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A total of 237 patients with surgically treated acetabular fractures were analyzed to identify the risk factors predisposing to development of heterotopic ossification (HO) following operative treatment, and to evaluate both clinical significance of HO and the clinical outcome of operative excision of ectopic bone. All patients had a minimum of 1 year followup time. The degree of HO was determined from anteroposterior radiographs of the pelvis at the 1 year followup and was classified as Grade 0 or Grade 1 according to the amount of ectopic bone present. Forty patients (17%) who developed a moderate to severe amount of ectopic bone were classified as Grade 1. Nine who developed significant ectopic bone resulting in 20% or greater loss of hip motion underwent excision of the ectopic bone; all six available for followup showed an improvement in range of motion. A significant correlation was found between poor clinical results at the 1 year followup and Grade 1 ectopic bone formation (p < 0.001). Four factors found to highly correlate with Grade 1 ectopic bone formation were: (1) the iliofemoral surgical approach; (2) multiple (2 or more) operative findings; (3) T type fractures; and (4) the presence of associated injuries to the abdomen and chest.

The clinical, histological and laboratory data from a series of 55 pediatric patients with Henoch-Schönlein purpura studied at the Hospital General de Mexico in a 16-years period are presented herein. Even when there are a few clinical features in this example of Mexican children, the clinical presentation and the course of the disease are similar to what is found in the literature.

Inpatient suicide attempters (n = 37) were compared with never-suicidal psychiatric controls (n = 29) with respect to prevalence and severity of personality disorder, history of aggression and assaultive behavior, and other measures of impulsive violence. Attempters, compared with controls, were more likely to show evidence of personality disorder or trait, particularly those of the borderline type. Attempters showed greater number of borderline symptoms than did controls, even after removing the item relating to suicidality. There were no differences between the groups with respect to lifetime history of aggression, history of assaultive behavior, or self-report measures of a tendency to impulsive aggression. Those attempters with personality disorder were much more likely to have made a previous attempt. The apparently high prevalence of personality disorder among adolescent inpatient suicide attempters indicates that the social impairment associated with personality disorder be viewed as an important aspect of treatment.

We have used electron paramagnetic resonance (EPR) to determine the effects of ADP on the orientational distribution of nitroxide spin labels attached to myosin heads in skinned rabbit psoas muscle fibers. To maximize the specificity of labeling, we spin-labeled isolated myosin heads (subfragment 1) on a single reactive thiol (SH1) and diffused them into unlabeled muscle fibers. To maximize spectral and orientational resolution, we used perdeuterated spin labels, 2H-MSL and 2H-IASL, eliminating superhyperfine broadening and thus narrowing the line widths. Two different spin labels were used, with different orientation relative to the myosin head, to ensure that the results are not affected by unfavorable probe orientation. In rigor, a very narrow three-line spectrum was observed for both spin labels, indicating a narrow orientational distribution, as reported previously (Thomas & Cooke, 1980). ADP induced very slight changes in the spectrum, corresponding to very slight (but significant) changes in the orientational distribution. These changes were quantified by a digital analysis of the spectra, using a two-step simplex fitting procedure (Fajer et al., 1990). First, the magnetic tensor values and line widths were determined by fitting the spectrum of a randomly oriented sample. Then the spectrum of oriented fibers was fit to a model by assuming a Gaussian distribution of the tilt angle (theta) and twist angle (phi) of the nitroxide principal axes relative to the fiber axis. A single-Gaussian distribution resulted in inadequate fits, but a two-component model gave excellent results. ADP induces a small (less than 5 degrees) rotation of the major components for both spin labels, along with a similarly small increase of disorder about the average positions.

Eight patients with disabling tibiotalar arthritis (one patient with a supramalleolar nonunion) were treated by arthrodesis. The procedure in all of these patients consisted of internal compression obtained by bone plates and the application of a bilateral tension device. A bilateral surgical approach was used. No bone grafting was required. This study compares two groups immobilized for ten and three weeks, respectively. In both groups, the procedure invariably produced union with excellent cosmesis, few complications, and good function.

A prospective study was planned to evaluate sperm morphology as a parameter to predict the fertilization outcome in an in vitro fertilization program. Couples applying to in vitro fertilization were admitted into this project when the sperm concentration was greater than 20 million per mL and motility greater than 30 per cent. Based on new strict criteria for evaluating normal sperm morphology, patients were divided prospectively into 2 groups. In group I (25 patients) normal sperm morphology was less than 14 per cent, and in group II (71 patients) normal sperm morphology was greater than 14 per cent, using a threshold established previously. Multiple regression analysis was used to evaluate different parameters: concentration, motility, and morphology against the dependent variables, fertilization, and cleavage. The only factor which was significantly correlated with fertilization and cleavage was normal sperm morphology (P less than 0.0001). The fertilization rate (per oocyte) and the cleavage rate were 49.4 per cent and 47.6 per cent in group I and 88.3 per cent and 87 per cent in group II (P less than 0.0001). The ongoing pregnancy rate per laparoscopy and per embryo transfer was 4 per cent and 5.5 per cent, respectively, in group I and 18.3 per cent and 18.5 per cent, respectively, in group II (no significant difference). This study demonstrates the value of analyzing sperm morphology using the criteria recommended in terms of predicting fertilization and perhaps pregnancy outcome. Patients can be better counseled and the probability of fertilization or no fertilization can be more accurately established. Furthermore a trend is shown in the pregnancy rate that may indicate the importance of the male genome in establishing a pregnancy.

One hundred two patients with 105 displaced fractures of the acetabulum were treated for fractures involving at least one column of the acetabulum and displaced at least 5 mm (rim fractures were excluded). The patients were primarily young adults with multiple injuries secondary to motor-vehicle-associated trauma. Fractures were classified according to the classification of Letournel. The most common fractures were the complex associated types with 44 complete both column, 19 T-shaped, and 18 associated transverse and posterior wall. Seventeen fractures were treated closed, and 88 were treated operatively. Closed treatment with skeletal traction was undertaken if roof arc measurements demonstrated a satisfactory remaining acetabular dome following fracture and in some cases of apparent congruence following complete both column fractures. Fractures not meeting these criteria were operated upon through the Kocher-Langenbeck, extended iliofemoral, or ilioinguinal approach. Ninety percent of the operations produced a satisfactory reduction of the fracture (3 mm or less displacement). A follow-up study longer than one year was obtained for 50 fractures. Clinical results were 80% satisfactory overall. Operative complications included 3% infection, 5% nerve palsy, and 7% significant ectopic bone. Operative treatment can produce satisfactory fracture reductions and clinical results with an acceptably low complication rate.

L(+) lactate dehydrogenase (LDH) activity from cultured cells of Aedes albopictus was studied as a kinetic model of carbohydrate metabolism. Enzyme kinetics were studied in the forward (lactate as substrate) and reverse (pyruvate as substrate) reactions and the apparent Km values were obtained showing LDH higher affinity for pyruvate. The Hill coefficient values for each substrate were similar and indicate the existence of only one binding site on the enzyme. Isozyme analysis on cellulose-acetate electrophoresis presented a single band of LDH which presumably is of the LDH-5 type. The results obtained contribute to the assumption that Aedes albopictus cells have a predominance of anaerobic metabolism.

One hundred twelve comminuted or rotationally unstable fractures of the femur were treated with the Grosse-Kempf interlocking nail. Two-thirds of the fractures had comminution involving more than 50% of the cortex. Of the 112 nailings, 82 were static and 30 dynamic. Clinical and radiographic fracture union occurred in 98% of cases; there were two nonunions. There were no instances of deep wound infection or osteomyelitis. Only two patients had a change of limb length greater than 1 cm. Angulation in any plane greater than 10 degrees was noted in three patients (2.5%). External rotation deformities occurred in eight patients (7.0%). The interlocking nail has expanded the indications for the use of closed intramedullary nailing in the treatment of complex fractures of the femur. The incidence of infection and nonunion is remarkably low. Immediate stability of the fracture allows for immediate mobilization of the patient, early rehabilitation of the limb, and a shorter hospital stay.

A roentgenographic analysis of 204 acetabular fractures is presented. In addition, 64 displaced fractures (43 treated surgically) are evaluated clinically and roentgenographically (average follow-up period, 3.7 years). Most fractures can be adequately evaluated from anteroposterior and oblique roentgenograms of the pelvis. The roentgenographic and clinical results correlate closely. Fractures must be reduced to a displacement of 3 mm or less, in addition to congruent reduction of the femoral head with the weight-bearing dome of the acetabulum, to achieve a satisfactory clinical result. Most displaced fractures involve the weight-bearing dome and require surgery. With an intact weight-bearing dome, nonoperative treatment is considered. Quantification of this dome with three measurements termed the medial, anterior, and posterior roof arc obtained from the standard roentgenograms is valuable in determination of appropriate treatment for displaced acetabular fractures.

Biochemical modifications of the glycolytic metabolism of the electric organ of Electrophorus electricus (L.) have been studied as a function of denervation. The activities of LDH, MDH and the concentrations of ATP, lactic and pyruvic acids were measured at intervals of zero, 15, 30 and 60 days following denervation. In parallel, CPK activity was also measured. All of these biochemical characteristics were substantially altered by denervation. The results obtained point to a change, after 15 days of denervation, from the normal anaerobic to an aerobic metabolism which remains after 30 days and reverts to anaerobic at 60 days.

The action of puromycin, nalidixic acid and cycloheximide on acetylcholinesterase has been studied using an "electrophoretically pure" preparation. Results obtained show that these well known inhibitors of protein synthesis have an inhibitory effect on acetylcholinesterase activity. The inhibitory action exercised by puromycin and nalidixic acid is of a mixed inhibition type, similar to the one seen when decamethonium and d-tubocurarine are used as inhibitory agents. Cycloheximide acts in a non competitive way on the enzyme activity.

Displaced acetabular fractures occur primarily in young adults involved in high energy trauma and can lead to disabling posttraumatic arthritis. An initial roentgenographic evaluation with accurate delineation of all fracture lines provides the key to decisions about whether to give closed or open treatment. When open treatment is indicated, a surgical approach can be chosen that will almost always lead to reduction without the necessity of a second approach. The authors have found that the Kocher-Langenbeck, ilioinguinal, and extended iliofemoral approaches are the most useful. A fracture table and specialized reduction instruments aid fracture reduction and fixation. Satisfactory operative reduction of the fracture is the factor that correlates best with a satisfactory clinical result. The rate of satisfactory operative reductions improved gradually over the first 50 operations of a prospective study of 121 displaced acetabular fractures. Overall, there were 80% satisfactory clinical results in this series. Complications included a 3% infection rate and a 5% incidence of nerve palsy. Open reduction and internal fixation are indicated for the majority of displaced fractures. However, closed treatment can produce satisfactory results in selected patients.

Properties of L(+) lactate dehydrogenase (LDH) of Electrophorus electricus (L.) electric organ were studied, comparing the substrates pyruvate and lactate. Electric organ LDH is a soluble enzyme with a pH optimum of 7.4 for pyruvate and 9.0 for lactate. The apparent Km was lower for pyruvate (Km = 2.5 X 10(-4) M) than for lactate (Km = 1.5 X 10(-2) M). With lactate as a substrate at pH 7.4, malonate, oxalate and pyruvate inhibited competitively. For pyruvate as substrate at pH 9.0 malonate inhibited non-competitively and oxalate shiwed uncompetitive inhibition. The different effects of the carboxylic acids on LDH activity suggest different stereospecificities of the two enzyme-coenzyme complexes in the forward and reserve reactions. The reactions of electric organ LDH with substrates and inhibitors are consistent with electrophoretic analysis suggesting that the enzyme is of the M-type.

We have each experienced a significant learning phase for surgical treatment of these fractures. However, problems of articular reduction remain significant, particularly for complex fractures. It is our opinion that a certain degree of centralization of acetabulum fracture treatment--especially for the associated types--can lead to an improved standard of care overall.

A new method for evaluation of sperm morphology using strict criteria is currently used in the andrology laboratory at the Eastern Virginia Medical School. A prospective study was designed to evaluate the following semen parameters in samples of all patients over a set period of time: sperm concentration and motility, and normal sperm morphology. These factors were correlated with results of the hamster zona-free oocyte/human sperm penetration assay (SPA). One hundred patients with a sperm concentration ranging from 2 to 219 X 10(6)/ml, a motile sperm fraction ranging from 6.9 to 87%, and normal sperm morphology ranging from 1 to 39%, were evaluated. The statistical analysis system general linear model was used to judge the influence of the different variables. There was a statistically significant relationship between the per cent of sperm with normal morphology and penetration rate in the SPA (P = 0.001). Outcome of the SPA was also correlated with in vitro fertilization, retrospectively, in 84 patients. Thirty-eight patients had an SPA less than 10%, with no fertilization in vitro in 13 patients (33.3%) and fertilization in 25 (66.7%). Forty-five had an SPA greater than 10% with fertilization in 37 (82.2%) and no fertilization in eight (17.8%) patients.

In patients with acceptable sperm count and motility, two patterns of abnormal morphology, judged with strict criteria, were identified and described. Patients with less than 4% normal forms and less than 30% morphology index (summation of normal and slightly amorphous forms) had a fertilization rate of 7.6% of the oocytes (P pattern, poor prognosis). Patients with normal morphology between 4 and 14% had a significantly better fertilization rate of 63.9% of the oocytes (P less than 0.0001). Cases with greater than 14% normal forms fertilized within the normal range for the laboratory. By evaluating sperm morphology with the proposed strict criteria, its predictive value in in vitro fertilization is enhanced.

L(+) lactate dehydrogenase (LDH) activity from the electric organ of Electrophorus electricus was measured in the presence of ATP in the forward (substrate lactate) and reverse (substrate pyruvate) enzymatic reactions. The I50 for ATP was first determined and then the kinetics of the reactions were investigated with either constant coenzyme (NAD or NADH) concentration and varying substrate (lactate or pyruvate) concentration, or, constant substrate and varying coenzyme concentration. The kinetic data showed that ATP inhibits LDH uncompetitively with respect to the reduced and the oxidized coenzyme. As for the substrates, ATP gives a mixed type inhibition for lactate and a noncompetitive inhibition for pyruvate.

The purpose of this study was to determine whether basal or stimulated (or both) serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) on day 3 of the cycle before administration of exogenous gonadotropins can predict stimulation response and in vitro fertilization (IVF) outcome. Eighty consecutive new patients underwent a gonadotropin-releasing hormone (GnRH) stimulation test on the morning of cycle day 3. All patients underwent the same stimulation protocol consisting of a combination of FSH and human menopausal gonadotropin (hMG). Paired discriminant analysis of FSH0 (at 0 minutes from GnRH injection) and LH0 revealed seven distinct groups of patients with statistically significant differences among the means: groups 1, 2, and 3 (26.25%) with higher means FSH0:LH0; group 4 (40%) with mean FSH0:LH0 (both levels less than 10 mIU/ml) of 1:1, and groups 5, 6, and 7 (33.75%) with higher mean LH0:FSH0. Canonical discriminant analysis of both basal and stimulated serum FSH and LH levels confirmed the seven groups and did not add to the information from analysis of FSH0 and LH0 only. Serum estradiol (E2) response during stimulation, as well as the number of preovulatory oocytes aspirated and transferred, was highest in the groups with a higher mean LH0:FSH0, intermediate in the group with mean FSH0:LH0 of 1:1, and lowest in the group with a higher mean FSH0:LH0. No pregnancy occurred in the higher FSH:LH groups. It is concluded that basal serum gonadotropin levels can distinguish different populations of IVF patients who tend to behave differently in terms of E2 response, oocytes obtained and transferred, and pregnancy rates and outcome.

The orthopedic care of unstable pelvic fractures requires reduction and stabilization in order to promote union in a satisfactory position and provide a satisfactory clinical result. The results of three treatment techniques, skeletal traction and/or pelvic sling, anterior frame external fixation, and internal fixation, were evaluated over a four-year period.

L(+)lactate dehydrogenase (LDH) from the electric organ of Electrophorus electricus (L.) was purified by ammonium sulfate precipitation, ion-exchange chromatography on DEAE-cellulose and gel filtration on Sephadex G-200. Purified LDH was homogeneous when examined by polyacrylamide gel electrophoresis under nondenaturing conditions. Both LDH activity and protein were demonstrable in the same band. The mobility of the LDH-5 isozyme is characteristic of the muscle type enzyme. Isoelectric focusing showed a single molecular species of pIO 6.5 +/- 0.4. The apparent molecular weight was 140,000 (+/- 10%) on the basis of gel filtration of Sephadex G-200. The effect of organic acids on the enzyme activity towards pyruvate (NADH) and lactate (NAD) was determined spectrophotometrically at 340 nm. Sodium oxamate behaved as a mixed inhibitor when lactate (NAD) was the substrate, whereas ethyl oxamate was an uncompetitive inhibitor. Both the sodium salt and the ester of oxamic acid were competitive inhibitors when pyruvate (NADH) was the substrate.

Endometrial receptivity and pre-embryo quality are the main factors determining embryo implantation in in vitro fertilization. If one embryo implants normally and goes to term, the endometrium can be assumed to be normal. Eighty-one patients (March 1981 to 1987) had transfers of multiple pre-embryos, resulting in multiple pregnancies with at least one reaching term. The number of gestational sacs at 8 to 12 weeks of pregnancy, at 20 weeks, and the number of term pregnancies were studied longitudinally. Twelve patients (14.8%) had 2 pre-embryos transferred, 19 (23.5%) had 3, 21 (25.9%) had 4, 17 (21.0%) had 5, 9 (11.1%) had 6, and 3 (3.7%) had 7. At 20 weeks 18 patients (22.2%) had a single viable fetus, 56 (69.1%) had twins, 6 (7.4%) had triplets, and 1 (1.2%) had quadruplets. A total of 325 pre-embryos were transferred; 178 gestational sacs were observed at 8 to 12 weeks, but only 153 showed fetal heartbeat. Total embryo loss at 8 to 12 weeks was 53.0%; when the "index" embryo was excluded, it reached 61%. Regardless of the number of pre-embryos transferred, only 2.2 embryos on average were able to establish a normal pregnancy. (A)synchronism of the pre-embryos did not affect outcome. Results suggest that with normal endometrial receptivity, the implantation potential of each pre-embryo is different.