Study Design:Prospective data collection on all patients with spinal cord injury (SCI) admitted for a comprehensive management programme. Objectives: To examine the epidemiology of SCI in Ireland over 1 year. Setting: Ireland's National Spinal Cord Injury Centre. Methods: Systematic data collection on all patients admitted with SCI for management. Results: A total of 46 patients (40 males) were admitted from January to December 2000; median age was 37 years (range 6-82 years). In all, 23 of the patients presented with cervical injuries, 19 patients had thoracic injuries. In all, 18 patients had complete injuries (American spinal injuries association (ASIA)). Motor vehicle collisions were the cause of 50% of SCI. Conclusions: The incidence of SCI in Ireland is 13.1 per million population. Demographic data from this study can go towards improving care for patients with SCI and also in the prevention of SCI.

The purpose of this study was to compare the bacteriologic and clinical efficacy of oral penicillin versus amoxicillin as first-line therapy for group A beta-hemolytic streptococcal (GABHS) tonsillopharyngitis. The prospective observational study was conducted over 18 months (January 2000-June 2001). Children enrolled had acute onset of symptoms and signs and a laboratory-documented GABHS tonsillopharyngitis illness. Follow-up examination and laboratory testing occurred 10 +/- 4 days following completion of treatment. In total, 389 patients were enrolled (intent-to-treat group): 195 received penicillin V and 194 received amoxicillin. Fifty-six of the penicillin-treated and 57 amoxicillin-treated patients refused to take the drug, or were noncompliant, or did not return for the follow-up visit, leaving 276 patients in the per-protocol group: 139 penicillin-treated and 137 amoxicillin-treated. Bacteriologic cure for amoxicillin-treated children occurred in 76% versus 64% in the penicillin-treated children (p = 0.04). The clinical cure rate for amoxicillin-treated children was 84% compared to 73% in the penicillin-treated children (p = 0.03). Since treatment allocation was not randomized, logistic regression analysis was used to adjust for treatment group differences. The odds ratio (OR) estimate for cure for patients in the amoxicillin versus penicillin V treatment group remained significant (OR = 1.84, 95% confidence interval 1.02-3.29); the same was true for dinical cure (OR = 1.99, 95% CI = 1.02-3.87). Amoxicillin may be superior to penicillin for bacteriologic and clinical cure of GABHS tonsillopharyngitis.

Compartment syndrome in the well leg as a complication of prolonged positioning in a hemilithotomy position is a serious complication that is rarely reported in the orthopaedic literature. A similar entity has been well described in urologic, gynecologic, and general surgery literature but, to the authors' knowledge, has been reported in only seven patients in the orthopaedic literature. The authors report two cases of unilateral compartment syndrome in a well leg during femoral nailing of the contralateral leg. Risk factors, theories of pathogenesis, and preventive measures are identified and discussed.

Compression foot pumps are widely used for the prevention of postoperative venous thrombosis. We tested the efficiency of the pump in ten healthy subjects; the velocity of venous blood flow in the common femoral vein was measured in the horizontal, Trendelenberg (foot-up) and reverse-Trendelenberg (foot-down) positions. Application of the foot pump produced an increase in the venous velocity in all subjects. The mean increase in the horizontal position was 27.2% and in the Trendelenberg position 15.4%. In the reverse-Trendelenberg position, the foot pump produced a mean increase of 102.8%. The efficiency of the compression foot pump in increasing venous return is improved by adopting the reverse-Trendelenberg position. This may increase its thromboprophylactic effect.

C ompression foot pumps are widely used for the prevention of postoperative venous thrombosis. We tested the efficiency of the pump in ten healthy subjects; the velocity of venous blood flow in the common femoral vein was measured in the horizontal, Trendelenberg (foot-up) and reverse-Trendelenberg (foot-down) positions.Application of the foot pump produced an increase in the venous velocity in all subjects. The mean increase in the horizontal position was 27.2% and in the Trendelenberg position 15.4%. In the reverse-Trendelenberg position, the foot pump produced a mean increase of 102.8%.The efficiency of the compression foot pump in increasing venous return is improved by adopting the reverse-Trendelenberg position. This may increase its thromboprophylactic effect.

This study compares the functional outcomes of retrograde and antegrade femoral nailing for femur shaft fractures. Thirty-two patients who underwent femoral nailing for femur shaft fractures at 2 urban level I trauma centers were evaluated retrospectively. Fourteen nails were inserted retrograde (13 patients) and 19 were inserted antegrade. A comparison of clinical outcomes between retrograde and antegrade nailing was performed. Data collected included patient demographics, injury and treatment details, Injury Severity Scores (ISS), New Injury Severity Scores (NISS), hospital length of stay, intensive care unit length of stay, and complications and reoperations. Knee and hip function was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS). A complete physical examination of the knee and hip was performed. Data analysis was performed using nonparametric tests. The average time to follow-up was 48.2 months. The 2 groups were not equivalent with respect to hospital length of stay, number of additional injuries and surgeries, and fracture location. The groups were equivalent with respect to age, time to follow-up, ISS, NISS, and intensive care unit length of stay. Knee scores and knee range of motion (ROM) were significantly worse in the retrograde group. Hip function was not significantly different between groups.

Gustilo and Anderson type IIIB open tibia fractures are associated with high rates of surgical site infection, wound complications, and flap failure. Controversy surrounds the optimal timing and method of wound management prior to flap coverage. No studies to date have investigated the use of negative pressure wound therapy with instillation and dwell for open type IIIB tibia fractures. We present a single case of an open type IIIB tibia fracture that was managed with 21 days of circumferentially applied negative pressure wound therapy with instillation and dwell prior to flap coverage. Our results suggest that negative pressure wound therapy with instillation and dwell may minimize infection risk, decrease wound size, and allow for delayed soft tissue coverage.

Understanding the interaction of O2 with ketones on metal oxide surfaces is important for the photo-oxidation of toxic organic molecules. The consecutive reaction steps of acetone molecules with oxygen adatoms (Oa's) on partially oxidized TiO2(110) surfaces have been studied using high-resolution scanning tunneling microscopy (STM) at 300 K. The sequential isothermal STM images reveal two types of acetone-Oa species as a result of reactions of acetone with an oxygen adatom and a bridging bound oxygen vacancy (V(O)). One such species is the Ti5c-bound acetone-Oa diolate formed from Ti5c-bound acetone reacting with Oa. The diolate is mobile at 300 K and can assist the diffusion of surface Oa by exchanging the acetone oxygen with the Oa. The second acetone-Oa species is the V(O)-bound acetone-Oa complex formed from a V(O)-bound acetone reacting with an Oa located on the neighboring Ti row. The V(O)-bound complex is stationary at 300 K. This species has not been reported previously.