Search

In recent years, there has been a large-scale boom in mining in the present-day Swedish part of Sapmi, leading to protests from Sami activists as well as environmentalist groups. To the protesters, issues of Swedish colonialism and Sami indigeneity are central, and history becomes important. Taking its starting point in the mining conflicts, this article discusses Sami archaeology and claims for Sami indigenous land and cultural rights. We argue that it is important to further explore the colonial history in Sapmi, and its meaning and consequences today. Archaeology can contribute with new perspectives on colonial histories and relations, and connections between past and present in Sapmi. At the same time, many issues concerning the ethics and politics of archaeology need to be discussed. Furthermore, in discussions on Sami archaeology and heritage management in Sapmi, it is important to consider experiences from the international fields of postcolonial studies and indigenous archaeology.

Resume La chirurgie orthopedique et traumatologique est une des chirurgies les plus exposees aux plaintes des patients. Une etude retrospective de 791 declarations de plaintes aupres d’une meme assurance survenues a une cohorte de 794 chirurgiens sur une periode de cinq ans (2002–2007) fournit un cadre d’analyse des dimensions du risque de l’exercice professionnel. Dans la base consideree, 6,8 % des chirurgiens concentrent 46,8 % des declarations de plaintes ; ils en ont eu cinq ou plus en cinq ans, et representent 64,1 % du cout a charge pour l’assurance. Inversement 65 % des chirurgiens n’ont eu aucune declaration dans cette periode. Le « sur-risque » concerne particulierement la chirurgie du rachis et de la hanche alors que la chirurgie du membre superieur est au contraire sous-representee. La discussion analyse les limites de l’etude et propose une comprehension des causes profondes de ces sinistres selon trois dimensions du risque : le type de chirurgie, le type d’exercice professionnel (etablissement, organisation de l’activite) et des facteurs personnels (competence a communiquer, traces de vie, etc.).

Summary Introduction Knee arthrodesis may be the last possible option for infected total knee arthroplasty (TKA) patients and in revision cases involving severe bone loss and/or extensor mechanism damages. Success in these situations depends on achieving good fixation assembly stability. We report bone fusion results using a fixation technique combining cross-pinning by two Steinman pins with a single-frame external fixator. Remission of infection at long-term follow-up was an additional criteria assessed for those cases initially treated for sepsis. Hypothesis This fixation modality improves fusion rates. Patients and methods In six of this series of eight patients (mean age: 59 years), surgery was performed in a context of infection: five cases of infected TKA, and one case of septic arthritis. In the other two cases, arthrodesis was respectively indicated for a severe post-traumatic stiffness compounded by extensor system rupture and for a fracture combined to a complete mechanical implant loosening. In three of the six infection cases, arthrodesis was performed as a single-stage procedure. All patients were operated on using the same technique: primary arthrodesis site stabilization by frontal cross-pinning with two Steinman pins, followed by installation of a sagittal external fixator frame. Results were assessed at a mean 8 year follow-up. Results All the arthrodeses showed fusion at a mean 3.5 months (range: 2.5 to 6 months) postoperative delay without reintervention. Weight-bearing was resumed at 2 to 3 months. The external fixator was removed at a mean 5.2 months. No recurrence of infection was observed over a mean follow-up of 8.2 years (range: 1 to 15 years). Three complications occurred: one hematoma, managed surgically; one supracondylar fracture treated orthopedically; and one osteitis, managed by surgical curettage. Discussion This knee arthrodesis technique proved effective, with no failures in this short series, especially in cases of primary infection. It is a reproducible means of osteosynthesis, with little subsequent morbidity. Fixation in two orthogonal planes seemed to provide the stability required to achieve bone fusion. This assembly avoids internal fixation, which is never risk-free in a context of primary sepsis. Level of evidence Level IV. Retrospective study.

Resume Introduction L’arthrodese de genou est parfois la seule solution therapeutique chez les patients presentant une prothese totale de genou infectee ou une perte osseuse majeure avec rupture de l’appareil extenseur. La reussite de cette intervention est correlee a l’obtention d’une bonne stabilite du montage d’osteosynthese. Nous avons etudie les resultats en termes de fusion osseuse d’une technique d’osteosynthese associant un brochage en croix par deux clous de Steinmann et un fixateur externe monoplan. Nous avons secondairement evalue le controle de la remission infectieuse au dernier recul pour les cas operes en contexte septique. Hyothese Le montage preconise ameliore le taux de consolidation. Patients et methodes Dans cette serie de huit patients, (âge moyen de 59 ans), six patients ont ete operes dans un contexte infectieux : cinq infections sur une prothese totale de genou et une osteoarthrite. Les deux autres indications d’arthrodese etaient une raideur post-traumatique associee a une rupture d’appareil extenseur et une fracture sur prothese descellee. Pour trois des six infections, l’arthrodese a ete realisee en un seul temps operatoire. Tous les patients ont ete operes selon la meme technique chirurgicale : stabilisation premiere du foyer d’arthrodese par deux clous de Steinmann en croix dans le plan frontal, puis mise en place d’un fixateur externe dans le plan sagittal. Les resultats ont ete evalues a un recul moyen de huit ans. Resultats Toutes les arthrodeses ont fusionne en premiere intention dans un delai moyen de 3,5 mois (2,5 a 6 mois). La reprise de l’appui a ete autorisee dans un delai de deux a trois mois postoperatoires. Le fixateur externe a ete retire a un delai moyen de 5,2 mois. Aucun reveil infectieux n’a ete constate a un recul moyen de 8,2 ans (1 a 15 ans). On rapporte trois complications : un hematome evacue chirurgicalement, une fracture supracondylienne traitee orthopediquement et une osteite sur fiche traitee par curetage chirurgical. Discussion Cette technique d’arthrodese du genou est efficace puisqu’elle n’a pas connu d’echec dans cette courte serie, meme en contexte infectieux. Il s’agit d’une solution d’osteosynthese reproductible et grevee d’une faible morbidite. La fixation dans deux plans orthogonaux semble efficace pour obtenir la stabilite suffisante necessaire a l’obtention de la fusion osseuse. Ce type de montage evite le recours a une fixation interne toujours discutable en contexte septique. Type d’etude : etude retrospective. Niveau IV.

Streams and riparian areas in the Bowron River watershed were assessed using the riparian management routine effectiveness evaluation, a protocol developed for postharvest operational monitoring in British Columbia. Located in the British Columbia interior, the study watershed has had several decades to recover since a period of intensive salvage logging from 1977 to 1987 in response to a spruce beetle ( Dendroctonus rufipennis ) outbreak. Correlations were found with site-specific watershed characteristics and attributes that are used to answer the protocol indicator questions. Channel width was the strongest covariate, exhibiting the most significant relationships with the stream and riparian attributes. Suggestions on how to adjust standard protocols for stream size and landscape heterogeneity are discussed and include the use of appropriate reference sites for baseline data. We used correlations with watershed characteristics and multiple regressions based on regional reference sites to predict upper and lower threshold values by which attribute measurements could be compared. Sites that were assessed above or below threshold values for an attribute were considered to be outside the range of natural variation and were given a failing score. Attributes with the most failures 20–30 years postharvest were disturbed ground, bare soil, undercut banks, and shade.

Adequate (wide or marginal and uncontaminated) margins and reconstruction are difficult to achieve when performing an internal hemipelvectomy for bone sarcomas involving the sacroiliac joint. We evaluated whether adequate surgical margins could be achieved and if functional outcomes could be predicted based on the type of resection and reconstruction. Forty patients had resections of the sacroiliac joint. Vertical sacral osteotomies were through the sacral wing (n = 2), ipsilateral sacral foramina (n = 27), sacral midline (n = 9), or contralateral foramina (n = 2). Iliac resections were Type I, Type I-II with partial or total acetabular re-section, or Type I-II-III. Surgical margins were adequate in 28 of 38 patients (74%), two (7%) of whom experienced local recurrence, compared with seven of 10 (70%) patients with inadequate margins. Reconstruction consisted of restoring continuity between the spine and pelvis. Resection of the entire acetabulum and removal of the lumbosacral trunk were the two main determinants of function, as assessed using the Musculoskeletal Tumor Society score. There were no life-threatening or function-threatening complications. Internal hemipelvectomy with a limb salvage procedure can be achieved with adequate surgical margins in selected patients. Functional outcomes can be predicted based on the type of resection and reconstruction, which helps the surgeon plan the procedure and inform the patient.

Resume L’etude rapporte les resultats d’une serie continue, prospective, multicentrique de 425 protheses Wallaby I ® conservant le ligament croise posterieur, posees par le groupe Guepar de 1992 a 1995. Le composant femoral de cette prothese presente des condyles asymetriques et divergents pour se rapprocher le plus possible de la cinematique du genou normal. Le plateau tibial en polyethylene est fixe. L’âge moyen des patients (70,5 ans), la repartition homme (28,3 %) et femme (71,7 %), l’etiologie (91 % d’arthrose primitive ou secondaire) et la deviation preoperatoire des genoux (65,6 % de varus > a 3° et 24 % de valgus > a 4°) etaient identiques a ceux qui sont publies dans la litterature pour ce type de prothese. Vingt-six protheses ont ete suivies moins de 1 an, 84 moins de 5 ans et 315 5 ans ou plus. Parmi les 399 genoux suivis plus de 1 an, il y a eu 4 infections (1 %) dont 3 ont necessite le changement de prothese, 3 fractures du femur toutes post-traumatiques, 2 descellements (1 global et 1 tibial) ayant necessite une reprise, 1 descellement tibial et 3 descellements rotuliens non-repris. Trois patients presentaient des douleurs anterieures du genou traitees avec succes par 2 resurfacages secondaires de la rotule et 1 section de l’aileron rotulien externe. Dix-neuf fractures de rotules (4,7 %) (dont 17 decouvertes fortuitement) constituaient la complication la plus frequente, sans retentissement fonctionnel. Le score moyen IKS genou postoperatoire etait de 90,5 points et le score moyen IKS fonction de 61,6 points. La mobilite moyenne etait de 110,5° ; 72,9 % des genoux etaient axes suivant la classification radiologique IKS, La survie de cette prothese a 8 ans (suivant Kaplan Meier) etait de 97,7 % quelle que soit la raison du changement de prothese et de 98,5 % en ne prenant comme evenement que la reprise pour descellement aseptique. Ces bons resultats corroborent ceux qui sont publies dans la litterature concernant les protheses conservant le ligament croise posterieur a plateau tibial fixe.

Resume L’objectif de ce travail etait de comparer les enregistrements electrogoniometriques de la marche d’un groupe temoin de 9 sujets et de 2 groupes de sujets porteurs de protheses totales de genou, conservant ou sacrifiant le ligament croise posterieur (LCP), comportant respectivement 10 et 6 patients. La marche a ete etudiee en terrain plat a 3 vitesses differentes. Nous avons recueilli les angles de flexion-extension du genou et les principaux parametres spatio-temporaux de la marche. La marche s’effectuait de la meme facon avec les protheses conservant ou sacrifiant le LCP, malgre les differences theoriques de cinematique articulaire entre les deux implants. Il existait une modification de la phase d’appui, pendant laquelle l’amplitude de flexion etait liee a la vitesse et etait diminuee dans le groupe des protheses. Cette diminution d’amplitude se repercutait probablement sur la qualite de la marche car elle etait correlee avec une diminution des parametres spatio-temporaux en rapport avec la performance de la marche. Nous avons attribue cette diminution d’amplitude pendant la marche, que la mobilite sans appui ne laissait pas prevoir, par une interaction entre la cinematique articulaire, le systeme musculo-ligamentaire et le schema locomoteur.

Remote dipole effects as a means to accelrate ru (aminoalcohol)-catalyzed transfer hydrogenation of ketones

2-Azanorbornyl-derived amino alcohols were prepared and evaluated as ligands in the Ru(II)-catalyzed asymmetric transfer hydrogenation of aromatic ketones. To improve selectivity and rate, the structure of the ligand was optimized. Acetophenone was reduced using 0.5 mol % catalyst in 40 min in 94% ee. This system was also able to reduce a wide range of aromatic ketones to the corresponding alcohols, while maintaining high enantioselectivities and yields. The effects of catalyst loading and the presence of cosolvents in the reaction vessel were examined, and a linearity study was also done.

The mechanism of the Ru(arene)(amino alcohol)-catalyzed transfer hydrogenation of ketones using isopropyl alcohol as the hydrogen source has been studied by means of hybrid density functional methods (B3PW91). Three mechanistic alternatives were evaluated, and it was shown that the reaction takes place via a six-membered transition state, where a metal-bound hydride and a proton of a coordinated amine are transferred simultaneously to the ketone. Further calculations provided a general rationale for the rate of the reaction by comparison of steric effects in the ground and transition states of the ruthenium hydride complex. It was found that the TS has a strong preference for planarity, and this in turn is dependent on the conformational behavior of the O,N-linkage of the amino alcohol ligand. Finally, a general model, rationalizing the enantioselectivity of the reaction, was developed. Experimental studies of both rate and enantioselectivity were used in order to support the computational results.

New Expedient Route to Both Enantiomers of Nonproteinogenic a-Amino Acid Derivatives from the Unsaturated 2-Aza-Bicyclo Moiety

Responders to spill accidents need to have at their fingertips a method of rapid prediction of chemical cloud dispersion behavior and other relative information to protect the public from death and injury during evacuation of the affected area. A survey of 123 chemical spill accidents in the US where evacuations occurred revealed that available mathematical models were not used to predict cloud dispersion behavior while the event was under way, although modeling was sometimes done after the fact. The evacuation distances based on a given downwind concentration (level of concern) vary considerably, depending upon the chemical released and upon atmospheric turbulence resulting from solar insolation and wind blowing across surface features. Examples are presented. The problem is complicated because available mathematical models and look-up tales often do not give the same answer under the same conditions, nor do authorities agree on the concentration levels representing a level of concern on which to base evacuations. The responders to chemical spills need to be aware of these limitations, recognizing that modeling is a tool and does not represent ultimate truth. Yet modeling is useful to responders and is required by law in the US in developing possible accident scenarios under risk managementmore » plans as part of the Clean Air Act. Western Research Institute, in surveying the problems, has determined a need to communicate the benefits of modeling in a format designed for responders and others in the decision-making processes. A system for estimating evacuation distances has been developed for a hand-held computer for field use. The major features are that the user inputs the chemical spilled, spill location, time of day, cloud cover, and source spill information; evacuation distances based on a level of concern are calculated in seconds. The system is designed for planners and emergency response personnel without special modeling or computer skills.« less

Isolated injuries of the scapho-trapezial ligament complex are not well recognized. The ligament complex comprises the stout scapho-trapezial ligament, the floor of the flexor carpi radialis (FCR) tendon sheath and the scapho-capitate ligament. Between August 1991 and May 1992, we diagnosed and treated four cases of partial chronic post-traumatic lesions of this ligament complex. There was chronic pain at the base of the thenar eminence and instability of the thumb-index-middle finger pinch. Standard X-rays were normal. The diagnosis of ligament rupture was confirmed by mid-carpal arthrography showing filling of the sheath of FCR tendon. Surgical exploration showed complete rupture of the tendon sheath of FCR in two cases, associated in the other two cases with complete rupture of the scapho-trapezial ligament. Direct repair of the ligamentous elements was performed in all cases. The tendon of FCR was sutured to the tubercle of scaphoid to protect and to reinforce the ligament repair. The patients have been followed-up for between 6 and 12 months. All four patients recovered normal pinch strength to the middle finger. One patient suffered from chronic pain at work.

A highly diastereoselective reaction of 2-azanorbornyl enolates with electrophiles has been studied. Deprotonation of 4 with LDA at low temperature affords the corresponding exocyclic lithium enolate 5, which reacts with different electrophiles such as alkyl halides, aldehydes and acyl chlorides to give the corresponding exo addition products 6. The products are formed in good yields and with diastereoselectivities above 95%.

2-Azanorbornyl alcohols: Very efficient Ligands for Ruthenium-Catalyzed Asymmetric Transfer Hydrogenation of Aromatic Ketones. D. A

A highly diastereoselective reaction of 2-azanorbornyl enolates with electrophiles has been studied. Deprotonation of 4 with LDA at low temperature affords the corresponding exocyclic lithium enolate 5, which reacts with different electrophiles such as alkyl halides, aldehydes and acyl chlorides to give the corresponding exo addition products 6. The products are formed in good yields and with diastereoselectivities above 95%.

The treatment of chronic osteomyelitis with large skin defects at the foot or the ankle is uneasy. In such cases, free muscular flaps are currently advised but they are less reliable in patients with medical diseases. In such difficult cases we have used the distally based soleus island flap, vascularized with retrograde flow on the posterior tibial artery. The technique and the indications of this flap are discussed.This flap has been used for seven patients with bone infection and skin defects measuring an average of 10 x 7 cm. The preoperative arteriography had to find the whole three arteries at the leg, with a good distal anastomotic arcade. The soleus muscle was raised with the posterior tibial artery, after it was ligated proximally and dissected up to the tarsal tunnel.All of the seven flaps totally survived, except one that a marginal necrosis treated by excision and iterative dissection of the pedicle for a more distal repositioning. No clinical vascular deficiency was found on the legs. At the last review, all the osteomyelitis were cured.The soleus island flap, distally vascularized on the posterior tibial artery, is a reliable flap, useful for the coverage of the distal leg, from the ankle to the very distal foot. Harvesting a major artery at the leg should be weighed against the failure of a free flap in high risk patients.

A test of comparative in vitro cerato-ulmin wilt toxin production in the aggressive and non-aggressive subgroups of the Dutch elm disease pathogen Ophiostoma ulmi was carried out by turbidity and ELISA methods. Ten non-aggressive, ten EAN aggressive and ten NAN aggressive isolates were tested from a range of geographical sources. In liquid shake cultures the non-aggressive isolates produced the greatest and the NAN aggressives the least mean biomass. Despite considerable variation in cerato-ulmin production by individual isolates in three separate experiments, both the turbidity and ELISA methods showed a clear separation of the non-aggressive and aggressive subgroups. Non-aggressive isolates produced little or no cerato-ulmin (ELISA range of means 0–56.0 ng/ml) and EAN and NAN aggressive isolates moderate to high levels (EAN 1.6–89.0 × 104 ng/ml and NAN 0.2–300 × 104 ng/ml). In the aggressive isolates no correlation was detected between cerato-ulmin production and either biomass or pathogenicity to clonal Commelin elm. The role of cerato-ulmin in the pathogenicity of O. ulmi is discussed.

Le choix de la conservation ou non du LCP repose avant tout sur des convictions personnelles et la notion d’avantages pratiques et theoriques, qui pour la plupart n’ont pas ete dementis par l’experience. Cette conservation du LCP, meme si elle ne reproduit que de facon inconstante le roulement-glissement des condyles femoraux sur le tibia, semble diminuer la frequence de l’instabilite prothetique, mais expose au risque rare de rupture secondaire. L’eclectisme en matiere de conservation ou non du LCP dans les protheses a plateau mobile peut rester la regle, meme si techniquement la quasi-totalite des genoux protheses peut beneficier, entre des mains expertes, d’une conservation en poussant loin ce type d’indication.

Posterior Wallaby I is a fixed polyethylene tibial plateau prosthesis enabling preservation of the posterior cruciate ligament (PCL). Its asymmetrical and divergent femoral condyles articulate with also asymmetrical tibial plateaus. The purpose of this prospective study was to analyze outcome of the first 425 Wallaby I prosthesis of the Guepar group implanted for first-intention treatment.These 425 prostheses were implanted from December 1992 to February 1995 by senior and junior surgeons. Mean patient age at implantation was 70.5 years. 91% had primary or secondary osteoarthritis and only 8.9% had inflammatory rheumatoid disease. The mean preoperative IKS score was 25.34 points and the IKS function score was 29.04. 10.35% of knees were aligned normally (mechanical axis between 2 degrees varus and 3 degrees valgus) according to the IKS criteria (Ewald), 24% presented valgusor = 4 degrees and 65.6% varusor = 3 degrees. All tibial and patellar components (except one) were cemented, 5.8% of the femoral pieces were inserted without cement. All but 11 patellae were resurfaced. Clinical outcome was assessed with the IKS score and radiological outcome with the IKS criteria. The patella was considered to be tilted when the alpha angle was5 degrees and dislocated when the AA' distance was5 mm. The chi-square test was used for comparison of quantitative variables (significance set at 0.05).Early postoperative complications were rare: two infections cured with debridement-lavage and antibiotics without removal of the prosthesis, one peronal nerve palsy which regressed partially, ten late unions without clinical consequence (particularly in the inflammatory rheumatoid patients). Twenty-six prostheses were followed less than one year (eight patients died and eighteen were lost to follow-up) and 84 less than five years (27 patients died and 57 lost to follow-up before five years). 315 prostheses were followed for more than five years (5-9 years) with a mean follow-up of 6.3 years. Among the 399 prostheses followed for one year or more, we noted: four infections including three requiring change of the prosthesis (one cured by arthroscopic lavage), two aseptic loosenings which were revised (one global one tibial), one tibial loosening and three patellar loosenings which were not revised, and two femoral ossifications limiting joint motion but improved by arthrolysis and resection of the ossifications. Three patients experienced anterior pain requiring secondary patellar resurfacing in two and section of the lateral patellar wing in one. Ninteen patellar fractures (4.7%) were noted, including 17 with no significant functional impact which were not revised. The mean IKS knee score among prostheses followed for five years was 90.5 points, with mean motion 110.5 degrees. Mean IKS function score was 61.63 points. 72.9% of the knees were aligned, 22.2% in varus and 4.9% in valgus. The mechanical axis of 94.3% of the knees was between 5 degrees varus and 5 degrees valgus. Prosthesis survival at eight years (Kaplan-Meier method) was 97.7% considering all reasons for prosthesis removal and 98.5% for removal for aseptic loosening.This prospective multicentric study demonstrated that the results obtained with the Wallaby I prosthesis are as good as those obtained with other prostheses sparing the PCL and published in the literature. Preservation of the PCL enables better knee stability, correct motion (110.5 degrees in our series) with almost no radiological wear of the tibial polyethylene at eight years. The only worrisome complication is patellar fracture.

We wanted to check whether the differences in joint kinematics between the normal and prosthesis knee, with or without preservation of the posterior cruciate ligament, have an effect on knee flexion-extension during gait and on gait performance.A control group of nine subjects was compared with two groups of subjects with total knee prostheses, with (n = 10 patients) or without (n = 6 patients) preservation of the posterior cruciate ligament. Gait was studied on flat ground at three different walking speeds. We measured the principal temporospatial gait parameters as well as knee flexion and extension angles using continuous electrogoniometry. Non-parametric statistical tests were used to analyze data due to the small number of subjects in each group.The flexion-extension cycles were different between the control group and the prostheses groups, but there was no difference between the two prostheses groups. Measurements made during gait confirmed this result, demonstrating a modification of the temporospatial parameters and a decrease in knee flexion during weight bearing in the prostheses groups compared with the control group. The statistical analysis demonstrated a correlation between these two results.The individual nature of gait parameters hindered data analysis. Indeed, there are many different ways to walk "normally". We were however able to demonstrate the following points. The theoretical differences in joint kinematics between prostheses with or without preservation of the posterior cruciate ligament did not have any effect on gait. There were however significant differences between the control group and the prostheses groups, and these differences depended on walking speed. The most interesting results concerned the changes in the weight-bearing phase. Flexion during this phase was related to walking speed and was decreased in amplitude in both prostheses groups. This lesser amplitude in knee flexion probably affected the quality of gait because it was correlated with decreased temporospatial parameters related to gait performance.This decreased amplitude of flexion during gait, which cannot be expected from motion measurements without weight bearing, can be explained by an interaction between joint kinematics, the musculoligamentary system and the locomotor schema.

We wanted to develop a gait evaluation protocol using an electrogoniometric device allowing simpler measurements than optoelectronic recordings.Gait was studied in a group of nine healthy subjects, mean age 58 years, walking on flat ground at three different speeds. We recorded the knee flexion and extension angles and the main temporospatial gait parameters. The principal conditions required for considering gait to be normal were taken from the literature.The subjects exhibited gait cycles which were normal in 83% of the cases for both knees at all three walking speeds. In 17% of the cases, the subjects walked with a flexed knee or without flexion during the weight-bearing phase. Knee motion was symmetrical between the right and left knee in all subjects. Increased walking speed was associated with increases temporospatial parameters and greater flexion and extension angles, particularly during the weight-bearing phase. There was a correlation between the weight-bearing flexion phase and stride length.The walking distance was moderate but sufficient to avoid the influence of the start and stop cycles. The electrogoniometers were small and did not perturb walking. Certain temporospatial parameters could not be measured directly but could be estimated. We checked that the results corresponded with data in the literature. Lateralization (right, left dominance) did not influence knee movement. Flexion during weight-bearing could influence gait quality by affecting the balance between gravity and quadriceps muscle force, particularly when considering forces used to progress forward. Knee motion varies with walking speed and depends not only on overall knee motion measured without weight bearing, but probably also on the interaction between joint kinematics, the musculoligamentary system, and the locomotor schema.

We conducted a prospective study to determine the therapeutic impact of systematic culture of suction drainage collections in Altemeier class I and II procedures.We examined the following questions: how many microbiologically positive samples and infections of the operative site were present in the included patients? for positive cases, what was the antibiotic prescription (excluding antibiotic prophylaxy protocols planned before surgery for cleaning)? if the sample was positive in a patient with no clinical infection, what antibiotics were prescribed?A total of 1039 samples were collected in 470 patients undergoing Altemeier class I and II procedures. One hundred five cultures were positive in 34 patients who had undergone major surgery. There were 11 postoperative infections during the study period. Mean delay to diagnosis of infection was 19.5 days. Only one infected patient with positive drainage samples developed an infection on the 7(th) day; the causal germ was different from that identified in the drainage collection. Only one of the patients with a positive drainage sample was given antibiotics, but this treatment was initiated at peroperative reception of the laboratory results.Our findings demonstrate that systematic samples of drainage collections make no contribution to therapeutic decision making in patients undergoing class I and II surgery.

Unlike injuries involving only one of the forearm bones, complex lesions of the proximal end of the radius and the ulna are particularly unstable. Various situations-Monteggia fracture, transolecraneal dislocation, or fracture-dislocation-are encountered. The classification systems proposed to date and recalled here are insufficient, making it difficult to provide optimal therapy and also hindering comparison between published series. We propose a descriptive classification including all the anatomic varieties of complex fractures of the proximal end of the radius and the ulna. This classification is based on our experience with 38 cases and takes into account 4 basic elements: the height of the ulnar fracture line, the direction of the displacement of the proximal radius, the association of a fracture of the proximal radius and/or of the coronoid process.

Complex lesions of the proximal end of the radius and ulna are uncommon and generally associate a fracture of the proximal ulna and a dislocation of the radial head, which also may be fractured. We assessed the effect of the type of fracture and treatment on functional outcome and complications.Thirty-eight adults (25 men and 13 women) were treated for complex fractures of the proximal end of the radius and ulna. For 25 of them, mean follow-up was 2.4 years. For the ulna, there was an epiphyseal fracture in 10 cases, a metaphyseal-epiphyseal fracture in 16 and a diaphyseal fracture in 12. The coronoid process was fractured in 20 cases and the proximal radius in 19. There was an anterior displacement in 24 cases. There were 9 open fractures and 13 patients had another injury of the upper limb. Functional outcome was assessed with a 100 point scale using subjective (pain) and objective (active motion, muscle force, stability) criteria.For the 25 fractures with more than 1 year follow-up, outcome was very good in 8, good in 6, fair in 8 and poor in 3. The pain and muscle force scores followed a similar pattern. Motion appeared as the determining factor for good outcome. Seven early revisions (2 for deep infections, 2 for disassembly of the fixation system, 3 for insufficient fixation) were required among the 38 patients. Among the late complications, there were 3 nonunions, 5 misalignments, and 4 proximal radio-ulnar synostoses. Six elbows required revision to restore motion.Certain characteristics of the fractures were predictive of poor outcome: skin opening, association with a lesion of the homolateral upper limb, mirror lesion of the lateral condyle, metaphyseal-epiphyseal fractures, communitive fractures, presence of a fracture of the radial head or the coronoid process.Complex proximal fractures of both bones of the forearm threaten the functional prognosis of the upper limb due to the risk of stiffness. Successful treatment depends on three factors: stable anatomic reconstruction of the ulnar articulation, and reconstruction of the lateral column and the coronoid process, necessary for a stable elbow. In addition, early mobilization, possible with a stable osteosynthesis, is indispensable for recovering useful joint movement.

In this study, the case has been examined of a 49-year old male who initially presented with a pathological fracture of the second metacarpal. This was first treated by curettage, iliac bone graft and internal fixation, without any complementary investigation being carried out, i.e., no preliminary biopsy and histological diagnosis were made. The results of this inadequate approach were poor: neither satisfactory fixation of the fracture nor control of the primary lesion were obtained. Moreover, the definitive diagnosis was only made four months later, when biopsy findings confirmed the presence of an osteosarcoma. After neoadjuvant chemotherapy, an en-bloc resection of the second metatarsal and the trapezoid bone was carried out. At ten months post-surgery, one and a half years after the original fracture, the hand was found to be disease-free and functioning satisfactory. However, nearly a year later the discovery of a large tumor mass at the site where the iliac bone graft was originally taken necessitated resection of the hemi-pelvis, with chemotherapy prior to resection and radiotherapy following surgery. Unfortunately, this salvage procedure did not limit the spread of the disease, and subsequent pulmonary and vertebral metastases were found, leading to the death of the patient three years after the initial fracture. This particular case underlines the fact that the basic rules for the management of malignant tumors should be taken into consideration from the onset, so that a catastrophic prognosis such as that described can be avoided.

Between 1990 and 1997, 18 patients with a mean age of 55.5 years (11 females, 7 males) underwent surgical treatment for a metastasis from thyroid cancer involving the axial skeleton. At the time of surgery all patients had a poor prognosis: 7 metastases revealed the thyroid cancer, all 18 patients had a neurological or mechanical complication, 9 had multiple metastases, all were over 40 years of age. After arteriography with embolization, the surgical procedure consisted of curettage of the tumor and reconstruction, followed by treatment with iodine 131. The survival rate 3 years after surgery was 50%. At the last review, the functional outcome was good and 17 patients had total neurological recovery. Four complications occurred: 1 operative hemorrhage, 3 postoperative infections. Four patients had local recurrence of the metastasis with a one-year survival rate of 20%. When the thyroid cancer was revealed by the axial metastasis, the 3-year-survival rate was 42%. In cases with huge metastases, the 3-year-survival rate was 71%. It appears from these data that surgical treatment of metastases from thyroid cancer in the axial skeleton still achieves a good functional outcome even in cases where neurological or mechanical complications had occurred before surgery.

Arthroscopic arthrolysis is a reliable technique for the treatment of knee stiffness due to arthrofibrosis following ligament replacement or following the treatment of knee fracture. However, its use is uncommon for this indication in total knee arthroplasty (TKA). In this study, we questioned whether or not arthroscopy is a reliable technique for treatment of knee stiffness following TKA, due to arthrofibrosis.Four men mean aged 54 (38-70) underwent knee arthroscopy for a history of arthrofibrosis following TKA. In two cases the arthrofibrosis had appeared after a primary TKA done for limited range of motion and in two other cases had followed a revision arthroplasty. The mean knee flexion before the TKA was 80 degrees (40-110) and it was 105 degrees (100-120) after performing the TKA. The knees were not mobilized under anesthesia though the mean flexion was 75 degrees (60-80) 15 days after the TKA. The indication for arthroscopy was a painless limited range of motion of the knee. The arthroscopy was performed 6 months (2.5-12) after the TKA and at this time the flexion was limited to 65 degrees (60-80). The extension was limited in 2 cases to 10 degrees and 30 degrees. Patients were evaluated an average of 20 months (8-36) after the arthroscopy. With 2 peripatellar portals we sectioned the adhesions in the suprapatellar pouch, the 2 retinaculars and the adhesive bands in the 2 gutters. Two anterior additional portals were used in case of extension lag. A suction drain was placed and the portals were sutured. A continuous passive motion machine was started in the recovery room.The mean operating time for arthroscopic arthrolysis was 38 minutes (30-60). The mean knee flexion was 116 degrees (100-130) at the end of arthroscopy and was 93 degrees (75-110) at the last review. The mean flexion improved by 31 degrees (15-50). The mean flexion improved by 45% (25-83). The 2 extension lags decreased respectively from 30 degrees to 10 degrees and from 10 degrees to 0 degree. For these 2 patients the increase in range of motion was 70 degrees and 40 degrees respectively. The average amount of bleeding was 200 ml (86-520). There were no complications.Few surgeons are experienced in arthroscopy for knee stiffness after TKA. Our results are similar to those reported by most authors. Regarding the technique, the section of the two retinaculars is necessary for the mobility of the patellar and most of the mobility is gained after the release of the gutters. The use of only two portals avoids damaging the TKA component and decreases the theoretical risk of infection. The major loss of motion after arthrolysis occurred during the first days following the arthroscopy. This is why we recommend using a regional anesthesia for the arthroscopy and during the following days to allow intensive mobilization of the knee. The arthrolysis should be done from 3 to 6 months after the TKA for better results.Arthroscopy for the treatment of knee stiffness, due to arthrofibrosis, following TKA is a useful, reliable and safe technique.

A cysteine protease that initiates degradation of vitellin (Vt) in the orthopteran Blattella germanica, and its proprotease precursor, were purified from yolk and partially characterized. The protease, purified 300-fold, contains three peptides of Mr 27,000, 29,000, and 31,000. A comparison of the purified enzyme's action pattern on Vt in vivo and in vitro confirmed its role in Vt processing. Protease-deficient yolk (day 0 postovulation) contained peptides of Mr 35,500, 37,000, 39,000, and 41,000, which were absent from yolk with protease activity. These were replaced by three peptides of approximately Mr 29,000, at days 2-3, the same time in development that protease expression and acidification of yolk granules occur (Nordin, J. H., Beaudoin, E. L., and Liu, X. (1991) Arch. Insect Biochem. Physiol. 18, 177-192). Acidification of purified proprotease converted it to three peptides of approximately Mr 29, 000 with cysteine protease activity. This conversion also required participation of a cysteine protease. Activated proprotease had the same pH activity profile, susceptibility to inhibitors, and cathepsin classification (L) as the protease. These results indicate that the Vt-processing protease is derived from a proprotease, which is activated in vivo by a developmentally regulated decrease in intragranular pH.

To assess the prevalence of lead intoxication in children in a defined low-risk population at the new levels recommended by the Centers for Disease Control and Prevention.During an 11-month period, whole blood lead tests were performed on 4678 children at routine well-child visits at 9 months and 2 years of age. For the last 8 months of the study, parents were asked to complete a prescreening risk factor questionnaire at these visits. The questionnaire and blood lead results were then matched. Data were collected from October 1, 1991 through August 31, 1992.The study subjects were all enrolled in Group Health, Inc, a large health maintenance organization. Its 17 staff model clinics serve urban and suburban populations in the Minneapolis-St. Paul area. More than 95% of the population had coverage based on employment, not Medicaid.Results indicated that 2.5% (n = 119) of the children had BPb levelsor = 10 micrograms/dL. Urban clinics had rates of elevated BPb levels three to eight times those of suburban clinics (P.00001), but the number of elevated BPb levels at the suburban clinics was greater than expected. BPb levels were significantly higher in summer and fall (P.00001). The prescreening questionnaire addressed five areas potentially associated with risk according to the literature: housing, siblings with lead poisoning, parental hobbies or work involving lead, proximity to highways, and use of cultural medicines. Positive correlations were found between elevated BPb levels and residences built before 1950 (P.00001). For children living in housing built before 1950, positive correlations were found between elevated blood lead levels and peeling paint (P.01) or remodeling (P.0001).Children who are at low socioeconomic risk but who live in housing built before 1950 are at increased risk for lead poisoning. The risk is greater if the house has peeling paint and especially if there is recent or ongoing renovation. Recommendations based on these results and the Centers for Disease Control and Prevention guidelines are made for screening programs in similar populations, and for the need to increase community awareness concerning this issue.

After defining the respective indications for the various knee prostheses: single-compartment, three-compartment sliding and hinge prostheses, essentially based on the preoperative radiological assessment, the authors emphasise the value of such films in operative planning. They then describe the radiological criteria of correct implantation of the three different types of prosthesis. Lastly, they stress the value of regular radiological follow-up of these arthroplasties looking for possible complications such as instability, loosening, wear and infection, which may alter the patient's osteoligamentous capital and his functional prognosis.

Isolated injuries of the scapho-trapezial ligament complex are not well recognized. The ligament complex comprises the stout scapho-trapezial ligament, the floor of the flexor carpi radialis (FCR) tendon sheath and the scapho-capitate ligament. Between August 1991 and May 1992, we diagnosed and treated four cases of partial chronic post-traumatic lesions of this ligament complex. There was chronic pain at the base of the thenar eminence and instability of the thumb-index-middle finger pinch. Standard X-rays were normal. The diagnosis of ligament rupture was confirmed by mid-carpal arthrography showing filling of the sheath of FCR tendon. Surgical exploration showed complete rupture of the tendon sheath of FCR in two cases, associated in the other two cases with complete rupture of the scaphotrapezial ligament. Direct repair of the ligamentous elements was performed in all cases. The tendon of FCR was sutured to the tubercle of scaphoid to protect and to reinforce the ligament repair. The patients have been followed-up for between 6 and 12 months. All four patients recovered normal pinch strength to the middle finger. One patient suffered from chronic pain at work.

The galactomannan of surface grown Aspergillus niger has been isolated by alkaline extraction of hyphal walls and characterized structurally. Its elution profile, from a column of Bio-Gel P-150, reveals a broad range of molecular sizes grouped into two fractions. Gas chromatographic and colorimetric analyses indicate that each fraction is composed of approximately equimolar quantities of galactose and mannose plus 12 to 14% glucose. Both have similar low optical rotations and contain acid labile galactose. Methylation, Smith degradation, acetolysis, reactivity with concanavalin A and beta-D-galactofuranosidase, plus digestionof galactose with D-galactose oxidase, were techniques employed to determine the polysaccharide's covalent structure. Results of these studies indicate that it is composed of a series of chains, 5 to 9 hexose units in length, connected by alpha1 leads to 6 bonds between mannopyranosyl moieties. The external portion of each chain consists of a galactose tri- or tetrasaccharide of the general structure Galf beta1 leads to 4 Galp(1-2) 1 leads to 4 Galp1 leads to. This segment is connected via a (1 leads to 2) linkage to the internal portion which is a di- to pentasaccharide of mannopyranosyl units joined in alpha1 leads to 2 glycoside linkage. Combination mild acid hydrolysis and methylation experiments indicate galactofuranosyl terminal units are attached only to galactose. The organization of glucose into the overall structure of the polymer has not been determined. Structural relationships of this polysaccharide to both fungal and yeast galactomannans are discussed.