[When the "tiger" from Teneriffa crushed admiral Nelson's arm].
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Amputation, Surgical↗
Biomedical subjects
A Ahlberg
Publications and source records attributed to A Ahlberg.
[Future cure of hearing disorders? Gene therapy and stem cell implantation are possible new therapeutic alternatives].
Hearing loss is a very common disorder; nearly 10 per cent of the population is affected. Recently, a few findings such as the roles of neurotrophins, nitric oxide, reactive oxygen species and glutamate receptors in the peripheral hearing system have been highlighted. In this review, focus is set on possible mechanisms of peripheral hearing disorders, and on recent advances to prevent and treat hearing loss. Clinically useful treatment strategies, especially gene therapy and the use of embryonic stem cells, are particularly stressed.
Animals↗
Solving story-based arithmetic problems: achievement of children with hearing impairment and their interpretation of meaning.
This article considers how a sample of Norwegian school children, ages 6 through 10 with hearing impairment, master three different types of elementary arithmetic problems presented in a nonreading format. The article outlines the effect of task-specific factors on the level of difficulty, as well as the children's understanding of problem structures. The results showed that semantic structure of the problems affected the level of difficulty. The problems were not solved significantly better by students from grade 4 than students from grade 1. Qualitative analyses revealed that the children interpreted the meaning of the imposed problems in three different ways: (1) as numbers and procedures, (2) as take-away situations, and (3) as part-part-whole relations.
Journal Article↗
The 1.8 A crystal structure of the dimeric peroxisomal 3-ketoacyl-CoA thiolase of Saccharomyces cerevisiae: implications for substrate binding and reaction mechanism.
The dimeric, peroxisomal 3-ketoacyl-CoA thiolase catalyses the conversion of 3-ketoacyl-CoA into acyl-CoA, which is shorter by two carbon atoms. This reaction is the last step of the beta-oxidation pathway. The crystal structure of unliganded peroxisomal thiolase of the yeast Saccharomyces cerevisiae has been refined at 1.8 A resolution. An unusual feature of this structure is the presence of two helices, completely buried in the dimer and sandwiched between two beta-sheets. The analysis of the structure shows that the sequences of these helices are not hydrophobic, but generate two amphipathic helices. The helix in the N-terminal domain exposes the polar side-chains to a cavity at the dimer interface, filled with structured water molecules. The central helix in the C-terminal domain exposes its polar residues to an interior polar pocket. The refined structure has also been used to predict the mode of binding of the substrate molecule acetoacetyl-CoA, as well as the reaction mechanism. From previous studies it is known that Cys125, His375 and Cys403 are important catalytic residues. In the proposed model the acetoacetyl group fits near the two catalytic cysteine residues, such that the oxygen atoms point towards the protein interior. The distance between SG(Cys125) and C3(acetoacetyl-CoA) is 3.7 A. The O2 atom of the docked acetoacetyl group makes a hydrogen bond to N(Gly405), which would favour the formation of the covalent bond between SG(Cys125) and C3(acetoacetyl-CoA) of the intermediate complex of the two-step reaction. The CoA moiety is proposed to bind in a groove on the surface of the protein molecule. Most of the interactions of the CoA molecule are with atoms of the loop domain. The three phosphate groups of the CoA moiety are predicted to interact with side-chains of lysine and arginine residues, which are conserved in the dimeric thiolases.
Acetyl-CoA C-Acyltransferase↗
Retrofascial nontuberculous psoas abscess.
Psoas abscess is usually associated with tuberculous spondylitis, but also occurs in relation to inflammatory bowel disease. We present 17 cases of primary pyogenic psoas abscess seen during a 10 year period at the King Fahd Hospital, Al-Khobar. There were 13 males and 4 females with a mean age of 24.9 years (range one to 55 years). Five patients had sickle cell disease. The average delay in presentation was 4.5 weeks (range 2 to 9 weeks). Pyrexia and a painful hip with a flexion deformity were the most obvious signs. The sedimentation rate and white cell count were markedly raised in every case. Staphylococci were cultured in 10 and anaerobic streptococci, salmonella and E coli in 2 each. Ultrasonography, CT and MR imaging were used to confirm the diagnosis. Early recognition and drainage are important to ensure a rapid recovery.
Adolescent↗
The scud missile disaster in Al-Khobar, Saudi Arabia, 1991: the orthopaedic experience.
The orthopaedic experience of the scud missile disaster in Al-Khobar, Saudi Arabia during the Gulf war is reviewed. This was by far the most severe of 70 scud attacks. The majority of casualties had 'orthopaedic' injuries, fractures and soft tissue lacerations of the extremities and the back. Our experience confirmed the importance of the principles of planning triage beforehand and open wound treatment with secondary suture. Repeated ward rounds with reassessment of the patients proved beneficial. The ready availability of hospital beds in high-risk situations of regional war highly facilitated the management of mass casualties.
Adult↗
Shigella osteomyelitis in a fit young man.
A case of shigella osteomyelitis in an apparently healthy young man is presented. Pre-operative and intra-operative swabs taken from the septic focus grew Shigella flexneri. Patient was successfully treated with surgery and a course of Ampicillin.
Adult↗
Fractured neck of the femur in young adults.
This retrospective study at King Fahd University Hospital was undertaken to assess the hospital-based incidence and the complication rate among young Saudi nationals with a fracture of the femur. Hospital records of 17 patients between 17 and 45 years of age (mean 27.4 years) with a fracture of the neck of the femur were studied for the period 1982 to 1988. Factors such as type and severity of injury, associated injuries, delay in internal fixation and the type of implant used, were analysed. Fracture of the neck of the femur in young adults was 28 per cent (22/79) of these fractures in all age groups during the study period. There were no complications encountered, such as avascular necrosis or late segmental collapse.
Adolescent↗
Osteoarthritis of the hip and knee in Saudi Arabia.
The records of 4721 patients, who were registered at a Primary Health Care Centre in the Eastern Province of Saudi Arabia during a 18 month period, were reviewed. One hundred and sixty-six (3.5%) had osteoarthritis of the hip or knee. The ratio of hip to knee was 1:80 which is very low compared to other populations, and the possible causes for this are discussed.
Age Factors↗
The anatomical pattern of gonarthrosis in Saudi Arabia.
Fifty patients in Saudi Arabia with primary gonarthrosis were randomly selected in order to study the anatomical pattern of the disease. Anteroposterior and lateral radiographs were taken with the patients nonweight-bearing and weight-bearing; axial projections of the patello-femoral joint were also taken. Involvement of more than one compartment was significantly more common than it was in a Swedish series. The patello-femoral joint was affected in 80% compared with 48% of the Swedish knees. Different living habits are suggested as a contributory cause for the different patterns of gonarthrosis in the two countries.
Adult↗
The syndrome of osteopetrosis, renal acidosis and cerebral calcification in two sisters.
The syndrome of osteopetrosis associated with renal tubular acidosis and cerebral calcification, inherited as an autosomal recessive disorder, as seen in two sisters, is described. The primary defect in this rare syndrome is deficiency of carbonic anhydrase (CA) II. Significant reduction in blood levels of CA II were found in both parents and another sister, suggesting that these individuals are heterozygotic carriers.
Acidosis, Renal Tubular↗
On geographical variations in the normal range of joint motion.
Fifty Saudi Arabian men 30 to 40 years of age without present or previous history of injury or disease related to the lower extremities were randomly selected for measurement of the range of motion in the basic planes of hip, knee, and ankle joint. The results were compared to a similar study from Scandinavia. There was a highly significant difference in external rotation of the hip, flexion of the knee, and dorsiflexion of the ankle. Cultural differences in the activities of daily life are suggested to explain the differences in the range of motion.
Adult↗
Computed tomography in hemophilic pseudotumor.
Computed tomography was used in 4 cases of hemophilic pseudotumor. Three of the patients were operated upon. The method proved to make the differential diagnosis safe and to yield valuable information on the extent of the lesion and the involvement of the skeleton and contiguous organs. The information facilitated the decision whether surgery was indicated and the planning of the operation as well as the follow-up of the conservatively treated case.
Adult↗
Radiologic evaluation of prophylaxis in severe haemophilia.
The effect of prophylactic treatment of severe haemophilia A and B was evaluated with a recently described radiologic score system for assessing the severity of arthropathy. The severity of the arthropathy was assessed in 50 patients with severe haemophilia receiving prophylaxis with factor VIII or IX (25--30 units factor VIII or IX/kg bodyweight at 4--7 day intervals), and in 9 in whom the condition was complicated by inhibitors and who were thus not receiving prophylaxis. The score values found in a recent investigation of the natural course of haemophilia served as controls in the evaluation of the effect of the prophylaxis. In the group with severe haemophilia receiving prophylaxis changes appeared only exceptionally in joints not affected already before the prophylaxis, and the course of the arthropathy and its severity according to age did not vary to any noteworthy extent from that in the control group with moderate haemophilia. In the cases complicated by inhibitors the joints were most often worse than those in the control group with severe haemophilia. It is concluded that prophylaxis has a considerable effect on the course of the arthropathy and the prophylaxis should be instituted at an early stage of the disease, when the joints are still unaffected.
Adolescent↗
Late results of ankle fusion.
Forty-four ankle joint fusions performed in the period 1950-1972 at the Department of Orthopedic Surgery, Malmö General Hospital, were evaluated. Thirty-one patients were re-examined. The mean follow-up time was 12.3 years (6.4-28 years). Two-thirds of the patients were much better or better than before operation, but still a lot of problems existed. Two-thirds of the patients had some kind of pain localized to the subtalar region. Three out of four patients had to use special footwear. The rate of forefoot deformities was not increased. In conclusion, patients with ankle fusion often have persistent trouble; therefore technical and clinical development of total ankle joint replacement seems to be indicated.
Ankle Joint↗
Secondary operations after knee joint replacement.
In 254 knee joint arthroplasties performed during the period between 1972 and 1977, secondary operations were done in 31 knee joints, a frequency of 12%. In the rheumatoid group the frequency was 6%, in those with osteoarthritis, 18%. Loosening was the indication for reoperation in 14 cases and infection in seven. Hinge prostheses required reoperations more often than the other types (Geomedic, St. Georg). Obesity and a previous operation on the same knee increased the risk of complication leading to reoperation. Reoperation involved exchange of prosthesis in 17 patients, arthrodeses in three, irrigation drain in three, femur amputation in one, and minor intervention in the remaining seven. The results of the reoperations were classified as good in 13 cases, fair in 12 and bad in six.
Arthritis, Rheumatoid↗
A procedure for removing high titer antibodies by extracorporeal protein-A-sepharose adsorption in hemophilia: substitution therapy and surgery in a patient with hemophilia B and antibodies.
A 37-yr-old hemophiliac with factor IX antibody in high titer required operation for a pseudotumor growing invasively into the bone in his left elbow. Exchange plasma-pheresis was not feasible, mainly because of possible stimulation of factor IX inhibitor. In addition, the patient had antibodies against tissue antigens. The factor IX antibodies were of IgG type and adsorbable to protein-A-agarose. The antibodies were removed by extracorporeal adsorption of the plasma (separated intermittently in a cell centrifuge) to sterile protein-A-Sepharose in columns, operated by a computer. The treated plasma was retransfused. In this manner, a total of 6000 ml of plasma was depleted of antibodies, and the antibody titer, as well as the total immunoglobulin content, decreased to one-fifth of the original values. The remaining antibodies were neutralized by infusion of factor IX concentrate. Conventional substitution therapy, in combination with immunosuppression, was then possible. The operation was performed without complications. No signs of hemolysis, complement activation, or activation of the coagulation system occurred. In principle, the same form of treatment can be used in patients with other forms of antibodies.
Absorption↗