there is a mesenchymal cell line in GCT that may spontaneously transform to sarcoma. [ABSTRACT FROM AUTHOR]

The seventh case of primary malignant mesenchymoma of bone is reported. It is compared to the other six cases in the literature and clinicopathologic pattern of this entity is developed. Primary malignant mesenchymoma of bone is compared to mesenchymal chondrosarcoma and dedifferentiated chondrosarcoma. Differences as well as similarities are discussed and a more current classification scheme for malignant mesenchymoma of bone is proposed. [ABSTRACT FROM AUTHOR]

A unique lesion discovered in the scapula of a 36-year-old woman is presented. The lesion has microscopic features resembling those of fibrous dysplasia and osteoid osteoma which we believe is identical to an entity previously only documented in the rib (fibro-osseous lesion of rib). We are of the opinion that the lesion probably represents a reactive response to trauma rather than a neoplasm and suggest the name of "fibro-osseous reparative pseudotumor" for this entity. [ABSTRACT FROM AUTHOR]

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The cleanup of high-level defense nuclear waste at the Hanford Site presents many challenges. These include removing and disposing of components from buried active waste tanks to allow new equipment insertion or hazards mitigation. This paper discusses a unique automated system that provides for retrieval, high-pressure washing, inventory measurement, and containment for disposal. Key to the inventory measurement is a three-detector high-purity germanium high-performance gamma-spectroscopy system capable of recovering data at up to 90-percent saturation (200,000 counts/s). Data recovery is based on a unique embedded electronic pulser and special software to report the inventory. Each detector has different shielding specified through simulation using the Monte Carlo computer code for N-particle transport modeling. This shielding provides performance over a dynamic range of eight orders of magnitude. This paper covers system description, calibration issues, and operation. [ABSTRACT FROM AUTHOR]

General results are given for the influence of coherence and misalignments on the complex amplitude addition and subtraction method using a holographic beam splitter. A new method for simultaneous complex addition and subtraction is also investigated. [ABSTRACT FROM AUTHOR]

General results are given for the influence of coherence and misalignment on the complex amplitude addition and subtraction by holographic Fourier transformation. For the method of Gabor et al. we have investigated the effects of longitudinal and transverse misalignment of the recording material between the first and second exposure. A method for complex addition and subtraction of Fourier transforms is investigated also. [ABSTRACT FROM AUTHOR]

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Blunt dissection of the esophagus is considered the least invasive technique in the treatment of either benign or malignant diseases of the esophagus. Its disadvantage is that it has to be carried out blindly. The results may be uncontrollable hemorrhage, unrecognized injuries to the trachea, and damage to the recurrent laryngeal nerve. In order to reduce the degree of invasiveness a new endoscopic microsurgical technique for the dissection of the esophagus has been developed and tried out in animals. This paper presents the operative technique. Our new endoscopic microsurgical technique obviates a thoracotomy, while direct endoscopic vision results in improved dissection. The magnified endoscopic view permits selective exposure of blood vessels and prevents injury to the adjacent organs. [ABSTRACT FROM AUTHOR]

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The Sickness Impact Profile (SIP) is gaining increasing popularity in clinical and epidemiological studies, assessing health status or the impact of therapeutic interventions. The SIP was created as a global measure, assessing generic dimensions of health. As there were only a few such methods available in our country, we decided in 1990 to validate a German version of the SIP and to test its appropriateness in patients with musculoskeletal disorders. Due to the up-to-dateness of our results, we decided to publish now the data of this German version of the SIP. Reliability, validity and sensitivity to change of the German version of the SIP were tested in 299 patients with musculoskeletal disorders. The test-retest correlation was high for the overall score ( r = 0.81), as well as for Cronbach's alpha ( r = 0.83). Results for categories were significantly lower. Validity was tested by comparing the SIP to the Keitel Index ( r = 0.6) and to the Measurement of Patient Outcome Scale ( r = 0.72), as well as to a control group, which showed significant differences in all categories and in the overall score. Furthermore, the SIP was able to demonstrate therapy-related improvements in health in all our patients. We concluded that the german version of the SIP fulfilled statistical test criteria. The results were comparable to those achieved in the original American version. A cross-cultural comparison using the SIP is justified for at least those patients with musculoskeletal disorders. [ABSTRACT FROM AUTHOR]

Medullary nails have only been used with reluctance in the treatment of open fractures since reaming interferes with the cortical circulation. The technique of interlocking offers the interesting possibility of inserting a relatively stiff nail which does not necessarily require reaming. The effects of reaming prior to nail insertion upon the cortical circulation was investigated in the canine tibia. Intravital staining with procion red was used to trace areas of disturbed circulation. Nail insertion without reaming provided clear advantages for the bone's blood supply, while reaming disturbed perfusion in two-thirds of the cortical area and regionally extended through the entire thickness of the cortex. The disturbance without reaming was limited to the inner layer of the cortex and involved only one-third of the cortical cross-section. [ABSTRACT FROM AUTHOR]

Several studies show that the application of oral glucocorticoids in patients with active RA leads to fast resolution of disease activity []. Treatment strategies that include the initial application of glucocorticoids seem to have a favourable outcome in terms of long-term control of disease activity []. Moreover, when tapered down to low doses, glucocorticoids show disease-modifying actions such as the inhibition of progression of structural damage to the inflamed joints []. The goal of this study was to examine the predictors of short-term response to intermediate-dose glucocorticoids in patients with active RA. [ABSTRACT FROM AUTHOR]

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