Hip fracture incidence in the canton of Vaud, Switzerland, 1986-1991.

The objective of this study was to estimate the incidence of hip fracture in the canton of Vaud, Switzerland (total population 584 000), for the period 1986-1991 using routine hospital discharge data collected by the Cantonal Service of Statistical Research and Information (SCRIS). For the survey period, the estimated average annual crude incidence rate of hip fractures was 167 per 100 000 persons aged 20 or older (241 for women and 84 for men). For the population aged 50 years or older, the crude incidence rate was 388 per 100 000 persons (546 for women and 185 for men). The average annual age-specific rates rose exponentially by successive 5-year age groups. The median age of patients at the time of the fracture was 82 years in women and 74 years in men. There was no significant difference between the total number of cervical and trochanteric fractures. Between the ages of 20 and 84 years, the cumulative risk for a woman to be admitted to hospital with a hip fracture was twice that of a man (15.8% vs 7.8%). From 1986 to 1991, the age- and sex-adjusted incidence, like the ratio of cervical to trochanteric fractures, did not show any significant trend, although it was consistent with an increase in men (p=0.09). However, the annual number of fractures rose from 644 to 776, particularly among very aged men. The mean length of stay in the acute care hospital fell from 38 days in 1986 to 25 days in 1991. Finally, the comparison of these results with those obtained in 1986 for the same population from more exhaustive sources has confirmed the provision of a consistent, although overestimated, assessment of hip fracture incidence by means of these routine hospital statistics in the canton of Vaud, Switzerland.

Vertebral microarchitecture and fragility fracture in men: a TBS study.

INTRODUCTION: Although osteoporosis is considered a disease of women, 25% of the individuals with osteoporosis are men. BMD measurement by DXA is the gold standard used to diagnose osteoporosis and assess fracture risk. Nevertheless, BMD does not take into account alterations of microarchitecture. TBS is an index of bone microarchitecture extracted from the spine DXA. Previous studies have reported the ability of the spine TBS to predict osteoporotic fractures in women. This is the first case-controlled study in men to evaluate the potential diagnostic value of TBS as a complement to bone mineral density (BMD), by comparing men with and without fractures. METHODS: To be eligible for this study, subjects had to be non-Hispanic US white men aged 40 and older. Furthermore, subjects were excluded if they have or have had previously any treatment or illness that may influence bone metabolism. Fractured subjects were included if the presence of at least one fracture was confirmed. Cases were matched for age (±3 years) and BMD (±0.04 g/cm(2)) with three controls. BMD and TBS were first retrospectively evaluated at AP spine (L1-L4) with a Prodigy densitometer (GE-Lunar, Madison, USA) and TBS iNsight® (Med-Imaps, France) in Lausanne University Hospital blinded from clinical outcome. Inter-group comparisons were undertaken using Student's t-tests or Wilcoxon signed rank tests. Odds ratios were calculated per one standard deviation decrease as well as areas under the receiver operating curve (AUC). RESULTS: After applying inclusion/exclusion criteria, a group of 180 male subjects was obtained. This group consists of 45 fractured subjects (age=63.3±12.6 years, BMI=27.1±4.2 kg/m(2)) and 135 control subjects (age=62.9±11.9 years, BMI=26.7±3.9 kg/m(2)) matched for age (p=0.86) and BMD (p=0.20). A weak correlation was obtained between TBS and BMD and between TBS and BMI (r=0.27 and r=-0.28, respectively, p<0.01). Subjects with fracture have a significant lower TBS compared to control subjects (p=0.013), whereas no differences were obtained for BMI, height and weight (p>0.10). TBS OR per standard deviation is 1.55 [1.09-2.20] for all fracture type. When considering vertebral fracture only TBS OR reached 2.07 [1.14-3.74]. CONCLUSION: This study showed the potential use of TBS in men. TBS revealed a significant difference between fractured and age- and spine BMD-matched nonfractured subjects. These results are consistent with those previously reported on for men of other nationalities.

Nitric oxide reduces Cl- absorption in the mouse cortical collecting duct through an ENaC-dependent mechanism.

Since nitric oxide (NO) participates in the renal regulation of blood pressure, in part, by modulating transport of Na(+) and Cl(-) in the kidney, we asked whether NO regulates net Cl(-) flux (JCl) in the cortical collecting duct (CCD) and determined the transporter(s) that mediate NO-sensitive Cl(-) absorption. Cl(-) absorption was measured in CCDs perfused in vitro that were taken from aldosterone-treated mice. Administration of an NO donor (10 μM MAHMA NONOate) reduced JCl and transepithelial voltage (VT) both in the presence or absence of angiotensin II. However, reducing endogenous NO production by inhibiting NO synthase (100 μM N(G)-nitro-l-arginine methyl ester) increased JCl only in the presence of angiotensin II, suggesting that angiotensin II stimulates NO synthase activity. To determine the transport process that mediates NO-sensitive changes in JCl, we examined the effect of NO on JCl following either genetic ablation or chemical inhibition of transporters in the CCD. Since the application of hydrochlorothiazide (100 μM) or bafilomycin (5 nM) to the perfusate or ablation of the gene encoding pendrin did not alter NO-sensitive JCl, NO modulates JCl independent of the Na(+)-dependent Cl(-)/HCO3(-) exchanger (NDCBE, Slc4a8), the A cell apical plasma membrane H(+)-ATPase and pendrin. In contrast, both total and NO-sensitive JCl and VT were abolished with application of an epithelial Na(+) channel (ENaC) inhibitor (3 μM benzamil) to the perfusate. We conclude that NO reduces Cl(-) absorption in the CCD through a mechanism that is ENaC-dependent.

Fracture de la paroi mediale de l'orbite. A propos de 4 observations. [Fracture of the medial wall of the orbit. Apropos of 4 cases]

Fractures or the medial wall of the orbit are uncommon and clinical signs are often discreet. This report was focused on isolated fractures of the medial wall of the orbit. Blow-out trauma is usually the cause. In these cases the clinical signs ranged from simple ecchymosis to blindness by haematoma of the orbital cone. Computed tomography is a major tool for diagnosis and making therapeutic indications for these fractures. Treatment depends on the oculomotor involvements as measured by forced duction tests.

Isolated bilateral zygomatic arch fracture: an unusual pattern.

Isolated fractures of the zygomatic arch represent 5% to 14% of all zygomatic complex fractures. Bilateral isolated zygomatic arch fractures, which are defined as fractures of both zygomatic arches without any other facial fracture, are extremely rare. In this case report, we present a rare case of this facial fracture pattern.

Defecto en la homeostasis del oxido nítrico. Mecanismo común subyacente de la insulino-resistencia, la hiperactividad simpática y la morbi-mortalidad cardiovascular [Defective nitric oxide homeostasis. Common underlying mechanism between insulin resistance, sympathetic overactivity and cardiovascular morbidity and mortality]

Obesity, insulin resistance and associated cardiovascular complications are reaching epidemic proportions worldwide and represent a major public health problem. Over the past decade, evidence has accumulated indicating that insulin administration, in addition to its metabolic effects, also has important cardiovascular actions. The sympathetic nervous system and the L-arginine-nitric oxide pathway are the central players in the mediation of insulin's cardiovascular actions. Based on recent animal and human research, we demonstrate that both defective and augmented NO synthesis represent a central defect triggering many of the metabolic, vascular and sympathetic abnormalities characteristic of insulin-resistant states. These observations provide the rationale for the use of pharmaceutical drugs releasing small and physiological amounts of NO and/or inhibitors of NO overproduction as a future treatment for insulin resistance and associated comorbidities.

A novel human aquaporin-4 splice variant exhibits a dominant-negative activity: a new mechanism to regulate water permeability.

Two major isoforms of aquaporin-4 (AQP4) have been described in human tissue. Here we report the identification and functional analysis of an alternatively spliced transcript of human AQP4, AQP4-Δ4, that lacks exon 4. In transfected cells AQP4-Δ4 is mainly retained in the endoplasmic reticulum and shows no water transport properties. When AQP4-Δ4 is transfected into cells stably expressing functional AQP4, the surface expression of the full-length protein is reduced. Furthermore, the water transport activity of the cotransfectants is diminished in comparison to transfectants expressing only AQP4. The observed down-regulation of both the expression and water channel activity of AQP4 is likely to originate from a dominant-negative effect caused by heterodimerization between AQP4 and AQP4-Δ4, which was detected in coimmunoprecipitation studies. In skeletal muscles, AQP4-Δ4 mRNA expression inversely correlates with the level of AQP4 protein and is physiologically associated with different types of skeletal muscles. The expression of AQP4-Δ4 may represent a new regulatory mechanism through which the cell-surface expression and therefore the activity of AQP4 can be physiologically modulated.

Lateral condyle fracture of the humerus in children treated with bioabsorbable materials

Les fractures du condyle externe de l'enfant sont un traumatisme relativement fréquent qui survient le plus souvent chez l'enfant entre 5 et 15 ans. Elles sont classées en 3 grades : le grade 1 sans déplacement qui peuvent être traitées conservativement et les grades 2 (déplacées) et 3 (disloquées) qui nécessitent une prise en charge chirurgicale par réduction ouverte et embrochage. Le traitement traditionnel de ces fractures consistent en la mise en place de broches/vis métalliques qui doivent être retirées quelques semaines plus tard lors d'une seconde intervention. Depuis les années 90, des matériaux bio-résorbables à base d'acide polyglycoliques sont apparus en chirurgie orthopédique et traumatologique. En raison de la survenue de complications telles que réactions inflammatoires, formation de séromes ou ostéolyse, l'utilisation du matériel conventionnel a été préférée. Cependant, depuis quelques années, de nouveaux matériaux en acide polylactique sont apparus sur le marché. La période de résorption étant beaucoup plus lente, ces matériaux induisent des réactions beaucoup plus faibles, sans conséquences cliniques relevées jusqu'à présent. Chez l'adulte, de récentes études ont prouvés l'efficacité et l'absence d'effets secondaires liés à ces matériaux. Par contre, chez l'enfant, peu d'études à moyen terme ont été réalisées et l'impact sur l'os en croissance est peu connu, même si pour l'heure aucune conséquence clinique n'a été relevée. Dans le cadre de notre étude, nous avons comparé 2 groupes d'enfants traités pour des fractures du condyle externe du coude. Le premier groupe traité par du matériel conventionnel et le second par matériel résorbable. Les enfants ont tous étés suivis de manière très étroite durant la première année et la récupération clinique est similaire pour les 2 groupes. A 4 ans du traumatisme, les résultats fonctionnels sont identiques pour les 2 groupes et aucune complication liée au matériel résorbable n'a été mise en évidence. Par ailleurs, à 1 et 4 ans, les clichés radiologiques montrent l'absence de lésions liées au matériel résorbable. En conclusion, dans le cadre de notre travail nous avons pu montrer l'efficacité des matériaux résorbables dans la prise en charge des fractures du condyle externe du coude chez l'enfant. Ces matériaux permettent d'optimiser la prise en charge de ce type de fracture en prévenant un risque opératoire et anesthésique liés à une seconde intervention nécessaire au retrait du matériel d'ostéosynthèse conventionnel. Par ailleurs le coût lié à la prise en charge globale de ce type de fracture est moindre lors de l'utilisation de matériel résorbable.

ENaC inhibition stimulates Cl- secretion in the mouse cortical collecting duct through an NKCC1-dependent mechanism.

In cortical collecting ducts (CCDs) perfused in vitro, inhibiting the epithelial Na(+) channel (ENaC) reduces Cl(-) absorption. Since ENaC does not transport Cl(-), the purpose of this study was to determine how ENaC modulates Cl(-) absorption. Thus, Cl(-) absorption was measured in CCDs perfused in vitro that were taken from mice given aldosterone for 7 days. In wild-type mice, we observed no effect of luminal hydrochlorothiazide on either Cl(-) absorption or transepithelial voltage (V(T)). However, application of an ENaC inhibitor [benzamil (3 μM)] to the luminal fluid or application of a Na(+)-K(+)-ATPase inhibitor to the bath reduced Cl(-) absorption by ∼66-75% and nearly obliterated lumen-negative V(T). In contrast, ENaC inhibition had no effect in CCDs from collecting duct-specific ENaC-null mice (Hoxb7:CRE, Scnn1a(loxlox)). Whereas benzamil-sensitive Cl(-) absorption did not depend on CFTR, application of a Na(+)-K(+)-2Cl(-) cotransport inhibitor (bumetanide) to the bath or ablation of the gene encoding Na(+)-K(+)-2Cl(-) cotransporter 1 (NKCC1) blunted benzamil-sensitive Cl(-) absorption, although the benzamil-sensitive component of V(T) was unaffected. In conclusion, first, in CCDs from aldosterone-treated mice, most Cl(-) absorption is benzamil sensitive, whereas thiazide-sensitive Cl(-) absorption is undetectable. Second, benzamil-sensitive Cl(-) absorption occurs by inhibition of ENaC, possibly due to elimination of lumen-negative V(T). Finally, benzamil-sensitive Cl(-) flux occurs, at least in part, through transcellular transport through a pathway that depends on NKCC1.

Tumor necrosis factor-alpha and alphaB-crystallin up-regulation during antibody-mediated demyelination in vitro: a putative protective mechanism in oligodendrocytes.

By using an in vitro model of antibody-mediated demyelination, we investigated the relationship between tumor necrosis factor-alpha (TNF-alpha) and heat shock protein (HSP) induction with respect to oligodendrocyte survival. Differentiated aggregate cultures of rat telencephalon were subjected to demyelination by exposure to antibodies against myelin oligodendrocyte glycoprotein (MOG) and complement. Cultures were analyzed 48 hr after exposure. Myelin basic protein (MBP) expression was greatly decreased, but no evidence was found for either necrosis or apoptosis. TNF-alpha was significantly up-regulated. It was localized predominantly in neurons and to a lesser extent in astrocytes and oligodendrocytes, and it was not detectable in microglial cells. Among the different HSPs examined, HSP32 and alphaB-crystallin were up-regulated; they may confer protection from oxidative stress and from apoptotic death, respectively. These results suggest that TNF-alpha, often regarded as a promoter of oligodendroglial death, could alternatively mediate a protective pathway through alphaB-crystallin up-regulation.

Prédiction de la fracture vertébrale: pouvoir discriminant de l'IMC, de la DMO, du TBS, du FRAX, seuls ou combinés. L'étude OsteoLaus.

Introduction. - L'ostéoporose est caractérisée par une diminution de la DMO et une altération de la microarchitecture (MA). La MA est évaluable en routine clinique par la mesure du Trabecular Bone Score (TBS), par simple ré-analyse de l'image lombaire de la DMO. Le TBS a démontré sa valeur diagnostique et pronostique, partiellement indépendante des FRC et le la DMO. Le but de la cohorte OsteoLaus est de combiner en routine clinique les FRC et les informations données par la DXA (DMO, TBS, VFA) et FRAX pour mieux identifier les femmes à risque de fracture. Matériels et Méthodes. - Dans la cohorte OsteoLaus (1 500 femmes, 50 à 80 ans, Lausanne, Suisse) les FRC, la DMO lombaire et de la hanche, l'IVA, le TBS et le FRAX sont relevés. La sensibilité et la spécificité des différents outils pour prédire les fractures vertébrales (FxV) de grade 2/3 ont été calculées. Résultats. - Nous avons inclus 451 femmes : âge 67,4 ± 6,7 ans, IMC 26,1 ± 4,6, DMO lombaire 0,943 ± 0,168 (T-score -1,4 SD), TBS 1,271 ± 0,103. La corrélation entre DMO et TBS est faible (r2 = 0,16). La prévalence des FxV 2/3 est de 9,3 %. Conclusion. - L'IMC a un mauvais pouvoir discriminant dans notre cohorte. Ces résultats préliminaires confirment l'indépendance partielle entre le TBS et la DMO. Une approche combinant TBS et FRAX semble être le meilleur compromis en termes de sensibilité/spécificité pour identifier les femmes avec une FxV 2/3 prévalente qui aurait pu être mal classifiée par la DMO ou le TBS ou le FRAX seuls.

Iliac wing fracture following graft harvesting from the anterior iliac crest: literature review based on a case report.

The morbidity of bone graft harvesting from the iliac crest has been widely discussed in the literature. For some authors, it is considered to be low and for others relatively high. We report on a case of a fracture of the iliac wing after graft harvesting from the anterior iliac crest despite good surgical technique. This complication is well known and most of these fractures heal uneventfully if treated conservatively. However, if anatomical and technical considerations are respected, the patient could be spared this inconvenience. Based on a literature review, we discuss the procedure's potential complications and how to avoid them in an update.

Traumatic hernia of the abdominal wall after pelvic and acetabular fracture: a case report.

Traumatic hernia of the abdominal wall is a rare and easily missed injury in the presence of major pelvic and abdominal lesions. We present a radiographically documented case of combined pelvic and acetabular fracture with a major contralateral traumatic hernia with avulsion of the internal oblique, the external oblique and the transverse abdominal muscles diagnosed four months after the initial trauma. To our knowledge no similar case has been described in the current literature.