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[Controlled vacuum extraction by measuring the pressure exercised by the truss (author's transl)].

The article explains a method for measuring the adhesivity between the anterior part of the foetus and the suction bulb of the vacuum extractor described by Malmström (1). The cover plate of the suction bulb, which is fitted with an expanding measuring strip, is used for reading off the measurements. This enables a quantitative recording of the pressure existing between the foetal part and the truss which corresponds very closely with the adhesivity of the suction bulb to the anterior part of the foetus. The device allows control and recording by means of an instrument with indicator and scale and a recording device. In this manner, vacuum extraction can be subjected to continuous control, thus rendering this obstetric procedure safer and easier.

Extraction, Obstetrical

Trusses.

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Equipment Design

Trusses.

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Aged

1H NMR studies of DNA recognition by the glucocorticoid receptor: complex of the DNA binding domain with a half-site response element.

The complex of the rat glucocorticoid receptor (GR) DNA binding domain (DBD) and half-site sequence of the consensus glucocorticoid response element (GRE) has been studied by two-dimensional 1H NMR spectroscopy. The DNA fragment is a 10 base-pair oligonucleotide, 5'd(GCTGTTCTGC)3'.5'd-(GCAGAACAGC)3', containing the stronger binding GRE half-site hexamer, with GC base pairs at each end. The 93-residue GR-DBD contains an 86-residue segment corresponding to residues 440-525 of the rat GR. Eleven NOE cross peaks between the protein and DNA have been identified, and changes in the chemical shift of the DNA protons upon complex formation have been analyzed. Using these protein-DNA contact points, it can be concluded that (i) the "recognition helix" formed by residues C460-E469 lies in the major groove of the DNA; (ii) the GR-DBD is oriented on the GRE half-site such that residues A477-D481, forming the so-called D-loop, are available for protein-protein interaction in the GR-DBD dimer on the intact consensus GRE; and (iii) the 5-methyl of the second thymine in the half-site and valine 462 interact, confirming indirect evidence [Truss et al. (1990) Proc. Natl. Acad. Sci. U.S.A. 87, 7180-7184; Mader et al. (1989) Nature 338, 271-274] that both play an important role in GR-DBD DNA binding. These findings are consistent with the model proposed by Härd et al. [(1990) Science 249, 157-160] and the X-ray crystallographic complex structure determined by Luisi et al. [(1991) Nature 352, 497-505].

Amino Acid Sequence

Surface tension and the dodecahedron model for lung elasticity.

Macroscopic elastic moduli governing the incremental deformations of lung parenchyma are calculated on the basis of a model for an individual lung element in the shape of a regular dodecahedron. Elastic stiffness within the element is provided by pin-jointed tension members along the edges of the dodecahedron, surface tension is incorporated into its pentagonal faces, and the influence of transpulmonary pressure is simulated by an externally applied hydrostatic tension. The analysis is based on a variational statement of nonlinear structural mechanics, and the results show how the moduli depend on the effective inflation pressure, the constitutive behavior of the idealized truss members, and the surface-area dependent surface tension. The theory is discussed in the light of available experimental information. A more general analysis is needed to account for the effects of structural as well as surface-tension hysteresis.

Elasticity

Nonlinear analysis of intervertebral disk under dynamic load.

This study pertains to the response of intervertebral joint under dynamic axial load. The numerical model represents two vertebral bodies with an interposed disk and uses three-dimensional elements. A transversely isotropic material law is adopted for cortical bone and an isotropic law for cancellous bone. Annulus collagen fibers are modelled using truss elements with no compressive resistance. The disk material is assumed hyperelastic, using a mixed finite element approach, allowing a representation of the disk involving the incompressibility characteristics for the material. The analysis considers finite displacement and strain fields under dynamic load. Intensity, trend and distribution of loads on the vertebral body are deduced from the literature. The problem is investigated with reference to different compressibility levels of disk material related to disk degenerationn phenomena.

Biomechanical Phenomena

External herniae: ventral herniae and summary.

1. In three articles, inguinal, femoral, and ventral herniae have been discussed, one of the aims being to draw the attention of those who are new to surgery in the tropics to some of the things the author thought were peculiar to these herniae. Experiences in the 1,100-bed Korle Bu Hospital, Accra, where a retrospective survey showed that 609 external herniaw were mended in 15 months, formed the basis of the discussions. 2. The applied anatomy of the inguinal canal of adult Ghanaians was described. Three things were pointed out: the infantile type of inguinal hernia was the rule not the exception; the floor and the conjoint tendon were well developed and useful for repair; the pubic branch of the inferior epigastric artery was normal not aberrant. 3. IN Accra inguinal herniae are big and a man's disease. The differential diagnosis of scrotal hernia includes vaginal hydrocele, scrotal elephantiasis, testicular tumours, and tuberculous epididymoorchitis. A case was made in favour of differentiating between direct and indirect inguinal herniae preoperatively. 4. Elective herniorrhaphy was recommended as the treatment of choice and operative techniques were described. The suture material to employ for the Bassini repair must be non-absorbable, e.g. silk or nylon. Whereas herniotomy is adequate in children, in women herniorrhaphy is combined with clearance and obliteration of the inguinal canal. 5. The author did not recommend a truss for an inguinal let alone a femoral hernia. There is suggestive evidence that even in the tropics a man's hernia could be safely repaired on an out-patient basis. 6. Since femoral hernia is rare, it was recommended that in the interest of the patients, skillful surgeons should repair them. 7. The surgical anatomy of the femoral canal, and clinical features of femoral hernia were described. The differential diagnosis included inguinal hernia, abscesses in the groin, hydrocele of the femoral canal, saphena varix, lymphadenopathy, simple tumours and aneurysm of the femoral artery. 8. The treatment of choic is a surgical operation of which three were named and one described ("the low" operation of Lockwood). Recurrence is rare...

Cesarean Section

[Mechanical principles of L-trapezoid compression plate in the fixation of trochanter fractures].

Three pairs of human cadaver femur were used for simulation electric test with load on both legs and single leg. An Evans III osteotomy was made, and stabilized with L-trapezoid compression plate (L-TCP). L-angled plate (L-AP) 95 degrees and 130 degrees respectively. The results demonstrated that the stability of fixation of L-TCP was significantly greater than L-AP. Since the cancellous screw of L-TCP can hold the proximal fragment and forms a stable triangular truss with the L end, the bony support of the medial posterior part can be reconstructed by holding the lesser trochanter with the lag screw. From June 1980 to August 1990, 68 patients with 71 trochanter fractures and osteotomies were treated with L-CTP. 54 patients with 57 fractures and osteotomies were followed up for 6-52 months. All fractures and osteotomies were healed. No bone cutting off failure was encountered. The hips and knees of 51 patients (54 limbs) (94.8%) showed excellent and good functions. Infection occurred in 3 patients (4.4%). Varus deformity developed in 2 patients with an Evans IV fracture, and plate fracture occurred in one of them.

Aged

[Preternatural anus and its care (author's transl)].

The most careful surgical technique, the guiding principles of which are outlined, is a prerequisite for the subsequent possibilities for correct care of preternatural anus and for preventing otherwise unavoidable complications. Four different programs are available to us for care; truss pad, adhesive bag, irrigation therapy and the Erlanger magnetic closure. For prophylaxis of frequent hernias and prolapses, wearing a made-to-measure body binder is indispensable. Skin lesions, formerly feared concomitant symptoms, can now be prevented or eliminated as a result of the development of non-irritant adhesives, combinations with sterculia rings or adhesive plasters and differentiated skin care products. A more comprehensive organization of those with preternatural anus within the framework of the German Ilco and the establishment of preternatural anus clinics and therapists would be desirable.

Aftercare

[Osteosynthesis of thalamic fractures of the calcaneus using triangulation-fixed 1/4-tube plates. Preliminary results of 32 osteosyntheses].

The authors present a new type of osteosynthesis fixture used in calcaneal thalamus fracture repair. This consists in triangulation fixation, the upper- and retromost part of the thalamus being the apex of the triangle. This is performed using 2 or 3 1/4-tube A.O. instrumentation plates, with adaptable positioning according to the type of fracture. This system presents two advantages compared to currently used fixation components: it is less bulky and is associated with a reduced risk of skin-related complications. Calcaneal reconstruction is much more stable because the plates are in alignment with talocalcaneal stress lines, on the one hand, and because they form a truss that counteracts secondary displacement of the reconstructed thalamus. 32 calcaneal syntheses were thus performed during the period between July 1983 and July 1988. These included 8 stage III DUPARC fracture cases (25%), 21 stage IV cases (65.6%), and 3 stage V cases (9.4%). Nine 2-plate fixtures were assembled in an circumflex-like manner and 23 operations involved setting up the fixation components in a "closed triangle". Cuboid anchorage was necessary in 11 cases. Uncomplicated cutaneous necrosis occurred only once in this series (i.e., 3.2%). The stability of this operative procedure was assessed by measurements of Boehler's angle in the immediate postoperative period and after consolidation. The fixation was perfectly stable in 94% of cases (angle loss less than or equal to 5 degrees). Secondary angle loss occurred in 6% of cases (i.e., 2 cases, 8 degrees and 12 degrees respectively), one of which was caused by untimely weight-bearing. Moreover, no case of plate disruption was reported in this series.

Adult

Inguinal hernia repair in England.

120,000 groin hernias are repaired every year in Britain by the 1,000 consultant general surgeons and their junior staff. Most of these are elective operation and the average patient stays in hospital for slightly less than a week. Some patients only present to the doctor when a complication of their hernia develops which requires an emergency operation. A few people prefer to live with truss. We must hope that the increasing safety of surgery and free health care will gradually eliminate both these latter two categories of patient.

Anesthesia, Local