7-year follow-up after open reduction and internal screw fixation in Bennett fractures

Bennett fractures are unstable, and, with inadequate treatment, lead to osteoarthritis, weakness and loss of function of the first carpometacarpal joint. This study focuses on long-term functional and radiological outcomes after open reduction and internal fixation.

Stabilization of Juxta-Physeal Distal Tibial and Fibular Fractures in a Juvenile Tiger Using a Hybrid Circular-Linear External Fixator

OBJECTIVE: To report stabilization of closed, comminuted distal metaphyseal transverse fractures of the left tibia and fibula in a tiger using a hybrid circular-linear external skeletal fixator. STUDY DESIGN: Clinical report. ANIMAL: Juvenile tiger (15 months, 90 kg). METHODS: From imaging studies, the tiger had comminuted distal metaphyseal transverse fractures of the left tibia and fibula, with mild caudolateral displacement and moderate compression. Multiple fissures extended from the fractures through the distal metaphyses, extending toward, but not involving the distal tibial and fibular physes. A hybrid circular-linear external skeletal fixator was applied by closed reduction, to stabilize the fractures. RESULTS: The fractures healed and the fixator was removed 5 weeks after stabilization. Limb length and alignment were similar to the normal contralateral limb at hospital discharge, 8 weeks after surgery. Two weeks later, the tiger had fractures of the right tibia and fibula and was euthanatized. Necropsy confirmed pathologic fractures ascribed to copper deficiency. CONCLUSION: Closed application of the hybrid construct provided sufficient stability to allow this 90 kg tiger's juxta-articular fractures to heal with minimal complications and without disrupting growth from the adjacent physes.

Use of a painless external fixator for unilateral mandibular fracture repair in nine equids

OBJECTIVE: To report use of a pinless external fixator (PEF) for unilateral mandibular fractures in 9 equids. STUDY DESIGN: Case series. ANIMALS: Equids (n=9) with unilateral mandibular fractures. METHODS: All fractures were stabilized with the AO/ASIF PEF using a minimum of 4 clamps, under general anesthesia. Fracture configuration, complications, outcome, and owner satisfaction were evaluated. RESULTS: All fractures were stabilized; 2 equids were euthanatized; 1 because of an inability to stand after surgery and 1 because of owner decision after PEF dislodgement. Seven repairs healed with good outcome and owner satisfaction. Complications included dislodgement of the PEF (3), bone sequestration (3), and weight loss (1). Drainage associated with repair resolved after removal of sequestra and clamps. CONCLUSIONS: Stabilization of unilateral mandibular fractures with the PEF in horses was minimally invasive with minimal risk of tooth root interference; however, after care is time consuming. CLINICAL RELEVANCE: PEF is an alternative technique for stabilizing unilateral mandibular fractures in equids.

Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery

Background and purpose Endovascular therapy is used increasingly for treatment of acute symptomatic internal carotid artery (ICA) occlusion, although randomized trials are lacking. Predictors of outcome are therefore of special interest. Methods From 1992 to 2010 we treated 201 patients with acute ICA occlusion with intra-arterial pharmacological thrombolysis (32), endovascular mechanical therapy (78) or a combination of both (91). All data were assessed prospectively. Results There were 76/38% patients with tandem occlusions [ICA plus middle (MCA) or anterior cerebral arteries (ACA)], 18/9% without concomitant occlusions of major intracranial arteries (ICA plus branch occlusion) and 107/53% with functional ICA-T occlusions (ICA plus MCA and ACA). Median baseline National Institute of Health Stroke Scale (NIHSS) score was 17. Good recanalization (Thrombolysis in Myocardial Infarction 2–3) was achieved in (157/201) 78% patients and good reperfusion (Thrombolysis in Cerebral Infarction 2–3) in (151/182) 83%. Better recanalization rates were obtained with mechanical approaches, with/without thrombolytics (78/91 = 86% and 64/78 = 82%) compared with pharmacological thrombolysis only (15/32 = 47%; P < 0.001). Twelve patients (6%) suffered symptomatic intracranial haemorrhages. The 3-month outcome was favourable [modified Rankin score (mRS) 0–2] in 54/28% patients and moderate (mRS 0–3) in 90/46%; 60/31% patients died. Only 17/16% patients with functional ICA-T occlusions had favourable outcomes compared with 32/44% with tandem occlusions and 5/31% with ICA plus cerebral branch occlusions (P = 0.001). In multivariate analysis age [odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.93–0.98], NIHSS on admission (OR = 0.9, 95% CI = 0.83–0.98) and functional ICA-T occlusion (OR = 0.35, 95% CI = 0.16–0.77) were non-modifiable predictors, and vessel recanalization was the only modifiable predictor of outcome (OR = 9.30, 95% CI = 2.03–42.63). Conclusions The outcome of acute symptomatic ICA occlusion is poor. However, recanalization is associated with better outcome, and recanalization rates with mechanical techniques were superior to merely pharmacological recanalization attempts.

Internal vs. external connections for abutments/reconstructions: a systematic review

The objectives of the review were (1) to evaluate the accuracy of implant-level impressions in cases with internal and external connection abutments/reconstructions, and (2) to evaluate the incidence of technical complications of internal and external connection metal- or zirconia-based abutments and single-implant reconstructions.

INTERNAL AUDIT AND GROWTH OF PUBLIC INSTITUTIONS

The ONATRACOM was established by the law number 08/2007 of 03/02/2007 determining the responsibilities, organization and functioning of Rwanda Public Transport Authority with function of promoting public transportation between Rwanda and other countries; participating in the implementation of the public transportation policy of Ministry in charge of transportation; perform any other activity that is directly or indirectly related to its objectives; and establish relations and collaborate with other regional and international agencies with similar attributions. In the recent days many public institutions have been listed by general auditor for being mismanaged and are on the course of deficit. This study aimed at examining internal audit growth of public institutions, case study of ONATRACOM – Rwanda. This research was conducted as a case study using ONATRACOM in NYARUGENGE District. The study was built at four specific objectives which are to determine if internal audit lead to the business growth of ONATRACOM, to find out if achieving internal audit increases the net profit and sales of ONATRACOM, to explore if there is internal sources of funds for pursuing growth opportunities in ONATRACOM, to assess whether ONATRACOM is able to obtain external sources of funds for pursuing growth opportunities as a result of internal audit impact or not. The findings were got from 27 respondents as the sample from the total target population of 96. Questionnaire was used as the technique to obtain primary data, while secondary data were obtained through examining the existing literature about the study. Chapter four presents the finding in form of descriptive statistical tables starting with the profile of the respondent and findings in line with the research objectives, It was found out that ONATRACOM was failure in its services because it was not achieve its targeted objectives and in this company, the internal audit was not effective in order to make performance of that company.

Microwave-Assisted Phospha-Michael Reactions with Internal Alkenes

The atom efficient phospha-Michael reaction between bis 4-methylphenyl phosphine oxide and several activated internal alkenes has been shown to occur under microwave irradiation without added solvent or catalyst. The alkenes used for this study were ethyl 4-nitrocinnamate, two chalcones ((E)-3-(4-methoxy-phenyl)-1-(4- nitrophenyl)-prop-2-en-1-one and (E)-1-(4-methoxyphenyl)-3-(3-nitro-phenyl)-prop-2- en-1-one), and 2-phenylmethylene-propanedinitrile. In the case of ethyl 4-nitrocinnamate, reaction with bis 4-methylphenyl phosphine oxide for sixty minutes at 130 °C yielded the desired phospha-Michael product in a 55% yield after purification. Varying the location of the nitro group on the phenyl rings of the chalcones did not seem to have a large effect on their reactivity. By NMR, both chalcones seemed to react to the same extent when the reaction times and temperatures were held constant. Interestingly, a phospha-Michael reaction was observed at a reaction temperature of 65°C for experiments involving 2- phenyl-methylene-propanedinitrile while the other substrates required a reaction temperature of 130 °C. Similar experiments were carried out with bis mesityl phosphine oxide and two internal alkenes: 2-phenylmethylene-propanedinitrile and ethyl-2-cyano-3- methyl-2-butenoate. These experiments did not yield any of the predicted phospha- Michael products, which suggest steric limitations to the Michael donor for this reaction.