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Sample records for 1-stage revision anterior

  1. Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

    2014-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  2. Two-Stage Revision Anterior Cruciate Ligament Reconstruction.

    PubMed

    Erickson, Brandon J; Cvetanovich, Gregory; Waliullah, Khalid; Khair, Michael; Smith, Patrick; Bach, Bernard; Sherman, Seth

    2016-05-01

    The number of primary anterior cruciate ligament (ACL) tears is rapidly increasing. In patients who wish to return to their preoperative level of function, specifically as it pertains to participation in sports, the gold standard of treatment following an ACL tear remains an anterior cruciate ligament (ACL) reconstruction. Despite a majority of good/excellent results following primary ACL reconstruction, there is a growing subset of patients with persistent or recurrent functional instability who require revision ACL reconstruction. Preoperative planning for revision ACL reconstruction requires a careful understanding of the root cause of ACL failure, including possible technical causes of primary ACL failure and the presence of combined knee pathology that was not addressed at the index ACL reconstruction. The decision to perform 2-stage revision ACL reconstruction is multifactorial and is reached by technical considerations that may make a 1-stage revision less optimal, including tunnel widening, arthrofibrosis, active infection, and others. Concomitant knee pathology such as meniscal deficiency, malalignment (including an increase in posterior tibial slope), chondral lesions, and other ligamentous laxity may also require a staged approach to treatment. This evidence-based review covers the indications for 2-stage revision ACL reconstruction, surgical techniques, evidence for and technique of bone grafting prior ACL tunnels, and outcomes of 2-stage revision stratified by initial cause of ACL reconstruction failure. With proper preoperative planning and an understanding of the cause of failure following the primary ACL reconstruction, revision ACL reconstruction can offer excellent outcomes in the motivated patient. [Orthopedics. 2016; 39(3):e456-e464.].

  3. Clinical Outcomes Following Revision Anterior Shoulder Stabilization

    PubMed Central

    Frank, Rachel M.; Mellano, Chris; Shin, Jason J.; Feldheim, Terrence F.; Mascarenhas, Randhir; Yanke, Adam Blair; Cole, Brian J.; Nicholson, Gregory P.; Romeo, Anthony A.; Verma, Nikhil N.

    2015-01-01

    Objectives: The purpose of this study was to determine the clinical outcomes following revision anterior shoulder stabilization performed either via all-arthroscopic soft tissue repair or via Latarjet coracoid transfer. Methods: A retrospective review of prospectively collected data on 91 shoulders undergoing revision anterior shoulder stabilization was performed. All patients underwent prior soft tissue stabilization; those with prior open bone grafting procedures were excluded. For patients with 25% glenoid bone loss, Latarjet was performed (n=28). Patients were queried regarding recurrent instability (subluxation or dislocation). Clinical outcomes were evaluated using validated patient reported outcome questionnaires including the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), visual analog scale (VAS) for pain, and Western Ontario Shoulder Instability Index (WOSI). Results: A total of 63 shoulders in 62 patients (46 males, 16 females) with an average age of 23.2 ± 6.9 years were included in the revision arthroscopy group. At an average follow-up of 46.9 ± 16.8 months (range, 15 to 78), the mean WOSI score was 80.1 (range, 15.0 to 100), and there were significant improvements (p<0.001) in ASES (63.7 to 85.1), SST (6.2 to 9.1), and VAS pain scores (2.89 to 0.81). Recurrent instability occurred in 12 of 63 shoulders (19%); the number of prior surgeries and baseline hyperlaxity were significant risk factors for failure (p<0.001 and p=0.04, respectively). No patients developed clinical or radiographic evidence of arthritis. A total of 28 shoulders in 28 patients (21 male, 7 female) with an average age of 27.5 years (range 14 to 45) were included in the Latarjet group. Thirteen (46%) had more than one previous stabilization attempt. ), the average WOSI score was 71.9, and there were significant improvements (p<0.001) in ASES (65.7 to 87.0), SST (7.2 to 10.3), and VAS (3.1 to 1.1). Recurrent instability occurred in 2 of 28 shoulders

  4. Revision anterior cruciate ligament surgery: experience from Miami.

    PubMed

    Uribe, J W; Hechtman, K S; Zvijac, J E; Tjin-A-Tsoi, E W

    1996-04-01

    Failed anterior cruciate ligament reconstruction as defined by recurrent patholaxity is increasingly commonplace. This report presents the findings of 54 patients who had unsuccessful intraarticular anterior cruciate ligament reconstruction to correct persistent instability and who subsequently underwent revision anterior cruciate ligament surgery. Before revision, patients were evaluated by clinical examination, KT-1000 arthrometer, radiographs, Lysholm knee score, Tegner activity scale, and subjective questionnaire. The results were compared at a mean of 32 months following revision surgery. There was an average of 16 months from index procedure to the time of revision. Autogenous patellar tendon grafts were used in 61% of the cases with 30% of these harvested from the contralateral knee. Fresh frozen patellar tendon was used in 35% and autogenous hamstring tendons in 4%. Revision was successful in objectively improving stability in all patients with an average KT-000 of 2.8 mm. Autogenous tissue grafts provided greater objective stability when compared with allograft tissue with average KT-1000 of 2.2 and 3.3, respectively. Functionally, however, there was no significant difference in outcome between the 2 groups. Harvesting of the contralateral patellar tendon was found to have no adverse long term effect. Subjectively, the results were significantly worse depending on the degree of articular cartilage degeneration. Only 54% of patients returned to their preanterior cruciate ligament injury activity level. Competence in various anterior cruciate ligament reconstruction techniques will facilitate revision surgery especially in avoiding preexisting tunnels and hardware. Correct graft placement and addressing the secondary restraints are critical to successful revision surgery.

  5. Predictors of Revision Surgery After Primary Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Yabroudi, Mohammad A.; Björnsson, Haukur; Lynch, Andrew D.; Muller, Bart; Samuelsson, Kristian; Tarabichi, Majd; Karlsson, Jón; Fu, Freddie H.; Harner, Christopher D.; Irrgang, James J.

    2016-01-01

    Background: Revision anterior cruciate ligament (ACL) reconstruction surgery occurs in 5% to 15% of individuals undergoing ACL reconstruction. Identifying predictors for revision ACL surgery is of essence in the pursuit of creating adequate prevention programs and to identify individuals at risk for reinjury and revision. Purpose: To determine predictors of revision ACL surgery after failed primary ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 251 participants (mean age ± SD, 26.1 ± 9.9 years) who had undergone primary ACL reconstruction 1 to 5 years earlier completed a comprehensive survey to determine predictors of revision ACL surgery at a mean 3.4 ± 1.3 years after the primary ACL reconstruction. Potential predictors that were assessed included subject characteristics (age at the time of surgery, time from injury to surgery, sex, body mass index, preinjury activity level, return to sport status), details of the initial injury (mechanism; concomitant injury to other ligaments, menisci, and cartilage), surgical details of the primary reconstruction (Lachman and pivot shift tests under anesthesia, graft type, femoral drilling technique, reconstruction technique), and postoperative course (length of rehabilitation, complications). Univariate and multivariate logistic regression analyses were performed to identify factors that predicted the need for revision ACL surgery. Results: Overall, 21 (8.4%) subjects underwent revision ACL surgery. Univariate analysis showed that younger age at the time of surgery (P = .003), participation in sports at a competitive level (P = .023), and double-bundle ACL reconstruction (P = .024) predicted increased risk of revision ACL surgery. Allograft reconstructions also demonstrated a trend toward greater risk of revision ACL surgery (P = .076). No other variables were significantly associated with revision ACL surgery. Multivariate analysis revealed that revision ACL surgery was

  6. Successful anterior fusion following posterior cervical fusion for revision of anterior cervical discectomy and fusion pseudarthrosis.

    PubMed

    Elder, Benjamin D; Sankey, Eric W; Theodros, Debebe; Bydon, Mohamad; Goodwin, C Rory; Lo, Sheng-Fu; Kosztowski, Thomas A; Belzberg, Allen J; Wolinsky, Jean-Paul; Sciubba, Daniel M; Gokaslan, Ziya L; Bydon, Ali; Witham, Timothy F

    2016-02-01

    Pseudarthrosis occurs after approximately 2-20% of anterior cervical discectomy and fusion (ACDF) procedures; it is unclear if posterior or anterior revision should be pursued. In this study, we retrospectively evaluate the outcomes in 22 patients with pseudarthrosis following ACDF and revision via posterior cervical fusion (PCF). Baseline demographics, preoperative symptoms, operative data, time to fusion failure, symptoms of pseudarthrosis, and revision method were assessed. Fusion outcome and clinical outcome were determined at last follow-up (LFU). Thirteen females (59%) and 9 (41%) males experienced pseudarthrosis at a median of 11 (range: 3-151)months after ACDF. Median age at index surgery was 51 (range: 33-67)years. All patients with pseudarthrosis presented with progressive neck pain, with median visual analog scale (VAS) score of 8 (range: 0-10), and/or myeloradiculopathy. Patients with pseudarthrosis <12 months compared to >12 months after index surgery were older (p=0.013), had more frequent preoperative neurological deficits (p=0.064), and lower baseline VAS scores (p=0.006). Fusion was successful after PCF in all patients, with median time to fusion of 10 (range: 2-14)months. Eighteen patients fused both anteriorly and posteriorly, two patients fused anteriorly only, and two patients fused posteriorly only. Median VAS neck score at LFU significantly improved from the time of pseudarthrosis (p=0.012). While uncommon, pseudarthrosis may occur after ACDF. All patients achieved successful fusion after subsequent posterior cervical fusion, with 91% fusing a previous anterior pseudarthrosis after posterior stabilization. Neck pain significantly improved by LFU in the majority of patients in this study.

  7. Revision Anterior Cruciate Ligament Reconstruction in Military Personnel.

    PubMed

    Balazs, George C; Grimm, Patrick D; Donohue, Michael A; Keblish, David J; Rue, John-Paul

    2016-08-01

    This study aims to report the clinical and functional outcomes of revision anterior cruciate ligament (ACL) reconstruction in a young, active duty military population. Patients undergoing revision ACL reconstruction were enrolled in an institutional clinical database and followed prospectively. The primary outcomes were patients' scores on a timed run, as compared with recorded scores before reinjury. Secondary outcomes included scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the International Knee Documentation Committee subjective (IKDC subjective), the Short Form - 36 health survey (SF-36) version 2, the Single Assessment Numeric Evaluation (SANE), and the Tegner activity scale. A total of 13 patients were identified who met the inclusion criteria and had complete follow-up. The mean age at revision ACL reconstruction was 20.5 years (range, 19-22 years), and mean follow-up was 40.2 months (range, 13-66 months). All patients underwent a single stage revision ACL reconstruction with ipsilateral bone-patellar tendon-bone autograft, ipsilateral hamstring autograft, or bone-tendon-bone allograft. Mean physical readiness test (PRT) score at final follow-up was not statistically different than documented preinjury PRT score (77.9 vs. 85.5, p > 0.05), nor was the mean run time (7:12 vs. 6:43/mile, p > 0.05). Significant improvements exceeding published minimal clinically important differences were seen in SANE score, SF-36 physical component summary score, KOOS sports and recreation, KOOS quality of life, WOMAC pain score, and WOMAC function score. Patients undergoing revision ACL reconstruction at our facility show good recovery of baseline physical performance as measured by the semiannual PRT and timed run test, and significant improvements in patient-reported outcome scores. Level of Evidence Level IV, case series.

  8. Patient expectations of primary and revision anterior cruciate ligament reconstruction.

    PubMed

    Feucht, Matthias J; Cotic, Matthias; Saier, Tim; Minzlaff, Philipp; Plath, Johannes E; Imhoff, Andreas B; Hinterwimmer, Stefan

    2016-01-01

    Unrealistic patient expectations have been shown to negatively influence patient-reported outcomes in orthopaedic surgery. Knowledge about patient expectations is important to associate preoperative expectations with the reasonable outcome of a specific procedure. The purpose of this study was to prospectively analyse and to compare patient expectations of primary and revision anterior cruciate ligament reconstruction (ACLR) and to assess the factors associated with patient expectations. Preoperative expectations of 181 consecutive patients undergoing ACLR were assessed prospectively using a 5-item questionnaire. Primary ACLR (P-ACLR) was performed in 133 patients (73%), whereas 48 patients (27%) underwent revision ACLR (R-ACLR). The questionnaire assessed the expectation of the overall condition of the knee joint, return to sports, instability, pain, and risk of osteoarthritis. All patients expected a normal (38%) or nearly normal (62%) condition of the knee joint. Return to sports at the same level was expected by 91%. With regard to instability (pain), no instability (pain) independent of the activity level was expected by 77% (58%). No or only a slightly increased risk of the development of osteoarthritis was expected by 98%. The R-ACLR group showed a significantly lower expectation of the overall condition (p = 0.001), return to sports (p < 0.001), and pain (p = 0.002). No statistically significant difference was found between female and male patients (n.s.). In the P-ACLR group, patients with a history of previous knee surgery showed inferior expectations of return to sports (p = 0.015) and risk of osteoarthritis (p = 0.011). Age, number of previous knee surgeries, and pre-injury sports level significantly influenced patient expectations. Overall, patient expectations of ACL reconstruction are high. Patients undergoing revision ACL reconstruction have lower but still demanding expectations. Younger patients, patients without a history of knee surgery, and

  9. Graft Subsidence and Revision Rates Following Anterior Cervical Corpectomy: A Clinical Study Comparing Different Interbody Cages.

    PubMed

    Weber, Michael H; Fortin, Maryse; Shen, Jian; Tay, Bobby; Hu, Serena S; Berven, Sigurd; Burch, Shane; Chou, Dean; Ames, Christopher; Deviren, Vedat

    2016-09-10

    Retrospective cohort study. To assess the subsidence and revision rates associated with different interbody cages following anterior cervical corpectomy and reconstruction. Different interbody cages are currently used for surgical reconstruction of the anterior and middle columns of the spine following anterior cervical corpectomy. However, subsidence and delayed union/nonunion associated with allograft and cage reconstruction are common complications, which may require revision with instrumentation. We reviewed the cases of 75 patients who underwent cervical corpectomy and compared the radiographic graft subsidence and revision rates for fibula allograft, titanium mesh cage, titanium expandable cage, and carbon fiber cages. Subsidence was calculated by comparing the immediate postoperative lateral x-ray films to those obtained during follow-up visits. The average graft subsidence was 3 mm and revision rate was 25% for fibula allograft versus 2.9 mm and 11.1%, 2.9 mm and 18.8% for titanium mesh cages and titanium expandable cages, respectively. The average graft subsidence for carbon fiber cages was 0.7 mm with no revision surgery in this subset. Our findings suggest that subsidence and revision rates following anterior corpectomy and interbody fusion could be minimized with the use of a carbon fiber cage.

  10. [Experience of using anterior windowing of the femur in revision total hip arthroplasty].

    PubMed

    Li, Hu; Lin, Jian-hao

    2012-05-01

    To discuss the clinical results of anterior windowing of the femur to remove the femoral component and cement in revision total hip arthroplasty. From September 1999 to May 2011, 31 revision cases received anterior windowing of the femur in operation. There were 12 male and 19 female, with the average age in operation was 61.8 years (from 40 to 83 years). The reason for revision included aseptic loosening in 12 cases, infection in 4 cases, breakage of femoral stem in 11 cases and acetabular liner wear in 4 hemi-arthroplasties. Nine cases were cemented and 22 were non-cemented for the primary stem. The position of the window located in the anterior femur with 6 cases of complete windowing from the proximal to the end of the stem. Another 25 cases received regional windowing just around the tip of the stem. In revisions, non-cemented rectangular revision stem were used for 27 cases and two-stage surgery were used for 4 infection cases. In all revisions, femoral stems and cement fragments were removed successfully and safely without any complications of fracture and perforation of new stems. All femur windows showed successfully union for average 14 weeks (12-18 weeks). There were some postoperative complications. One recurrent dislocation was treated using plaster external fixation for 8 weeks. One case with dislocation and fracture along with the window was revised by cerclage fixation. One periprosthetic fracture due to trauma was treated by cerclage fixation. The average Harris score of the hip improved to 83 points (75 to 90 points) at an average 5.5 years follow-up (0.5 to 12.0 years). Twenty six cases were completely followed up. Revision femoral stems were well-fixed without any subsidence or loosening. Anterior windowing of the femur is a proven technique which can be used to remove femoral stem and cement conveniently and safely without any fractures in revision total hip arthroplasty.

  11. Revision open Bankart surgery after arthroscopic repair for traumatic anterior shoulder instability.

    PubMed

    Cho, Nam Su; Yi, Jin Woong; Lee, Bong Gun; Rhee, Yong Girl

    2009-11-01

    Only a few studies have provided homogeneous analysis of open revision surgery after a failed arthroscopic Bankart procedure. Open Bankart revision surgery will be effective in a failed arthroscopic anterior stabilization but inevitably results in a loss of range of motion, especially external rotation. Case series; Level of evidence, 4. Twenty-six shoulders that went through traditional open Bankart repair as revision surgery after a failed arthroscopic Bankart procedure for traumatic anterior shoulder instability were enrolled for this study. The mean patient age at the time of revision surgery was 24 years (range, 16-38 years), and the mean duration of follow-up was 42 months (range, 25-97 months). The preoperative mean range of motion was 173 degrees in forward flexion and 65 degrees in external rotation at the side. After revision surgery, the ranges measured 164 degrees and 55 degrees, respectively (P = .024 and .012, respectively). At the last follow-up, the mean Rowe score was 81 points, with 88.5% of the patients reporting good or excellent results. After revision surgery, redislocation developed in 3 shoulders (11.5%), all of which had an engaging Hill-Sachs lesion and associated hyperlaxity (2+ or greater laxity on the sulcus sign). Open revision Bankart surgery for a failed arthroscopic Bankart repair can provide a satisfactory outcome, including a low recurrence rate and reliable functional return. In open revision Bankart surgery after failed stabilization for traumatic anterior shoulder instability, the surgeon should keep in mind the possibility of a postoperative loss of range of motion and a thorough examination for not only a Bankart lesion but also other associated lesions, including a bone defect or hyperlaxity, to lower the risk of redislocation.

  12. Revision anterior cruciate ligament reconstruction with ipsi- or contralateral hamstring tendon grafts.

    PubMed

    Legnani, Claudio; Peretti, Giuseppe; Borgo, Enrico; Zini, Stefania; Ventura, Alberto

    2017-05-01

    With the increasing number of primary anterior cruciate ligament (ACL) reconstructions, the need for revision ACL surgery has risen over the past few years. The purpose of the present study is to retrospectively compare the clinical outcome of ipsilateral versus contralateral hamstring tendon autografts for ACL revision surgery, specifically with regard to patient satisfaction, post-operative functional outcomes, and return to sports. Between 2004 and 2011, 64 patients underwent ACL revision surgery. Forty-five were successfully recontacted and retrospectively reviewed at an average follow-up of 6.3 years. Twenty-two subjects underwent revision ACL reconstruction with ipsilateral autogenous hamstring tendon grafts; in 23 subjects contralateral hamstring were used for reconstruction. Clinical, arthrometric, and functional evaluations were performed. The Tegner activity level, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Subjective Knee Form were used. Objective evaluation included range of motion, Lachman test, pivot shift test and KT-1000 instrumented laxity testing. No major complications were reported. Follow-up examination showed that there were no significant differences in the IKDC and KOOS scores between the groups. No differences in anterior tibial translation as measured with KT-1000 arthrometer were reported between the groups, although there was a trend for more of the patients undergoing ipsilateral DGST reconstruction to have a glide on the pivot shift test. The percentage of patients returning to pre-injury level was high in both groups. The use of contralateral hamstring tendon autografts for ACL revision surgery produced similar subjective and objective outcomes at 6-years follow-up compared to revision with ipsilateral hamstring tendon autografts. Patients undergoing revision surgery with contralateral autografts experienced a quicker return to sports compared to patients who underwent

  13. Increased incidence of anterior cruciate ligament revision surgery in paediatric verses adult population.

    PubMed

    Astur, Diego Costa; Cachoeira, Charles Marcon; da Silva Vieira, Tierri; Debieux, Pedro; Kaleka, Camila Cohen; Cohen, Moisés

    2017-09-25

    To evaluate the anterior cruciate ligament graft failure rate in a population of 1376 patients submitted to single-bundle anterior cruciate ligament reconstruction procedure. It was hypothesized that the younger the patient, the greater the chance of a new anterior cruciate ligament graft ligament injury. A retrospective chart review was performed on patients who had SB anterior cruciate ligament reconstruction between the years, 2001 and 2016, with a minimum post-operative follow-up period of 6 months. The patient population was divided into three groups, according to age: group 1-under 16 years old; group 2-between 16 and 18 years old; and group 3-older than 18 years old. Data collected included sex, laterality and graft choice data. In group 1 (under 16 years old), there were 61 primary ACL surgeries performed and 15 (24.6%) revision ACL surgeries. In group 2 (between 16 and 18 years old), there was 57 primary ACL procedures, of which 10 (17.5%) were revisions. In the group 3 (older than 18 years of age), 1258 surgeries were done with 116 (9.2%) revisions. The rate of ACL revision surgery in patients under 16 years of age was significantly higher than that found in patients older than 18 years old. When compared to the population between 16 and 18 years old, there were a higher number of failure cases, however, statistically non-significant. IV.

  14. Factors Influencing Graft Choice in Revision Anterior Cruciate Ligament Reconstruction in the MARS Group.

    PubMed

    Group, Mars

    2016-08-01

    It has not been known what drives revision anterior cruciate ligament (ACL) reconstruction graft choice in the past. We undertook this study to utilize the Multicenter ACL Revision Study (MARS) group and propensity score statistical analysis to determine the drivers of revision ACL reconstruction graft choice. We hypothesized that propensity analysis would demonstrate that individual surgeons still have significant impact on revision ACL reconstruction. Twelve hundred patients were enrolled in this longitudinal revision cohort by 83 surgeons at 52 sites. The median age was 26 years and 505 (42%) were females. One thousand forty-nine (87%) patients were undergoing their first ACL revision. Graft choice for revision ACL reconstruction for these patients was 48% autograft, 49% allograft, and 3% combination. The independent variables of this model included gender, age, ethnicity, body mass index, smoking status, sport, activity level, previous graft, revision number, surgeon, surgeon's opinion of failure, previous technical aspects, etc. Surgeons were defined as those who contributed more than 15 patients during the enrollment period. . We calculated a propensity score for graft type based on the predicted probability of receiving an allograft from a logistic regression model. Propensity scores demonstrated that surgeon, prior graft choice, and patient age each had significant influence on which graft type was chosen for the revision ACL reconstruction (p  < 0.0001). The revising surgeon had the largest impact upon graft choice: ∼ 5 times that of the second-most important factor (prior graft). If the prior graft type was an autograft, then an allograft was 3.6 times more likely to be chosen for the revision. This current study demonstrates that the individual surgeon is ultimately the most important factor in revision ACL reconstruction graft choice. Additional statistically significant influences of graft choice included age, gender, previous graft choice, ACL

  15. Causes of Failure of Anterior Cruciate Ligament Reconstruction and Revision Surgical Strategies

    PubMed Central

    Di Benedetto, Paolo; Di Benedetto, Enrico; Fiocchi, Andrea; Beltrame, Alessandro; Causero, Araldo

    2016-01-01

    Purpose Long-term outcomes of anterior cruciate ligament (ACL) reconstruction are good or excellent; however, 0.7%–20% of patients suffer from recurrent instability due to graft failure. The purpose of this paper was to analyse failure aetiology and the possibilities of revision surgical strategies, with a description of our experience. We obtained optimal and good results in most of our patients. Materials and Methods We retrospectively reviewed 42 patients who underwent revision surgery (43 revisions) due to relapsing instability after ACL reconstruction between 2006 and 2015. We used allografts in 39 cases and autografts in 4 cases. Results The 85.7% of the patients obtained optimal results (normal knee; group A) and the 7.2% obtained good results (nearly normal knee; group B) according to the International Knee Documentation Committee score. The most frequent failure causes were traumatic events, non-anatomic tunnel placement, and lack of graft incorporation. Conclusions A correct revision surgery requires accurate patient evaluation and knee imaging. Preoperative planning starts with the identification of the cause of failure of the primary reconstruction. Then, the most suitable procedure should be determined for each case. It is also important to accurately inform the patient of all the complexity of an ACL revision surgery even if it is a procedure with high rates of excellent and good outcomes. PMID:27894180

  16. Patient Outcomes and Predictors of Success After Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Johnson, William R.; Makani, Amun; Wall, Andrew J.; Hosseini, Ali; Hampilos, Perry; Li, Guoan; Gill, Thomas J.

    2015-01-01

    Background: Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample. Purpose: To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients’ medical records were also thoroughly reviewed. Results: Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P < .017). Conclusion: Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction

  17. Return to sports and functional results after revision anterior cruciate ligament reconstruction by fascia lata autograft.

    PubMed

    Mirouse, G; Rousseau, R; Casabianca, L; Ettori, M A; Granger, B; Pascal-Moussellard, H; Khiami, F

    2016-11-01

    The surgical revision rate following anterior cruciate ligament (ACL) surgery is 3% at 2 years and 4% at 5 years. Revision ACL surgery raises the question of the type of graft to be used. The present study assessed return to sports and functional results after revision ACL reconstruction by fascia lata graft. The hypothesis was that fascia lata provides a reliable graft in revision ACL surgery. A single-center retrospective continuous study included 30 sports players with a mean age of 26.8±8 years undergoing surgical revision for iterative ACL tear between 2004 and 2013. Multi-ligament lesions were excluded. Type and level of sports activity were assessed preoperatively, after primary surgery and at end of follow-up. Clinical assessment used subjective IKDC, Lysholm and KOOS scores. At a mean 4.6±1.6 years' follow-up, all patients had resumed sport activity, but only 12 with the same sport at the same level. Median subjective IKDC score increased from 57 [54.3; 58.5] preoperatively to 82 [68.3; 90] at last follow-up, and Lysholm score from 46 [42.3; 51] to 90.5 [80.8; 96.8]; KOOS score at last follow-up was 94.7 [83; 100]. Functional results in revision ACL reconstruction by fascia lata graft were satisfactory, with similar return-to-sports rates as with other techniques. Fascia lata provides a reliable graft in revision ACL surgery. IV, retrospective study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  18. Anterior cruciate ligament reconstruction tunnel size: causes of tunnel enlargement and implications for single versus two-stage revision reconstruction.

    PubMed

    Rizer, Magda; Foremny, Gregory Brian; Rush, Augustus; Singer, Adam D; Baraga, Michael; Kaplan, Lee D; Jose, Jean

    2017-02-01

    Anterior cruciate ligament (ACL) reconstructions have increased over the past 25 years. The increased incidence of ACL reconstructions has translated into a larger number of graft failures and revision ACL procedures. It is important to understand the causes of graft failure when evaluating for a revision ACL reconstruction and to appreciate changes in tunnel anatomy over time prior to planning revision surgery. In this manuscript, tunnel size for ACL reconstruction and implications for single-stage versus two-stage revision ACL reconstruction will be discussed, as well as causes of tunnel enlargement, including mechanical and biological factors.

  19. Revision anterior cruciate ligament reconstruction: clinical outcome and evidence for return to sport.

    PubMed

    Andriolo, Luca; Filardo, Giuseppe; Kon, Elizaveta; Ricci, Margherita; Della Villa, Francesco; Della Villa, Stefano; Zaffagnini, Stefano; Marcacci, Maurilio

    2015-10-01

    An increasing number of patients undergo revision anterior cruciate ligament (ACL) reconstruction, with the intention of returning to sport being a major indication. The aim of this study is to assess the available evidence for clinical improvement and return to sport, to understand the real potential of this procedure in regaining functional activity, and to facilitate improved counselling of patients regarding the expected outcome after revision ACL reconstruction. The search was conducted on the PubMed database. Articles reporting clinical results for revision ACL reconstruction were included. A meta-analysis was performed on return to sport, and results were compared to the literature on primary ACL reconstruction. Other specific clinical outcomes (Lysholm, Tegner, IKDC Objective scores) were also included in the meta-analysis. Of the 503 identified records, a total of 59 studies involving 5365 patients were included in the qualitative data synthesis. Only 31 articles reported the rate of return to sport. Whereas 73 % of good objective results and satisfactory subjective results were documented, 57 % of patients did not return to the same level of sport activity, significantly inferior to that of a primary procedure. The real potential of revision ACL reconstruction should not be overestimated due to the low number of patients able to return to their previous activity level, significantly inferior with respect to that reported for primary ACL reconstruction. This finding will help physicians in the clinical practice providing realistic expectations to the patients. Future studies should focus on participation-based outcome measures such as return to sport and in strategies to improve the results in terms of return to previous activities after revision ACL reconstruction. Systematic review and meta-analysis including Level IV studies, Level IV.

  20. Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction.

    PubMed

    Allen, Christina R; Anderson, Allen F; Cooper, Daniel E; DeBerardino, Thomas M; Dunn, Warren R; Haas, Amanda K; Huston, Laura J; Lantz, Brett Brick A; Mann, Barton; Nwosu, Sam K; Spindler, Kurt P; Stuart, Michael J; Wright, Rick W; Albright, John P; Amendola, Annunziato Ned; Andrish, Jack T; Annunziata, Christopher C; Arciero, Robert A; Bach, Bernard R; Baker, Champ L; Bartolozzi, Arthur R; Baumgarten, Keith M; Bechler, Jeffery R; Berg, Jeffrey H; Bernas, Geoffrey A; Brockmeier, Stephen F; Brophy, Robert H; Bush-Joseph, Charles A; Butler, J Brad; Campbell, John D; Carey, James L; Carpenter, James E; Cole, Brian J; Cooper, Jonathan M; Cox, Charles L; Creighton, R Alexander; Dahm, Diane L; David, Tal S; Flanigan, David C; Frederick, Robert W; Ganley, Theodore J; Garofoli, Elizabeth A; Gatt, Charles J; Gecha, Steven R; Giffin, James Robert; Hame, Sharon L; Hannafin, Jo A; Harner, Christopher D; Harris, Norman Lindsay; Hechtman, Keith S; Hershman, Elliott B; Hoellrich, Rudolf G; Hosea, Timothy M; Johnson, David C; Johnson, Timothy S; Jones, Morgan H; Kaeding, Christopher C; Kamath, Ganesh V; Klootwyk, Thomas E; Levy, Bruce A; Ma, C Benjamin; Maiers, G Peter; Marx, Robert G; Matava, Matthew J; Mathien, Gregory M; McAllister, David R; McCarty, Eric C; McCormack, Robert G; Miller, Bruce S; Nissen, Carl W; O'Neill, Daniel F; Owens, Brett D; Parker, Richard D; Purnell, Mark L; Ramappa, Arun J; Rauh, Michael A; Rettig, Arthur C; Sekiya, Jon K; Shea, Kevin G; Sherman, Orrin H; Slauterbeck, James R; Smith, Matthew V; Spang, Jeffrey T; Svoboda, Steven J; Taft, Timothy N; Tenuta, Joachim J; Tingstad, Edwin M; Vidal, Armando F; Viskontas, Darius G; White, Richard A; Williams, James S; Wolcott, Michelle L; Wolf, Brian R; York, James J

    2017-09-01

    Revision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes compared with primary ACL reconstruction. Certain factors under the control of the surgeon at the time of revision surgery can both negatively and positively affect outcomes. Case-control study; Level of evidence, 3. Patients undergoing revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, intraoperative surgical technique and joint disorders, and a series of validated patient-reported outcome instruments (International Knee Documentation Committee [IKDC] subjective form, Knee Injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Marx activity rating scale) completed before surgery. Patients were followed up for 2 years and asked to complete an identical set of outcome instruments. Regression analysis was used to control for age, sex, body mass index (BMI), activity level, baseline outcome scores, revision number, time since last ACL reconstruction, and a variety of previous and current surgical variables to assess the surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction. A total of 1205 patients (697 male [58%]) met the inclusion criteria and were successfully enrolled. The median age was 26 years, and the median time since their last ACL reconstruction was 3.4 years. Two-year follow-up was obtained on 82% (989/1205). Both previous and current surgical factors were found to be significant contributors toward poorer clinical outcomes at 2 years. Having undergone previous arthrotomy (nonarthroscopic open approach) for ACL reconstruction compared with the 1-incision technique resulted in significantly poorer outcomes for the 2-year IKDC ( P = .037; odds ratio [OR], 2.43; 95% CI, 1.05-5.88) and KOOS pain, sports/recreation, and quality of life (QOL) subscales ( P ≤ .05; OR range, 2

  1. Revision anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft and extra-articular iliotibial band tenodesis.

    PubMed

    Mascarenhas, Randy; McConkey, Mark O; Forsythe, Brian; Harner, Christopher D

    2015-04-01

    Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure with outcomes that generally fail to reach those seen with primary ACL reconstruction. With most index procedures using autograft tissue, it is not uncommon for allograft tissue to be required for revision ACL reconstruction. Compared with autografts, allografts take longer to incorporate and lead to more episodes of instability. In this article, we describe ipsilateral iliotibial band tenodesis performed to augment use of bone-patellar tendon-bone allograft in revision ACL reconstruction. This technique adds rotational stability to protect the allograft tissue while it incorporates.

  2. Trends in primary and revision anterior cruciate ligament reconstruction among National Basketball Association team physicians.

    PubMed

    Mall, Nathan A; Abrams, Geoffrey D; Azar, Frederick M; Traina, Steve M; Allen, Answorth A; Parker, Richard; Cole, Brian J

    2014-06-01

    Anterior cruciate ligament (ACL) tears are common in athletes. Techniques and methods of treatment for these injuries continue to vary among surgeons. Thirty National Basketball Association (NBA) team physicians were surveyed during the NBA Pre-Draft Combine. Survey questions involved current and previous practice methods of primary and revision ACL reconstruction, including technique, graft choice, rehabilitation, and treatment of combined ACL and medial collateral ligament injuries. Descriptive parametric statistics, Fisher exact test, and logistic regression were used, and significance was set at α = 0.05. All 30 team physicians completed the survey. Eighty-seven percent indicated they use autograft (81% bone-patellar tendon-bone) for primary ACL reconstruction in NBA athletes, and 43% indicated they use autograft for revision cases. Fourteen surgeons (47%) indicated they use an anteromedial portal (AMP) for femoral tunnel drilling, whereas 5 years earlier only 4 (13%) used this technique. There was a significant (P = .009) positive correlation between fewer years in practice and AMP use. NBA team physicians' use of an AMP for femoral tunnel drilling has increased over the past 5 years.

  3. Knee laxity control in revision anterior cruciate ligament reconstruction versus anterior cruciate ligament reconstruction and lateral tenodesis: clinical assessment using computer-assisted navigation.

    PubMed

    Colombet, Philippe

    2011-06-01

    Rotational laxity control is one of the different options to improve functional results after anterior cruciate ligament reconstruction. Lateral extra-articular tenodesis has been proposed to reduce the rotational laxity, especially in challenging situations such as revision reconstruction after biological failure. We currently lack the practical clinical tools to objectively assess knee rotational laxities. Addition of a lateral tenodesis to anatomic single-bundle anterior cruciate ligament reconstruction with hamstring tendon graft could improve the knee laxity control, particularly the internal rotation, compared with a standard single-bundle anterior cruciate ligament reconstruction. Controlled laboratory study. Twenty patients underwent navigated anatomic anteromedial bundle revision anterior cruciate ligament reconstruction with addition of percutaneous extra-articular tenodesis using the same hamstring tendon graft. The navigation was used to optimize femoral and tibial tunnel positions and to measure the knee kinematics in response to the anterior drawer test, Lachman test, maximum internal/external rotation test, and pivot-shift test. All patients underwent revision after failure without any technical error found or new trauma. Two sequential reconstruction protocols were used to assess the contribution of the extra-articular tenodesis and single anteromedial bundle anterior cruciate ligament reconstruction to restrain tibial translations and coupled axial rotation occurring with the manually performed clinical laxity tests. In group A, the intra-articular reconstruction was fixed first and then the lateral tenodesis was fixed, and in group B, the protocol was reversed. Measurements were performed before the reconstruction, after the first part was fixed, and after the second part was fixed in each protocol. At 90° of flexion, addition of lateral tenodesis had a significant effect on coupled internal rotation (P = .003). Addition of the intra

  4. Risk for Revision After Anterior Cruciate Ligament Reconstruction Is Higher Among Adolescents

    PubMed Central

    Faunø, Peter; Rahr-Wagner, Lene; Lind, Martin

    2014-01-01

    Background: The number of children and adolescents with anterior cruciate ligament (ACL) reconstructions is increasing, and disturbing reports on high rerupture rates in this group have been noted. Purpose: To describe the outcome of ACL reconstruction in children and adolescents based on data from the Danish Knee Ligament Reconstruction Registry (DKRR). Study Design: Cohort study; Level of evidence, 3. Methods: Data were retrieved from the DKRR, a national population-based registry. The analysis was based on a population of 14,806 ACL-reconstructed patients. The outcome was evaluated using risk of ACL revision, subjective outcome score (Knee injury and Osteoarthritis Outcome Score [KOOS]), Tegner function score, and objective knee laxity. Three age groups were defined (A, <13 years; B, 13-15 years; and C, 15-20 years) and compared with D, patients ≥20 years (adults). There were 95 patients in group A, 327 in B, 2888 in C, and 11,496 in D. Results: There was a significantly increased risk of revision surgery in the age groups B (6.7%) and C (4.9%) compared with the adults in group D (2.0%). Objective knee laxity did not differ between the 4 groups. Groups A, B, and C had a higher score on the combined KOOS symptoms, pain, sport, and quality of life subscales (KOOS4; 79.6, 76.6, and 73.1, respectively) compared with the adults (69.7). Group B had higher KOOS quality of life (76.6) and sports (71.1) scores than did group C (73.1 and 66.4, respectively). The Tegner activity score did not differ between the 4 groups. No impact of the use of extracortical graft fixation was detected in the youngest age group. Conclusion: Study results indicated an increased risk of graft failure in patients between 13 and 20 years of age. This is in contrast to the better subjective and equal objective knee score found in the same age groups. Clinical Relevance: The new knowledge about the high revision rate among ACL-reconstructed teenagers is important for evidence

  5. Age-Related Risk Factors for Revision Anterior Cruciate Ligament Reconstruction: A Cohort Study of 21,304 Patients From the Kaiser Permanente Anterior Cruciate Ligament Registry.

    PubMed

    Maletis, Gregory B; Chen, Jason; Inacio, Maria C S; Funahashi, Tadashi T

    2016-02-01

    It is not clear whether risk factors for revision anterior cruciate ligament reconstruction (ACLR) are the same throughout patients' lives. To assess (1) the risk of revision ACLR by age and (2) age-specific risk factors for revision ACLR. Cohort study; Level of evidence, 2. A cohort study using patients having undergone primary ACLR who were registered in the Kaiser Permanente ACLR Registry (February 2005 to June 2013) was conducted. Aseptic revision was the main endpoint. Age was evaluated as a risk factor for revision. The cohort was stratified into 4 age groups: <21, 21-30, 31-40, and >40 years. Graft type, sex, body mass index (BMI), and race were assessed as revision risk factors within each group. Survival analyses were conducted. Of the 21,304 patients evaluated, 7026 (33%) patients were aged <21 years, 5762 (27%) were 21-30 years, 4656 (22%) were 31-40 years, and 3860 (18%) were >40 years. Allografts were used in 8671 (41%) patients, hamstring autografts in 6823 (32%), and bone-patellar tendon-bone (BPTB) autografts in 5260 (25%). The 5-year revision probability was highest in patients <21 years old (9.0%; 95% CI, 8.0%-10.1%) and lowest in those >40 years old (1.9%; 95% CI, 1.3%-2.7%). Compared with patients aged >40 years, the adjusted revision risk for patients aged <21 years was 7.76 (95% CI, 5.52-10.90). In patients aged <21 years, a lower revision risk was seen in female patients (hazard ratio [HR], 0.76; 95% CI, 0.61-0.93) compared with male patients, patients with a BMI of 30-35 kg/m(2) (HR, 0.75; 95% CI, 0.59-0.95) and BMI >35 kg/m(2) (HR, 0.49; 95% CI, 0.34-0.70) compared with those with a BMI <30 kg/m(2), and black patients (HR, 0.55, 95% CI, 0.36-0.85) compared with white patients. Sex, BMI, and race were not associated with the risk of revision in older patients. In patients ≤40 years old, those with allografts had a higher risk of revision than those with BPTB autografts (HR, 2.69, 2.35, and 3.04 for patients aged <21, 21-30, and 31-40 years

  6. Association Between Previous Meniscal Surgery and the Incidence of Chondral Lesions at Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Brophy, Robert H.; Wright, Rick W.; David, Tal S.; McCormack, Robert G.; Sekiya, Jon K.; Svoboda, Steven J.; Huston, Laura J.; Haas, Amanda K.; Steger-May, Karen

    2013-01-01

    Background Knees undergoing revision anterior cruciate ligament (ACL) reconstruction typically have more intra-articular injuries than do knees undergoing primary reconstruction. Hypothesis Previous partial meniscectomy (PM) is associated with a higher rate of chondral lesions at revision ACL reconstruction, whereas previous meniscal repair (MR) is not associated with a higher rate of chondral lesions at revision ACL reconstruction, compared with knees undergoing revision ACL with no previous meniscal surgery. Study design Cohort study (Prevalence); Level of evidence, 2. Methods Data from a multicenter cohort was reviewed to determine the history of prior meniscal surgery (PM/MR) and the presence of grade II/III/IV chondral lesions at revision ACL reconstruction. The association between previous meniscal surgery and the incidence of chondral lesions was examined. Patient age was included as a covariate to determine if surgery type contributes predictive information independent of patient age. Results The cohort included 725 ACL revision surgeries. Chondrosis was associated with patient age (P < .0001) and previous meniscal surgery (P < .0001). After adjusting for patient age, knees with previous PM were more likely to have chondrosis than knees with previous MR (P = .003) or no previous meniscal surgery (P < .0001). There was no difference between knees without previous meniscal surgery and knees with previous MR (P = .7). Previous partial meniscectomy was associated with a higher rate of chondrosis in the same compartment compared with knees without previous meniscal surgery (P < .0001) and knees with previous MR (P ≤ .03). Conclusion The status of articular cartilage at the time of revision ACL reconstruction relates to previous meniscal surgery independent of the effect of patient age. Previous partial meniscectomy is associated with a higher incidence of articular cartilage lesions, whereas previous meniscal repair is not. Although this association may

  7. Increased Risk of Revision After Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Allografts Compared With Autografts.

    PubMed

    Maletis, Gregory B; Chen, Jason; Inacio, Maria C S; Love, Rebecca M; Funahashi, Tadashi T

    2017-05-01

    The use of allograft tissue for anterior cruciate ligament reconstruction (ACLR) remains controversial. To compare the risk of aseptic revision between bone-patellar tendon-bone (BPTB) autografts and BPTB allografts. Cohort study; Level of evidence, 2. A retrospective cohort study of prospectively collected data was conducted using the Kaiser Permanente ACLR Registry. A cohort of patients who underwent primary unilateral ACLR with BPTB autografts and BPTB allografts was identified. Aseptic revision was the endpoint. The type of graft and allograft processing method (nonprocessed, <1.8-Mrad, and ≥1.8-Mrad irradiation) were the exposures of interest evaluated. Age (≤21 and ≥22 years) was evaluated as an effect modifier. Analyses were adjusted for age, sex, and race. Kaplan-Meier curves and Cox proportional hazards models were employed. Hazard ratios (HRs) and 95% CIs are provided. The BPTB cohort consisted of 5586 patients: 3783 (67.7%) were male, 2359 (42.2%) were white, 1029 (18.4%) had allografts (nonprocessed: 155; <1.8 Mrad: 525; ≥1.8 Mrad: 288), and 4557 (81.6%) had autografts. The median age was 34.9 years (interquartile range [IQR], 25.4-44.0) for allograft cases and 22.0 years (IQR, 17.6-30.0) for autograft cases. The estimated cumulative revision rate at 2 years was 4.1% (95% CI, 2.9%-5.9%) for allografts and 1.7% (95% CI, 1.3%-2.2%) for autografts. BPTB allografts had a significantly higher adjusted risk of revision than BPTB autografts (HR, 4.54; 95% CI, 3.03-6.79; P < .001). This higher risk of revision was consistent with all allograft processing methods when compared with autografts and was also consistently higher in patients with allografts regardless of age. When BPTB allograft tissue was used for ACLR, an overall 4.54 times adjusted higher risk of revision was observed compared with surgery performed with a BPTB autograft. Whether the tissue was irradiated with either high- or low-dose radiation, chemically processed, or not processed at

  8. A new technique for femoral and tibial tunnel bone grafting using the OATS harvesters in revision anterior cruciate ligament reconstruction.

    PubMed

    Said, Hatem G; Baloch, Khalid; Green, Marcus

    2006-07-01

    Revision anterior cruciate ligament (ACL) reconstruction is becoming more frequent, especially in specialized centers, because of the large numbers of primary ACL procedures performed. In 2-stage revisions, bone grafting of the tunnels may be undertaken if the primary position was inaccurate or if osteolysis has caused widening of the tunnels. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. It is technically difficult to deliver and impact bone graft into the femoral tunnel with the standard surgical and arthroscopic instruments. We describe a new technique for femoral and tibial tunnel impaction grafting in 2-stage ACL revisions, using the OATS grafting instruments (Osteochondral Autologous Transfer System; Arthrex, Naples, FL). The appropriately sized OATS harvester is chosen 1 mm larger than the tunnel size and is used to harvest bone graft from the iliac crest through a percutaneous approach. This provides a cylindrical graft, which is delivered to the femoral tunnel through the arthroscopic portal. The inside punch of the harvester is tapped and this allows delivery of the graft in a controlled manner and its impaction into the tunnel. The same is repeated for the tibial tunnel while providing support for the proximal end of the tunnel.

  9. The Effect of Autologous Hamstring Graft Diameter on the Likelihood for Revision of Anterior Cruciate Ligament Reconstruction.

    PubMed

    Spragg, Lindsey; Chen, Jason; Mirzayan, Raffy; Love, Rebecca; Maletis, Gregory

    2016-06-01

    Hamstring autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) have become popular in the past 2 decades; however, it is difficult to predict the diameter of the harvested tendons before surgery. Previous biomechanical studies have suggested that a smaller graft diameter leads to a lower load to failure, but clinical studies looking at various predictors for failure, including graft size, have been inconclusive. To evaluate the relationship of hamstring graft diameter to ACL revision within a large cohort of patients, while controlling for sex, age, body mass index (BMI), and femoral and tibial fixation type. Case-control study; Level of evidence, 3. A case-control study using patients registered in an ACLR registry was conducted. Revision was used as a marker for graft failure. A case was defined as a patient who underwent primary ACLR with a hamstring autograft that was revised during the study period (April 2006 to September 2012). Three controls, defined as patients who underwent primary ACLR with a hamstring autograft that was not revised, were matched to each of the cases according to age, sex, BMI, and femoral and tibial fixation type. Descriptive characteristics were employed, and conditional logistic regression was conducted to produce estimates of odds ratios and 95% CIs. A total of 124 cases and 367 controls were identified. There were no significant differences between cases and controls in the distribution of sex (52.4% male vs 52.9% male, respectively; P = .932), median age (17.6 years [interquartile range (IQR), 15.9-20.4] vs 17.6 years [IQR, 15.9-20.4], respectively; P = .999), median BMI (23.4 kg/m(2) [IQR, 21.5-26.4] vs 23.4 kg/m(2) [IQR, 21.6-25.8], respectively; P = .954), femoral fixation (P = .459), and tibial fixation (P = .766). The mean (±SD) graft diameter was 7.9 ± 0.75 mm in the cases and 8.1 ± 0.73 mm in the controls. The likelihood of a patient needing revision ACLR in the study cohort was 0.82 times lower (95% CI

  10. Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases.

    PubMed

    Flouzat-Lachaniette, Charles-Henri; Delblond, William; Poignard, Alexandre; Allain, Jérôme

    2013-04-01

    After a first anterior approach to the lumbar spine, formation of adhesions of soft tissues to the spine increases the surgical difficulties and potential for iatrogenic injury during the revision exposure. The objective of this study was to identify the intraoperative difficulties and postoperative complications associated with revision anterior lumbar spine procedures in a single institution. This is a retrospective review of 25 consecutive anterior revision lumbar surgeries in 22 patients (7 men and 15 women) operated on between 1998 and 2011. Patients with trauma or malignancies were excluded. The mean age of the patients at the time of revision surgery was 56 years (range 20-80 years). The complications were analyzed depending on the operative level and the time between the index surgery and the revision. Six major complications (five intraoperatively and one postoperatively) occurred in five patients (20 %): three vein lacerations (12 %) and two ureteral injuries (8 %), despite the presence of a double-J ureteral stent. The three vein damages were repaired or ligated by a vascular surgeon. One of the two ureteral injuries led to a secondary nephrectomy after end-to-end anastomosis failure; the other necessitated secondary laparotomy for small bowel obstruction. Anterior revision of the lumbar spine is technically challenging and is associated with a high rate of vascular or urologic complications. Therefore, the potential complications of the procedure must be weighted against its benefits. When iterative anterior lumbar approach is mandatory, exposure should be performed by an access surgeon in specialized centers that have ready access to vascular and urologic surgeons.

  11. Agility to INBONE: anterior and posterior approaches to the difficult revision total ankle replacement.

    PubMed

    DeVries, J George; Scott, Ryan T; Berlet, Gregory C; Hyer, Christopher F; Lee, Thomas H; DeOrio, James K

    2013-01-01

    Total ankle replacement is now acknowledged as a viable alternative to ankle arthrodesis for end-stage ankle arthritis. The authors present a series of 14 patients who were converted from the Agility total ankle replacement to an INBONE total ankle replacement. This report is unique in that anterior and posterior approaches are discussed and detailed. Although the authors present successful conversion of the Agility total ankle replacement to an INBONE total ankle replacement, the difficulty of this procedure is demonstrated by the high complication rate and 2 early failures.

  12. Overpowering posterior lumbar instrumentation and fusion with hyperlordotic anterior lumbar interbody cages followed by posterior revision: a preliminary feasibility study.

    PubMed

    Kadam, Abhijeet; Wigner, Nathan; Saville, Philip; Arlet, Vincent

    2017-09-29

    OBJECTIVE The authors' aim in this study was to evaluate whether sagittal plane correction can be obtained from the front by overpowering previous posterior instrumentation and/or fusion with hyperlordotic anterior lumbar interbody fusion (ALIF) cages in patients undergoing revision surgery for degenerative spinal conditions and/or spinal deformities. METHODS The authors report their experience with the application of hyperlordotic cages at 36 lumbar levels for ALIFs in a series of 20 patients who underwent revision spinal surgery at a single institution. Included patients underwent staged front-back procedures: ALIFs with hyperlordotic cages (12°, 20°, and 30°) followed by removal of posterior instrumentation and reinstrumentation from the back. Patients were divided into the following 2 groups depending on the extent of posterior instrumentation and fusion during the second stage: long constructs (≥ 6 levels with extension into thoracic spine and/or pelvis) and short constructs (< 6 levels). Preoperative and postoperative standing radiographs were evaluated to measure segmental lordosis (SL) along with standard sagittal parameters. Radiographic signs of pseudarthrosis at previously fused levels were also sought in all patients. RESULTS The average patient age was 54 years (range 30-66 years). The mean follow-up was 11.5 months (range 5-26 months). The mean SL achieved with 12°, 20°, and 30° cages was 13.1°, 19°, and 22.4°, respectively. The increase in postoperative SL at the respective surgically treated levels for 12°, 20°, and 30° cages that were used to overpower posterior instrumentation/fusion averaged 6.1° (p < 0.05), 12.5° (p < 0.05), and 17.7° (p < 0.05), respectively. No statistically significant difference was found in SL correction at levels in patients who had pseudarthrosis (n = 18) versus those who did not (n = 18). The mean overall lumbar lordosis increased from 44.3° to 59.8° (p < 0.05). In the long-construct group, the mean

  13. Revising.

    ERIC Educational Resources Information Center

    Wyman, Linda, Ed.

    1983-01-01

    In focusing on recursive writing, the nine articles in this journal issue suggest that student writing should be taken seriously. The first article states that revision should occur throughout the writing process while the second discusses how to invite writers to become active readers of their own texts. The third article presents methods of…

  14. Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament.

    PubMed

    Odate, Seiichi; Shikata, Jitsuhiko; Soeda, Tsunemitsu; Yamamura, Satoru; Kawaguchi, Shinji

    2017-04-01

    OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. An anterior cervical decompression and fusion (ACDF) procedure for cervical OPLL is theoretically feasible, as the lesion exists anteriorly; however, such a procedure is considered technically demanding and is associated with serious complications. Cervical laminoplasty is reportedly an effective alternative procedure with few complications; it is recognized as a comparatively safe procedure, and has been widely used as an initial surgery for cervical OPLL. After posterior surgery, some patients require revision surgery because of late neurological deterioration due to kyphotic changes in cervical alignment or OPLL progression. Here, the authors retrospectively investigated the surgical results and complications of revision ACDF after initial posterior surgery for OPLL. METHODS This was a single-center, retrospective study. Between 2006 and 2013, 19 consecutive patients with cervical OPLL who underwent revision ACDF at the authors' institution after initial posterior surgery were evaluated. The mean age at the time of revision ACDF was 66 ± 7 years (± SD; range 53-78 years). The mean interval between initial posterior surgery and revision ACDF was 63 ± 53 months (range 3-235 months). RESULTS The mean follow-up period after revision ACDF was 41 ± 26 months (range 24-108 months). Before revision ACDF, the mean maximum thickness of the ossified posterior longitudinal ligament was 7.2 ± 1.5 mm (range 5-10 mm), and the mean C2-7 angle was 1.3° ± 14° (range -40° to 24°). The K-line was plus (OPLL did not exceed the K-line) in 8 patients and minus in 11 (OPLL exceeded the K-line). The mean Japanese Orthopaedic Association score improved from 10 ± 3 (range 3-15) before revision ACDF to 11 ± 4 (range 4-15) at the last follow-up, and the mean improvement rate was 18% ± 18% (range 0%-60%). A total of 16 surgery-related complications developed in 12 patients (63%). The

  15. The Direct Anterior Approach for Hip Revision: Accessing the Entire Femoral Diaphysis Without Endangering the Nerve Supply.

    PubMed

    Nogler, Michael M; Thaler, Martin R

    2017-02-01

    The direct anterior approach (DAA) to the hip has been criticized as an approach that is limited to primary arthroplasty only. Our study objective was to demonstrate, in a cadaveric setting, that an alternate extension of the DAA can be used to reach the femur at the posterior border of the lateral vastus muscle without endangering the nerve supply. The iliotibial tract is split anteriorly and pulled laterally, thereby opening the interval to the lateral-posterior aspect of the vastus muscle. The muscle fascia is incised at the posterior border to access the femoral diaphysis. The vastus mobilization is started distally and laterally to the greater trochanter, leaving a muscular bridge between the vastus and the medial gluteal muscle intact. If it is necessary to open the femoral cavity for implant retrieval, we perform an anterior wall osteotomy instead of an extended trochanteric osteotomy. It was possible to split the iliotibial band and pull it laterally, thereby exposing the entire vastus lateralis muscle. The junction of the vastus lateralis and vastus intermedius was not encountered in all cases, nor was the nerve supply with all nerve fibers in that interval. The alternate technique described here for accessing the femoral diaphysis allows for easy access to the lateral aspect of the vastus lateralis and the femoral diaphysis. Using this technique, it should also be possible to access the femur and perform all necessary reconstructive procedures on it without damaging the surrounding nerve structures. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Influence of Different Tibial Fixation Techniques on Initial Stability in Single-Stage Anterior Cruciate Ligament Revision With Confluent Tibial Tunnels: A Biomechanical Laboratory Study.

    PubMed

    Schliemann, Benedikt; Treder, Maximilian; Schulze, Martin; Müller, Viktoria; Vasta, Sebastiano; Zampogna, Biaggio; Herbort, Mirco; Kösters, Clemens; Raschke, Michael J; Lenschow, Simon

    2016-01-01

    To kinematically and biomechanically compare 4 different types of tibial tunnel management in single-stage anterior cruciate ligament (ACL) revision reconstruction with the control: primary ACL reconstruction using a robotic-based knee testing setup. Porcine knees and flexor tendons were used. One hundred specimens were randomly assigned to 5 testing groups: (1) open tibial tunnel, (2) bone plug technique, (3) biodegradable interference screw, (4) dilatation technique, and (5) primary ACL reconstruction. A robotic/universal force-moment sensor testing system was used to simulate the KT-1000 (MEDmetric, San Diego, CA) and pivot-shift tests. Cyclic loading and load-to-failure testing were performed. Anterior tibial translation increased significantly with all of the techniques compared with the intact ACL (P < .05). In the simulated KT-1000 test, groups 2 and 3 achieved results equal to those of primary ACL reconstruction (P > .05). The open tunnel and dilated tunnel techniques showed significantly greater anterior tibial translation (P < .05). The results of the simulated pivot-shift test were in accordance with those of the KT-1000 test. No significant differences could be observed regarding stiffness or maximum load to failure. However, elongation was significantly lower in the primary ACL reconstruction group compared with groups 1 and 3 (P = .02 and P = .03, respectively). Filling an incomplete and incorrect tibial tunnel with a press-fit bone plug or a biodegradable interference screw in a standardized laboratory situation provided initial biomechanical properties and knee stability comparable with those of primary ACL reconstruction. In contrast, the dilatation technique or leaving the malplaced tunnel open did not restore knee kinematics adequately in this model. Backup extracortical fixation should be considered because the load to failure depends on the extracortical fixation when an undersized interference screw is used for aperture fixation. Our

  17. Spontaneous patella fracture associated with anterior tibial tubercle pseudarthrosis in a revised knee replacement following knee Arthrodesis

    PubMed Central

    2013-01-01

    Background Conversion of a knee arthrodesis to a Total Knee Arthroplasty is an uncommon procedure. Revision Total Knee Arthroplasty in this setting presents the surgeon with a number of challenges including the management of the extensor mechanism and patella. Case presentation We describe a unique case of a 69 years old Caucasian man who underwent a revision Total Knee Arthroplasty using a tibial tubercle osteotomy after a previous conversion of a knee arthrodesis without patella resurfacing. Unfortunately 9 months following surgery a tibial tubercle pseudarthrosis and spontaneous patella fracture occurred. Both were managed with open reduction and internal fixation. At 30 months follow-up the tibial tubercle osteotomy had completely consolidated while the patella fracture was still evident but with no signs of further displacement. The patient was completely satisfied with the outcome and had a painless range of knee flexion between 0-95°. Conclusions We believe that patients undergoing this type of surgery require careful counseling regarding the risk of complications both during and after surgery despite strong evidence supporting improved functional outcomes. PMID:24195600

  18. Risk for Revision After Anterior Cruciate Ligament Reconstruction Is Higher Among Adolescents: Results From the Danish Registry of Knee Ligament Reconstruction.

    PubMed

    Faunø, Peter; Rahr-Wagner, Lene; Lind, Martin

    2014-10-01

    The number of children and adolescents with anterior cruciate ligament (ACL) reconstructions is increasing, and disturbing reports on high rerupture rates in this group have been noted. To describe the outcome of ACL reconstruction in children and adolescents based on data from the Danish Knee Ligament Reconstruction Registry (DKRR). Cohort study; Level of evidence, 3. Data were retrieved from the DKRR, a national population-based registry. The analysis was based on a population of 14,806 ACL-reconstructed patients. The outcome was evaluated using risk of ACL revision, subjective outcome score (Knee injury and Osteoarthritis Outcome Score [KOOS]), Tegner function score, and objective knee laxity. Three age groups were defined (A, <13 years; B, 13-15 years; and C, 15-20 years) and compared with D, patients ≥20 years (adults). There were 95 patients in group A, 327 in B, 2888 in C, and 11,496 in D. There was a significantly increased risk of revision surgery in the age groups B (6.7%) and C (4.9%) compared with the adults in group D (2.0%). Objective knee laxity did not differ between the 4 groups. Groups A, B, and C had a higher score on the combined KOOS symptoms, pain, sport, and quality of life subscales (KOOS4; 79.6, 76.6, and 73.1, respectively) compared with the adults (69.7). Group B had higher KOOS quality of life (76.6) and sports (71.1) scores than did group C (73.1 and 66.4, respectively). The Tegner activity score did not differ between the 4 groups. No impact of the use of extracortical graft fixation was detected in the youngest age group. Study results indicated an increased risk of graft failure in patients between 13 and 20 years of age. This is in contrast to the better subjective and equal objective knee score found in the same age groups. The new knowledge about the high revision rate among ACL-reconstructed teenagers is important for evidence-based preoperative information of ACL patients and their parents.

  19. Revision pediatric anterior cruciate ligament reconstruction after failure of iliotibial band technique treated with all-epiphyseal technique in a prepubescent with Ehlers-Danlos syndrome: a case report.

    PubMed

    Erdman, Mary K; Warnick, Drew E

    2017-09-01

    The increasing number of pediatric anterior cruciate ligament (ACL) injuries and the failure of nonoperative management of these patients has elicited a concordant response in the surgical community to devise reconstruction techniques that stabilize the knee joint without causing iatrogenic growth disturbances. Likewise, the rise in pediatric ACL reconstructions forecasts a consequent rise in revision ACL reconstructions in patients with open physes. In this case report, we describe a prepubescent with Ehlers-Danlos syndrome and congenital ACL deficiency, who underwent physeal-sparing iliotibial band ACL reconstruction and revision to an all-epiphyseal ACL reconstruction with allograft. We also underscore the lack of evidence addressing graft choice and outcomes for ACL reconstructions in patients with connective tissue disorders.

  20. Graft Diameter as a Predictor for Revision Anterior Cruciate Ligament Reconstruction and KOOS and EQ-5D Values: A Cohort Study From the Swedish National Knee Ligament Register Based on 2240 Patients.

    PubMed

    Snaebjörnsson, Thorkell; Hamrin Senorski, Eric; Ayeni, Olufemi R; Alentorn-Geli, Eduard; Krupic, Ferid; Norberg, Fredrik; Karlsson, Jón; Samuelsson, Kristian

    2017-07-01

    Anterior cruciate ligament (ACL) reconstruction (ACLR) using a hamstring tendon (HT) autograft is an effective and widespread method. Recent studies have identified a relationship between the graft diameter and revision ACLR. To evaluate the influence of the graft diameter on revision ACLR and patient-reported outcomes in patients undergoing primary ACLR using HT autografts. Cohort study; Level of evidence, 2. A prospective cohort study was conducted using the Swedish National Knee Ligament Register (SNKLR) involving all patients undergoing primary ACLR using HT autografts. Patients with graft failure who needed revision surgery (cases) were compared with patients not undergoing revision surgery (controls). The control group was matched for sex, age, and graft fixation method in a 3:1 ratio. Conditional logistic regression was performed to produce odds ratios and 95% CIs. Univariate linear regression analyses were performed for patient-related outcomes. The Knee injury and Osteoarthritis Outcome Score (KOOS) and EuroQol 5 dimensions questionnaire (EQ-5D) values were obtained. A total of 2240 patients were included in which there were 560 cases and 1680 controls. No significant differences between the cases and controls were found for sex (52.9% male), mean age (21.7 years), and femoral and tibial fixation. The mean graft diameter for the cases was 8.0 ± 0.74 mm and for the controls was 8.1 ± 0.76 mm. In the present cohort, the likelihood of revision surgery for every 0.5-mm increase in the HT autograft diameter between 7.0 and 10.0 mm was 0.86 (95% CI, 0.75-0.99; P = .03). Univariate linear regression analysis found no significant regression coefficient for the change in KOOS or EQ-5D values. In a large cohort of patients after primary ACLR with HT autografts, an increase in the graft diameter between 7.0 and 10.0 mm resulted in a 0.86 times lower likelihood of revision surgery with every 0.5-mm increase. This study provides further evidence of the importance of

  1. The association of meniscal status, lower extremity alignment, and body mass index with chondrosis at the time of revision Anterior Cruciate Ligament reconstruction

    PubMed Central

    Brophy, Robert H.; Haas, Amanda K.; Huston, Laura J.; Nwosu, Sam K.; Wright, Rick W.

    2015-01-01

    Background Knees undergoing revision ACL reconstruction (rACLR) have a high prevalence of articular cartilage lesions. Hypothesis The purpose of this study was to test the hypothesis that the prevalence of chondrosis at the time of rACLR is associated with meniscus status and lower extremity alignment. Study design Cross sectional study. Methods Data from the prospective Multicenter ACL Revision Study (MARS) cohort was reviewed to identify patients with pre-operative lower extremity alignment films. Lower extremity alignment was defined by the weight bearing line (WBL) as a percentage of the tibial plateau width, while the chondral and meniscal status of each weight bearing compartment was recorded at the time of surgery. Multivariable proportional odds models were constructed and adjusted for relevant factors in order to examine which risk factors were independently associated with the degree of medial and lateral compartment chondrosis. Results The cohort included 246 patients with lower extremity alignment films at the time of rACLR. Average (SD) patient age was 26.9 (9.5) years with a BMI of 26.4 (4.6). The medial compartment had more chondrosis (Grade 2/3: 42%, Grade 4: 6.5%) than the lateral compartment (Grade 2/3: 26%, Grade 4: 6.5%). Disruption of the meniscus was noted in 35% of patients on the medial side and 16% in the lateral side. The average (SD) WBL was measured to be 0.43 (0.13). Medial compartment chondrosis was associated with BMI (p=0.025), alignment (p=0.002), and medial meniscus status (p=0.001). None of the knees with the WBL lateral to 0.625 had Grade 4 chondrosis in the medial compartment. Lateral compartment chondrosis was significantly associated with age (p=0.013) and lateral meniscus status (p<0.001). Subjects with ‘intact’ menisci were found to decrease their odds of having chondrosis by 64–84%. Conclusions The status of articular cartilage in the tibiofemoral compartments at the time of rACLR is related to meniscal status. Lower

  2. Revision arthroscopic Bankart repair.

    PubMed

    Abouali, Jihad Alexander Karim; Hatzantoni, Katerina; Holtby, Richard; Veillette, Christian; Theodoropoulos, John

    2013-09-01

    Failed anterior shoulder stabilization procedures have traditionally been treated with open procedures. Recent advances in arthroscopic techniques have allowed for certain failed stabilization procedures to be treated by arthroscopic surgery. The aim of this systematic review was to determine the outcomes of revision arthroscopic Bankart repair. We searched Medline, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for articles on revision arthroscopic Bankart repairs. Key words included shoulder dislocation, anterior shoulder instability, revision surgery, and arthroscopic Bankart repair. Two reviewers selected studies for inclusion, assessed methodologic quality, and extracted data. We included 16 studies comprising 349 patients. All studies were retrospective (1 Level II study and 15 Level IV studies). The mean incidence of recurrent instability after revision arthroscopic Bankart repair was 12.7%, and the mean follow-up period was 35.4 months. The most common cause for failure of the primary surgeries was a traumatic injury (62.1%), and 85.1% of patients returned to playing sports. The reasons for failure of revision cases included glenohumeral bone loss, hyperlaxity, and return to contact sports. With proper patient selection, the outcomes of revision arthroscopic Bankart repair appear similar to those of revision open Bankart repair. Prospective, randomized clinical trials are required to confirm these findings. Level IV, systematic review of Level II and Level IV studies. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  3. Current strategies with 1-stage prosthetic breast reconstruction

    PubMed Central

    2015-01-01

    Background 1-stage prosthetic breast reconstruction is gaining traction as a preferred method of breast reconstruction in select patients who undergo mastectomy for cancer or prevention. Methods Critical elements to the procedure including patient selection, technique, surgical judgment, and postoperative care were reviewed. Results Outcomes series reveal that in properly selected patients, direct-to-implant (DTI) reconstruction has similar low rates of complications and high rates of patient satisfaction compared to traditional 2-stage reconstruction. Conclusions 1-stage prosthetic breast reconstruction may be the procedure of choice in select patients undergoing mastectomy. Advantages include the potential for the entire reconstructive process to be complete in one surgery, the quick return to normal activities, and lack of donor site morbidity. PMID:26005643

  4. Contractual Revision.

    ERIC Educational Resources Information Center

    Engel, Mary F.; Sawyer, Thomas M.

    Contractual revision promotes cooperation between teachers and tutors and, being student initiated, provides a method to increase student control over the revision process and encourage students to communicate their strengths and weaknesses in writing to their teachers or tutors. The contractual revision process requires students to form contracts…

  5. Revision Gore-Tex medialization laryngoplasty.

    PubMed

    Cohen, Jacob T; Bates, Dwight D; Postma, Gregory N

    2004-09-01

    To evaluate the indications, results, and safety of revision Gore-Tex medialization laryngoplasty (GML). A retrospective chart review of 156 patients that underwent GML procedures between the years 1998-2002. Study population consisted of those patients who required revision surgery for any reason. Sixteen patients required 22 revision procedures. Indications for revision were divided into 2 groups, complications and glottal closure problems. Complications included extruded or displaced implants (n = 4). The most common glottal closure problem was undercorrection (n = 9). Others included anterior overcorrection (n = 1) and persistent posterior glottal gap (n = 2). Revision procedures included GML (n = 9), injection augmentation (n = 9), endoscopic implant removal (n = 2), and arytenoid adduction (n = 2). In patients with glottal closure problems, the GCI improved in all 10 and the voice rating scale improved in 9. Reasons for revision of GML are variable, the most common being undercorrection. A variety of safe, effective revision techniques are available with a high success rate.

  6. Scar revision

    MedlinePlus

    ... corrects skin changes (disfigurement) caused by an injury, wound, poor healing, or previous surgery. Description Scar tissue forms as ... stiffening of the joint, you may need physical therapy after surgery. Apply sunscreen to keep sunlight from permanently ... Keloid revision; Hypertrophic scar revision; ...

  7. America Revising.

    ERIC Educational Resources Information Center

    Marty, Myron

    1982-01-01

    Reviews Frances FitzGerald's book, "America Revised," and discusses FitzGerald's critique of recent revisions in secondary-level U.S. history textbooks. The author advocates the implementation of a core curriculum for U.S. history which emphasizes political and local history. (AM)

  8. Direct cord implantation in brachial plexus avulsions: revised technique using a single stage combined anterior (first) posterior (second) approach and end-to-side side-to-side grafting neurorrhaphy

    PubMed Central

    2009-01-01

    Background The superiority of a single stage combined anterior (first) posterior (second) approach and end-to-side side-to-side grafting neurorrhaphy in direct cord implantation was investigated as to providing adequate exposure to both the cervical cord and the brachial plexus, as to causing less tissue damage and as to being more extensible than current surgical approaches. Methods The front and back of the neck, the front and back of the chest up to the midline and the whole affected upper limb were sterilized while the patient was in the lateral position; the patient was next turned into the supine position, the plexus explored anteriorly and the grafts were placed; the patient was then turned again into the lateral position, and a posterior cervical laminectomy was done. The grafts were retrieved posteriorly and side grafted to the anterior cord. Using this approach, 5 patients suffering from complete traumatic brachial plexus palsy, 4 adults and 1 obstetric case were operated upon and followed up for 2 years. 2 were C5,6 ruptures and C7,8T1 avulsions. 3 were C5,6,7,8T1 avulsions. C5,6 ruptures were grafted and all avulsions were cord implanted. Results Surgery in complete avulsions led to Grade 4 improvement in shoulder abduction/flexion and elbow flexion. Cocontractions occurred between the lateral deltoid and biceps on active shoulder abduction. No cocontractions occurred after surgery in C5,6 ruptures and C7,8T1 avulsions, muscle power improvement extended into the forearm and hand; pain disappeared. Limitations include spontaneous recovery despite MRI appearance of avulsions, fallacies in determining intraoperative avulsions (wrong diagnosis, wrong level); small sample size; no controls rule out superiority of this technique versus other direct cord reimplantation techniques or other neurotization procedures; intra- and interobserver variability in testing muscle power and cocontractions. Conclusion Through providing proper exposure to the brachial plexus

  9. Passage of an Anterior Odontoid Screw through Gastrointestinal Tract

    PubMed Central

    Leitner, L.; Brückmann, C. I.; Gilg, M. M.; Bratschitsch, G.; Radl, R.

    2017-01-01

    Purpose. Anterior screw fixation has become a popular surgical treatment method for instable odontoid fractures. Screw loosening and migration are a rare, severe complication following anterior odontoid fixation, which can lead to esophagus perforation and requires revision operation. Methods. We report a case of screw loosening and migration after anterior odontoid fixation, which perforated the esophagus and was excreted without complications in a 78-year-old male patient. Results. A ventral dislocated anterior screw perforated through the esophagus after eight years after implantation and was excreted through the gastrointestinal (GI) tract. At a 6-month follow-up after the event the patient was asymptomatic. Conclusion. Extrusion via the GI tract is not safe enough to be considered as a treatment option for loosened screws. Some improvements could be implemented to prevent such an incident. Furthermore, this case is a fine example that recent preoperative imaging is mandatory before revision surgery for screw loosening. PMID:28194180

  10. Surgical technique for revision surgery of cervical artificial disc replacements.

    PubMed

    Onken, Julia; Meyer, Bernhard; Vajkoczy, Peter

    2017-01-01

    OBJECTIVE Cervical artificial disc replacement (C-ADR) is a widely used procedure with low risk at implantation. Few cases have been reported about the surgical techniques of C-ADR revision. The authors describe their surgical experience with the explantation of a Galileo C-ADR. METHODS Revision surgery was performed in a 58-year-old patient. Patient positioning and surgical opening techniques were performed as appropriate for anterior cervical decompression. RESULTS Revision surgery via the initial anterior approach was successful following an atraumatic removal of the implant. Fusion of the C5-6 segment was performed without complications. CONCLUSIONS In general, the authors observed recurrent nerve palsy and malpositioning of the revised implant in C-ADR revision surgery. Problems with implant removal did not occur because the fusion rate was low due to the short time between initial surgery and C-ADR revision surgery. The video can be found here: https://youtu.be/32CUEDquinc .

  11. Revision Rhinoplasty.

    PubMed

    Loyo, Myriam; Wang, Tom D

    2016-01-01

    Revision rhinoplasty is one of the most challenging operations the facial plastic surgeon performs given the complex 3-dimensional anatomy of the nose and the psychological impact it has on patients. The intricate interplay of cartilages, bone, and soft tissue in the nose gives it its aesthetic and function. Facial harmony and attractiveness depends greatly on the nose given its central position in the face. In the following article, the authors review common motivations and anatomic findings for patients seeking revision rhinoplasty based on the senior author's 30-year experience with rhinoplasty and a review of the literature.

  12. Bilateral Anterior Shoulder Dislocation

    PubMed Central

    Siu, Yuk Chuen; Lui, Tun Hing

    2014-01-01

    Introduction: Unilateral anterior shoulder dislocation is one of the most common problems encountered in orthopedic practice. However, simultaneous bilateral anterior dislocation of the shoulders is quite rare. Case Presentation: We report a case of a 75-year-old woman presented with simultaneous bilateral anterior shoulder dislocation following a trauma, complicated with a traction injury to the posterior cord of the brachial plexus. Conclusions: Bilateral anterior shoulder dislocation is very rare. The excessive traction force during closed reduction may lead to nerve palsy. Clear documentation of neurovascular status and adequate imaging before and after a reduction should be performed. PMID:25685749

  13. Femoral tunnel malposition in ACL revision reconstruction.

    PubMed

    Morgan, Joseph A; Dahm, Diane; Levy, Bruce; Stuart, Michael J

    2012-11-01

    The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed to study a large cohort of revision ACL reconstruction patients. The purpose of this subset analysis study of the MARS database is to describe specific details of femoral tunnel malposition and subsequent management strategies that surgeons chose in the revision setting. The design of this study is a case series. The multicenter MARS database is compiled from a questionnaire regarding 460 ACL reconstruction revision cases returned by 87 surgeons. This subset analysis described technical aspects and operative findings in specifically those cases in which femoral tunnel malposition was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions included for study, 276 (60%) cases cited a specific "technical cause of failure." Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction, autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral tunnel malposition in primary ACL reconstruction was the most commonly cited reason for graft failure in this cohort. Graft selection is widely variable among surgeons. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  14. Preoperative Planning for ACL Revision Surgery.

    PubMed

    Osti, Leonardo; Buda, Matteo; Osti, Raffaella; Massari, Leo; Maffulli, Nicola

    2017-03-01

    The number of patients undergoing revision surgery following failure of anterior cruciate ligament (ACL) reconstruction has increased over the recent past, following the overall increased number of primary ACL reconstruction performed. Failure of primary ACL reconstruction can be attributed to technical errors, biological failures, or new traumatic injuries. Technical errors include femoral and/or tibial tunnels malposition, untreated associated ligaments insufficiencies, uncorrected lower limb malalignment, and graft fixation failures. Candidates for revision surgery should be carefully selected, and the success of ACL revision requires precise preoperative planning to obtain successful results. Preoperative planning begins with the analysis of the mechanisms of ACL reconstruction failure, and information regarding previous surgery, such as the type of graft implanted, and the position of existing hardware. Appropriate imaging is necessary to evaluate the position of the femoral and tibial tunnels, and abnormal tunnel widening. On the basis of clinical examination and imaging, surgeon can perform an ACL revision procedure in 1 or 2 stages.

  15. ACL Revision

    PubMed Central

    Costa-Paz, Matias; Dubois, Julieta Puig; Zicaro, Juan Pablo; Rasumoff, Alejandro; Yacuzzi, Carlos

    2017-01-01

    Objectives: The purpose of this study was to evaluate a series of patients one year after an ACL revision with clinical evaluation and MRI, to consider their condition before returning to sports activities. Methods: A descriptive, prospective and longitudinal study was performed. A series of patients who underwent an ACL revision between March 2014 and March 2015 were evaluated after one year post surgery. They were evaluated using the Lysholm score, IKDC, Tegner, artrometry and MRI (3.0 t). A signal pattern and osteointegration was determined in the MRI. Graft signal intensity of the ACL graft using the signal/noise quotient value (SNQ) was also determined to evaluate the ligamentatization process state. Results: A total of 18 male patients were evaluated with a mean age of 31 years old.Average scores were: Lysholm 88 points, IKDC 80 points, Pre-surgical Tegner 9 points and postoperative 4 points. Artrhometry (KT1000) at 20 newtons showed a side to side difference of less than 3 mm in 88%. Only 44% of patients returned to their previous sport activity one year after revision.The MRI showed a heterogeneous signal in neoligaments in 34% of patients. SNQ showed graft integration in only 28%. Synovial fluid was found in bone-graft interphase in 44% of tunnels, inferring partial osteointegration. The heterogeneous signal was present in 50% of patients who did not return to the previous sport level activity. (Fisher statistics: p = 0.043) There were no meaningful differences in patients with auto or allografts. Conclusion: Although the clinical evaluation was satisfactory, only 44% of patients returned to the previous level of sport activity one year after the ACL surgery. The ligamentatization process was found in 28% of knees evaluated with MRI one year later. Partial osteointegration is inferred in 44%. Results showed a meaningful relation between the signal of neoligaments in the MRI and the return to sport activity in said series of patients. MRI is a useful tool

  16. Anterior cruciate ligament (ACL) injury

    MedlinePlus

    Cruciate ligament injury - anterior; ACL injury; Knee injury - anterior cruciate ligament (ACL) ... knee. It prevents the knee from bending out. Anterior cruciate ligament (ACL) is in the middle of the knee. ...

  17. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePlus

    ... Week of Healthy Breakfasts Shyness Anterior Cruciate Ligament (ACL) Injuries KidsHealth > For Teens > Anterior Cruciate Ligament (ACL) ... and Recovery Coping With an ACL Injury About ACL Injuries A torn anterior cruciate ligament (ACL) is ...

  18. [Anterior tarsal tunnel syndrome].

    PubMed

    Miliam, Palle B; Basse, Peter N

    2009-03-30

    Anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the extensor retinaculum of the ankle. It may be rare because it is underrecognized clinically.We present a case regarding a 29-year-old man, drummer, who for one and a half year experienced clinical symptoms of anterior tarsal tunnel syndrome. A surgical decompression of the anterior tarsal tunnel was performed, and at the check three months later the symptoms where gone. One year after, there were still no symptoms.

  19. [Isolated anterior cervical hypertrichosis].

    PubMed

    Monteagudo, B; Cabanillas, M; de las Heras, C; Cacharrón, J M

    2009-01-01

    Anterior cervical hypertrichosis was described by Trattner and coworkers in 1991. It consists of a of hair at the anterior cervical level just above the laryngeal prominence. To date, only 28 cases of anterior cervical hypertrichosis have been reported. Although it is normally an isolated finding, it may be associated with mental retardation, hallux valgus, retinal disorders, other hair disorders, facial dysmorphism, or sensory and motor peripheral neuropathy. We report the case of a 27-year-old woman who presented with this condition as an isolated finding.

  20. Scar revision

    PubMed Central

    Sharma, Mohit; Wakure, Abhijeet

    2013-01-01

    Most surgical patients end up with a scar and most of these would want at least some improvement in the appearance of the scar. Using sound techniques for wound closure surgeons can, to a certain extent, prevent suboptimal scars. This article reviews the principles of prevention and treatment of suboptimal scars. Surgical techniques of scar revision, i.e., Z plasty, W plasty, and geometrical broken line closure are described. Post-operative care and other adjuvant therapies of scars are described. A short description of dermabrasion and lasers for management of scars is given. It is hoped that this review helps the surgeon to formulate a comprehensive plan for management of scars of these patients. PMID:24516292

  1. 1-stage primary arthroplasty of mechanically failed internally fixated of hip fractures with deep wound infection

    PubMed Central

    Klatte, Till O; O’Loughlin, Padraigh F; Citak, Mustafa; Rueger, Johannes M; Gehrke, Thorsten; Kendoff, Daniel

    2013-01-01

    Background and purpose Mechanically failed internal fixation following hip fracture is often treated by salvage arthroplasty. If deep wound infection is present, a 2-stage procedure is often used. We have used a 1-stage procedure in infected cases, and we now report the outcome. Patients and methods We reviewed 16 cases of deep wound infection after mechanically failed hip fracture fixation, treated between 1994 and 2010. In all patients, a joint prosthesis was implanted in a 1-stage procedure. Results After an average follow-up period of 12 (2–18) years, no reinfection was detected. In 4 cases, a hip dislocation occurred and 3 of these needed further surgery. Interpretation A 1-stage procedure for arthroplasty of an infected, mechanically failed hip fracture fixation is feasible and carries a low risk of infection. PMID:23799345

  2. Failure of Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Samitier, Gonzalo; Marcano, Alejandro I.; Alentorn-Geli, Eduard; Cugat, Ramon; Farmer, Kevin W; Moser, Michael W

    2015-01-01

    The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL) surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient. PMID:26550585

  3. Anterior cruciate ligament repair - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100230.htm Anterior cruciate ligament repair - Series—Normal anatomy To use the sharing ... to slide 5 out of 5 Overview The anterior cruciate ligament (ACL) is a ligament in the center of ...

  4. Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty.

    PubMed

    Zijlstra, Wierd P; De Hartog, Bas; Van Steenbergen, Liza N; Scheurs, B Willem; Nelissen, Rob G H H

    2017-08-01

    Background and purpose - Recurrent dislocation is the commonest cause of early revision of a total hip arthropasty (THA). We examined the effect of femoral head size and surgical approach on revision rate for dislocation, and for other reasons, after total hip arthroplasty (THA). Patients and methods - We analyzed data on 166,231 primary THAs and 3,754 subsequent revision THAs performed between 2007 and 2015, registered in the Dutch Arthroplasty Register (LROI). Revision rate for dislocation, and for all other causes, were calculated by competing-risk analysis at 6-year follow-up. Multivariable Cox proportional hazard regression ratios (HRs) were used for comparisons. Results - Posterolateral approach was associated with higher dislocation revision risk (HR =1) than straight lateral, anterolateral, and anterior approaches (HR =0.5-0.6). However, the risk of revision for all other reasons (especially stem loosening) was higher with anterior and anterolateral approaches (HR =1.2) and lowest with posterolateral approach (HR =1). For all approaches, 32-mm heads reduced the risk of revision for dislocation compared to 22- to 28-mm heads (HR =1 and 1.6, respectively), while the risk of revision for other causes remained unchanged. 36-mm heads increasingly reduced the risk of revision for dislocation but only with the posterolateral approach (HR =0.6), while the risk of revision for other reasons was unchanged. With the anterior approach, 36-mm heads increased the risk of revision for other reasons (HR =1.5). Interpretation - Compared to the posterolateral approach, direct anterior and anterolateral approaches reduce the risk of revision for dislocation, but at the cost of more stem revisions and other revisions. For all approaches, there is benefit in using 32-mm heads instead of 22- to 28-mm heads. For the posterolateral approach, 36-mm heads can safely further reduce the risk of revision for dislocation.

  5. Anterior tarsal tunnel syndrome.

    PubMed

    DiDomenico, Lawrence A; Masternick, Eric B

    2006-07-01

    Compression of the deep peroneal nerve is commonly referred to as anterior tarsal tunnel syndrome. Although rare, this syndrome remains poorly diagnosed. The syndrome is characterized by pain, weakness, and sensory changes of the foot and ankle. Non-operative measures should be attempted to reduce or remove the external compression along the anterior aspect of the foot and ankle. Other options include shoe modifications, cortisone injections,and physical therapy. If conservative management fails to relieve the symptoms, surgical decompression of the entrapped nerve can be performed. The deep peroneal nerve is released from compressive forces in the entrapment site. This can be performed at the more proximal level at the extensor retinaculum or more distally at the level of the tarsal metatarsal site.

  6. [Anterior pseudodiverticulum after laryngectomy].

    PubMed

    Pitzer, G; Oursin, C; Wolfensberger, M

    1998-01-01

    An anterior neopharyngeal pseudodiverticulum is a mucosal pouch located between the tongue and hypopharynx due to an epiglottis-like posterior tissue band that forms after total laryngectomy. This condition has rarely been mentioned in literature. Incidence, symptoms, treatment, and possible etiologic factors were examined. Twenty post-laryngectomy patients were questioned about swallowing disorders and were examined clinically and by barium swallow. Eleven patients were found to have a pseudodiverticulum, of which 9 patients suffered from dysphagia. We found no correlation between the formation of a pseudodiverticulum and radiotherapy or post-laryngectomy complications. All symptomatic patients were treated by dissecting the posterior tissue band endoscopically with a CO2-laser, bringing complete relief of symptoms in 8 of 9 patients. Our study showed that the anterior pseudodiverticulum can be a frequent cause of dysphagia after laryngectomy. It can easily be diagnosed clinically and radiologically. Endoscopic treatment with a CO2-laser is simple and effective.

  7. Case report: a modified 1-stage technique for the treatment of brachymetatarsia.

    PubMed

    Brown, Michael J C; Yeoman, Thomas F M; Roberts, Sam; Pillai, Anand

    2012-12-01

    Brachymetatarsia is an abnormal shortening of a metatarsal. It causes disruption of the normal metatarsal parabola, resulting in metatarsalgia, calluses and dislocation of the digits. Patients often express discontent with the appearance of their feet. Lengthening by distraction osteogenesis and 1-stage intercalary bone grafting procedures are the mainstays of operative treatment. We present a modified 1-stage technique, combining the use of a Chevron osteotomy of the fourth metatarsal with shortening osteotomies of the second and third metatarsals. Bone removed from the third metatarsal was used to lengthen the fourth. The Chevron segments provided mediolateral, dorsoplantar, and rotational stability. The technique was used on both feet of 1 patient. The mean increase in AOFAS score was 34.5 (right foot, 46; left foot, 23.) There were no complications. A 1-stage technique does not require an external fixator or postoperative manipulation and has a quicker healing time. Taking the bone graft from neighboring metatarsals decreases the discrepancy between metatarsal lengths. A smaller increase in the length of the fourth ray is then required, and the chance of neurovascular injury as a result of soft-tissue stretching is minimized. This technique allows restoration of the metatarsal parabola and provides good correction, immediate stability, and good integration. Therapeutic Level IV, Case Study.

  8. The Padua Inventory: Do Revisions Need Revision?

    ERIC Educational Resources Information Center

    Gonner, Sascha; Ecker, Willi; Leonhart, Rainer

    2010-01-01

    The purpose of the present study was to examine the psychometric properties, factorial structure, and validity of the Padua Inventory-Washington State University Revision and of the Padua Inventory-Revised in a large sample of patients with obsessive-compulsive disorder (n = 228) and with anxiety disorders and/or depression (n = 213). The…

  9. The Padua Inventory: Do Revisions Need Revision?

    ERIC Educational Resources Information Center

    Gonner, Sascha; Ecker, Willi; Leonhart, Rainer

    2010-01-01

    The purpose of the present study was to examine the psychometric properties, factorial structure, and validity of the Padua Inventory-Washington State University Revision and of the Padua Inventory-Revised in a large sample of patients with obsessive-compulsive disorder (n = 228) and with anxiety disorders and/or depression (n = 213). The…

  10. Anterior knee pain.

    PubMed

    LLopis, Eva; Padrón, Mario

    2007-04-01

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries.

  11. Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties

    PubMed Central

    Born, Philipp; Ilchmann, Thomas; Zimmerli, Werner; Zwicky, Lukas; Graber, Peter; Ochsner, Peter E; Clauss, Martin

    2016-01-01

    Background and purpose — The use of uncemented revision stems is an established option in 2-stage procedures in patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, in 1-stage procedures, they are still rarely used. There are still no detailed data on radiological outcome after uncemented 1-stage revisions. We assessed (1) the clinical outcome, including reoperation due to persistent infection and any other reoperation, and (2) the radiological outcome after 1- and 2-stage revision, using an uncemented stem. Patients and methods — Between January 1993 and December 2012, an uncemented revision stem was used in 81 THAs revised for PJI. Patients were treated with 1- or 2-stage procedures according to a well-defined algorithm (1-stage: n = 28; 2-stage: n = 53). All hips had a clinical and radiological follow-up. Outcome parameters were eradication of infection, re-revision of the stem, and radiological changes. Survival was calculated using Kaplan-Meier analysis. Radiographs were analyzed for bone restoration and signs of loosening. The mean clinical follow-up time was 7 (2–15) years. Results — The 7-year infection-free survival was 96% (95% CI: 92–100), 100% for 1-stage revision and 94% for 2-stage revision (95% CI: 87–100) (p = 0.2). The 7-year survival for aseptic loosening of the stem was 97% (95% CI: 93–100), 97% for 1-stage revision (95% CI: 90–100) and 97% for 2-stage revision (95% CI: 92–100) (p = 0.3). No further infection or aseptic loosening occurred later than 7 years postoperatively. The radiographic results were similar for 1- and 2-stage procedures. Interpretation — Surgical management of PJI with stratification to 1- or 2-stage exchange according to a well-defined algorithm combined with antibiotic treatment allows the safe use of uncemented revision stems. Eradication of infection can be achieved in most cases, and medium- and long-term results appear to be comparable to those for revisions

  12. Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties.

    PubMed

    Born, Philipp; Ilchmann, Thomas; Zimmerli, Werner; Zwicky, Lukas; Graber, Peter; Ochsner, Peter E; Clauss, Martin

    2016-12-01

    Background and purpose - The use of uncemented revision stems is an established option in 2-stage procedures in patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, in 1-stage procedures, they are still rarely used. There are still no detailed data on radiological outcome after uncemented 1-stage revisions. We assessed (1) the clinical outcome, including reoperation due to persistent infection and any other reoperation, and (2) the radiological outcome after 1- and 2-stage revision, using an uncemented stem. Patients and methods - Between January 1993 and December 2012, an uncemented revision stem was used in 81 THAs revised for PJI. Patients were treated with 1- or 2-stage procedures according to a well-defined algorithm (1-stage: n = 28; 2-stage: n = 53). All hips had a clinical and radiological follow-up. Outcome parameters were eradication of infection, re-revision of the stem, and radiological changes. Survival was calculated using Kaplan-Meier analysis. Radiographs were analyzed for bone restoration and signs of loosening. The mean clinical follow-up time was 7 (2-15) years. Results - The 7-year infection-free survival was 96% (95% CI: 92-100), 100% for 1-stage revision and 94% for 2-stage revision (95% CI: 87-100) (p = 0.2). The 7-year survival for aseptic loosening of the stem was 97% (95% CI: 93-100), 97% for 1-stage revision (95% CI: 90-100) and 97% for 2-stage revision (95% CI: 92-100) (p = 0.3). No further infection or aseptic loosening occurred later than 7 years postoperatively. The radiographic results were similar for 1- and 2-stage procedures. Interpretation - Surgical management of PJI with stratification to 1- or 2-stage exchange according to a well-defined algorithm combined with antibiotic treatment allows the safe use of uncemented revision stems. Eradication of infection can be achieved in most cases, and medium- and long-term results appear to be comparable to those for revisions for aseptic

  13. Anterior vitrectomy for shallow anterior chamber after cataract extraction.

    PubMed

    Dottan, S; Levartovsky, S; Oliver, M

    1982-06-01

    Pars plana anterior vitrectomy was performed in 9 patients with shallow anterior chamber after cataract extraction. Five patients had choroidal and/or ciliary body effusion (CCBE), and 4 had aphakic pupillary block (APB). Vitrectomy was performed only after medical treatment failed to restore a normal anterior chamber depth. In all patients the anterior chamber restored during surgery and remained so thereafter, although in patients with CCBE, the fundal pathology subsided days or even months later. The only surgical complication was a longstanding cystoid macular oedema in one patient. Pars plana vitrectomy would appear to have advantages over other surgical techniques, in similar circumstances.

  14. Uveitis (acute anterior).

    PubMed

    Islam, Niaz; Pavesio, Carlos

    2010-04-08

    Anterior uveitis is rare, with an annual incidence of 12/100,000 population, although it is more common in Finland (annual incidence of 23/100,000), probably because of genetic factors, such as high frequency of HLA-B27 in the population. It is often self-limiting, but can, in some cases, lead to complications such as posterior synechiae, cataract, glaucoma, and chronic uveitis. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of anti-inflammatory eye drops on acute anterior uveitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found six systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids, mydriatics, and non-steroidal anti-inflammatory drug eye drops.

  15. Evolving "Diagnostic" Criteria for Axial Spondyloarthritis in the Context of Anterior Uveitis.

    PubMed

    Rosenbaum, James T

    2016-08-01

    Anterior uveitis is far more common than intermediate, posterior or panuveitis. About 50% of patients with acute anterior uveitis are HLA B27+. Those who are HLA B27+ are highly likely to have associated back, joint, or tendon disease. The majority of patients with acute anterior uveitis and inflammatory low back pain are suffering from axial spondyloarthritis and radiographic evidence for abnormal sacroiliac joints is not required to make this diagnosis. Received 12 October 2015; revised 31 January 2016; accepted 16 February 2016; published online 12 April 2016.

  16. Scheimpflug imaging in anterior megalophthalmos

    PubMed Central

    Nemeth, Gabor; Hassan, Ziad; Berta, Andras; Modis, Laszlo

    2013-01-01

    We report an anterior megalophthalmos case with decreased corneal thickness and show the findings using Scheimpflug imaging. A 25-year-old male was diagnosed with anterior megalophthalmos. In both eyes, enlarged corneal length was measured. Beside a comparatively good visual acuity, a thin but clear cornea, a fairly deep anterior chamber, and central lens opacity were found. Scheimpflug images were taken using Pentacam HR. Scheimpflug-based imaging can provide us new data at the examination of this syndrome affecting the whole anterior segment. PMID:23275220

  17. Bioengineered anterior cruciate ligament

    NASA Technical Reports Server (NTRS)

    Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

    2001-01-01

    The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the

  18. Anterior hip pain.

    PubMed

    O'Kane, J W

    1999-10-15

    Anterior hip pain is a common complaint with many possible causes. Apophyseal avulsion and slipped capital femoral epiphysis should not be overlooked in adolescents. Muscle and tendon strains are common in adults. Subsequent to accurate diagnosis, strains should improve with rest and directed conservative treatment. Osteoarthritis, which is diagnosed radiographically, generally occurs in middle-aged and older adults. Arthritis in younger adults should prompt consideration of an inflammatory cause. A possible femoral neck stress fracture should be evaluated urgently to prevent the potentially significant complications associated with displacement. Patients with osteitis pubis should be educated about the natural history of the condition and should undergo physical therapy to correct abnormal pelvic mechanics. "Sports hernias," nerve entrapments and labral pathologic conditions should be considered in athletic adults with characteristic presentations and chronic symptoms. Surgical intervention may allow resumption of pain-free athletic activity.

  19. [Anterior cervical hypertrichosis: case report].

    PubMed

    Orozco-Gutiérrez, Mario H; Sánchez-Corona, José; García-Ortiz, José E; Castañeda-Cisneros, Gema; Dávalos-Rodríguez, Nory O; Corona-Rivera, Jorge R; García-Cruz, Diana

    2016-10-01

    The non-syndromic anterior cervical hypertrichosis (OMIM N° 600457) is a genetic disorder characterized by a patch of hair at the level of the laryngeal prominence. We present a 12-year-old boy with anterior cervical hypertrichosis and mild generalized hypertrichosis. He has no neurological, ophthalmological or skeletal anomalies. The clinical follow up is 10 years.

  20. Stripping for Revision.

    ERIC Educational Resources Information Center

    Smith, Donna

    1996-01-01

    Describes a three-step process by which students are taught to revise their writing by listing each sentence on another paper, combining sentences by eliminating redundancy, reducing information to appositives, and reducing information to participles, as well as revising the reduced number of sentences by including verbals, action verbs,…

  1. Writing as Revision.

    ERIC Educational Resources Information Center

    Della-Piana, Gabriel M.; Endo, George T.

    This proposal for a longitudinal experimental study with a treatment intervention focuses on the process of writing as revision. Revision refers to the process which occurs prior to and throughout the writing of a work, rather than the final editing. According to this process, the writer goes through five stages: preconceptions concerning style…

  2. Missing Screw as a Rare Complication of Anterior Cervical Instrumentation

    PubMed Central

    Duransoy, Yusuf Kurtuluş; Mete, Mesut; Zengel, Baha; Selçukı, Mehmet

    2013-01-01

    Although anterior cervical arthrodesis is an effective procedure for the treatment of cervical disorders, the method has some complications. Here, we describe this rare complication of cervical instrumentation with a literature review. A 23-year-old male patient was operated for a C6-C7 dislocation. At postoperative month 10, he presented with hemoptysis and dysphagia. Cervical roentgenograms showed anterior migrations of one broken screw and a plate-locking screw at the C6 corpus. One screw was missing. We concluded that the missing screw had perforated the esophagus and had been eliminated spontaneously through the gastrointestinal tract. No screw should migrate. Even loose screws should be noted in follow-up X-ray studies. If such findings are detected, a second operation for revision should be considered as soon as possible to prevent potentially fatal complications. PMID:23634313

  3. Missing screw as a rare complication of anterior cervical instrumentation.

    PubMed

    Duransoy, Yusuf Kurtuluş; Mete, Mesut; Zengel, Baha; Selçukı, Mehmet

    2013-01-01

    Although anterior cervical arthrodesis is an effective procedure for the treatment of cervical disorders, the method has some complications. Here, we describe this rare complication of cervical instrumentation with a literature review. A 23-year-old male patient was operated for a C6-C7 dislocation. At postoperative month 10, he presented with hemoptysis and dysphagia. Cervical roentgenograms showed anterior migrations of one broken screw and a plate-locking screw at the C6 corpus. One screw was missing. We concluded that the missing screw had perforated the esophagus and had been eliminated spontaneously through the gastrointestinal tract. No screw should migrate. Even loose screws should be noted in follow-up X-ray studies. If such findings are detected, a second operation for revision should be considered as soon as possible to prevent potentially fatal complications.

  4. Clubfoot posteromedial release: advantages of tibialis anterior tendon lengthening.

    PubMed

    Wicart, Philippe R; Barthes, Xavier; Ghanem, Ismat; Seringe, Raphaël

    2002-01-01

    The aim of this study is to evaluate the eventual advantages of tibialis anterior (TA) tendon lengthening during clubfoot posteromedial release. A continuous series of 60 idiopathic clubfeet has been retrospectively studied. Tibialis anterior lengthening (TAL) began to be performed in 1984. Two groups of 30 feet have been distinguished: without TAL (before 1984) and with TAL (after 1984). There was no significant difference between the 2 groups concerning mean age at surgery, preoperative clinical and radiologic data. Mean postoperative follow-up was 10 years and minimal follow-up required was 5 years. TAL decreased Triceps surae relative insufficiency and improved monopodal jump. TAL balanced TA and peroneus longus, decreased dynamic supination and balanced forefoot pronation and supination. The feet without TAL presented lack of anteromedial support (20% without TAL, 0% with TAL) and medial arch cavus with dorsal talo-navicular subluxation (20% without TAL, 3,3% with TAL). TAL decreased the rate of recurrence and surgical revision.

  5. Comparison of Ankle Fusion Rates With and Without Anterior Plate Augmentation.

    PubMed

    Mitchell, Phillip M; Douleh, Diana G; Thomson, A Brian

    2017-04-01

    The optimal fixation construct for tibiotalar arthrodesis continues to be debated. While biomechanical data and clinical series support anterior plate augmentation, comparative studies assessing its use are sparse. The purpose of this study was to compare the rates of successful tibiotalar arthrodesis with and without anterior plate augmentation of a compression screw construct. We studied 64 patients (65 ankles) undergoing tibiotalar arthrodesis done by a single surgeon over a 10-year period (2006-2016) with anterior plate augmentation beginning in 2010. Twenty-six ankles had a construct using compression screws only and 39 ankles had anterior plate augmentation of a compression screw construct. We reviewed clinical notes, operative reports, and postoperative radiographs to evaluate for union, incidence of revision, and postoperative complications. The nonunion rate in the compression screw (CS) cohort was 15.4% and 7.7% in the anterior plate augmentation (AP) cohort ( P = .33). The revision rate was 7.7% in the CS group and 2.6% in the AP cohort ( P = .34). The use of autograft harvested through a separate incision was 19.2% and 17.9% in the CS and AP cohorts, respectively. There were 2 deep postoperative infections in the AP group and none in the patients with CS only ( P = .24). There were no superficial wound complications in either group. Anterior plate augmentation was a viable fixation strategy in tibiotalar arthrodesis. In a trend toward an improved rate of fusion and decreased revision rate in the anterior plate augmentation cohort. Level III, retrospective comparative series.

  6. Cementless acetabular revision arthroplasty

    PubMed Central

    Jain, Rina; Schemitsch, Emil H.; Waddell, James P.

    2000-01-01

    Objective To evaluate the effects of clinical factors on outcome after acetabular revision with a cementless beaded cup. Design Retrospective case series. Setting Tertiary care referral centre. Patients Forty-one patients who underwent acetabular revision with a cementless cup were followed up for a mean of 3.4 years. Interventions Acetabular revision with a beaded cementless cup in all patients. A morcellized allograft was used in 10 patients. Outcome measures A modified Harris hip score (range of motion measurement omitted), the SF-36 health survey, and the Western Ontario McMaster (WOMAC) osteoarthritis index. Multivariate analysis was used to evaluate the effects of age, gender, morcellized allografting, time to revision from the previous operation, acetabular screw fixation and concurrent femoral revision on outcome. Results Gender accounted for a significant portion of the variation seen in the SF-36 physical component scores (r = 0.36, p = 0.02), with women tending to have worse results. Increasing age was associated with lower WOMAC index function scores (r = 0.36, p = 0.03), whereas concurrent femoral revision tended to have a positive effect on WOMAC index function (r = 0.39, p = 0.01). None of the potential clinical predictors had any significant effect on the SF-36 mental component scores, or WOMAC index pain and stiffness scores. Conclusions In cementless acetabular revision arthroplasty, physical function, as measured by generic and limb-specific scales, may be affected by gender, age and the presence of a concurrent femoral revision. Time to revision from the previous operation, morcellized allografting and screw fixation of the acetabulum did not affect outcomes. This information may provide some prognostic value for patients’ expectations. PMID:10948687

  7. Anterior Knee Pain (Chondromalacia Patellae).

    ERIC Educational Resources Information Center

    Garrick, James G.

    1989-01-01

    This article presents a pragmatic approach to the definition, diagnosis, and management of anterior knee pain. Symptoms and treatment are described. Emphasis is on active involvement of the patient in the rehabilitation exercise program. (IAH)

  8. Anterior Knee Pain (Chondromalacia Patellae).

    ERIC Educational Resources Information Center

    Garrick, James G.

    1989-01-01

    This article presents a pragmatic approach to the definition, diagnosis, and management of anterior knee pain. Symptoms and treatment are described. Emphasis is on active involvement of the patient in the rehabilitation exercise program. (IAH)

  9. Editorial Commentary: The Jury Remains Out on Hybrid Autograft-Plus-Allograft for Diminutive Hamstring Anterior Cruciate Ligament Autografts.

    PubMed

    Dhawan, Aman

    2016-11-01

    In a Level III, single center, retrospective, nonrandomized observational study, anterior cruciate ligament reconstruction revision rates and patient-reported outcomes were found to be similar at 2-year follow-up when using autograft hamstrings versus a hybrid graft (autograft and nonirradiated allograft), with both groups reporting low levels of revisions and excellent outcomes. Despite previous published data that were cause for concern, a study in this issue provides support for use of a hybrid graft technique when encountering the challenging situation of a diminutive hamstring autograft when performing anterior cruciate ligament reconstruction. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  10. Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort.

    PubMed

    Wright, Rick W; Huston, Laura J; Spindler, Kurt P; Dunn, Warren R; Haas, Amanda K; Allen, Christina R; Cooper, Daniel E; DeBerardino, Thomas M; Lantz, Brett Brick A; Mann, Barton J; Stuart, Michael J

    2010-10-01

    Revision anterior cruciate ligament (ACL) reconstruction has worse outcomes than primary reconstructions. Predictors for these worse outcomes are not known. The Multicenter ACL Revision Study (MARS) Group was developed to perform a multisurgeon, multicenter prospective longitudinal study to obtain sufficient subjects to allow multivariable analysis to determine predictors of clinical outcome. To describe the formation of MARS and provide descriptive analysis of patient demographics and clinical features for the initial 460 enrolled patients to date in this prospective cohort. Cross-sectional study; Level of evidence, 2. After training and institutional review board approval, surgeons began enrolling patients undergoing revision ACL reconstruction, recording patient demographics, previous ACL reconstruction methods, intra-articular injuries, and current revision techniques. Enrolled subjects completed a questionnaire consisting of validated patient-based outcome measures. As of April 1, 2009, 87 surgeons have enrolled a total of 460 patients (57% men; median age, 26 years). For 89%, the reconstruction was the first revision. Mode of failure as deemed by the revising surgeon was traumatic (32%), technical (24%), biologic (7%), combination (37%), infection (<1%), and no response (<1%). Previous graft present at the time of injury was 70% autograft, 27% allograft, 2% combination, and 1% unknown. Sixty-two percent were more than 2 years removed from their last reconstruction. Graft choice for revision ACL reconstruction was 45% autograft, 54% allograft, and more than 1% both allograft and autograft. Meniscus and/or chondral damage was found in 90% of patients. The MARS Group has been able to quickly accumulate the largest revision ACL reconstruction cohort reported to date. Traumatic reinjury is deemed by surgeons to be the most common single mode of failure, but a combination of factors represents the most common mode of failure. Allograft graft choice is more common

  11. Deep prosthetic joint infection: a qualitative study of the impact on patients and their experiences of revision surgery

    PubMed Central

    Blom, Ashley W; Whitehouse, Michael R; Gooberman-Hill, Rachael

    2015-01-01

    Objectives Around 1% of patients who have a hip replacement have deep prosthetic joint infection (PJI) afterwards. PJI is often treated with antibiotics plus a single revision operation (1-stage revision), or antibiotics plus a 2-stage revision process involving more than 1 operation. This study aimed to characterise the impact and experience of PJI and treatment on patients, including comparison of 1-stage with 2-stage revision treatment. Design Qualitative semistructured interviews with patients who had undergone surgical revision treatment for PJI. Patients were interviewed between 2 weeks and 12 months postdischarge. Data were audio-recorded, transcribed, anonymised and analysed using a thematic approach, with 20% of transcripts double-coded. Setting Patients from 5 National Health Service (NHS) orthopaedic departments treating PJI in England and Wales were interviewed in their homes (n=18) or at hospital (n=1). Participants 19 patients participated (12 men, 7 women, age range 56–88 years, mean age 73.2 years). Results Participants reported receiving between 1 and 15 revision operations after their primary joint replacement. Analysis indicated that participants made sense of their experience through reference to 3 key phases: the period of symptom onset, the treatment period and protracted recovery after treatment. By conceptualising their experience in this way, and through themes that emerged in these periods, they conveyed the ordeal that PJI represented. Finally, in light of the challenges of PJI, they described the need for support in all of these phases. 2-stage revision had greater impact on participants’ mobility, and further burdens associated with additional complications. Conclusions Deep PJI impacted on all aspects of patients’ lives. 2-stage revision had greater impact than 1-stage revision on participants’ well-being because the time in between revision procedures meant long periods of immobility and related psychological distress

  12. Revised Total Coliform Rule

    EPA Pesticide Factsheets

    The Revised Total Coliform Rule (RTCR) aims to increase public health protection through the reduction of potential pathways for fecal contamination in the distribution system of a public water system (PWS).

  13. Risk factors for dysphagia after anterior cervical spine surgery

    PubMed Central

    Liu, Feng-Yu; Yang, Da-Long; Huang, Wen-Zheng; Huo, Li-Shuang; Ma, Lei; Wang, Hui; Yang, Si-Dong; Ding, Wen-Yuan

    2017-01-01

    Abstract Background: Dysphagia is a well-known complication following anterior cervical spine surgery. Although risk factors for dysphagia have been reported in the literature, they still remain controversial. This study aims to investigate the risk factors associated with dysphagia following anterior cervical spinal surgery. Methods: PubMed, EMBASE, and The Cochrane Library were searched up to June 2016 for studies examining dysphagia following anterior cervical spinal surgery. Risk factors associated with dysphagia were extracted. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for outcomes. Data analysis was conducted with RevMan 5.3 and STATA 12.0. Results: The final analysis includes a total of 18 distinct studies. The pooled analysis reveals that there are significant differences in female gender (OR = 2.30, 95% CI: 1.76–2.99, P < 0.001), the use of anterior cervical plate (OR = 1.66, 95% CI: 1.05–2.62, P = 0.03), more than 1 surgical level (OR = 2.07, 95% CI: 1.62–2.66, P < 0.001), the upper surgical level at C3/4 (OR = 3.08, 95% CI: 1.44–6.55, P = 0.004), and the use of bone morphogenetic protein-2 (rhBMP-2) (OR = 5.52, 95% CI: 2.16–14.10, P < 0.001). However, no significant difference is found in revision surgery (OR = 1.67, 95% CI: 0.60–4.68, P = 0.33), the type of fusion (OR = 1.02, 95% CI: 0.62–1.67, P = 0.95), and cervical disc arthroplasty (OR = 1.37, 95% CI: 0.75–2.51, P = 0.30). Conclusion: Female gender, the use of anterior cervical plate, more than 1 surgical level, the upper surgical level at C3/4, and the use of rhBMP-2 are the risk factors for dysphagia following anterior cervical spinal surgery. However, revision surgery, the type of fusion, and cervical disc arthroplasty are unassociated with dysphagia. Considering the limited number of studies, this conclusion should be interpreted cautiously, and larger scale studies are required. PMID

  14. Anterior Surgical Fixation for Cervical Spine Flexion-Distraction Injuries.

    PubMed

    Jack, Andrew; Hardy-St-Pierre, Godefroy; Wilson, Mitchell; Choy, Godwin; Fox, Richard; Nataraj, Andrew

    2017-05-01

    Optimal surgical management for flexion-distraction cervical spine injuries remains controversial with current guidelines recommending anterior, posterior, and circumferential approaches. Here, we determined the incidence of and examined risk factors for clinical and radiographic failure in patients with 1-segment cervical distraction injuries having undergone anterior surgical fixation. A retrospective review of 57 consecutive patients undergoing anterior fixation for subaxial flexion-distraction cervical injuries between 2008 and 2012 at our institution was performed. The primary outcome was the number of patients requiring additional surgical stabilization and/or radiographic failure. Data collected included age, gender, mechanism and level of injury, facet pattern injury, and vertebral end plate fracture. A total of 6 patients failed clinically and/or radiographically (11%). Four patients (7%) required additional posterior fixation. Although 2 other patients identified met radiographic failure criteria, at follow-up they had fused radiographically, were stable clinically, and no further treatment was pursued. Progressive kyphosis and translation were found to be significantly correlated with need for revision (P < 0.05 and P = 0.02, respectively). No differences were identified for all other clinical and radiologic factors assessed, including unilateral or bilateral facet injury, facet fracture, and end plate fracture. This study contributes to the growing body of evidence supporting anterior fixation alone for flexion-distraction injuries. Findings suggest that current measurements of radiographic failure including segmental translation and kyphosis may predict radiographic failure and need for further surgical stabilization in some patients. Future follow-up studies assessing for independent risk factors for anterior approach failure with a validated predictive scoring model should be considered. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. A case series on the technical use of three-dimensional image guidance in subaxial anterior cervical surgery.

    PubMed

    Pirris, Stephen M; Nottmeier, Eric W

    2015-03-01

    Three dimensional (3D) image guidance has been used to improve the safety of complex spine surgeries, but its use has been limited in anterior cervical spine approaches. Twenty-two patients underwent complex anterior cervical spine surgeries in which 3D image guidance provided intraoperative assistance with the dissection, decompression and implant placement. One of two paired systems, the BrainLAB (BrainLAB, Westchester, Illinois) system, or Stealth (Medtronic Inc., Littleton, Massachusetts) system was used for 3D image guidance in this study. Image guidance was able to reliably locate pertinent anatomical structures in complex anterior cervical spine surgery involving re-exploration, dissection around vertebral arteries or deformity correction. No complications occurred, and no patients required a revision anterior surgery. This technical note describes the setup and technique for the use of cone beam computed tomography (cbCT)-based, 3D image guidance in subaxial anterior cervical surgery. The authors have found this technique to be a useful adjunct in revision anterior cervical procedures, as well as anterior cervical procedures involving corpectomy or tumor removal. Copyright © 2014 John Wiley & Sons, Ltd.

  16. Preprosthetic movement of anterior teeth.

    PubMed

    Melsen, B

    1982-05-01

    Preprosthetic movement of anterior teeth is often performed on patients with missing anterior teeth, providing a better basis for subsequent bridgework. This can often be achieved by horizontal tooth movements of a tipping or translatory art whilst other patients present problems of a vertical nature with a deep overbite inconsistent with a healthy periodontal status. Intrusive tooth movements are needed as changes in facial height are not tolerated. The importance of understanding the biological basis for tooth movements in the planning of the biomechanics is stressed. Forces should be monitored according to the amount of general and local bone loss.

  17. Acetabular Cup Revision.

    PubMed

    Kim, Young-Ho

    2017-09-01

    The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.

  18. [Dehiscence of the anterior semicircular canal and otosclerosis: a case report].

    PubMed

    Nguyen, D Q; Morel, N; Dumas, G; Boubagra, K; Schmerber, S

    2006-01-01

    The dehiscence of the anterior semicircular canal is a new clinical entity, it is necessary to consider this when a gusher occurs during stapedial surgery. We report a rare case of dehiscence of the anterior canal associated with otosclerosis. This was revealed by a gusher during the initial stapedectomy. At 3 months, an obliteration of the dehiscence was necessary by middle cranial fossa approach (persistant vestibular symptoms), seven months later. Revision stapedial surgery resulted in complete closure of the air-bone-gap. High resolution CT scans of the temporal bone are the key to diagnosis. It is necessary to appreciate this pathology with advances in canal and vestibular surgery.

  19. Anterior knee pain after total knee arthroplasty: a narrative review.

    PubMed

    Petersen, Wolf; Rembitzki, Ingo Volker; Brüggemann, Gerd-Peter; Ellermann, Andree; Best, Raymond; Koppenburg, Andreas Gösele-; Liebau, Christian

    2014-02-01

    Anterior knee pain is one of the most common causes of persistent problems after implantation of a total knee replacement. It can occur in patients with or without patellar resurfacing. As a result of the surgical procedure itself many changes can occur which may affect the delicate interplay of the joint partners in the patello-femoral joint. Functional causes of anterior knee pain can be distinguished from mechanical causes. The functional causes concern disorders of inter- and intramuscular coordination, which can be attributed to preoperative osteoarthritis. Research about anterior knee pain has shown that not only the thigh muscles but also the hip and trunk stabilising muscles may be responsible for the development of a dynamic valgus malalignment. Dynamic valgus may be a causative factor for patellar maltracking. The mechanical causes of patello-femoral problems after knee replacement can be distinguished according to whether they increase instability in the joint, increase joint pressure or whether they affect the muscular lever arms. These causes include offset errors, oversizing, rotational errors of femoral or tibial component, instability, maltracking and chondrolysis, patella baja and aseptic loosening. In these cases, reoperation or revision is often necessary.

  20. Anterior cruciate ligament - updating article.

    PubMed

    Luzo, Marcus Vinicius Malheiros; Franciozi, Carlos Eduardo da Silveira; Rezende, Fernando Cury; Gracitelli, Guilherme Conforto; Debieux, Pedro; Cohen, Moisés

    2016-01-01

    This updating article on the anterior cruciate ligament (ACL) has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.

  1. Proposed Revisions to Method 202

    EPA Pesticide Factsheets

    EPA is proposing the following revisions to Method 202: Revisions to the procedures for determining the systematic error of the method, which is used to correct the results of the measurements made using this method; Removes some procedural options to

  2. Anterior Cruciate Ligament Injuries in Baseball Players.

    PubMed

    Dugas, Jeffrey R; Bedford, Benjamin B; Andrachuk, John S; Scillia, Anthony J; Aune, Kyle T; Cain, E Lyle; Andrews, James R; Fleisig, Glenn S

    2016-11-01

    To determine common mechanisms of anterior cruciate ligament (ACL) injury in baseball players and to quantify the rate of return to play after primary surgical reconstruction and review intermediate clinical outcomes. Surgical injuries involving the ACL in youth, high school, collegiate, and professional baseball players were queried for an 11-year period (2001 to 2011). Over the study period, 42 baseball players were identified who had undergone arthroscopically assisted primary ACL reconstruction by 1 of 3 attending surgeons. Retrospective chart review was performed for all 42 patients to evaluate variables of age, level of competition, position, mechanism of injury, graft choice, and associated meniscal injuries. Twenty-six patients were reached for telephone survey and International Knee Documentation Committee questionnaire and they answered questions about their original injury and playing history. The most common mechanism of injury was fielding, followed by base running. Infielders and outfielders (32% each) were the most commonly injured position, followed by pitchers (29%). Among the 32 players for whom it could be determined, 30 (94%) were able to return to playing baseball at a mean follow-up of 4.2 years (range 1.0 to 9.9 years). The mean International Knee Documentation Committee score was 84.0 (range 63 to 91). Among the 26 patients contacted for telephone interview, no one required revision ACL surgery, but 3 required a subsequent procedure for meniscal tear. Twenty-five patients (96%) denied any episodes of instability in the knee after reconstruction. The overwhelming majority of baseball players that sustain ACL injuries do so while fielding or base running. Outfielders are significantly more likely than infielders to suffer ACL injuries while fielding versus base running. The results with respect to return to play are promising, as nearly all patients were able to return to baseball and none required a revision ACL surgery at a mean follow

  3. Revising Russian History.

    ERIC Educational Resources Information Center

    Wertsch, James V.

    1999-01-01

    Examines the production of new history textbooks that appeared after the breakup of the Soviet Union. Argues that the radical revisions in official history in this context are shaped by the Bakhtinian process of "hidden dialogicality." Suggests that the importance of hidden dialogicality between narrative forms must be considered. (SC)

  4. School Safety Handbook. Revised.

    ERIC Educational Resources Information Center

    Association of School Business Officials International, Reston, VA.

    The revised edition of this handbook represents a concerted effort to bring school safety to the forefront of business managers' daily and long-range planning activities. Although statistics show few fatalities on school grounds, schools appear to have a high frequency and incident rate of nonfatal injuries. According to the introduction, school…

  5. Scar revision - slideshow

    MedlinePlus

    ... anatomy URL of this page: //medlineplus.gov/ency/presentations/100098.htm Scar revision - series—Normal anatomy To use the sharing features on this page, please enable JavaScript. Go to slide 1 out of 4 Go to slide 2 ...

  6. Hospital Nurse Aide. Revised.

    ERIC Educational Resources Information Center

    Iowa Univ., Iowa City. Coll. of Education.

    This report presents results of a project to revise the current 120-hour advanced nurse aide course to include all recommended minimum competencies. A three-page description of project objectives, activities, and outcomes is followed by a list of the competencies for the 75-hour nurse aide course for long-term care and for the 120-hour advanced…

  7. Residential Wiring. Revised.

    ERIC Educational Resources Information Center

    Taylor, Mark

    This competency-based curriculum guide contains materials for conducting a course in residential wiring. A technically revised edition of the 1978 publication, the guide includes 28 units. Each instructional unit includes some or all of the following basic components: performance objectives, suggested activities for teachers and students,…

  8. School Safety Handbook. Revised.

    ERIC Educational Resources Information Center

    Association of School Business Officials International, Reston, VA.

    The revised edition of this handbook represents a concerted effort to bring school safety to the forefront of business managers' daily and long-range planning activities. Although statistics show few fatalities on school grounds, schools appear to have a high frequency and incident rate of nonfatal injuries. According to the introduction, school…

  9. Variables Associated with Chondral and Meniscal Injuries in Anterior Cruciate Ligament Surgery.

    PubMed

    Cain, E Lyle; Fleisig, Glenn S; Ponce, Brent A; Boohaker, Hikel A; George, Martha P; McGwin, Gerald; Andrews, James R; Lemak, Lawrence J; Clancy, William G; Dugas, Jeffrey R

    2017-09-01

    This article aims to evaluate factors associated with chondral and meniscal lesions in primary and revision anterior cruciate ligament (ACL) reconstructions. ACL reconstructions from 2001 to 2008 at a single institution were retrospectively analyzed. Logistic regression was used to estimate the association between chondral and meniscal injuries and age, gender, tear chronicity, additional ligamentous injuries, sport type, and participation level. Of the 3,040 ACL reconstructions analyzed, 90.4% were primary reconstructions and 9.6% were revisions. Meniscal injuries were significantly lower in the revision group (44.0 vs. 51.9%; p = 0.01), while chondral injuries were significantly higher in the revision group (39.9 vs. 24.0%; p < 0.0001). Inspection of the small subgroup (n = 85) receiving both primary and revision ACL surgery at our center indicated that meniscal injuries at revision were evenly split between menisci with and without previous repairs, whereas the vast majority of Grade III and IV chondral lesions were new. More patients presented for surgery later in the revision group than in the primary group (56.5 vs. 35.3%; p < 0.0001). Male gender, primary reconstruction, and short interval (less than 2 weeks) between injury and surgery were associated with increased likelihood of meniscus tear. Age (greater than 22 years) and long interval (greater than 6 weeks) between injury to surgery and higher sport activity level were associated with chondral lesions. Revision ACL reconstructions are associated with a higher proportion of chondral lesions and a lower proportion of meniscal tears. Early primary and revision ACL construction is recommended to reduce the probability of chondral lesions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. Anterior Retroperitoneal Spine Exposure following Prior Endovascular Aortic Aneurysm Repair.

    PubMed

    Ullery, Brant W; Thompson, Patrick; Mell, Matthew W

    2016-08-01

    We describe successful anterior retroperitoneal spine exposure to facilitate anterior lumbar interbody fusion (ALIF) in a patient with a prior endovascular aneurysm repair (EVAR). A 74-year-old male with an extensive spine surgical history presented with progressive neurogenic claudication and paresthesia involving both feet. In addition, his surgical history was notable for an EVAR performed elsewhere 5 years earlier, with subsequent right renal stent placement for encroachment of the right renal artery. Diagnostic evaluation identified severe L3-4 and L4-5 canal stenosis, and a 48 × 36-mm aneurysm sac with a type II endoleak. Revision L3-L5 fusion from an anterior approach with vascular surgery assistance was recommended. The retroperitoneum was accessed through a left paramedian abdominal incision. The abdominal aortic aneurysm sac was visualized and noted to be nonpulsatile. The distal aorta and left iliac vessels were dissected and retracted medially to facilitate anterior exposure of the L3-4 and L4-5 disk spaces. Successful ALIF of the L3-5 vertebrae was then performed. Retractors were removed and the aortoiliac vessels were carefully returned to anatomic position. The aneurysm sac remained nonpulsatile, with normal pulses in the iliac arteries. Postoperative imaging demonstrated stable appearance of aortic stent graft. At 1-year follow-up, the patient reports complete resolution of symptoms and imaging demonstrates a patent aortic stent graft with a stable type II endoleak. Widespread application of ALIF will inevitably include an increasing subgroup of patients with previous EVAR. Such patients require thorough clinical and radiographic perioperative considerations for the access surgeon. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Laparoscopic revision from LAP-BAND to gastric bypass.

    PubMed

    Spivak, Hadar; Beltran, Oscar R; Slavchev, Plamen; Wilson, Erik B

    2007-08-01

    While the majority of patients achieve good outcomes with the LAP-BAND, there is a subset of patients who experience complications or fail to lose sufficient weight after the banding procedure. This study examines the feasibility and outcome of performing laparoscopic Roux-en-Y gastric bypass (RYGBP) as a single-step revision surgery after a failed LAP-BAND procedure. In the past five years we have performed more than 1400 LAP-BAND procedures. We laparoscopically converted 33 (30 females) of these patients (mean age = 43.8 years) from LAP-BAND to RYGBP because of inadequate weight loss and/or complications. Key steps in the revision procedures were (1) identification and release of the band capsule; (2) careful dissection of the gastrogastric sutures; (3) creation of a small gastric pouch; and (4) Roux-en-Y anterior colic anterior gastric pouch-jejunum anastomosis. Revisions took place at a mean 28.2 months (range = 11-46; SD = 11.3) after the original gastric banding. Change in body mass index (BMI) between pre- and postrevision was evaluated with paired t tests. Among the 33 patients who would undergo revision surgery, the mean BMI before the LAP-BAND procedure was 45.7 kg/m2 (range = 39.9-53.0; SD = 3.4) and the mean weight was 126 kg (range = 99-155; SD = 17). The lowest BMI achieved by this group with the LAP-BAND before revision was 39.7 kg/m2 (range = 30-49.2; SD = 4.9); however, the mean BMI at the time of revision was 42.8 kg/m2 (range = 33.1-50; SD = 4.8). The mean revision operative time was 105 min (range = 85-175), and the mean hospital stay was 2.8 days (range = 1-10). Complications included one patient who underwent open reoperation and splenectomy for a bleeding spleen and one patient who required repair of an internal hernia. After conversion to RYGBP, mean BMI decreased to 33.9 kg/m2 at 6 months (p < 0.001) and 30.7 kg/m2 (range = 22-39.6; SD = 5.3) at 12 months or more of followup (average = 15.7 months; p < 0.0001). Laparoscopic conversion from

  12. Extradural anterior clinoidectomy. Technical note.

    PubMed

    Noguchi, Akio; Balasingam, Vijayabalan; Shiokawa, Yoshiaki; McMenomey, Sean O; Delashaw, Johnny B

    2005-05-01

    The anterior clinoid process (ACP), located on the skull base, is a relatively small structure, although its removal provides enormous gain in facilitating the management of lesions--either tumors or aneurysms--in the paraclinoid region and upper basilar artery. The extensive surgical field gained contributes to safer exposure of the neurovascular elements in the vicinity while avoiding excessive and hazardous retraction of the brain. In this report the authors present a technically simpler avenue for performing an extradural anterior clinoidectomy after reviewing the anatomy of the ACP and its anatomical variations. Additionally, the original Dolenc procedure and its subseqtient derivatives are compared and contrasted to the authors' simpler and less laborious technique. Different clinical situations in which to use the procedure are described based on the authors' experience from 60 cases (40 aneurysm cases and 20 tumor cases) during a 4-year period.

  13. 38 CFR 3.379 - Anterior poliomyelitis.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it...

  14. 38 CFR 3.379 - Anterior poliomyelitis.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it is...

  15. 38 CFR 3.379 - Anterior poliomyelitis.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it is...

  16. 38 CFR 3.379 - Anterior poliomyelitis.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it is...

  17. 38 CFR 3.379 - Anterior poliomyelitis.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it is...

  18. “8 Plate”: An Alternative Device to Fix Highly Recurrent Traumatic Anterior Gleno-Humeral Instability in Patients with Severe Impairment of the Anterior Capsule

    PubMed Central

    Tudisco, C; Bisicchia, S; Savarese, E; Ippolito, E

    2014-01-01

    Background: There is still debate about the best treatment option for highly recurrent anterior shoulder dislocation in patients with severe impairment of the anterior capsule and/or recurrence after either arthroscopic or open capsulorrhaphy. Materials and Methods: The clinical and radiological findings of 7 patients treated with an open capsulorrhaphy stabilized with an “8 plate” for a highly recurrent traumatic anterior shoulder dislocation with severe impairment of the anterior capsule and a large Bankart lesion were retrospectively reviewed. Follow-up evaluation included VAS for pain, Constant-Murley, Simple Shoulder Test, ASES, UCLA, Quick DASH, Rowe, Walsch-Duplay scores, as well as X-rays of the operated shoulder. Results: At follow-up none of the patients reported subsequent dislocations. Range of motion of the shoulder was complete in all cases, but one. Results of the functional scoring systems were satisfactory. X-rays showed no osteolysis and good position of the plate. Conclusion: To our knowledge, this is the first report in the literature about an open capsular tensioning and Bankart lesion repair performed with an “8 plate”. We believe that this is a reliable and effective procedure to address traumatic anterior re-dislocation of the gleno-humeral joint when the capsule is extensively torn and frayed or in revision cases. Moreover the “8 plate” is ideal to be applied in such a narrow space on the slant surface of the scapular neck close to the glenoid rim. PMID:25621080

  19. Patellar options in revision total knee arthroplasty.

    PubMed

    Rorabeck, Cecil H; Mehin, Ramin; Barrack, Robert L

    2003-11-01

    There are numerous options that need to be considered by the surgeon at the time of revision total knee arthroplasty (TKA). One needs to consider the reason for the revision, the type of patella in place, and the length of time the patella has been in place. The surgeon also needs to consider the status of the patellar bone stock, the stability of the patellar component (well-fixed or loose), and the component type (cemented or metal-backed). Assuming that the existing prosthesis is not metal-backed and has minimal PE wear, then it is preferable to retain a well-fixed all-PE cemented patellar button. However, if the button is metal-backed, then it probably is best to remove the button and replace it with an all-PE domed patellar component. Assuming more than 8 mm of patellar bone stock is remaining, it usually is best to cement an all-PE dome-shaped patella. However, if less than 8 mm is remaining, then that patient can be left with a patelloplasty, recognizing that this individual is going to continue with a high likelihood of anterior knee pain, subluxation, and poor functional results. In that situation, it may be preferable to consider a bone stock augmentation.

  20. Production of anterior segment ischemia.

    PubMed Central

    Hiatt, R L

    1977-01-01

    Anterior segment ischemic changes can occur without detachment of any muscles. The most common cause of such ischemic changes of the anterior segment is the removal of too many rectus muscles in one operation. Twenty dog eyes and eight monkey eyes were subjected to the disinsertion and detachment of various combinations of extraocular muscles. The dogs were sacrificed at intervals from 30 to 90 days. During the observation period, they were observed for gross and slit-lamp changes. The enucleated eyes were studied microscopically for signs of ischemic and necrotic changes. Two patients who were studied, observed, and treated for anterior segment ischemia following muscle surgery are described. The changes which occur after extraocular muscle surgery are extensive and include corneal edema, cataract, chemosis, corneal changes, decreases in intraocular pressure, decreases in outflow or glaucoma, and frank necrosis. The variables which lead to this reaction are described in detail. Also, some unanswered queries, such as the duration of the reaction and the time interval of the reaction after multiple muscle operations are discussed. Images FIGURE 1 A FIGURE 1 B FIGURE 1 C FIGURE 2 A FIGURE 2 B FIGURE 2 C FIGURE 2 D FIGURE 3 FIGURE 4 PMID:418549

  1. Erectile function after anterior urethroplasty.

    PubMed

    Coursey, J W; Morey, A F; McAninch, J W; Summerton, D J; Secrest, C; White, P; Miller, K; Pieczonka, C; Hochberg, D; Armenakas, N

    2001-12-01

    We ascertained the impact of anterior urethroplasty on male sexual function. A validated questionnaire was mailed to 200 men who underwent anterior urethroplasty to evaluate postoperative sexual function. Questions addressed the change in erect penile length and angle, patient satisfaction with erection, preoperative and postoperative coital frequency, and change in erection noted by the sexual partner. Results were stratified by the urethral reconstruction method, namely anastomosis, buccal mucosal graft, penile flap and all others, and compared with those in a similar group of men who underwent circumcision only. Of the 200 men who underwent urethroplasty 152 who were 17 to 83 years old (mean age 45.7) completed the questionnaire. Average followup was 36 months (range 3 to 149). Overall there was a similar incidence of sexual problems after urethroplasty and circumcision. Penile skin flap urethroplasty was associated with a slightly higher incidence of impaired sexual function than other procedures (p >0.05). Men with a longer stricture were most likely to report major changes in erectile function and penile length (p <0.05) but improvement was evident with time in 61.8%. Overall anterior urethral reconstruction appears no more likely to cause long-term postoperative sexual dysfunction than circumcision. Men with a long stricture may be at increased risk for transient erectile changes.

  2. [Osteosynthesis and cup revision in periprosthetic acetabulum fractures using a Kocher-Langenbeck approach].

    PubMed

    Schwabe, P; Märdian, S; Perka, C; Schaser, K-D

    2016-04-01

    Reconstruction/stable fixation of the acetabular columns to create an adequate periacetabular requirement for the implantation of a revision cup. Displaced/nondisplaced fractures with involvement of the posterior column. Resulting instability of the cup in an adequate bone stock situation. Periprosthetic acetabulum fractures with inadequate bone stock. Extended periacetabular defects with loss of anchorage options. Isolated periprosthetic fractures of the anterior column. Septic loosening. Dorsal approach. Dislocation of hip. Mechanical testing of inlaying acetabular cup. With unstable cup situation explantation of the cup, fracture fixation of acetabulum with dorsal double plate osteosynthesis along the posterior column. Cup revision. Hip joint reposition. Early mobilization; partial weight bearing for 12 weeks. Thrombosis prophylaxis. Clinical and radiological follow-ups. Periprosthetic acetabular fracture in 17 patients with 9 fractures after primary total hip replacement (THR), 8 after revision THR. Fractures: 12 due to trauma, 5 spontaneously; 7 anterior column fractures, 5 transverse fractures, 4 posterior column fractures, 1 two column fracture after hemiendoprosthesis. 5 type 1 fractures and 12 type 2 fractures. Operatively treated cases (10/17) received 3 reinforcement ring, 2 pedestal cup, 1 standard revision cup, cup-1 cage construct, 1 ventral plate osteosynthesis, 1 dorsal plate osteosynthesis, and 1 dorsal plate osteosynthesis plus cup revision (10-month Harris Hip Score 78 points). Radiological follow-up for 10 patients: consolidation of fractures without dislocation and a fixed acetabular cup. No revision surgeries during follow-up; 2 hip dislocations, 1 transient sciatic nerve palsy.

  3. Anterior cervical discectomy and fusion: analysis of surgical outcome with and without plating.

    PubMed

    Mobbs, Ralph J; Rao, Prakash; Chandran, Nadana K

    2007-07-01

    The aim of this study is to analyse the differences in clinical and radiological outcome of anterior cervical discectomy and fusion for cervical degenerative disease, with and without the addition of an anterior cervical locking plate. Although disc arthoplasty is gaining popularity, the anterior cervical decompression and fusion procedure remains the gold standard. The outcome of 242 cases operated between 1991 to 1998 were analysed. Two groups of patients were operated on by the same surgeon. The only difference in technique between the two groups was the addition of an anterior cervical plate, with all other technical details matching, including the use of iliac crest autograft. The indications for surgery for both groups was identical. We made an attempt to study radiological fusion, clinical outcome and complications between the non-plated and plated groups. Our main finding is that the addition of an anterior plate reduces the number of poor clinical outcomes, but does not increase the number of excellent outcomes. Anterior discectomy and fusion with plating in our series had a significantly higher fusion rate; 98% fusion was noted in the plating group as compared to 93.5% in the non-plating group (Fisher's exact test, p=0.029). Union was faster in the plated group with no significant increase in surgical complications. Although clinical outcomes were superior in the plated group for the radiculopathy cohort, excellent outcomes were not significantly higher as compared to the non-plated group. The non-plated group had a significantly higher rate of poor outcomes, with 10% of patients requiring revision surgery for non-union, kyphosis, graft extrusion and graft collapse with foraminal stenosis. 1.8% of the plated group required revision surgery.

  4. Avoiding revision rhinoplasty.

    PubMed

    Waite, Peter D

    2011-02-01

    Reoperation of the nose is challenging and sometimes emotionally difficult for the surgeon and patient. There are multiple pitfalls to be avoided and it is always best to carefully diagnose and establish a surgical treatment plan. Even among the best of plans and surgical techniques, revision may be necessary. The patient and surgeon should understand the limitations of the surgical techniques and the individual anatomy. Published by Elsevier Inc.

  5. Grafting in revision rhinoplasty.

    PubMed

    Bussi, M; Palonta, F; Toma, S

    2013-06-01

    Rhinoplasty is one of the most difficult aesthetic surgery procedures with a high rate of revision. In revision rhinoplasty the surgeon should explore the patient's concerns and then verify the possibility to satisfy expectations after complete internal and external examination of the nose. For the vast majority of complex secondaries, an open approach is the only reasonable method. In fact, in secondary nasal surgery, because of the scarring process following the primary operation, dissection is tedious, and landmarks are lost. One of the main objectives for the surgeon who approaches secondary rhinoplasty is to restore the structural support of the nose and to replace the lost volume of soft tissues. To achieve this purpose, the surgeon must often rely on grafts. An ideal grafting material must be easy to sculpt, resistant to trauma, infection and extrusion, mechanically stable, inert and readily available. For all these reasons, autogenous cartilage grafts harvested from septum, auricular concha and rib represent the first choice in rhinoplasty. In order to obtain a camouflage graft that provides natural contouring to the nose, temporalis fascia can be used. All these carefully trimmed grafts are useful in tip revision surgery, in secondary surgery of the dorsum and to resolve or reduce functional problems.

  6. The role of offset stems in revision knee arthroplasty.

    PubMed

    Baldini, Andrea; Balato, Giovanni; Franceschini, Vincenzo

    2015-12-01

    Revision total knee arthroplasty (TKA) represents a technically challenging procedure. The use of an offset stem extension can help in addressing some of the difficulties that can be encountered during surgery and, in particular, anatomical mismatch, malalignment, and gap balancing. Different offset stem extensions are available and can be classified according to four parameters: modularity, location of the offset, direction, and size of the displacement. Offset stem extensions can assist with implant alignment on the metaphysis if there is an offset diaphysis, can avoid medial-lateral or anterior-posterior component overhang, can reduce the incidence of coronal or sagittal malalignment, and can help in balancing the flexion and extension spaces by effectively translating the components. The aim of this study is to give an overview of the currently available evidence regarding the use of offset stem extensions in revision TKA as well as some useful surgical tips.

  7. Multiple Spinal Revision Surgery in a Patient with Parkinson's Disease

    PubMed Central

    Malla, Hridayesh Pratap; Kim, Min Ki; Kim, Tae Sung

    2016-01-01

    Parkinson's disease (PD) patients frequently have several spinal deformities leading to postural instabilities including camptocormia, myopathy-induced postural deformity, Pisa syndrome, and progressive degeneration, all of which adversely affect daily life activities. To improve these postural deformities and relieve the related neurologic symptoms, patients often undergo spinal instrumentation surgery. Due to progressive degenerative changes related to PD itself and other complicating factors, patients and surgeons are faced with instrument failure-related complications, which can ultimately result in multiple revision surgeries yielding various postoperative complications and morbidities. Here, we report a representative case of a 70-year-old PD patient with flat back syndrome who had undergone several revision surgeries, including anterior and posterior decompression and fusion for a lumbosacral spinal deformity. The patient ultimately benefitted from a relatively short segment fixation and corrective fusion surgery. PMID:27847583

  8. Revision strategy for posterior extrusion of the CHARITÉ polyethylene core.

    PubMed

    Eskander, Mark S; Onyedika, Ikechukwu I; Eskander, Jonathan P; Connolly, Patrick J; Eck, Jason C; Lapinsky, Anthony

    2010-11-15

    This is a case report of a posterior extrusion of the polyethylene core from a CHARITÉ arthroplasty. This is the first reported case of posterior dislocation of the polyethylene and the revision strategies used to correct this problem. To report a novel failure mechanism and revision strategy for CHARITÉ total disc arthroplasty (TDA). Case report at a Level 1 tertiary care referral center in the northeastern United States. This is a case report and review of the literature of a patient who sustained posterior dislocation of the polyethylene core from a CHARITÉ TDA several months after the index procedure. Core dislocation is a known complication of TDA. However, of the known reported dislocations all have been anterior. This case describes the first known occurrence of posterior core dislocation and the revision strategy for this problem. This case report highlights the first known case of a posterior dislocation of a CHARITÉ core. It is likely that altered biomechanical forces generated over time attributed to device failure. An instrumented posterior fusion with removal of the core is what ultimately led to a stable revision construct.

  9. Distal anterior cerebral artery aneurysms.

    PubMed

    Lehecka, Martin; Dashti, Reza; Lehto, Hanna; Kivisaari, Riku; Niemelä, Mika; Hernesniemi, Juha

    2010-01-01

    Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal artery aneurysms, represent about 6% of all intracranial aneurysms. They are located on the A2-A5 segments of the anterior cerebral artery and on its distal branches. This paper summarizes present knowledge on radiological features, treatment options, treatment results, and long-term follow-up of DACA aneurysms. Typical features of DACA aneurysms are small size, broad base, and branches originating from the base. When ruptured, they cause intracerebral hematoma in nearly half of the cases. DACA aneurysms are nowadays more often treated with microsurgical clipping than endovascular coiling due to their distal location and morphologic features. With clipping the results are same or slightly better than for aneurysms at other locations, coiling is often associated with more complications than in other aneurysms. Clipping is a long-lasting treatment with very small recurrence rate, there is no long-term data available on efficacy of coiling yet. For ruptured DACA aneurysms the most important factors affecting outcome is the severity of initial bleeding and patient's age.

  10. [Anterior skull-base schwannoma].

    PubMed

    Esquivel-Miranda, Miguel; De la O Ríos, Elier; Vargas-Valenciano, Emmanuelle; Moreno-Medina, Eva

    2017-06-24

    Schwannomas are nerve sheath tumours that originate in Schwann cells. They are usually solitary and sporadic and manifest on peripheral, spinal or cranial nerves. Intracranial schwannomas tend to manifest on the eighth cranial nerve, particularly in patients with neurofibromatosis type2. Anterior skull-base schwannomas represent less than 1% of all intracranial schwannomas. They are more frequent in young people and are typically benign. These tumours represent a diagnostic challenge due to their rarity and difficult differential diagnosis, and numerous theories have been postulated concerning their origin and development. In this article, we present the case of a 13-year-old male with a single anterior cranial-base tumour not associated with neurofibromatosis who presented with headache, papilloedema, eye pain and loss of visual acuity. Complete resection of the tumour was performed, which was histopathologically diagnosed as a schwannoma. The patient made a complete clinical recovery with abatement of all symptoms. We conducted a review of the literature and found 66 cases worldwide with this diagnosis. We describe the most relevant epidemiological and clinical characteristics of this kind of tumour and its relation with the recently discovered and similar olfactory schwannoma. Copyright © 2017 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Neck Pain: Revision 2017.

    PubMed

    Blanpied, Peter R; Gross, Anita R; Elliott, James M; Devaney, Laurie Lee; Clewley, Derek; Walton, David M; Sparks, Cheryl; Robertson, Eric K

    2017-07-01

    The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to neck pain. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302.

  12. Revision Total Elbow Arthroplasty.

    PubMed

    Ramirez, Miguel A; Cheung, Emilie V; Murthi, Anand M

    2017-08-01

    Despite recent technologic advances, total elbow arthroplasty has complication rates higher than that of total joint arthroplasty in other joints. With new antirheumatic treatments, the population receiving total elbow arthroplasty has shifted from patients with rheumatoid arthritis to those with posttraumatic arthritis, further compounding the high complication rate. The most common reasons for revision include infection, aseptic loosening, fracture, and component failure. Common mechanisms of total elbow arthroplasty failure include infection, aseptic loosening, fracture, component failure, and instability. Tension band fixation, allograft struts with cerclage wire, and/or plate and screw constructs can be used for fracture stabilization.

  13. Revision and Validation of the Revised Teacher Beliefs Survey.

    ERIC Educational Resources Information Center

    Benjamin, Jane

    This study revised the Teacher Beliefs Survey (S. Wooley and A. Wooley, 1999; TBS), an instrument to assess teachers beliefs related to constructivist and behaviorist theories of learning, and then studied the validity of the revised TBS. Drawing on a literature review, researchers added items for the existing constructs of the TBS and added a new…

  14. Anterior Cruciate: Methods of Physical Examination

    PubMed Central

    Grant, John; Kirby, R. Lee

    1982-01-01

    Tear of the anterior cruciate ligament is a common, serious injury. Since the long-range consequences of uncorrected anterior cruciate incompetence are better understood, and surgical and rehabilitative measures improved, early accurate diagnosis is increasingly important. Besides a careful history, diagnosis requires the use of specific physical examination methods to reproduce the symptomatic subluxation (anterior shift or internal rotation) and to assess functional performance of the knee. ImagesFig. 1Fig. 2Fig. 3 PMID:21286055

  15. Thrombosis of the Azygos Anterior Cerebral Artery

    PubMed Central

    Avelino, Marcelo Coelho; Bastos, Breno Braga; Moreira de Sousa, Rafael Soares

    2017-01-01

    The azygos anterior cerebral artery is a rare variant, characterized by the absence of the anterior communicating artery and the union of two proximal segments of the anterior cerebral artery, forming a single trunk and ascending through the interhemispheric fissure. The incidence in the population varies from 0.3 to 2%. The presence of occlusion for this vessel causes bifrontal infarcts, with potentially devastating functional consequences, hence the importance of recognizing this anatomical variation in imaging exams. PMID:28299225

  16. Incidental Anterior Cruciate Ligament Calcification: Case Report.

    PubMed

    Hayashi, Hisami; Fischer, Hans

    2016-03-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding.

  17. Incidental Anterior Cruciate Ligament Calcification: Case Report

    PubMed Central

    Hayashi, Hisami; Fischer, Hans

    2016-01-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding. PMID:27200163

  18. MRI of anterior knee pain.

    PubMed

    Samim, Mohammad; Smitaman, Edward; Lawrence, David; Moukaddam, Hicham

    2014-07-01

    Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa's disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning.

  19. Gendered Performances during Peer Revision

    ERIC Educational Resources Information Center

    Styslinger, Mary E.

    2008-01-01

    This study explored the ways gender is accomplished in varied social contexts during the peer revision process in a secondary English classroom. Using a post-structural feminist theoretical framework, an analysis of classroom discourse provided a basis for understanding the performance of gender during peer revision, the effects of gender…

  20. Interior Design: Revision as Focus.

    ERIC Educational Resources Information Center

    Smede, Shelly D.

    2000-01-01

    Describes how the author teaches her eighth-grade students to revise their writing, providing "working revision days" in class, offering direction and structure, and thereby helping students learn how much impact going back to a piece of writing and making sweeping changes can have on the end result. (SR)

  1. Emotion Processes in Knowledge Revision

    ERIC Educational Resources Information Center

    Trevors, Gregory J.; Kendeou, Panayiota; Butterfuss, Reese

    2017-01-01

    In recent years, a number of insights have been gained into the cognitive processes that explain how individuals overcome misconceptions and revise their previously acquired incorrect knowledge. The current study complements this line of research by investigating the moment-by-moment emotion processes that occur during knowledge revision using a…

  2. Multimodal Revision Techniques in Webtexts

    ERIC Educational Resources Information Center

    Ball, Cheryl E.

    2014-01-01

    This article examines how an online scholarly journal, "Kairos: Rhetoric, Technology, Pedagogy," mentors authors to revise their webtexts (interactive, digital media scholarship) for publication. Using an editorial pedagogy in which multimodal and rhetorical genre theories are merged with revision techniques found in process-based…

  3. Multimodal Revision Techniques in Webtexts

    ERIC Educational Resources Information Center

    Ball, Cheryl E.

    2014-01-01

    This article examines how an online scholarly journal, "Kairos: Rhetoric, Technology, Pedagogy," mentors authors to revise their webtexts (interactive, digital media scholarship) for publication. Using an editorial pedagogy in which multimodal and rhetorical genre theories are merged with revision techniques found in process-based…

  4. TRICARE reimbursement revisions. Final rule.

    PubMed

    2012-06-27

    This final rule provides several necessary revisions to the regulation in order for TRICARE to be consistent with Medicare. These revisions affect: Hospice periods of care; reimbursement of physician assistants and assistant-at-surgery claims; and diagnosis-related group values, removing references to specific numeric diagnosis-related group values and replacing them with their narrative description.

  5. Surgical Scar Revision: An Overview

    PubMed Central

    Garg, Shilpa; Dahiya, Naveen; Gupta, Somesh

    2014-01-01

    Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods. PMID:24761092

  6. Revision Trabeculectomy: Pearls and Pitfalls

    PubMed Central

    Crowston, Jonathan

    2012-01-01

    ABSTRACT Revision trabeculectomy is used to describe any surgical intervention subsequent to an existing trabeculectomy. Mostly, it is used to describe resurgery for failure of trabeculectomy, as defined by inadequate pressure control. Revision may also be performed for unsafe, uncomfortable or leaking blebs. Mostly bleb failure occurs within the subconjunctival space, although the flap and ostium may be involved or causative. Clear surgical principles, meticulous surgical technique and scrupulous postoperative care are key to successful revision surgery. This review is an attempt to elucidate the technique of bleb revision for bleb failure. How to cite this article: Coote M, Crowston J. Revision Trabeculectomy: Pearls and Pitfalls. J Current Glau Prac 2012;6(3):131-138. PMID:26997769

  7. Bleb Revision With Temporalis Fascia Autograft.

    PubMed

    Qu-Knafo, Lise; Le Du, Brivael; Boumendil, Julien; Nordmann, Jean-Philippe

    2017-01-01

    We report the first description of temporalis fascia autograft to repair a late leakage bleb with scleral defect that occurred long time after trabeculectomy with mitomycin C. A 65-year-old woman was referred to our hospital with chronic late bleb leakage on her right eye. She had previously undergone a trabeculectomy with mitomycin C 3 years ago for a pigmentary glaucoma. Bleb leakage occurred 1½ year after the initial surgery. She underwent 2 surgical revisions consisting of a conjunctival advancement then an autologous conjunctival with partial scleral grafts without success. The initial best-corrected visual acuity of the right eye was 20/50 (Snellen scale). Slit-lamp examination revealed an avascular filtering bleb with leakage (massive positive Seidel test) and a scleral defect. The anterior chamber was deep and intraocular pressure (IOP) was 9 mm Hg.Faced with the risk of blebitis, endophthalmitis, and with the failure of the previous surgeries announced earlier, a surgical revision with autologous superficial temporalis fascia graft was decided to repair the leaking bleb. After local anesthesia, a sample of superficial temporalis fascia was harvested. The necrotic avascular conjunctiva around the bleb was dissected to separate and excise it from the sclera. The autologous fascia graft was sutured on the scleral defect with 10-0 nylon. Subsequently healthy conjunctiva was sutured above the graft. No bleb leakage occurred postoperatively, best-corrected visual acuity improved to 20/25, and IOP remained within normal levels 6 months after surgery without IOP-lowering medication. Superficial temporalis fascia autograft seems to be an effective, safe, and easy technique for ophthalmologists. It is a new procedure in the management of late-onset bleb leakage.

  8. Demographic, Clinical, and Operative Factors Affecting Long-Term Revision Rates After Cervical Spine Arthrodesis.

    PubMed

    Derman, Peter B; Lampe, Lukas P; Hughes, Alexander P; Pan, Ting Jung; Kueper, Janina; Girardi, Federico P; Albert, Todd J; Lyman, Stephen

    2016-09-21

    Limited data exist on long-term revision rates following cervical spine arthrodeses. The purposes of this study were to define reoperation rates after primary cervical arthrodeses and to identify risk factors for revisions. New York State's all-payer health-care database was queried to identify all primary subaxial cervical arthrodeses occurring in the 16 years from 1997 through 2012. A total of 87,042 patients were included in the study cohort. Demographic information was extracted. Patients' preoperative medical comorbidities, surgical indications, and operative approaches were assembled using codes from the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification). The cohort was followed to revision surgical procedures, death, or the end of the study period. All subsequent contiguous spinal arthrodeses, including in the subaxial cervical spine, were considered revisions. The overall revision risk and the risk associated with various preoperative characteristics, surgical indications, and operative approaches were assessed using a Cox proportional hazard model. During the study period, 6,721 patients (7.7%) underwent revision. The median time to revision was 24.5 months. The probability of undergoing at least one revision by 192 months was 12.6%. Arthrodeses performed via anterior-only approaches had a significantly higher probability of revision (p < 0.001) at 13.4% (95% confidence interval [95% CI], 12.9% to 13.9%) than those performed via posterior approaches at 7.4% (95% CI, 6.6% to 8.4%) or circumferential (anterior and posterior) approaches at 5.2% (95% CI, 4.0% to 6.8%). This relationship persisted in multivariate analysis; compared with anterior surgical procedures, there was a significantly lower risk of revision (p < 0.001) for posterior surgical approaches at a hazard ratio of 0.76 (95% CI, 0.69 to 0.84) and circumferential approaches at a hazard ratio of 0.53 (95% CI, 0.42 to 0.66). Patient age of 18 to 34 years

  9. Giant Cavernous Haemangioma of the Anterior Mediastinum

    PubMed Central

    Kaya, Seyda Ors; Samancılar, Ozgur; Usluer, Ozan; Acar, Tuba; Yener, Ali Galip

    2015-01-01

    Cavernous hemangiomas of the anterior mediastinum is rare. We present a case of a 56-year-old male patient with a giant cavernous hemangioma of the anterior mediastinum, 18 cm in diameters, approached by left posterolateral thoracotomy. To the best of our knowledge, such a unique case has not been previously presented in the literature. PMID:26644773

  10. Anterior cervical hypertrichosis: a sporadic case

    PubMed Central

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-01-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature. PMID:27103865

  11. Anterior cervical hypertrichosis: a sporadic case.

    PubMed

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-03-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature.

  12. Correlates of knee anterior laxity in sportswomen.

    PubMed

    Vauhnik, Renata; Morrissey, Matthew C; Rutherford, Olga M; Turk, Zmago; Pilih, Iztok A; Perme, Maja Pohar

    2009-12-01

    The purpose of this study was to evaluate whether any of the following factors are related to knee anterior laxity in healthy sportswomen: anthropometric characteristics, lower limb alignment characteristics, hormone-related factors and sport history. Six hundred and sixteen sportswomen were tested in the pre-season. The data have been analysed using linear regression for possible association of knee anterior laxity with other variables. Univariate linear regression indicated a positive association of knee anterior laxity with knee extension and navicular drop and a negative association with body height. Multivariate linear regression analysis showed statistically significant associations between knee anterior laxity and the combination of passive knee extension and the chosen sport (R(2)=0.089; p<0.05). The combination of passive knee extension and sport type was found to be related to the amount of knee anterior laxity, although the association was weak with this combination of factors able to explain only about 9% of the variability in laxity. Knowing which factors influence the amount of knee anterior laxity will help us to better interpret the results of knee anterior laxity testing and help us to understand the possible role of knee anterior laxity as a risk factor for knee injury.

  13. Recurrent anterior uveitis in Henoch Schonlein's vasculitis.

    PubMed

    Erer, Burak; Kamali, Sevil; Cingu, Kursat; Kilicaslan, Isin; Gul, Ahmet; Inanc, Murat; Aral, Orhan; Tugal-Tutkun, Ilknur

    2010-08-01

    Uveitis is an important component of many rheumatic diseases. The main causes of recurrent uveitis are seronegative spondylarthropathies and Behçet's disease. We describe a rare case of Henoch Schönlein vasculitis (HSV) along with multiple recurrences of acute anterior uveitis. In cases of skin rash and recurrent anterior uveitis, HSV should be considered in the differential diagnosis.

  14. Anterior capsulotomy using the CO2 laser

    NASA Astrophysics Data System (ADS)

    Barak, Adiel; Ma-Naim, Tova; Rosner, Mordechai; Eyal, Ophir; Belkin, Michael

    1998-06-01

    Continuous circular capsulorhexis (CCC) is the preferred technique for removal of the anterior capsule during cataract surgery due to this technique assuring accurate centration of the intraocular lens. During modern cataract surgery, especially with small or foldable intra ocular lenses, centration of the lens is obligatory. Radial tears at the margin of an anterior capsulotomy may be associated with the exit of at least one loop of an intraocular lens out of the capsular bag ('pea pod' effect) and its subsequent decentration. The anterior capsule is more likely to ream intact if the continuous circular capsulorhexis (CCC) technique is used. Although manual capsulorhexis is an ideal anterior capsulectomy technique for adults, many ophthalmologists are still uncomfortable with it and find it difficult to perform, especially in complicated cases such as these done behind small pupil, cataract extraction in children and pseudoexfoliation syndrome. We have developed a technique using a CO2 laser system for safe anterior capsulotomy and tested it in animal eyes.

  15. Comparison of revision surgeries for one- to two-level cervical TDR and ACDF from 2002 to 2011.

    PubMed

    Nandyala, Sreeharsha V; Marquez-Lara, Alejandro; Fineberg, Steven J; Singh, Kern

    2014-12-01

    Cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) provide comparable outcomes for degenerative cervical pathology. However, revisions of these procedures are not well characterized. The purpose of this study is to examine the rates, epidemiology, perioperative complications, and costs between the revision procedures and to compare these outcomes with those of primary cases. This study is a retrospective database analysis. A total of 3,792 revision and 183,430 primary cases from the Nationwide Inpatient Sample (NIS) database from 2002 to 2011 were included. Incidence of revision cases, patient demographics, length of stay (LOS), in-hospital costs, mortality, and perioperative complications. Patients who underwent revision for either one- to two-level cervical TDR or ACDF were identified. SPSS v.20 was used for statistical analysis with χ(2) test for categorical data and independent sample t test for continuous data. The relative risk for perioperative complications with revisions was calculated in comparison with primary cases using a 95% confidence interval. An alpha level of less than 0.05 denoted statistical significance. There were 3,536 revision one- to two-level ACDFs and 256 revision cervical TDRs recorded in the NIS database from 2002 to 2011. The revision cervical TDR cohort demonstrated a significantly greater LOS (3.18 vs. 2.25, p<.001), cost ($16,998 vs. $15,222, p=.03), and incidence of perioperative wound infections (13.6 vs. 5.3 per 1,000, p<.001) compared with the ACDF revision cohort (p<.001). There were no differences in mortality between the revision surgical cohorts. Compared with primary cases, both revision cohorts demonstrated a significantly greater LOS and cost. Furthermore, patients who underwent revision demonstrated a greater incidence and risk for perioperative wound infections, hematomas, dysphagia, and neurologic complications relative to the primary procedures. This study demonstrated a

  16. Anterior Cruciate Ligament Graft Choices

    PubMed Central

    Macaulay, Alec A.; Perfetti, Dean C.; Levine, William N.

    2012-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is a common surgical procedure; however, there is no consensus to what the best graft option is to replace the injured ACL. The main options available consist of allografts and autografts, which include patellar tendon, hamstring tendon, and quadriceps tendon autografts. Evidence Acquisition: The PubMed database was searched in August 2010 for English-language articles pertaining to ACL grafts. Results: Postoperative outcome variables were analyzed to determine similarities and differences among the different graft options. These variables include stability, strength, function, return to sports, patient satisfaction, complications, and cost. Conclusions: Both allografts and the 3 main options for autografts can provide excellent results in ACL reconstruction and lead to a high percentage of satisfied patients. However, differences exist among the graft choices. Both the similarities and the differences are important to discuss with a patient who will be undergoing ACL reconstruction so that he or she has the best information available when making a choice of graft. PMID:23016071

  17. Ameloblastoma of the anterior mandible

    PubMed Central

    Hariram; Mohammad, Shadab; Malkunje, Laxman R.; Singh, Nimisha; Das, Sugata; Mehta, Gagan

    2014-01-01

    Ameloblastoma or adamantinoma is the rarest of the three forms of tumor of the odontogenic type. They are benign, locally aggressive neoplasms arising from ameloblasts, which typically occur at the angle of the mandible, and are often associated with an un-erupted tooth and must, therefore, be differentiated from a dentigerous cyst which will be centered on the crown. When in the maxilla (less common), they are located in the premolar region, and can extend up in the maxillary sinus. Ameloblastoma is reported to constitute about 1-3% of tumors and cysts of the jaws. The tumor is by far more common in the mandible than in the maxilla and shows predilection for various parts of the mandible in different racial groups. The relative frequency of the mandible to maxilla is reported as varying from 80-20% to 99-1%. Here, we are representing a case of ameloblastoma of anterior mandible which was considered as a rare site of occurrence. PMID:25298718

  18. Anterior space management: interdisciplinary concepts.

    PubMed

    Ittipuriphat, Iyarint; Leevailoj, Chalermpol

    2013-02-01

    This case report describes the treatment of one patient with maxillary anterior spacing, caused by bilateral lateral peg-shaped incisors, using a planned sequence of multidisciplinary approaches for esthetic treatment. An asymmetrical gingival line was visible when the patient smiled. To evaluate the desired gingival level and the proportion of restoration to be made using the recurring esthetic dental (RED) proportion method, a diagnostic wax-up model was fabricated. Esthetic crown lengthening corrected the gingival line. RED proportion analysis suggested minor tooth movement prior to any restoration. Two weeks' use of an orthodontic removable appliance with finger springs achieved the proper dental proportion. Home whitening was prescribed for 2 weeks, with an additional 2-week waiting period to ensure tooth color stability. Resin composite treatment corrected the mesial contour of the maxillary canines and reduced the space between the canines and lateral incisors. Final restoration was obtained by placing ceramic veneers on the lateral peg-shaped incisors. The esthetic treatment achieved excellent results; after veneer cementation, the patient exhibited greater confidence with a new smile. Esthetic dental treatment requires various disciplines to achieve the treatment goal. This case report is an example of well-planned sequences of treatment from the beginning to complete treatment. By conservative and practical treatment approaches used in this case, the clinician will be able to manage to obtain the highest result of esthetic treatment. © 2012 Wiley Periodicals, Inc.

  19. Estrogens sensitize anterior pituitary gland to apoptosis.

    PubMed

    Pisera, D; Candolfi, M; Navarra, S; Ferraris, J; Zaldivar, V; Jaita, G; Castro, M G; Seilicovich, A

    2004-10-01

    Tissue homeostasis results from a balance between cell proliferation and cell death by apoptosis. Estradiol affects proliferation as well as apoptosis in hormone-dependent tissues. In the present study, we investigated the apoptotic response of the anterior pituitary gland to lipopolysaccharide (LPS) in cycling female rats, and the influence of estradiol in this response in ovariectomized (OVX) rats. The OVX rats were chronically estrogenized with implanted Silastic capsules containing 1 mg of 17beta-estradiol (E2). Cycling or OVX and E2-treated rats were injected with LPS (250 microg/rat ip). Apoptosis was determined by the terminal deoxynucleotidyl-mediated dUTP nick-end labeling (TUNEL) method in sections of the anterior pituitary gland and spleen. Chronic estrogenization induced apoptosis in the anterior pituitary gland. Acute endotoxemia triggered apoptosis of cells in the anterior pituitary gland of E2-treated rats but not of OVX rats. No differences were observed in the apoptotic response to LPS in spleen between OVX and E2-treated rats. The apoptotic response of the anterior pituitary to LPS was variable along the estrous cycle, being higher at proestrus than at estrus or diestrus I. Approximately 75% of the apoptotic cells were identified as lactotropes by immunofluorescence. In conclusion, our results indicate that estradiol induces apoptosis and enables the proapoptotic action of LPS in the anterior pituitary gland. Also, our study suggests that estrogens may be involved in anterior pituitary cell renewal during the estrous cycle, sensitizing lactotropes to proapoptotic stimuli.

  20. Anterior instability in the throwing shoulder.

    PubMed

    Savoie, Felix H; O'Brien, Michael J

    2014-06-01

    The disabled throwing shoulder is a multifactorial problem. Laxity of the glenohumeral joint is necessary to achieve a satisfactory velocity. Normal wear and tear with throwing may convert this normal amount of excessive translation into instability. Instability in the throwing athlete manifests itself in 2 forms: traumatic anterior instability that happens to occur in a throwing athlete and excessive anterior subluxation because of overuse that occurs in conjunction with the disabled throwing shoulder. In most cases, it is difficult to determine by physical examination or imaging how much laxity is too much; therefore, the managing physician should always err on the side of caution. A trial of rest and rehabilitation should always be attempted before any consideration of surgery. The multifactorial issues in the disabled throwing athlete should be corrected during this phase of treatment, including assessment and treatment of hip abnormalities, restoration of satisfactory core strength, correction of scapular dyskinesis, and an evaluation and correction of any biomechanical abnormalities in the throwing mechanism. Surgical management of anterior instability in the throwing shoulder depends on the mechanism of injury. The traumatic anterior instability patient is managed by acute surgical repair without a shift, utilizing mattress sutures to prevent suture chondromalacia on the humeral head or glenoid. The anterior laxity management centers on the posterior superior labrum, although occasionally the anterior labrum or capsule may be involved as well. Overall, symptomatic anterior instability is less common in the throwing shoulder. Jobe and colleagues are credited with the first successful technique for the correction of anterior instability in the throwing athlete, the anterior capsulolabral reconstruction by a subscapularis split. The success of this technique paved the way for the adoption of the current arthroscopic techniques that are utilized to correct

  1. Revision of a lumbar disc arthroplasty following late infection

    PubMed Central

    Petrizzo, Anthony M.

    2009-01-01

    Anterior removal of a lumbar total disc replacement implant is often a very technically demanding procedure. The anterior retroperitoneal anatomy is prone to scarring, limiting remobilization and making a direct anterior exposure above the L5–S1 level difficult if not impossible to achieve safely. Anterolateral approach strategies can be more safely achieved at L4–L5 and above, but may require vertebral osteotomy in order to remove a keeled prosthesis. Successful conversion to a fusion with implant removal can be achieved, even when osteotomy is needed for implant removal. This Grand Rounds case presentation involves an unusual late retroperitoneal abscess following two-level TDR with direct extension to one of the implants, and the subsequent nonoperative and operative management. Removal of a well-fixed keeled implant at the L4–L5 level following nonoperative treatment of a surrounding retroperitoneal abscess and conversion to fusion represents close to, if not a ‘worst-case’ scenario for revision TDR. However, with proper preoperative planning and surgical experience, a safe and successful procedure can be the end result. PMID:19937351

  2. 78 FR 48667 - Revised Company Registration System

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-09

    ... Energy Regulatory Commission Revised Company Registration System AGENCY: Federal Energy Regulatory Commission. ACTION: Notice. SUMMARY: This document revises the effective date of the Revised Company... in Docket No. RM07-16-000, et al. (February 7, 2013 Order) directing revisions to the...

  3. Annotation and Classification of Argumentative Writing Revisions

    ERIC Educational Resources Information Center

    Zhang, Fan; Litman, Diane

    2015-01-01

    This paper explores the annotation and classification of students' revision behaviors in argumentative writing. A sentence-level revision schema is proposed to capture why and how students make revisions. Based on the proposed schema, a small corpus of student essays and revisions was annotated. Studies show that manual annotation is reliable with…

  4. Annotation and Classification of Argumentative Writing Revisions

    ERIC Educational Resources Information Center

    Zhang, Fan; Litman, Diane

    2015-01-01

    This paper explores the annotation and classification of students' revision behaviors in argumentative writing. A sentence-level revision schema is proposed to capture why and how students make revisions. Based on the proposed schema, a small corpus of student essays and revisions was annotated. Studies show that manual annotation is reliable with…

  5. Knowledge-Directed Theory Revision

    NASA Astrophysics Data System (ADS)

    Ali, Kamal; Leung, Kevin; Konik, Tolga; Choi, Dongkyu; Shapiro, Dan

    Using domain knowledge to speed up learning is widely accepted but theory revision of such knowledge continues to use general syntactic operators. Using such operators for theory revision of teleoreactive logic programs is especially expensive in which proof of a top-level goal involves playing a game. In such contexts, one should have the option to complement general theory revision with domain-specific knowledge. Using American football as an example, we use Icarus' multi-agent teleoreactive logic programming ability to encode a coach agent whose concepts correspond to faults recognized in execution of the play and whose skills correspond to making repairs in the goals of the player agents. Our results show effective learning using as few as twenty examples. We also show that structural changes made by such revision can produce performance gains that cannot be matched by doing only numeric optimization.

  6. The anterior open bite problem (infraclusion).

    PubMed

    Champagne, M

    1995-06-01

    Anterior open bite is a major orthodontic problem that is very difficult to treat (Fig. 1). It may not be the most frequent problem but it is a major functional problem. Quite often it is very difficult to correct an anterior open bite problem and even more difficult to treat in an adult after growth. Most of the time anterior open bite is a myofunctional problem related to a bad habit like thumb or finger sucking and/or is related to a breathing and swallowing problem. How can we understand the functional open bite problem? What are the available treatment options? This article will try to answer some of these questions.

  7. Mini-open anterior lumbar interbody fusion.

    PubMed

    Gandhoke, Gurpreet S; Ricks, Christian; Tempel, Zachary; Zuckerbraun, Brian; Hamilton, D Kojo; Okonkwo, David O; Kanter, Adam S

    2016-07-01

    In deformity surgery, anterior lumbar interbody fusion provides excellent biomechanical support, creates a broad surface area for arthrodesis, and induces lordosis in the lower lumbar spine. Preoperative MRI, plain radiographs, and, when available, CT scan should be carefully assessed for sacral slope as it relates to pubic symphysis, position of the great vessels (especially at L4/5), disc space height, or contraindication to an anterior approach. This video demonstrates the steps in an anterior surgical procedure with minimal open exposure. The video can be found here: https://youtu.be/r3bC4_vu1hQ .

  8. Anterior cruciate ligament augmentation for rotational instability following primary reconstruction with an accelerated physical therapy protocol.

    PubMed

    Carey, Timothy; Oliver, David; Pniewski, Josh; Mueller, Terry; Bojescul, John

    2013-01-01

    The purpose of the present study is to present the results of anterior cruciate ligament (ACL) augmentation for patients having rotational instability despite an intact vertical graft in lieu of conventional revision ACL reconstruction. ACL augmentation surgery with a horizontal graft was performed to augment a healed vertical graft on five patients and an accelerated rehabilitation protocol was instituted. Functional outcomes were assessed by the Lower Extremity Functional Scale (LEFS) and the Modified Cincinnati Rating System (MCRS). All patients completed physical therapy within 5 months and were able to return to full military duty without limitation. LEFS and MCRS were significantly improved. ACL augmentation with a horizontal graft provides an excellent alternative to ACL revision reconstruction for patients with an intact vertical graft, allowing an earlier return to duty for military service members.

  9. [Pressure sore revision surgery].

    PubMed

    Dorsche, Karin Marion

    2010-02-22

    Pressure sores are a major problem for patients as well as society in general. Immobilised patients are especially at risk. This group of patients with pressure sores should be hospitalised to perform surgical revision of the wound and reconstruction using a flap. Such surgery demands extensive postoperative relief of the flap. The University Centre for Wound Healing at Odense University Hospital has tested the effects of a reduction of the formerly recommended relief period from three to two weeks. In this article we report results covering all patients who have undergone surgery and reconstruction of pressure sores during the period from 1st October 2001 to 1st November 2008. The results are divided into two periods: the period before and the period after the introduction of the reduced relief period. A total of 80 patients were included; 34 in the first period and 46 in the second period. We achieved a considerable reduction in median length of stay from 38 to 27 days with no increase in surgical or complication frequency. Furthermore, the share of fully healed remained unchanged. We believe that there is no risk in shortening the immobile postoperative relief phase following reconstruction of pressure wounds in immobilised patients.

  10. Impact of Mitochondria-Mediated Apoptosis in U251 Cell Cycle Arrest in G1 Stage and Caspase Activation.

    PubMed

    Zhang, Lei; Liang, Peng; Zhang, Rui

    2015-11-23

    BACKGROUND Most mitochondria-mediated apoptosis has some relevance to the cell cycle, but there is still a lack of investigations about U251 cell cycle in human brain glioma cells. In this study, we aimed to clarify the correlation of mitochondria-mediated apoptosis with the U251 cell cycle and its influence on apoptosis, through observing the impact of mitochondria-mediated apoptosis in U251cell specificity cycle arrest and Caspase activation. MATERIAL AND METHODS AnnexinV/PI and API were used to label the brain glioma cells for flow cytometry analysis of U251 cell apoptosis and cell cycle. RT-PCR and Western blot were performed to detect Caspase-3 and Caspase-9 activation. RESULTS Peripheral blood in stationary phase is not sensitive to apoptosis induction, but U251 cells have obvious apoptosis. Mitochondria-mediated apoptosis mainly occurs in the G1 phase of the cell cycle. Caspase-3 and Caspase-9 mRNAs and proteins expression increased significantly after the cells were treated by mitochondrial apoptosis-related gene Bax induction. CONCLUSIONS Mitochondria-mediated apoptosis is related to the U251 cell cycle with specific G1 stage arrest. Caspase activation occurs in the process of cell apoptosis.

  11. How I do it: Anterior pull-through tympanoplasty for anterior eardrum perforations.

    PubMed

    Harris, Jeffrey P; Wong, Yu-Tung; Yang, Tzong-Hann; Miller, Mia

    2016-01-01

    Conclusions This technique is offered as a convenient and reliable method for cases with anterior TM perforation and inadequate anterior remnant. Objectives Chronic otitis media surgery is one of the most common procedures in otology. Anterior tympanic membrane (TM) perforation with inadequate anterior remnant is associated with higher rates of graft failure. It was the goal of this series to evaluate the anatomical and functional outcomes of a modified underlay myringoplasty technique-the anterior pull-through method. Materials and methods In a retrospective clinical study, 13 patients with anterior TM perforations with inadequate anterior remnants underwent tympanoplasty with anterior pull-through technique. The anterior tip of the temporalis fascia was pulled through and secured in a short incision lateral to the anterior part of the annulus. Data on graft take rate, pre-operative, and post-operative hearing status were analyzed. Results A graft success rate of 84.6% (11 out of 13) was achieved, without lateralization, blunting, atelectasia, or epithelial pearls. The air-bone gap was 21.5 ± 6.8 dB before intervention and 11.75 ± 5.7 dB after surgery (p = 0.003).

  12. A Radiological Comparison of Anterior Fusion Rates in Anterior Lumbar Interbody Fusion

    PubMed Central

    McCarthy, M. J. H.; Ng, L.; Vermeersch, G.; Chan, D.

    2012-01-01

    Aim To compare anterior fusion in standalone anterior lumbar interbody fusion (ALIF) using cage and screw constructs and anterior cage–alone constructs with posterior pedicle screw supplementation but without posterior fusion. Methods Eighty-five patients underwent single- or two-level ALIF procedure for degenerative disk disease or lytic spondylolisthesis (SPL). Posterior instrumentation was performed without posterior fusion in all cases of lytic SPL and when the anterior cage used did not have anterior screw through cage fixation. Results Seventy (82%) patients had adequate radiological follow-up at a mean of 19 months. Forty patients had anterior surgery alone (24 single level and 16 two levels) and 30 had front-back surgery (15 single level and 15 two levels). Anterior locked pseudarthrosis was only seen in the anterior surgery–alone group when using the STALIF cage (Surgicraft, Worcestershire, UK) (37 patients). This occurred in five of the single-level surgeries (5/22) and nine of the two-level surgeries (9/15). Fusion was achieved in 100% of the front-back group and only 65% (26/40) of the anterior surgery–alone group. Conclusion Posterior pedicle screw supplementation without posterolateral fusion improves the fusion rate of ALIF when using anterior cage and screw constructs. We would recommend supplementary posterior fixation especially in cases where more than one level is being operated. PMID:24353968

  13. Benzodiazepines and anterior pituitary function.

    PubMed

    Arvat, E; Giordano, R; Grottoli, S; Ghigo, E

    2002-09-01

    its role in the neuroendocrine control of anterior pituitary function; their usefulness probably overrides what had been supposed before.

  14. Nonarteritic anterior ischemic optic neuropathy.

    PubMed

    Atkins, Edward J

    2011-02-01

    Currently there is no generally accepted, well-proven treatment for nonarteritic anterior ischemic optic neuropathy (NAION). Most proposed treatments are empirical and include antithrombotics, vasodynamic agents, treatments aimed at reducing optic disc edema, and various neuroprotective strategies. Most potential treatments have been inadequately studied, prematurely embraced, or prematurely discarded. Evidence for antithrombotic agents is lacking, and small vessel arterial occlusion has never been demonstrated in NAION. Antiplatelet agents have not been studied in acute NAION, but they are often prescribed for acute treatment because of their proven role in stroke prevention. Because NAION is an ischemic disorder occurring more often after the age of 50 in patients with vascular risk factors, I recommend aggressive risk-factor management and antiplatelet therapy. The evidence that aspirin can help to prevent NAION in the fellow eye is divided. I recommend aspirin for secondary prevention, mostly for its proven role in stroke prevention. NAION occurs in patients with physiologically crowded optic nerves and small cup-to-disc ratios. Disc edema may contribute to a "compartment syndrome," which compresses the fine capillary blood supply of the optic nerve head, resulting in ischemia and axonal damage. There is some limited and debatable evidence that oral steroids may shorten the duration of disc edema and improve visual outcome in NAION. I discuss this evidence with patients who present acutely with NAION, and although I consider prescribing oral steroids on a case-by-case basis, I will not routinely recommend oral steroids until a properly randomized clinical trial is performed. Some neuroprotective strategies have been studied, but none have proven to be helpful. Although some (eg, brimonidine) are probably not harmful, I do not recommend these treatments. Early referral to low vision services may help to improve functional visual outcome.

  15. Arthroscopic revision of Bankart repair.

    PubMed

    Neri, Brian R; Tuckman, David V; Bravman, Jonathan T; Yim, Duke; Sahajpal, Deenesh T; Rokito, Andrew S

    2007-01-01

    The success of revision surgery for failed Bankart repair is not well known. This purpose of this study was to report the success rates achieved using arthroscopic techniques to revise failed Bankart repairs. Twelve arthroscopic revision Bankart repairs were performed on patients with recurrent unidirectional shoulder instability after open or arthroscopic Bankart repair. Follow-up was available on 11 of the 12 patients at a mean of 34.4 months (range, 25-56 months). The surgical findings, possible modes of failure, shoulder scores (Rowe score, University of California Los Angeles [UCLA], Simple Shoulder Test), and clinical outcome were evaluated. Various modes of failure were recognized during revision arthroscopic Bankart repairs. Good-to-excellent results were obtained in 8 patients (73%) undergoing revision stabilization according to Rowe and UCLA scoring. A subluxation or dislocation event occurred in 3 (27%) of the 11 patients at a mean of 8.7 months (range, 6-12 months) postoperatively. Arthroscopic revision Bankart repairs are technically challenging procedures but can be used to achieve stable, pain-free, functional shoulders with return to prior sport. Owing to limited follow-up and the small number of patients in this study, we were unable to conclude any pattern of failure or selection criteria for this procedure.

  16. Acetabular bone loss in revision total hip arthroplasty: principles and techniques.

    PubMed

    Noordin, Shahryar; Masri, Bassam A; Duncan, Clive P; Garbuz, Donald S

    2010-01-01

    Bone stock deficiency presents the major challenge in acetabular reconstruction during revision hip arthroplasty. The preoperative assessment of acetabular bone stock before revision surgery is critical because the amount and location of pelvic osteolysis can determine the type and success of revision surgery. Traditionally, plain radiographs with AP and lateral views have been used for this purpose; however, Judet views can provide additional information about the integrity of the anterior and posterior columns. CT and MRI scans are indicated in selected patients. A variety of surgical options are available for treating Paprosky type 3 defects. Jumbo cups, the high hip center technique, impaction grafting, bilobed implants, antiprotrusio cages, and structural allografts, in addition to other types of implants, are part of the armamentarium available for revision hip arthroplasty. Segmental bone loss involving more than 50% of the acetabulum is one of the biggest challenges in revision hip replacement. The short-term clinical and radiographic results of treating these large defects with modular, highly porous metal components appear promising. However, potential problems with these components include their unknown long-term durability, potential for debris generation at the shell-augment interface, potential for fatigue failure, and the inability to restore bone stock if future revisions are needed.

  17. Anterior cruciate ligament (ACL) injury -- aftercare

    MedlinePlus

    ... ACL injury - aftercare References Amy E, Micheo W. Anterior cruciate ligament tear. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation . 2nd ed. St. Louis, MO: ...

  18. Anterior regeneration in the hemichordate Ptychodera flava

    PubMed Central

    Rychel, Amanda L.; Swalla, Billie J.

    2008-01-01

    Ptychodera flava is a hemichordate whose anterior structures regenerate reproducibly from posterior trunk pieces when amputated. We characterized the cellular processes of anterior regeneration with respect to programmed cell death and cell proliferation, following wound healing. We found scattered proliferating cells at day two of regeneration using a PCNA antibody. On day four, most proliferating cells were associated with the nerve tract under the epidermis, and on day six, a small proboscis derived from proliferated cells was regenerated, and a mouth had broken though the epidermis. TUNEL detected elevated levels of apoptosis in the endoderm that began furthest away from the region of wound healing, then moved anteriorly over eight days. Posterior to anterior apoptosis is likely to remove digestive endoderm for later differentiation of pharyngeal endoderm. We hypothesize that P. flava regeneration is nerve dependent and that remodeling in the gut endoderm plays an important role in regeneration. PMID:18924231

  19. Revised Extended Grid Library

    SciTech Connect

    Martz, Roger L.

    2016-07-15

    The Revised Eolus Grid Library (REGL) is a mesh-tracking library that was developed for use with the MCNP6TM computer code so that (radiation) particles can track on an unstructured mesh. The unstructured mesh is a finite element representation of any geometric solid model created with a state-of-the-art CAE/CAD tool. The mesh-tracking library is written using modern Fortran and programming standards; the library is Fortran 2003 compliant. The library was created with a defined application programmer interface (API) so that it could easily integrate with other particle tracking/transport codes. The library does not handle parallel processing via the message passing interface (mpi), but has been used successfully where the host code handles the mpi calls. The library is thread-safe and supports the OpenMP paradigm. As a library, all features are available through the API and overall a tight coupling between it and the host code is required. Features of the library are summarized with the following list: • can accommodate first and second order 4, 5, and 6-sided polyhedra • any combination of element types may appear in a single geometry model • parts may not contain tetrahedra mixed with other element types • pentahedra and hexahedra can be together in the same part • robust handling of overlaps and gaps • tracks element-to-element to produce path length results at the element level • finds element numbers for a given mesh location • finds intersection points on element faces for the particle tracks • produce a data file for post processing results analysis • reads Abaqus .inp input (ASCII) files to obtain information for the global mesh-model • supports parallel input processing via mpi • support parallel particle transport by both mpi and OpenMP

  20. Anterior Eye Imaging with Optical Coherence Tomography

    NASA Astrophysics Data System (ADS)

    Huang, David; Li, Yan; Tang, Maolong

    The development of corneal and anterior segment optical coherence tomography (OCT) technology has advanced rapidly in recently years. The scan geometry and imaging wavelength are both important choices to make in designing anterior segment OCT systems. Rectangular scan geometry offers the least image distortion and is now used in most anterior OCT systems. The wavelength of OCT light source affects resolution and penetration. An optimal choice of the OCT imaging wavelength (840, 1,050, or 1,310 nm) depends on the application of interest. Newer generation Fourier-domain OCT technology can provide scan speed 100-1000 times faster than the time-domain technology. Various commercial anterior OCT systems are available on the market. A wide spectrum of diagnostic and surgical applications using anterior segment OCT had been investigated, including mapping of corneal and epithelial thicknesses, keratoconus screening, measuring corneal refractive power, corneal surgery planning and evaluation in LASIK, intracorneal ring implantation, assessment of angle closure glaucoma, anterior chamber biometry and intraocular lens implants, intraocular lens power calculation, and eye bank donor cornea screening.

  1. Anterior condylar displacement: its diagnosis and treatment.

    PubMed

    Weinberg, L A

    1975-08-01

    A deflective slide in centric relation to centric occlusion does not necessarily mean anterior condylar displacement. Its diagnosis and treatment depend on the correlation of three factors: the direction and magnitude of the mandibular slide from centric relation to centric occlusion, the change in vertical dimension of occlusion during the slide, and the position of the condyles in the fossae when the teeth are in the maximum occlusion (centric occlusion). When the change in vertical dimension almost equals to amount of slide from the deflective contact in centric relation to maximum intercuspation, very little anterior condylar displacement would be expected. Conversely, with proportionately little change in vertical dimension, more anterior condylar translation is required for a given degree of anterior slide. Examples of each type of anterior slide were related to the TMJ radiographs of the condylar position. If the direction and magnitude of the deflective occlusal contact can be correlated with the TMJ radiographs, the centric relation is "functional,'' and the clinically retruded mandibular position should be used. When this correlation does not exist, the centric relation is "dysfunctional'' and the terminal hinge position (retruded mandibular position) should not be used for restorative or corrective procedures. Examples of anterior condylar displacement were given, including deviation, with a comparison of "before'' and "after'' TMJ radiographs.

  2. Laser peripheral iridotomy changes anterior chamber architecture.

    PubMed

    Theinert, Christian; Wiedemann, Peter; Unterlauft, Jan D

    2017-01-19

    The pressure gradient between anterior and posterior chamber in acute angle closure (AAC) and primary angle closure suspects is balanced by a sufficient laser peripheral iridotomy (LPI). The anterior chamber changes induced by LPI in patients with unilateral AAC were examined and compared to healthy eyes to define threshold values, which may help to discriminate between healthy and diseased eyes. Using Scheimpflug photography, anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), and central corneal thickness (CCT) were measured before and after LPI in both eyes of unilateral AAC cases. These measurements were compared to a group of healthy control eyes to determine threshold values for ACD, ACV, and ACA. The ACD, ACV, and ACA increased significantly in the 25 AAC eyes after LPI. The ACD, ACV, ACA, and CCT values in the AAC eyes obtained before LPI were compared to a control group of 59 healthy eyes with wide open chamber angles. The cutoff values revealed by receiver operating characteristic analysis were 2.1 mm for ACD, 90.5 mm2 for ACV, and 27.25° for ACA. Our results confirm the significant changes of the anterior segments architecture induced by LPI in AAC eyes. The found threshold values for ACD, ACV, and ACA may help in daily clinical routine to discriminate between healthy eyes and those in need for a prophylactic LPI.

  3. Anterior Insula Volume and Guilt

    PubMed Central

    Belden, Andy C.; Barch, Deanna M.; Oakberg, Timothy J.; April, Laura M.; Harms, Michael P.; Botteron, Kelly N.; Luby, Joan L.

    2016-01-01

    IMPORTANCE This is the first study to date to examine volumetric alterations in the anterior insula (AI) as a potential biomarker for the course of childhood major depressive disorder (MDD). OBJECTIVES To examine whether children with a history of preschool-onset (PO) MDD show reduced AI volume, whether a specific symptom of PO MDD (pathological guilt) is related to AI volume reduction (given the known relationship between AI and guilt processing), and whether AI volumes predict subsequent likelihood of having an episode of MDD. DESIGN, SETTING, AND PARTICIPANTS In a prospective longitudinal study, 306 children (age range, 3.00–5.11 years) and caregivers completed DSM diagnostic assessments at 6 annual time points during 10 years as part of the Preschool Depression Study. Magnetic resonance imaging was completed on a subset of 145 school-age children (age range, 6.11–12.11 years). MAIN OUTCOMES AND MEASURES Whole-brain–adjusted AI volume measured using magnetic resonance imaging at school age and children’s diagnosis of MDD any time after their imaging. RESULTS Compared with children without a history of PO MDD, school-age children previously diagnosed as having PO MDD had smaller left and right AI volumes (Wilks Λ = 0.94, F2,124 = 3.37, P = .04, Cohen d = 0.23). However, the effect of PO MDD on reduced AI volumes was better explained by children’s experience of pathological guilt during preschool (Λ = 0.91, F2,120 = 6.17, P = .003, d = .30). When covarying for children’s lifetime history of MDD episodes, their experience of pathological guilt during preschool, as well as their sex and age at the time of imaging, schoolchildren’s right-side AI volume was a significant predictor of being diagnosed as having an MDD episode after imaging (odds ratio, 0.96; 95% CI, 0.01–0.75; P = .03). CONCLUSIONS AND RELEVANCE These results provide evidence that structural abnormalities in AI volume are related to the neurobiology of depressive disorders starting in

  4. 1-stage versus 2-stage lateral maxillary sinus lift procedures: 4-month post-loading results of a multicenter randomised controlled trial.

    PubMed

    Felice, Pietro; Pistilli, Roberto; Piattelli, Maurizio; Soardi, Elisa; Pellegrino, Gerardo; Corvino, Valeria; Esposito, Marco

    2013-01-01

    To compare the efficacy of 1-stage versus 2-stage lateral maxillary sinus lift procedures. Sixty partially edentulous patients requiring 1 to 3 implants and having 1 to 3 mm of residual bone height and at least 5 mm of bone width below the maxillary sinus, as measured on CT scans, were randomised into two equal groups to receive either a 1-stage lateral window sinus lift with simultaneous implant placement or a 2-stage procedure with implant placement delayed by 4 months using a bone substitute in 3 different centres. Implants were submerged for 4 months and loaded with reinforced provisional prostheses, which were replaced, after 4 months, by definitive prostheses. Outcome measures were augmentation procedure failures, prosthesis failures, implant failures, complications and marginal peri-implant bone loss assessed by a blinded outcome assessor. Patients were followed up to 4 months after loading. Only data of implants placed in 1 to 3 mm of bone height were reported. Two patients dropped out from the 1-stage group and none from the 2-stage group. No sinus lift procedure failed in the 1-stage group but 1 failed in the 2-stage group, the difference was not statistically significant (P = 1.00). Two prostheses failed or could not be placed in the planned time in the 1-stage group and 1 in the 2-stage group, the difference was not statistically significant (P = 0.51). Three implants failed in 3 patients of the 1-stage group versus 1 implant in the 2-stage group, the difference was not statistically significant (P = 0.28). Two complications occurred in the 1-stage group and 1 in the 2-stage group, the difference was not statistically significant (P = 0.61). There were no statistically significant differences in bone loss between groups at loading (0.05 mm). Sites treated in 1 stage lost an average of 0.56 mm (SD: 0.36; 95% CI: -0.70 to -0.42; P < 0.001) of peri-implant bone and 2-stage sites approximately 0.61 mm (SD: 0.34; 95% CI: -0.74 to -0.48; P < 0.001). No

  5. 1-stage versus 2-stage lateral sinus lift procedures: 1-year post-loading results of a multicentre randomised controlled trial.

    PubMed

    Felice, Pietro; Pistilli, Roberto; Piattelli, Maurizio; Soardi, Elisa; Barausse, Carlo; Esposito, Marco

    2014-01-01

    To compare the efficacy of 1-stage versus 2-stage lateral maxillary sinus lift procedures. Sixty partially edentulous patients requiring 1 to 3 implants and having 1 to 3 mm of residual bone height and at least 5 mm bone width below the maxillary sinus, as measured on CT scans were selected. They were randomised according to a parallel group study design into two equal arms to receive either a 1-stage lateral window sinus lift with simultaneous implant placement or a 2-stage procedure with implant placement delayed by 4 months, using a bone substitute in three different centres. Implants were submerged for 4 months, loaded with reinforced provisional prostheses, which were replaced, after 4 months, by definitive prostheses. Outcome measures, assessed by masked assessors, were: augmentation procedure failures; prosthesis failures and implant failures; complications; and marginal peri-implant bone level changes. Patients were followed up to 1 year after loading. Only data of implants placed in 1 to 3 mm of bone height were reported. Two patients dropped out from the 1-stage group and none from the 2-stage group. No sinus lift procedure failed in the 1-stage group but one failed in the 2-stage group, the difference being not statistically significant (P = 1.00). Two prostheses failed or could not be placed in the planned time in the 1-stage group and one in the 2-stage group, the difference being not statistically significant (P = 0.51). Three implants failed in three patients of the 1-stage group, versus one implant in the 2-stage group, the difference being not statistically significant (P = 0.28). Two complications occurred in the 1-stage group and one in the 2-stage group, the difference being not statistically significant (P = 0.61). One year after loading, 1-stage treated patients lost an average of -1.01 mm (SD: 0.56) of peri-implant bone and 2-stage sites about -0.93 mm (SD: 0.40). There were no statistically significant differences in bone level change

  6. Preliminary results of staged anterior debridement and reconstruction using titanium mesh cages in the treatment of thoracolumbar vertebral osteomyelitis.

    PubMed

    Fayazi, Amir H; Ludwig, Steven C; Dabbah, Michael; Bryan Butler, R; Gelb, Daniel E

    2004-01-01

    Vertebral osteomyelitis can be successfully treated with spinal immobilization and parenteral antibiotics. Failure of medical therapy may necessitate surgical treatment consisting of anterior debridement and structural anterior column reconstruction. Autologous structural bone graft has traditionally been the gold standard in anterior column reconstruction. Because of the morbidity related to graft harvest, vertebral body replacement cages have emerged as a viable option for reconstructing a deficient anterior column. To evaluate the efficacy of titanium mesh cages in the reconstruction of anterior column defects in the presence of active pyogenic infection. Prospective case series. Eleven patients underwent operative treatment for osteomyelitis of the thoracolumbar spine using staged anterior debridement and reconstruction with cylindrical titanium mesh cages followed by delayed posterior spinal fusion with pedicle screw instrumentation during a 2-year period. Patients were postoperatively evaluated clinically and radiographically. Follow-up averaged 17+/-9 months. Average increase in kyphosis of 10+/-6 degrees corresponding to 4+/-4 mm loss in the height (subsidence) of the anterior construct. One patient died during revision surgery for hardware failure. Seven of the remaining 10 patients have not required antibiotics after the initial postoperative course of treatment. Three patients are maintained on chronic suppressive therapy as a precaution. There has been no evidence of recurrence or residual infection in any patient. Seven of the 10 patients were pain free at latest follow-up. There has been one case of pseudarthrosis. Cylindrical titanium mesh can be used with consistently good results for large anterior column defect reconstructions even in the face of active pyogenic infection. In our cohort of patients with pyogenic vertebral osteomyelitis, the use of titanium mesh cages has not been associated with early recurrence of infection.

  7. Revision of Primary Series Maps

    USGS Publications Warehouse

    ,

    2000-01-01

    In 1992, the U.S. Geological Survey (USGS) completed a 50-year effort to provide primary series map coverage of the United States. Many of these maps now need to be updated to reflect the construction of new roads and highways and other changes that have taken place over time. The USGS has formulated a graphic revision plan to help keep the primary series maps current. Primary series maps include 1:20,000-scale quadrangles of Puerto Rico, 1:24,000- or 1:25,000-scale quadrangles of the conterminous United States, Hawaii, and U.S. Territories, and 1:63,360-scale quadrangles of Alaska. The revision of primary series maps from new collection sources is accomplished using a variety of processes. The raster revision process combines the scanned content of paper maps with raster updating technologies. The vector revision process involves the automated plotting of updated vector files. Traditional processes use analog stereoplotters and manual scribing instruments on specially coated map separates. The ability to select from or combine these processes increases the efficiency of the National Mapping Division map revision program.

  8. Multilevel Corpectomy With Anterior Column Reconstruction and Plating for Subaxial Cervical Osteomyelitis.

    PubMed

    Theologis, Alexander A; Lansdown, Drew; McClellan, R Trigg; Chou, Dean; Pekmezci, Murat

    2016-09-15

    A retrospective case series. The aim of this study was to evaluate patients with cervical spine osteomyelitis who underwent multilevel (≥2) subaxial corpectomies and anterior column reconstruction and plating. Neglected multilevel subaxial cervical osteomyelitis is a potentially dangerous disease. As it is rare, early radiographic and clinical outcomes after multilevel anterior corpectomy and reconstruction for subaxial cervical osteomyelitis are incompletely defined. Adults who underwent multilevel corpectomy and anterior plating/reconstruction for subaxial cervical osteomyelitis at two institutions were reviewed. Analysis of patient demographics, operative details, and radiographic cervical alignment parameters [segmental kyphosis, cervical lordosis, C2-7 sagittal vertical axis (SVA)] was performed. Nineteen patients [15 males, four females; average age 48 years (20-81 yrs)] met inclusion criteria. The majority had pre-operative neurologic deficits or was immunosuppressed. All were treated with ≥6 weeks of intravenous antibiotics following operation. All had anterior plating/reconstruction with titanium cages (expandable-6; mesh-6) or structural bone graft (fibular allogaft-6; tricortical iliac crest-1). The average number of corpectomies was 2.4 (2-4). The average numbers of levels fused anteriorly was 4.4 (4-6) and posteriorly was 6.3 (4-9). The majority of patients (74%) was treated with an anterior/posterior approach. Average follow-up was 16 ± 9 months. There was significant improvement in all cervical alignment parameters (segmental kyphosis, C2-7 SVA, cervical lordosis). No intraoperative complications occurred and no patient deteriorated neurologically postoperatively. Postoperative complications included anterior cage/graft dislodgement (n = 2), recurrent neck hematomas requiring revision (n = 1), epidural hematoma (n = 1), and wound infection (n = 1). Sixty percent of patients had persistent neurologic dysfunction at final

  9. Giant anterior cervical osteophyte leading to Dysphagia.

    PubMed

    Hwang, Jin Seop; Chough, Chung Kee; Joo, Won Il

    2013-09-01

    Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis(DISH). Large osteophytes can produce otolaryngological symptoms such as dysphagia, dysphonia, and foreign body sensation. We describe a DISH patient with giant anterior cervical osteophyte causing chronic dysphagia and dysphonia. A 56-year-old man presented with increasing dysphagia, dysphonia, neck pain and neck stiffness. Physical examination of the neck showed a non-tender and hard mass on the left side at the level of C4-5. Radiography showed extensive ossification of anterior longitudinal ligament along the left anterolateral aspect of vertebral bodies from C2 to T1. The ossification was espe cially prominent at the level of C4-5 and linear breakage was noted at same level. Esophagogram revealed a filling defect along the pharynx and lateral displacement of the esophagus. Giant anterior cervical osteophyte was removed through the leftsided anterolateral cervical approach to the spine. Anterior cervical interbody fusion at C4-5 was followed by posterior cervical fixation using lateral mass screws from C3 to C6. After surgery, dysphagia and dysphonia improved immediately. One year later, cervical CT showed bone fusion at C4-5 bodies and no recurrence of osteophyte. DISH is a common cause of anterior cervical osteophyte leading to progressive dysphagia. Keeping this clinical entity in the differential diagnosis is important in patients with progressive neck stiffness, dysphagia or dysphonia. And surgical treatment of symptomatic anterior cervical osteophyte due to DISH should be considered with a solid fusion procedure preventing postoperative instability or osteophyte progress.

  10. Factors informing fear of reinjury after anterior cruciate ligament reconstruction.

    PubMed

    Ross, Cheryl A; Clifford, Amanda; Louw, Quinette A

    2017-02-01

    Fear of reinjury is associated with cessation of sport after anterior cruciate ligament (ACL) reconstruction despite normal postoperative knee function. The objective of this study is to describe factors informing athletes' experience of fear of reinjury post ACL reconstruction, in athletes who cited fear as the sole reason for not returning to their pre-injury level of sport. Mixed-methods study design of qualitative and a preliminary quantitative component. A conveniently selected private hospital. Ten male and two female athletes, aged between 19 and 45 years, were eligible for the interview from 68 male and 32 female potential participants (age range 17-50) who underwent an ACL reconstruction using any graft type, excluding revision or multi-ligament surgery. To explore factors informing fear of reinjury in participants citing fear of reinjury as the sole reason for not returning to sport, albeit normal knee function. From the participant interview, four themes emerged: undergoing the surgery and recovery again, nature of the pre-injury sport imposing risk of reinjury, personality traits, and social priorities. Clinicians should be aware of factors informing fear of reinjury post ACL reconstruction. Modifiable fears including pain, mode and length of rehabilitation and psychological factors should be considered during rehabilitation to potentially improve the return to sport rate.

  11. The revised classification of eukaryotes

    PubMed Central

    Adl, Sina M.; Simpson, Alastair. G.; Lane, Christopher E.; Lukeš, Julius; Bass, David; Bowser, Samuel S.; Brown, Matt; Burki, Fabien; Dunthorn, Micah; Hampl, Vladimir; Heiss, Aaron; Hoppenrath, Mona; Lara, Enrique; leGall, Line; Lynn, Denis H.; McManus, Hilary; Mitchell, Edward A. D.; Mozley-Stanridge, Sharon E.; Parfrey, Laura Wegener; Pawlowski, Jan; Rueckert, Sonja; Shadwick, Lora; Schoch, Conrad; Smirnov, Alexey; Spiegel, Frederick W.

    2012-01-01

    This revision of the classification of eukaryotes, which updates that of Adl et al. (2005), retains an emphasis on the protists and incorporates changes since 2005 that have resolved nodes and branches in phylogenetic trees. Whereas the previous revision was successful in re-introducing name stability to the classification, this revision provides a classification for lineages that were then still unresolved. The supergroups have withstood phylogenetic hypothesis testing with some modifications, but despite some progress, problematic nodes at the base of the eukaryotic tree still remain to be statistically resolved. Looking forward, subsequent transformations to our understanding of the diversity of life will be from the discovery of novel lineages in previously under-sampled areas and from environmental genomic information. PMID:23020233

  12. The revised classification of eukaryotes.

    PubMed

    Adl, Sina M; Simpson, Alastair G B; Lane, Christopher E; Lukeš, Julius; Bass, David; Bowser, Samuel S; Brown, Matthew W; Burki, Fabien; Dunthorn, Micah; Hampl, Vladimir; Heiss, Aaron; Hoppenrath, Mona; Lara, Enrique; Le Gall, Line; Lynn, Denis H; McManus, Hilary; Mitchell, Edward A D; Mozley-Stanridge, Sharon E; Parfrey, Laura W; Pawlowski, Jan; Rueckert, Sonja; Shadwick, Laura; Shadwick, Lora; Schoch, Conrad L; Smirnov, Alexey; Spiegel, Frederick W

    2012-09-01

    This revision of the classification of eukaryotes, which updates that of Adl et al. [J. Eukaryot. Microbiol. 52 (2005) 399], retains an emphasis on the protists and incorporates changes since 2005 that have resolved nodes and branches in phylogenetic trees. Whereas the previous revision was successful in re-introducing name stability to the classification, this revision provides a classification for lineages that were then still unresolved. The supergroups have withstood phylogenetic hypothesis testing with some modifications, but despite some progress, problematic nodes at the base of the eukaryotic tree still remain to be statistically resolved. Looking forward, subsequent transformations to our understanding of the diversity of life will be from the discovery of novel lineages in previously under-sampled areas and from environmental genomic information.

  13. Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures.

    PubMed

    Joaquim, Andrei F; Murar, Jozef; Savage, Jason W; Patel, Alpesh A

    2014-09-01

    Anterior cervical spine surgery is one of the most common spinal procedures performed around the world, but dysphagia is a frequent postoperative complication. Many factors have been associated with an increased risk of swallowing difficulties, including multilevel surgery, revision surgery, and female gender. The objective of this study was to review and define potential preventative measures that can decrease the incidence of dysphagia after anterior cervical spine surgery. This was a systematic literature review. A systematic review in the Medline database was performed. Articles related to dysphagia after anterior cervical spine surgery and potential preventative measures were included. Twenty articles met all inclusion and exclusion criteria. These articles reported several potential preventative measures to avoid postoperative dysphagia. Preoperative measures include performing tracheal exercises before the surgical procedure. Intraoperative measures can be summarized as avoiding a prolonged operative time and the use of recombinant human bone morphogenetic protein in routine anterior cervical spine surgery, using small and smoother cervical plates, using anchored spacers instead of plates, application of steroid before wound closure, performing arthroplasty instead of anterior cervical fusion for one-level disease, decreasing tracheal cuff pressure during medial retraction, using specific retractors, and changing the dissection plan. Current literature supports several preventative measures that may decrease the incidence of postoperative dysphagia. Although the evidence is limited and weak, most of these measures did not appear to increase other complications and can be easily incorporated into a surgical practice, especially in patients who are at high risk for postoperative dysphagia. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Warfare-related secondary anterior cranioplasty

    PubMed Central

    Ebrahimi, Ali; Nejadsarvari, Nasrin; Rasouli, Hamid Reza; Ebrahimi, Azin

    2016-01-01

    Background: Anterior cranial bone defects secondary to global war cranial defects pose a unique reconstructive challenge. The objective of this study was to evaluate the outcomes of alloplastic reconstructions of cranial bone with titanium mesh and fat graft after warfare-related cranial trauma. Patients and Methods: Thirty-five patients at the plastic and reconstructive surgery ward of our hospital underwent anterior cranioplasty with titanium mesh with or without fat grafts from lower abdominal wall. Inclusion criteria were anterior cranial bone defect due to warfare injuries, the mean age of these patients was 31 years (range, 23–48 years). Ninety-five percent were male, and 5% were female. Average follow-up was 12 months. Fat grafts were used to help obliterate endocranial dead spaces. Results: Twenty-five patients (71%) had more than 0.5 cm dead space under cranial defects, and we used fat graft under the titanium mesh. The majority groups of patients (80%) were injured as a result of previous explosive device blasts with or without neurosurgical procedures in the past. The average patient age was 31 years, and 95% of patients were male. The mean anterior cranial defect size was 6 cm × 8 cm, and there were no wound infection or flap necrosis after operations. Conclusion: We recommend this procedure (titanium mesh with or without fat graft) for warfare injured cranial defects in secondary anterior cranial reconstructions. Fat grafts eliminates dead space and reduce secondary complications. PMID:27563609

  15. HEDR modeling approach: Revision 1

    SciTech Connect

    Shipler, D.B.; Napier, B.A.

    1994-05-01

    This report is a revision of the previous Hanford Environmental Dose Reconstruction (HEDR) Project modeling approach report. This revised report describes the methods used in performing scoping studies and estimating final radiation doses to real and representative individuals who lived in the vicinity of the Hanford Site. The scoping studies and dose estimates pertain to various environmental pathways during various periods of time. The original report discussed the concepts under consideration in 1991. The methods for estimating dose have been refined as understanding of existing data, the scope of pathways, and the magnitudes of dose estimates were evaluated through scoping studies.

  16. Revised evaluations for ENDF/B-VI Revision 2

    SciTech Connect

    Wright, R.Q.

    1993-03-01

    The purpose of this paper is to report on revised cross-section evaluations for 17 nuclides that have been prepared for ENDF/B-VI Revision 2. The nuclides considered include five fission products and various isotopes of cadmium and hafnium. The previous ENDF/B-VI evaluations for these 17 nuclides were carried over from ENDF/B-V and were completed in the 1974--1980 time period. By utilizing the experimental data that have become available since 1980 the revised evaluations will result in significant improvements in the evaluated nuclear data files. The primary emphasis was placed on the resolved and unresolved resonance regions, but new experimental data were also used to improve the cross sections for energies above the unresolved resonance region. Negative elastic scattering cross sections were encountered in some of the previous evaluations; since the revised evaluations use multilevel Breit-Wigner (MLBW) parameters, rather than single-level Breit-Wigner (SLBW), this problem is eliminated.

  17. Volitional control of the anterior insula in criminal psychopaths using real-time fMRI neurofeedback: a pilot study

    PubMed Central

    Sitaram, Ranganatha; Caria, Andrea; Veit, Ralf; Gaber, Tilman; Ruiz, Sergio; Birbaumer, Niels

    2014-01-01

    This pilot study aimed to explore whether criminal psychopaths can learn volitional regulation of the left anterior insula with real-time fMRI neurofeedback. Our previous studies with healthy volunteers showed that learned control of the blood oxygenation-level dependent (BOLD) signal was specific to the target region, and not a result of general arousal and global unspecific brain activation, and also that successful regulation modulates emotional responses, specifically to aversive picture stimuli but not neutral stimuli. In this pilot study, four criminal psychopaths were trained to regulate the anterior insula by employing negative emotional imageries taken from previous episodes in their lives, in conjunction with contingent feedback. Only one out of the four participants learned to increase the percent differential BOLD in the up-regulation condition across training runs. Subjects with higher Psychopathic Checklist-Revised (PCL:SV) scores were less able to increase the BOLD signal in the anterior insula than their lower PCL:SV counterparts. We investigated functional connectivity changes in the emotional network due to learned regulation of the successful participant, by employing multivariate Granger Causality Modeling (GCM). Learning to up-regulate the left anterior insula not only increased the number of connections (causal density) in the emotional network in the single successful participant but also increased the difference between the number of outgoing and incoming connections (causal flow) of the left insula. This pilot study shows modest potential for training psychopathic individuals to learn to control brain activity in the anterior insula. PMID:25352793

  18. The Extended Direct Anterior Approach for Column Augmentation in the Deficient Pelvis: A Novel Surgical Technique, and Case Series Report.

    PubMed

    Spanyer, Jonathon M; Beaumont, Christopher M; Yerasimides, Jonathan G

    2017-02-01

    Anterior column deficiency of the pelvis may pose a serious threat to the stability of the acetabular component after total hip arthroplasty and, thus, jeopardize the overall success of the procedure. After Institutional Review Board approval, a retrospective review was undertaken to identify all patients undergoing revision total hip arthroplasty with anterior column augmentation through an extended direct anterior approach. Demographics and surgical details were collected, and subjects were followed for a 2-year minimum period to measure patient outcomes and to evaluate for the stability of construct fixation. A novel surgical procedure description was provided and supplemented with an illustrative case example. At 2 years post augmentation, patients had favorable functional outcomes with radiologic evidence of stable fixation. Proximal extension of the direct anterior approach to the hip can facilitate anterior column access and augmentation to improve stability of the hip reconstruction. This treatment may be an alternative to spanning constructs such as cup-cage constructs and custom implants, affording the potential for long-term biologic fixation. Further investigation into this technique is warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. A comparison of revision and rerupture rates of ACL reconstruction between autografts and allografts in the skeletally immature.

    PubMed

    Nelson, Ian R; Chen, Jason; Love, Rebecca; Davis, Brent R; Maletis, Gregory B; Funahashi, Tadashi T

    2016-03-01

    Anterior cruciate ligament reconstructions (ACLRs) in skeletally immature patients are increasing. The purpose of this study is to describe the demographics, graft usage, revision, and re-operation rates in skeletally immature ACLRs in the Kaiser Permanente healthcare system. Skeletally immature patients (<17.0 years old with open physes) were identified using the Kaiser Permanente ACLR registry. Multi-ligament reconstructions and physeal-sparing ACLRs were excluded. Aseptic revision and same-knee re-operation were the outcomes of interest. Exposure of interest was graft type; bone-patellar-tendon-bone (BPTB) autograft, hamstring autograft, and any type of allograft. Age, gender, body mass index (BMI), and race were evaluated as confounders. Cox proportional hazard models stratified by surgeon were used to analyse the risk of revision and re-operation. A total of 534 primary ACLR cases were evaluated with a mean follow-up of 2.9 years. The majority were hamstring autografts (n = 388, 72.7%), male (n = 339, 63.9%), and White (n = 232, 43.4%). Median age was 14.9 years, and median BMI was 21.9 kg/m(2). There were 44 (8.2%) aseptic revisions and 48 (9.0%) same-knee re-operations. The incidence rate for revision was BPTB autograft 5.5%, hamstring autograft 7.5%, and allograft 13.2%. After adjusting for confounders and surgeon clustering effect, the risk of aseptic revision and revision between allograft and hamstring autograft did not reach statistical significance. Graft selection differs in skeletally immature patients with a preponderance of surgeries being performed with hamstring tendon autografts. High revision rates were identified for all graft types used, though differences in revision rates across different graft types did not reach statistical significance. Surgeons should be aware of high rates of revision in this skeletally immature young population, although type of graft used did not appear to make a difference. III.

  20. Surgical anatomy of the anterior clinoid process.

    PubMed

    Huynh-Le, Phuong; Natori, Yoshihiro; Sasaki, Tomio

    2004-04-01

    We studied the surgical anatomy of the anterior clinoid process (ACP) and its adjacent structures in cadaver heads. We paid special attention to the anatomical relationships between the ACP and adjacent structures to determine the surgical landmarks for safe anterior clinoidectomy. Thirty-five cadaver heads were dissected and the ACP regions were examined in 55 skull sides. We observed that in eight sides the ACP had been pneumatized from the sphenoid sinus. The caroticoclinoid foramen was revealed in only eight sides. The extra-ocular nerves ran forward to the superior orbital fissure at the inferolateral aspect of the ACP, with the oculomotor nerve being closest. The posterolateral area of the carotico-oculomotor membrane was thin and incomplete in nine sides. The study clarified the anatomical relationship between the ACP and its surrounding structures, and identified the major variations experienced. We used these to identify anatomical landmarks to assist the surgeon in the planning of a safe and effective anterior clinoidectomy.

  1. Serratus anterior paralysis in the young athlete.

    PubMed

    Gregg, J R; Labosky, D; Harty, M; Lotke, P; Ecker, M; DiStefano, V; Das, M

    1979-09-01

    Ten cases of isolated, complete paralysis of the serratus anterior muscle were diagnosed in young athletes during a three-year period. One patient had recurrent partial paralysis of the serratus anterior muscle, the first such case reported. From studies on cadavera and clinical observations, we concluded that paralysis of the serratus anterior muscle results from a traction injury to the long thoracic nerve of Bell. Since full recovery usually occurs in an average of nine months, surgical methods of treatment should be reserved for patients in whom function fails to return after a two-year period. Non-strenuous use of the involved extremity with avoidance of the precipitating activity, followed by exercises designed to maintain the range of motion of the shoulder and to increase the strength of associated muscles, is advocated for treatment of acute or repetitive injuries to the long thoracic nerve of Bell.

  2. Anterior chamber collapse syndrome in a koala.

    PubMed

    Liddle, Vl; Naranjo, C; Bernays, Me

    2014-05-01

    Anterior chamber collapse syndrome has been recognised in various species and is associated with early-life ocular disease or trauma. It is important to differentiate this acquired condition from a congenital malformation. An adult female koala (Phascolarctos cinereus) was referred for assessment of buphthalmos and severe keratitis of the right eye. The degree of keratitis obstructed examination of intraocular structures. Enucleation of the affected eye was performed and the histopathological diagnosis was anterior chamber collapse syndrome and secondary glaucoma. This case contributes to the limited information available in the literature on anterior chamber collapse syndrome, a disease unique in having secondary glaucoma with minimal or no inflammation. The case also expands the literature available on ocular disease in koalas. More specifically, this is the only reported case of glaucoma, of any aetiology, in the koala. © 2014 Australian Veterinary Association.

  3. Silicone oil in the anterior chamber.

    PubMed

    Gao, R L; Neubauer, L; Tang, S; Kampik, A

    1989-01-01

    A total of 42 cases (42 eyes) with silicone oil in the anterior chamber after pars plana vitrectomy (PPV) and after silicone oil injection into the vitreous cavity (SIV) were analyzed. The main complications caused by silicone oil were corneal endothelial cell damage and secondary glaucoma. Specular microscopy showed decreased cell density, apparent pleomorphism of endothelial cells, and increased corneal thickness. In some cases, edematous and necrotic endothelial cells were found. The characteristic optical artifacts resulting from silicone oil coming into contact with the endothelium, such as a bright reflex, reversed pattern of illumination, and interference fringes, were also observed. There was a definite correlation between elevated intraocular pressure (IOP) and the presence of silicone oil in the anterior chamber; the IOP dropped significantly on removal of the oil. The treatment and prevention of conditions involving silicone oil in the anterior chamber are briefly discussed.

  4. Revised Human Health Risk Assessment on Chlorpyrifos

    EPA Pesticide Factsheets

    We have revised our human health risk assessment and drinking water exposure assessment for chlorpyrifos that supported our October 2015 proposal to revoke all food residue tolerances for chlorpyrifos. Learn about the revised analysis.

  5. Diet History Questionnaire: Database Revision History

    Cancer.gov

    The following details all additions and revisions made to the DHQ nutrient and food database. This revision history is provided as a reference for investigators who may have performed analyses with a previous release of the database.

  6. Final CSAPR Revisions Rule (77 FR 10324)

    EPA Pesticide Factsheets

    EPA finalizes revisions to the Transport Rule (76 FR 48208). These revisions address discrepancies in unit-specific modeling assumptions that affect the proper calculation of Transport Rule state budgets and assurance levels in several states.

  7. Revision Process and Practice: A Kindergarten Experience

    ERIC Educational Resources Information Center

    Chase, Maggie

    2012-01-01

    Many educators teach students that are reluctant about the revisions process in writing. However, this longitudinal study follows a group of students from kindergarten through 8th grade who embraced the importance of the revision process. (Contains 8 figures.)

  8. 24 CFR 968.225 - Budget revisions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... competitively funded, by deleting or substantially revising approved work items or adding new work items that... originally approved modernization program, the PHA needs to delete or revise approved work items or add new...

  9. 24 CFR 968.225 - Budget revisions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... competitively funded, by deleting or substantially revising approved work items or adding new work items that... originally approved modernization program, the PHA needs to delete or revise approved work items or add new...

  10. Special Consolidated Checklists for Toxicity Characteristics Revisions

    EPA Pesticide Factsheets

    This checklist consolidates the changes to the Federal code addressed by the Toxicity Characteristic (TC) Rule [55 FR 11798; March 29, 1990; Revision Checklist 74] and subsequent revisions which have occurred through December 31, 2002.

  11. Retrograde ejaculation after anterior lumbar spine surgery.

    PubMed

    Lindley, Emily M; McBeth, Zachary L; Henry, Sarah E; Cooley, Robert; Burger, Evalina L; Cain, Christopher M J; Patel, Vikas V

    2012-09-15

    A retrospective cohort study. To compare the incidence of retrograde ejaculation (RE) after anterior lumbar spine surgery with disc replacement versus fusion with the use of recombinant human bone morphogenetic protein-2 (BMP). Anterior lumbar interbody fusion (ALIF) has become a popular choice for treating a number of pathologies, largely because it preserves the posterior paravertebral muscles and ligaments. Despite these advantages, the anterior approach is also associated with various complications, one of which is RE. A recent study has questioned whether the risk of RE is increased by the use of BMP in ALIF procedures rather than by the approach alone. We conducted a retrospective review of all male patients who received ALIF using BMP or artificial disc replacement (ADR) on at least the L5-S1 level between 2004 and 2011. Medical records were evaluated for the occurrence of RE, and patients were contacted via the phone to obtain current information. The incidence of RE was then compared between the 2 anterior lumbar surgery procedures. Of the 95 cases of anterior surgery including L5-S1, 54 patients underwent ALIF with BMP (56.8%) and 41 patients were treated with ADR (43.2%). Postoperative RE occurred in 4 of the 54 ALIF patients (7.4%) and in 4 of the 41 ADR patients (9.8%). The incidence of RE was not significantly different between groups (P = 0.7226). At latest follow-up, 1 ALIF and 1 ADR patient reported resolution of the RE. This study found that RE occurred at a similar rate in patients treated with ADR and ALIF with BMP. The overall rate of RE after retroperitoneal anterior lumbar surgery was higher than expected, which underscores the importance of counseling patients about this risk and specifically questioning patients about the symptoms of RE at postoperative visits.

  12. The skewer technique for anterior capsule remnants.

    PubMed

    Hecht, S D; McCarthy, E F

    1984-07-01

    A technique has been developed which enables the removal of a narrow, long remnant of anterior capsule which is connected inferiorly and inadvertently left during planned extracapsular cataract surgery. The technique is especially useful when the wound has already been partly or completely closed. A partial thickness incision is made at the limbus and a short 30-gauge needle is inserted through the incision into the anterior chamber. The needle then skewers the remnant, tearing it along its edge. The end of the capsular remnant is put on stretch by grasping its edge with a small forceps. This results in a transverse tear, with amputation of the remnant.

  13. Anterior ischemic optic neuropathy following dengue fever

    PubMed Central

    Ramakrishnan, Reshma; Shrivastava, Saurabh; Deshpande, Shrikant; Patkar, Priyanka

    2016-01-01

    Dengue fever is caused by a flavivirus. This infection is endemic in the tropics and warm temperate regions of the world. Ocular manifestations of dengue fever include subconjunctival, vitreous, and retinal haemorrhages; posterior uveitis; optic neuritis; and maculopathies, haemorrhage, and oedema. However anterior ischemic optic neuropathy is a rare presentation. Optic nerve ischemia most frequently occurs at the optic nerve head, where structural crowding of nerve fibers and reduction of the vascular supply may combine to impair perfusion to a critical degree and produce optic disc oedema. Here we present a case of anterior ischemic optic neurapathy associated with dengue fever. PMID:27843231

  14. Anterior ischemic optic neuropathy following dengue fever.

    PubMed

    Ramakrishnan, Reshma; Shrivastava, Saurabh; Deshpande, Shrikant; Patkar, Priyanka

    2016-01-01

    Dengue fever is caused by a flavivirus. This infection is endemic in the tropics and warm temperate regions of the world. Ocular manifestations of dengue fever include subconjunctival, vitreous, and retinal haemorrhages; posterior uveitis; optic neuritis; and maculopathies, haemorrhage, and oedema. However anterior ischemic optic neuropathy is a rare presentation. Optic nerve ischemia most frequently occurs at the optic nerve head, where structural crowding of nerve fibers and reduction of the vascular supply may combine to impair perfusion to a critical degree and produce optic disc oedema. Here we present a case of anterior ischemic optic neurapathy associated with dengue fever.

  15. Extramedullary Plasmacytoma Arising From the Anterior Mediastinum.

    PubMed

    Sato, Kiyoshi; Fumimoto, Satoshi; Fukada, Takehisa; Ichihashi, Yoshio; Ochi, Kaoru; Satomi, Hidetoshi; Morita, Takuya; Hanaoka, Nobuharu; Okada, Yoshikatsu; Katsumata, Takahiro

    2017-05-01

    Plasmacytomas are a localized proliferation of plasma cells in the bone marrow and soft tissue. Extramedullary plasmacytomas are rare and typically solitary plasma cell neoplasms originating from extraosseous organs and tissues. A 31-year-old woman was referred to our hospital with a rapidly growing abnormal shadow on a chest roentgenogram. Chest computed tomography showed that the lesion was located in the anterior mediastinum. She underwent surgery, and the tumor was diagnosed as an extramedullary plasmacytoma. She remains well 2 years postoperatively without recurrence. An extremely rare case of an anterior mediastinal extramedullary plasmacytoma is presented. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Automated revision of CLIPS rule-bases

    NASA Technical Reports Server (NTRS)

    Murphy, Patrick M.; Pazzani, Michael J.

    1994-01-01

    This paper describes CLIPS-R, a theory revision system for the revision of CLIPS rule-bases. CLIPS-R may be used for a variety of knowledge-base revision tasks, such as refining a prototype system, adapting an existing system to slightly different operating conditions, or improving an operational system that makes occasional errors. We present a description of how CLIPS-R revises rule-bases, and an evaluation of the system on three rule-bases.

  17. Soft tissue trauma and scar revision.

    PubMed

    Mobley, Steven R; Sjogren, Phayvanh P

    2014-11-01

    Numerous techniques and treatments have been described for scar revision, with most studies focusing on the adult population. A comprehensive review of the literature reveals a paucity of references related specifically to scar revision in children. This review describes the available modalities in pediatric facial scar revision. The authors have integrated current practices in soft tissue trauma and scar revision, including closure techniques and materials, topical therapy, steroid injection, cutaneous laser therapy, and tissue expanders.

  18. Revised Accounting for Business Combinations

    ERIC Educational Resources Information Center

    Wilson, Arlette C.; Key, Kimberly

    2008-01-01

    The Financial Accounting Standards Board (FASB) has recently issued Statement of Financial Accounting Standards No. 141 (Revised 2007) Business Combinations. The object of this Statement is to improve the relevance, representational faithfulness, and comparability of reported information about a business combination and its effects. This Statement…

  19. Standards for Reading Professionals. Revised.

    ERIC Educational Resources Information Center

    International Reading Association, Newark, DE.

    A revision of a 1992 publication, this booklet presents standards intended to assist in the establishment and evaluation of programs of teacher preparation, to guide the assessment of the qualifications of literacy professionals, and to inform private and state agencies, policymakers, and the general public as they shape literacy instruction now…

  20. Ethical considerations in revision rhinoplasty.

    PubMed

    Wayne, Ivan

    2012-08-01

    The problems that arise when reviewing another surgeon's work, the financial aspects of revision surgery, and the controversies that present in marketing and advertising will be explored. The technological advances of computer imaging and the Internet have introduced new problems that require our additional consideration. Copyright © 2012 by Thieme Medical Publishers, Inc.

  1. Revised adage graphics computer system

    NASA Technical Reports Server (NTRS)

    Tulppo, J. S.

    1980-01-01

    Bootstrap loader and mode-control options for Adage Graphics Computer System Significantly simplify operations procedures. Normal load and control functions are performed quickly and easily from control console. Operating characteristics of revised system include greatly increased speed, convenience, and reliability.

  2. Air Pollution Primer. Revised Education.

    ERIC Educational Resources Information Center

    Corman, Rena

    This revised and updated book is written to inform the citizens on the nature, causes, and effects of air pollution. It is written in terms familiar to the layman with the purpose of providing knowledge and motivation to spur community action on clean air policies. Numerous charts and drawings are provided to support discussion of air pollution…

  3. Modern Indian Psychology. Revised Edition.

    ERIC Educational Resources Information Center

    Bryde, John F.

    Written on the basis of senior Indian verbal relatings collected over a 23-year span, this revised edition on modern Indian psychology incorporates suggestions from Indian students and their teachers, Indian and non-Indian social studies experts, and other Indian people. The book contains 6 major divisions: (1) "Culture and Indian…

  4. How Adults Learn. Revised Edition.

    ERIC Educational Resources Information Center

    Kidd, J. R.

    The book's emphasis is on learning during the years of adulthood and examines present-day practice of adult education for practitioners. This revised edition brings up to date advances in such areas of learning as controversial theory; the effects of environment; sensory processes; intellectual capacities; motivation and attitude; transactional…

  5. Nuffield Chemistry: Revised and Revisited.

    ERIC Educational Resources Information Center

    Dawson, B. E.

    1980-01-01

    Presents data from a survey of schools, colleges, and other institutions and entering candidates for the special GCE examination using Nuffield O-level materials. Examines the effects of curriculum design on subject choice in these institutions. Reviews teacher comments on the publications associated with revision of course materials. (Author/CS)

  6. Error Correction, Revision, and Learning

    ERIC Educational Resources Information Center

    Truscott, John; Hsu, Angela Yi-ping

    2008-01-01

    Previous research has shown that corrective feedback on an assignment helps learners reduce their errors on that assignment during the revision process. Does this finding constitute evidence that learning resulted from the feedback? Differing answers play an important role in the ongoing debate over the effectiveness of error correction,…

  7. Collaborative Revision on a Computer.

    ERIC Educational Resources Information Center

    Cornell, Cynthia; Newton, Robert

    A study investigated the effects of using a computer image projected on a large screen to teach revision to college students. Subjects, 19 students at DePauw University, enrolled in a writing intensive literature course in a Writing across the Curriculum program, were divided into test and control groups. It was hypothesized that the modeling of…

  8. Modern Indian Psychology. Revised Edition.

    ERIC Educational Resources Information Center

    Bryde, John F.

    Written on the basis of senior Indian verbal relatings collected over a 23-year span, this revised edition on modern Indian psychology incorporates suggestions from Indian students and their teachers, Indian and non-Indian social studies experts, and other Indian people. The book contains 6 major divisions: (1) "Culture and Indian…

  9. Air Pollution Primer. Revised Education.

    ERIC Educational Resources Information Center

    Corman, Rena

    This revised and updated book is written to inform the citizens on the nature, causes, and effects of air pollution. It is written in terms familiar to the layman with the purpose of providing knowledge and motivation to spur community action on clean air policies. Numerous charts and drawings are provided to support discussion of air pollution…

  10. DDN New User Guide. Revision.

    DTIC Science & Technology

    1992-10-01

    it to the sender . Many mail programs allow you to use a local text editor to revise or correct the text of the message you are ptepermg. The mail ...23 5.1 Electronic M ail .................................................. 23 5.1.1 UNIX Mail Examples...25 Sending Mail Via UNIX ........................................ 25 Reading UNIX Mail

  11. 7 CFR 3015.115 - Budget revisions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Budget revisions. 3015.115 Section 3015.115..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Programmatic Changes and Budget Revisions § 3015.115 Budget revisions. (a) Nonconstruction projects. (1) Except as provided in paragraph (a)(2) of...

  12. 24 CFR 968.225 - Budget revisions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Budget revisions. 968.225 Section... Fewer Than 250 Units) § 968.225 Budget revisions. (a) A PHA shall not incur any modernization cost in excess of the total HUD-approved CIAP budget. A PHA shall submit a budget revision, in a form prescribed...

  13. Graphic Arts: Program/Curriculum Revision.

    ERIC Educational Resources Information Center

    Martin, Timothy L.

    In the years since the Williamsport Area Community College's Graphic Arts Program was last revised, the graphic arts industry has been changed by an influx of new technologies. The graphic arts program and curriculum was revised to provide graduates with skills required by the industry. The objectives of this revision were to (1) identify…

  14. Revising: New Essays for Teachers of Writing.

    ERIC Educational Resources Information Center

    Sudol, Ronald A., Ed.

    Intended to help writing teachers better understand how to help students effectively revise their written work, this book contains essays that, as a group, focus on the problem of the definition of revision. The first half of the book discusses the background of revision, while the second half discusses contexts and techniques for application. The…

  15. "SOAR" to the Stars through Revising.

    ERIC Educational Resources Information Center

    Johnson, Jan

    1995-01-01

    Explains how a teacher uses the acronym SOAR (Sentences Organized and Revised) as the core of a game designed to motivate a class to revise their work through the promise of popcorn, free time, or snacks for their revision work. Describes a worksheet that forces students to pay attention to various parts of their paper. (TB)

  16. Humeral windows in revision total elbow arthroplasty.

    PubMed

    Peach, Chris A; Salama, Amir; Stanley, David

    2016-04-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery.

  17. Competencies Revisited: Revising the Overseas ESL Curriculum.

    ERIC Educational Resources Information Center

    Kharde, Linda Smith; Corey, Kathleen

    1986-01-01

    This paper reports on the review and revision of the Overseas Refugee Training Program's curriculum in English as a second language. The discussion focuses on the rationale and guidelines for the revision, the resources used to guide the process, and the criteria used in the selection of competencies. Specific intentions in revising the list of…

  18. 22 CFR 214.14 - Charter revision.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Charter revision. 214.14 Section 214.14 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADVISORY COMMITTEE MANAGEMENT Establishment of Advisory Committees § 214.14 Charter revision. (a) Sponsoring A.I.D. Bureaus and Offices initiate revisions to...

  19. 22 CFR 214.14 - Charter revision.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Charter revision. 214.14 Section 214.14 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADVISORY COMMITTEE MANAGEMENT Establishment of Advisory Committees § 214.14 Charter revision. (a) Sponsoring A.I.D. Bureaus and Offices initiate revisions to...

  20. The evolution of a manual revision.

    PubMed

    Luzinski, Craig

    2012-10-01

    This month, the director of the Magnet Recognition Program® provides an in-depth overview of the Magnet Recognition Program's Application Manual revision process. The history of the 2005 Manual revision, an evidence-based review of the literature, and revisions to the 2008 Manual are key elements of this article.

  1. Outcomes of Secondary Laminoplasty for Patients with Unsatisfactory Results after Anterior Multilevel Cervical Surgery

    PubMed Central

    Liu, Hong-Wei; Chen, Liang; Xu, Nan-Wei; Yang, Hui-Lin

    2015-01-01

    Objective To investigate the causes for failed anterior cervical surgery and the outcomes of secondary laminoplasty. Methods Seventeen patients failed anterior multilevel cervical surgery and the following conservative treatments between Feb 2003 and May 2011 underwent secondary laminoplasty. Outcomes were evaluated by the Japanese Orthopaedic Association (JOA) Scale and visual analogue scale (VAS) before the secondary surgery, at 1 week, 2 months, 6 months, and the final visit. Cervical alignment, causes for revision and complications were also assessed. Results With a mean follow-up of 29.7±12.1 months, JOA score, recovery rate and excellent to good rate improved significantly at 2 months (p<0.05) and maintained thereafter (p>0.05). Mean VAS score decreased postoperatively (p<0.05). Lordotic angle maintained during the entire follow up (p>0.05). The causes for secondary surgery were inappropriate approach in 3 patients, insufficient decompression in 4 patients, adjacent degeneration in 2 patients, and disease progression in 8 patients. Complications included one case of C5 palsy, axial pain and cerebrospinal fluid leakage, respectively. Conclusion Laminoplasty has satisfactory results in failed multilevel anterior surgery, with a low incidence of complications. PMID:25674342

  2. A Simple Radiographic Sign of Vertical Anterior Cruciate Ligament Tunnel Placement.

    PubMed

    Farrow, Lutul Dashaun; Morris, Parisa M; Huston, Kellen L; Hall, Evan Tyler; Kaar, Scott

    2015-10-01

    The purpose of this study is to describe a novel radiographic sign indicative of vertical tunnel placement following anterior cruciate ligament (ACL) reconstruction. We reviewed 190 consecutive ACL reconstructions. Operative records, patient charts, arthroscopic images, and preoperative and postoperative orthogonal plain radiographic images were reviewed. We made special note of the operative technique. Note was made of tunnel position and whether the posterior (proximal) aspect of Blumensaat line was violated on standard lateral knee radiographic images. Of 190 patients, 17 patients did not have postoperative imaging and were excluded. Of the 173 remaining knees, 163 were primary ACL reconstructions and 10 were revision ACL reconstructions. We found that no anatomically placed ACL femoral tunnel violated Blumensaat line. In all revision cases exhibiting violation of Blumensaat line, a new femoral tunnel was able to be drilled while completely avoiding the previously placed, nonanatomic ACL femoral tunnel. The principal findings of our study demonstrate that violation of Blumensaat line following ACL reconstruction is an indicator of vertical, nonanatomic femoral tunnel placement. Furthermore, presence of this radiographic sign indicates that an anatomically placed femoral tunnel may be drilled while completely avoiding the existing femoral tunnel during cases of revision ACL reconstruction.

  3. Increased revision rate with posterior tibial tunnel placement after using the 70-degree tibial guide in ACL reconstruction.

    PubMed

    Inderhaug, Eivind; Raknes, Sveinung; Østvold, Thomas; Solheim, Eirik; Strand, Torbjørn

    2017-01-01

    To map knee morphology radiographically in a population with a torn ACL and to investigate whether anatomic factors could be related to outcomes after ACL reconstruction at mid- to long-term follow-up. Further, we wanted to assess tibial tunnel placement after using the 70-degree "anti-impingement" tibial tunnel guide and investigate any relation between tunnel placement and revision surgery. Patients undergoing ACL reconstruction involving the 70-degree tibial guide from 2003 to 2008 were included. Two independent investigators analysed pre- and post-operative radiographs. Demographic data and information on revision surgery were collected from an internal database. Anatomic factors and post-operative tibial tunnel placements were investigated as predictors of revision. Three-hundred and seventy-seven patients were included in the study. A large anatomic variation with significant differences between men and women was seen. None of the anatomic factors could be related to a significant increase in revision rate. Patients with a posterior tibial tunnel placement, defined as 50 % or more posterior on the Amis and Jakob line, did, however, have a higher risk of revision surgery compared to patients with an anterior tunnel placement (P = 0.03). Use of the 70-degree tibial guide did result in a high incidence (47 %) of posterior tibial tunnel placements associated with an increased rate of revision surgery. The current study was, however, not able to identify any anatomic variation that could be related to a higher risk of revision surgery. Avoiding graft impingement from the femoral roof in anterior tibial tunnel placements is important, but the insight that overly posterior tunnel placement can lead to inferior outcome should also be kept in mind when performing ACL surgery. IV.

  4. Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions

    PubMed Central

    Chen, James L.; Allen, Christina R.; Stephens, Thomas E.; Haas, Amanda K.; Huston, Laura J.; Wright, Rick W.; Feeley, Brian T.

    2013-01-01

    Background The factors that lead to patients failing multiple anterior cruciate ligament (ACL) reconstructions are not well understood. Hypothesis Multiple-revision ACL reconstruction will have different characteristics than first-time revision in terms of previous and current graft selection, mode of failure, chondral/meniscal injuries, and surgical charactieristics. Study Design Case-control study; Level of evidence, 3. Methods A prospective multicenter ACL revision database was utilized for the time period from March 2006 to June 2011. Patients were divided into those who underwent a single-revision ACL reconstruction and those who underwent multiple-revision ACL reconstructions. The primary outcome variable was Marx activity level. Primary data analyses between the groups included a comparison of graft type, perceived mechanism of failure, associated injury (meniscus, ligament, and cartilage), reconstruction type, and tunnel position. Data were compared by analysis of variance with a post hoc Tukey test. Results A total of 1200 patients (58% men; median age, 26 years) were enrolled, with 1049 (87%) patients having a primary revision and 151 (13%) patients having a second or subsequent revision. Marx activity levels were significantly higher (9.77) in the primary-revision group than in those patients with multiple revisions (6.74). The most common cause of reruptures was a traumatic, noncontact ACL graft injury in 55% of primary-revision patients; 25% of patients had a nontraumatic, gradual-onset recurrent injury, and 11% had a traumatic, contact injury. In the multiple-revision group, a nontraumatic, gradual-onset injury was the most common cause of recurrence (47%), followed by traumatic noncontact (35%) and nontraumatic sudden onset (11%) (P < .01 between groups). Chondral injuries in the medial compartment were significantly more common in the multiple-revision group than in the single-revision group, as were chondral injuries in the patellofemoral

  5. [Clinical experience with power-regulated contact laser surgery for the paranasal sinuses and the anterior skull base].

    PubMed

    Ilgner, J; Emmerling, O; Biesterfeld, S; Westhofen, M

    2002-05-01

    While laser surgical methods in Otorhinolaryngology have become widely established, their use in revision surgery for chronic-polypous sinusitis has been regarded as hazardous due to the vicinity of the anterior skull base and the orbit. However, new experience with laser-tissue interaction in contact irradiation together with effective power feedback control mechanisms require a re-evaluation of laser revision surgery in this field. After 742 primary, endonasal-microscopic sinus surgery procedures, 86 patients had 128 Nd:YAG-laser sessions performed within an interval of 1 - 24 months after primary surgery for recurrent polyposis, which had been irresponsive to medication. The maximum power delivered was 10 to 20 W. Recurrent polyposis appeared mostly in the maxillo-ethmoid angle, followed by the maxillary sinus roof and the maxillary sinus bottom. In 63 of 86 patients, no further polyposis was seen after laser surgery. If more than one laser session had to be performed, recurrent polyposis appeared in a different region in most cases. Those areas lasered first showed a reduced tendency to recurrence. There was moderate bleeding during laser surgery in 6 cases with reduced visibility, but no other serious complications were recorded. Laser surgery for chronic-polypous sinusitis is an alternative to conventional revision surgery, if medical treatment fails and recurrent polyposis is confined to certain regions. Feedback-controlled contact laser power delivery adds further therapeutic safety when applied next to the anterior skull base and the orbit.

  6. Penetrated arrow shot injury in anterior neck.

    PubMed

    Aremu, Shuaib K; Dike, Benjamin

    2011-03-01

    Although gunshot injuries are the most common penetrating anterior neck injuries in the developed world, this finding is not the case in the developing world, where knives, spears, arrows, and machetes are the preferred weapons, particularly in tribal societies. To present the case report of a patient with arrow shot injury to the anterior neck. A 48 year old cattle rearer in a village in northern part of Nigeria presented with 3 hr history of an arrow shot in anterior part of the neck which he sustained the while trying to prevent some armed robbers from stealing his cow. There was scanty bleeding from the site with the arrow in-situ sealing the wound. The entrance point of the arrow, about 1 cm in diameter, was just at the anterior border of the right sternocleidomastoid muscle; about 4 cm above the medial end of the right clavicle. There was a small skin bruise with slight swelling and tenderness around the opening but no active bleeding and no crepitus. Penetrating neck trauma from arrow shot may lead to potentially life-threatening injuries. A prompt diagnosis, a systematic treatment protocol, and an experienced trauma team are necessary to prevent a potential catastroph.

  7. Anorgasmia in anterior spinal cord syndrome.

    PubMed

    Berić, A; Light, J K

    1993-05-01

    Three male and two female patients with anorgasmia and dissociated sensory loss due to an anterior spinal cord syndrome are described. Clinical, neurophysiological and quantitative sensory evaluation revealed preservation of the large fibre dorsal column functions from the lumbosacral segments with concomitant severe dysfunction or absence of the small fibre neospinothalamic mediated functions. These findings indicate a role for the spinothalamic system in orgasm.

  8. The anterior pituitary gland: lessons from livestock.

    PubMed

    Scanes, C G; Jeftinija, S; Glavaski-Joksimovic, A; Proudman, J; Arámburo, C; Anderson, L L

    2005-07-01

    There has been extensive research of the anterior pituitary gland of livestock and poultry due to the economic (agricultural) importance of physiological processes controlled by it including reproduction, growth, lactation and stress. Moreover, farm animals can be biomedical models or useful in evolutionary/ecological research. There are for multiple sites of control of the secretion of anterior pituitary hormones. These include the potential for independent control of proliferation, differentiation, de-differentiation and/or inter-conversion cell death, expression and translation, post-translational modification (potentially generating multiple isoforms with potentially different biological activities), release with or without a specific binding protein and intra-cellular catabolism (proteolysis) of pituitary hormones. Multiple hypothalamic hypophysiotropic peptides (which may also be produced peripherally, e.g. ghrelin) influence the secretion of the anterior pituitary hormones. There is also feedback for hormones from the target endocrine glands. These control mechanisms show broadly a consistency across species and life stages; however, there are some marked differences. Examples from growth hormone, prolactin, follicle stimulating hormone and luteinizing hormone will be considered. In addition, attention will be focused on areas that have been neglected including the role of stellate cells, multiple sub-types of the major adenohypophyseal cells, functional zonation within the anterior pituitary and the role of multiple secretagogues for single hormones.

  9. Two cases of isolated anterior cervical hypertrichosis.

    PubMed

    Reddy, Swapna; Antaya, Richard J

    2010-01-01

    Two unrelated Hispanic females, ages 4 and 3 years, respectively, each presented with a solitary patch of excessive terminal hair growth in the midline of the neck. This rare form of congenital localized hypertrichosis, known as anterior cervical hypertrichosis, is reported here as an isolated defect with no other underlying abnormalities.

  10. Luxury perfusion following anterior ischemic optic neuropathy.

    PubMed

    Friedland, S; Winterkorn, J M; Burde, R M

    1996-09-01

    We present five patients who developed luxury perfusion following anterior ischemic optic neuropathy in whom fluorescein angiography was misinterpreted as "capillary hemangioma" or neovascularization of the disc. In each case, the segment of disc hyperemia corresponded to a spared region of visual field. Luxury perfusion represents a reparative autoregulatory reaction to ischemia.

  11. Anterior Chamber Live Loa loa: Case Report

    PubMed Central

    Kagmeni, G.; Cheuteu, R.; Bilong, Y.; Wiedemann, P.

    2016-01-01

    We reported a case of unusual intraocular Loa loa in a 27-year-old patient who presented with painful red eye. Biomicroscopy revealed a living and active adult worm in the anterior chamber of the right eye. After surgical extraction under local anesthesia, parasitological identification confirmed L. loa filariasis. PMID:27441005

  12. Anterior Chamber Live Loa loa: Case Report.

    PubMed

    Kagmeni, G; Cheuteu, R; Bilong, Y; Wiedemann, P

    2016-01-01

    We reported a case of unusual intraocular Loa loa in a 27-year-old patient who presented with painful red eye. Biomicroscopy revealed a living and active adult worm in the anterior chamber of the right eye. After surgical extraction under local anesthesia, parasitological identification confirmed L. loa filariasis.

  13. How I do it: epidural anterior petrosectomy.

    PubMed

    Roche, Pierre-Hugues; Lubrano, Vincent F; Noudel, Rémy

    2011-06-01

    Among the potential approaches to access the petroclival area, epidural anterior petrosectomy (EAP) appears to be the most direct and conservative transpetrous route. In this article, we aim to detail the relevant surgical steps necessary to perform EAP in a reproducible and safe manner. The temporo-pterional bone flap is tailored to access the floor of the middle fossa and expose the foramen ovale and foramen spinosum. Elevation of the dura covering the upper surface of the petrous apex is conducted medially toward the level of the petrous ridge. Identification of the landmarks of the rhomboid fossa delineates the limits of the drilling zone (necessary for removal of the petrous apex)-beneath Meckel's cave and just anterior to the anterior margin of the internal auditory meatus. The tentorium is divided at its free edge and is followed by opening of the posterior fossa dura. Epidural anterior petrosectomy is a conservative trans-petrous approach that offers an excellent direct surgical corridor for exposure of disease processes involving Meckel's cave, the petroclival area and the ventrolateral pons.

  14. Anterior Cervical Spine Surgery for Degenerative Disease: A Review

    PubMed Central

    SUGAWARA, Taku

    Anterior cervical spine surgery is an established surgical intervention for cervical degenerative disease and high success rate with excellent long-term outcomes have been reported. However, indications of surgical procedures for certain conditions are still controversial and severe complications to cause neurological dysfunction or deaths may occur. This review is focused mainly on five widely performed procedures by anterior approach for cervical degenerative disease; anterior cervical discectomy, anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, anterior cervical foraminotomy, and arthroplasty. Indications, procedures, outcomes, and complications of these surgeries are discussed. PMID:26119899

  15. Revision surgery of irreducible atlantoaxial dislocation: a retrospective study of 16 cases.

    PubMed

    Tan, Mingsheng; Jiang, Xin; Yi, Ping; Yang, Feng; Tang, Xiangsheng; Hao, Qingying; Zhang, Guangbo

    2011-12-01

    There is lack data concerning anterior cervical spine revision surgeries; even more data are missing concerning posterior cervical revision surgeries, to determine the feasibility, safety, and clinical efficacy of revision surgery for irreducible atlantoaxial dislocation (RS-IAAD). Patients with IAAD-FS underwent one-stage transoral release and posterior reduction. Their medical history was documented in detail. The JOA score system was used to evaluate each patient's neurological status pre and postoperatively, and serial MRI and radiographs were used to determine the status of the reduction and the autografts. 16 patients (average age, 36 years old) underwent successful surgery. There was no intraoperative or postoperative neurological deficit except in two cases that suffered transient neurological deficit that alleviated after conservative treatment. Solid bony union was seen at the end of 3 months after surgery in all patients. The mean follow-up period was 28.8 months (range 18-66 months). No pseudarthrosis was noted. Anterior transoral release and posterior instrumented fusion remain significant surgeries with the potential for serious complications, but in the current series there were no major complications.

  16. Arthroscopic Findings in Anterior Shoulder Instability

    PubMed Central

    Hantes, Michael; Raoulis, Vasilios

    2017-01-01

    Background: In the last years, basic research and arthroscopic surgery, have improved our understanding of shoulder anatomy and pathology. It is a fact that arthroscopic treatment of shoulder instability has evolved considerably over the past decades. The aim of this paper is to present the variety of pathologies that should be identified and treated during shoulder arthroscopy when dealing with anterior shoulder instability cases. Methods: A review of the current literature regarding arthroscopic shoulder anatomy, anatomic variants, and arthroscopic findings in anterior shoulder instability, is presented. In addition, correlation of arthroscopic findings with physical examination and advanced imaging (CT and MRI) in order to improve our understanding in anterior shoulder instability pathology is discussed. Results: Shoulder instability represents a broad spectrum of disease and a thorough understanding of the pathoanatomy is the key for a successful treatment of the unstable shoulder. Patients can have a variety of pathologies concomitant with a traditional Bankart lesion, such as injuries of the glenoid (bony Bankart), injuries of the glenoid labrum, superiorly (SLAP) or anteroinferiorly (e.g. anterior labroligamentous periosteal sleeve avulsion, and Perthes), capsular lesions (humeral avulsion of the glenohumeral ligament), and accompanying osseous-cartilage lesions (Hill-Sachs, glenolabral articular disruption). Shoulder arthroscopy allows for a detailed visualization and a dynamic examination of all anatomic structures, identification of pathologic findings, and treatment of all concomitant lesions. Conclusion: Surgeons must be well prepared and understanding the normal anatomy of the glenohumeral joint, including its anatomic variants to seek for the possible pathologic lesions in anterior shoulder instability during shoulder arthroscopy. Patient selection criteria, improved surgical techniques, and implants available have contributed to the enhancement of

  17. Anterior Segment Ischemia after Strabismus Surgery

    PubMed Central

    Göçmen, Emine Seyhan; Atalay, Yonca; Evren Kemer, Özlem; Sarıkatipoğlu, Hikmet Yavuz

    2017-01-01

    A 46-year-old male patient was referred to our clinic with complaints of diplopia and esotropia in his right eye that developed after a car accident. The patient had right esotropia in primary position and abduction of the right eye was totally limited. Primary deviation was over 40 prism diopters at near and distance. The patient was diagnosed with sixth nerve palsy and 18 months after trauma, he underwent right medial rectus muscle recession. Ten months after the first operation, full-thickness tendon transposition of the superior and inferior rectus muscles (with Foster suture) was performed. On the first postoperative day, slit-lamp examination revealed corneal edema, 3+ cells in the anterior chamber and an irregular pupil. According to these findings, the diagnosis was anterior segment ischemia. Treatment with 0.1/5 mL topical dexamethasone drops (16 times/day), cyclopentolate hydrochloride drops (3 times/day) and 20 mg oral fluocortolone (3 times/day) was initiated. After 1 week of treatment, corneal edema regressed and the anterior chamber was clean. Topical and systemic steroid treatment was gradually discontinued. At postoperative 1 month, the patient was orthophoric and there were no pathologic symptoms besides the irregular pupil. Anterior segment ischemia is one of the most serious complications of strabismus surgery. Despite the fact that in most cases the only remaining sequel is an irregular pupil, serious circulation deficits could lead to phthisis bulbi. Clinical properties of anterior segment ischemia should be well recognized and in especially risky cases, preventative measures should be taken. PMID:28182149

  18. Acute multiple infarction involving the anterior circulation.

    PubMed

    Bogousslavsky, J; Bernasconi, A; Kumral, E

    1996-01-01

    To evaluate the frequency and clinical, topographic, and etiologic patterns of acute multiple infarction involving the anterior circulation. Data analysis from a prospective acute stroke registry in a community-based primary care center. Among 751 patients with first ischemic stroke in the anterior circulation over a 4-year period, 40 patients (5%) had acute multiple infarcts involving the anterior circulation. On computed tomography and magnetic resonance imaging with gadolinium enhancement, there were four topographic patterns of infarction: (1) superficial infarcts (11 patients [28%]); (2) superficial and deep infarcts (12 patients [30%]); (3) deep infarcts (three patients [8%]); and (4) infarcts involving the anterior and the posterior circulation (14 patients [35%]). Both cerebral hemispheres were involved in one fourth of the cases. A specific clinical picture was found in up to 20% of the patients. This included global aphasia with left hemianopia, hemisensory loss or hemiparesis (in right-handed patients), transcortical mixed aphasia with hemianopia, and acute pure cognitive impairment ("dementia"). Large-artery disease was found in 13 patients (33%); a cardiac source of embolism was found in 11 patients (28%); and both were found in three patients (8%). Bilateral infarcts were related to cardioembolism (four patients) and bilateral large-artery disease (three patients). One month after stroke, one fourth of the patients were independent, one third had some disability, and 40% were either dead or completely dependent. Acute multiple infarcts involving the anterior circulation may be bilateral more frequently than is currently thought, and they are often associated with posterior circulation infarcts. They mainly involve the pial hemispheral territories, commonly being caused by cardioembolism or bilateral carotid atheroma. They may be associated with a specific neurologic-neuropsychological dysfunction pattern in up to one fifth of the patients, allowing

  19. Revision of the Tephritis maccus species group (Diptera: Tephritidae) with description of a new species from Iran.

    PubMed

    Namin, Saeed Mohamadzade; Korneyev, Severyn V; Parchami-Araghi, Mehrdad; Gilasian, Ebrahim

    2015-05-12

    The maccus species group of the genus Tephritis Latreille 1804 is revised. The maccus group contains five species with a radiate wing pattern, cell r without or with only one large hyaline spot or indentation on the anterior wing margin, and the aculeus moderately broad, sharply narrowing and pointed at the very apex. The included species are: Tephritis azari Mohamadzade Namin & Korneyev, Tephritis gharalii sp. nov., Tephritis maccus Hering, Tephritis sophus and Tephritis urelliosomima Korneyev & Dirlbek.

  20. Cementless acetabular revision: past, present, and future

    PubMed Central

    Pulido, Luis; Rachala, Sridhar R.

    2011-01-01

    Background Acetabular revision is probably the most difficult aspect of hip reconstructive surgery. Although the majority of acetabular revisions can be performed using an uncemented hemispherical acetabular device with ancillary fixation, patients with severe acetabular deficiencies and poor bone quality require more complex alternatives for revision. The limitations of traditional cementless acetabular implants has promoted the development of improved methods of fixation and revision techniques. Highly porous metals have been introduced for clinical use in arthroplasty surgery over the last decade. Their higher porosity and surface friction are ideal for acetabular revision, optimising biological fixation. The use of trabecular metal cups in acetabular revision has yielded excellent clinical results. Purpose This review focuses on the use of cementless implants for acetabular revision. The use of trabecular metal cups, augments, jumbo cups, oblong cups, cages, and structural grafting are also discussed. PMID:21234562

  1. Measurement of anterior chamber diameter and biometry of anterior segment by Scheimpflug slitlamp photography

    SciTech Connect

    Lerman, S.; Hockwin, O.

    1985-03-01

    Twenty-eight fresh donor eyes (Georgia Lions Eye Bank) ranging in age from four months to 87 years were used for an in vitro study to determine the feasibility of obtaining accurate anterior chamber diameter measurements with our Scheimpflug ultraviolet-visible slitlamp densitography apparatus. The in vivo study was performed on 16 hybrid monkeys (of varying age). These data were within 0.1 mm of measurements obtained with a modified paracentesis needle specially designed to obtain such measurements. The results of the foregoing study demonstrate that the Scheimpflug slitlamp photographic analyses can provide an accurate measurement of the anterior chamber diameter without entering the globe surgically. This will enable the surgeon to determine the diameter and order an anterior chamber IOL of a specified size prior to surgery. The authors have devised an automated program to analyze the negatives and provide direct anterior chamber diameter measurements.

  2. Anterior insular cortex is necessary for empathetic pain perception

    PubMed Central

    Gu, Xiaosi; Gao, Zhixian; Wang, Xingchao; Liu, Xun; Knight, Robert T.; Hof, Patrick R.

    2012-01-01

    Empathy refers to the ability to perceive and share another person’s affective state. Much neuroimaging evidence suggests that observing others’ suffering and pain elicits activations of the anterior insular and the anterior cingulate cortices associated with subjective empathetic responses in the observer. However, these observations do not provide causal evidence for the respective roles of anterior insular and anterior cingulate cortices in empathetic pain. Therefore, whether these regions are ‘necessary’ for empathetic pain remains unknown. Herein, we examined the perception of others’ pain in patients with anterior insular cortex or anterior cingulate cortex lesions whose locations matched with the anterior insular cortex or anterior cingulate cortex clusters identified by a meta-analysis on neuroimaging studies of empathetic pain perception. Patients with focal anterior insular cortex lesions displayed decreased discrimination accuracy and prolonged reaction time when processing others’ pain explicitly and lacked a typical interference effect of empathetic pain on the performance of a pain-irrelevant task. In contrast, these deficits were not observed in patients with anterior cingulate cortex lesions. These findings reveal that only discrete anterior insular cortex lesions, but not anterior cingulate cortex lesions, result in deficits in explicit and implicit pain perception, supporting a critical role of anterior insular cortex in empathetic pain processing. Our findings have implications for a wide range of neuropsychiatric illnesses characterized by prominent deficits in higher-level social functioning. PMID:22961548

  3. Early postoperative dislocation of the anterior Maverick lumbar disc prosthesis: report of 2 cases.

    PubMed

    Gragnaniello, Cristian; Seex, Kevin A; Eisermann, Lukas G; Claydon, Matthew H; Malham, Gregory M

    2013-08-01

    fault: Both plates of the dislocated implants looked normal and manufacturer analysis reported no fault; 4) patient factors: Both dislocations happened early in the postoperative period, after hyperextension of the spine while the patient was supine in bed. Bracing would not have reduced hyperextension. Dislocation of a lumbar spinal implant represents a life-threatening complication and should therefore be considered and recognized early. Radiographic and CT studies of both the lumbar spine (for prosthesis) and the abdomen (for hematoma) should be performed, as should CT angiography (for vessel damage or occlusion). Any anterior lumbar revision surgery is hazardous, and it is strongly advisable to have a vascular surgeon scrubbed. In cases of dislocation or extrusion of a lumbar interbody prosthesis, the salvage revision strategy is fusing the segment via the same anterior approach. Surgeons should be aware of the risk of anterior dislocation of the Maverick prosthesis. Keel cutters should be regularly checked for sharpness, as they may be implicated in the loosening of implants. Patients and their physical therapists should also avoid lumbar hyperextension in the early postoperative period.

  4. Revise Inc. - Getting Bought Out

    NASA Astrophysics Data System (ADS)

    Ehrlich, Daniel

    2010-03-01

    From its inception Revise Inc. was designed to be acquired by a larger firm. Revise was always tightly controlled with no outside investors. As a well-focused company of ten people we were able to engineer a major piece of semiconductor capital equipment, then sell and maintain this product in the field internationally. We made a profit in year one and every succeeding year until we were acquired. This model made us attractive to a publicly-traded acquirer, who saw an opportunity to buy a prepackaged asset that, with low risk, should add to it's earnings ratios. The technology that we brought fit, but the business argument worked with no need to exaggerate the technology's value.

  5. Revision IPAA: strategies for success.

    PubMed

    Larson, David W

    2014-07-01

    The history of ileal pouch-anal anastomosis (IPAA) is one of success with durable surgical and functional results. However, pouch failure, due to infection, mechanical, or functional disability, represents a challenge to both surgeon and patient. Practicing surgeons who deal with the revision pouch face a variety of challenges. Success requires a strategy, which includes critical planning, preparation, and surgical techniques in order that surgeons continue to provide solutions and hope to patients.

  6. Clean Air Act. Revision 5

    SciTech Connect

    Not Available

    1994-02-15

    This Reference Book contains a current copy of the Clean Air Act, as amended, and those regulations that implement the statute and appear to be most relevant to DOE activities. The document is provided to DOE and contractor staff for informational purposes only and should not be interpreted as legal guidance. This Reference Book has been completely revised and is current through February 15, 1994.

  7. Mortality following revision total knee arthroplasty: a matched cohort study of septic versus aseptic revisions.

    PubMed

    Choi, Ho-Rim; Bedair, Hany

    2014-06-01

    We report the medium-term mortality after septic versus aseptic revision total knee arthroplasty (TKA) and factors that can contribute to mortality in revision TKA. Mortality rates of 88 patients undergoing septic revision (septic group) were compared with age- and year of surgery-matched 88 patients of aseptic revision (aseptic group). The overall mortality after revision TKA was 10.7% at a median of 4 years of follow-up (range, 2-7 years). However, the mortality after septic revision (18%, 16/88) was six times higher than that of aseptic revision (3%, 3/88) (P = 0.003). Infections with Staphylococcus aureus and/or methicillin resistance was not associated with higher mortality rates. Multivariate analysis indicated that increased age (P < 0.001), higher ASA class (P = 0.002), and septic revision (P < 0.001) were identified as independent predictors of increased mortality after revision TKA.

  8. Comparison between Two Scheimpflug Anterior Segment Analyzers

    PubMed Central

    Baradaran-Rafii, Alireza; Motevasseli, Tahmineh; Yazdizadeh, Forouzan; Karimian, Farid; Fekri, Sahba; Baradaran-Rafii, Amir

    2017-01-01

    Purpose: To compare the anterior segment indices measured by two Scheimpflug camera machines; Galilei and Pentacam. Methods: In this observational case series, the anterior segment indices of myopic healthy subjects seeking for refractive surgery were measured by Pentacam and Galilei on the same day. Analyzed parameters were anterior and posterior best fit spheres (BFS), axial curvature, true corneal power, central corneal thickness (CCT), anterior chamber (AC) depth, AC volume, AC angle, and pupil diameter. Results: This study included 176 eyes of 88 participants. Mean radius of the anterior BFS was 7.79 ± 0.34 mm versus 7.75 ± 0.39 mm measured by Pentacam and Galilei, respectively (r = 0.877, P < 0.001). Corresponding values for the mean radius of posterior BFS were 6.42 ± 0.32 and 6.47 ± 0.38 mm, respectively (r = 0.879, P < 0.001). Anterior corneal mean power was 43.8 ± 1.9 diopters (D) with Pentacam and 43.8 ± 2.4 D with Galilei (r = 0.905,P < 0.001). Posterior corneal mean power was measured − 6.3 ± 0.3 and − 6.3 ± 0.4 D using Pentacam and Galilei, respectively (r = 0.873, P < 0.001). True corneal power was 43.9 ± 1.9 D with Pentacam and 43.5 ± 2.3 D with Galilei (r = 0.909, P < 0.001). CCT was 537 ± 44 and 553 ± 51 μm measured by Pentacam and Galilei, respectively (r = 0.796, P < 0.001). AC depth measurements using Pentacam and Galilei were 3.29 ± 0.4 and 3.3 ± 0.38 mm (P < 0.001), respectively; AC volume was 207 ± 50 and 129 ± 39 mm3≥ (P = 0.004), and AC angle was 39.7 ± 9.2 and 54.2 ± 5.2 degrees (P = 0.051), respectively. Average pupil diameter was measured 3.91 ± 1.77 mm by Pentacam and 3.34 ± 0.89 mm by Galilei (P = 0.018). Conclusions: There was a significant correlation between the Pentacam and Galilei in all measured parameters except AC angle, AC volume, and average pupil diameter. PMID:28299003

  9. Current approach in diagnosis and management of anterior uveitis

    PubMed Central

    Agrawal, Rupesh V; Murthy, Somasheila; Sangwan, Virender; Biswas, Jyotirmay

    2010-01-01

    Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated appropriately. The present article will assist ophthalmologists in accurately diagnosing anterior uveitis, improving the quality of care rendered to patients with anterior uveitis, minimizing the adverse effects of anterior uveitis, developing a decision-making strategy for management of patients at risk of permanent visual loss from anterior uveitis, informing and educating patients and other healthcare practitioners about the visual complications, risk factors, and treatment options associated with anterior uveitis. PMID:20029142

  10. Surgical Management of Intramyocardial Left Anterior Descending Artery.

    PubMed

    De Salvatore, Sergio; Segreto, Antonio; Chiusaroli, Alessandro; Congiu, Stefano; Bizzarri, Federico

    2015-11-01

    An intramyocardial left anterior descending artery can be found in up to 30% of patients undergoing coronary artery bypass graft procedures. We review the various techniques available to identify an intramyocardial left anterior descending artery.

  11. Ehrlichia chaffeensis presenting with bilateral anterior thigh pain (Louria's sign).

    PubMed

    Cunha, Burke A; Petelin, Andrew; Hage, Jean E

    2012-09-01

    Bilateral anterior thigh pain may indicate bacteremia (Louria's Sign). We present a case of Ehrlichiosis due to Ehrlichia chaffeensis whose predominant presenting symptom was localized bilateral anterior thigh pain. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Increased anterior insula activity in anxious individuals is linked to diminished perceived control

    PubMed Central

    Alvarez, R P; Kirlic, N; Misaki, M; Bodurka, J; Rhudy, J L; Paulus, M P; Drevets, W C

    2015-01-01

    Individuals with high-trait anxiety frequently report decreased perceived control. However, it is unclear how these processes are instantiated at a neural level. Prior research suggests that individuals prone to anxiety may have exaggerated activity in the anterior insula and altered activity in the cingulate cortex during anticipation of aversive events. Thus, we hypothesized that anxiety proneness influences anterior insula activation during anticipation of unpredictable threat through decreased perceived control. Forty physically healthy adults underwent neuroimaging while they explored computer-simulated contexts associated either with or without the threat of an unpredictable shock. Skin conductance, anxiety ratings and blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging were used to assess responses to threat versus no threat. Perceived control was measured using the Anxiety Control Questionnaire-Revised. Mediation analysis examined how anxiety proneness influenced BOLD activity. Anticipation of unpredictable threat resulted in increased skin conductance responses, anxiety ratings and enhanced activation in bilateral insula, anterior midcingulate cortex (aMCC) and bed nucleus of the stria terminalis. Individuals with greater anxiety proneness and less perceived control showed greater activity in dorsal anterior insula (dAI). Perceived control mediated the relationship between anxiety proneness and dAI activity. Increased dAI activity was associated with increased activity in aMCC, which correlated with increased exploratory behavior. Results provide evidence that exaggerated insula activation during the threat of unpredictable shock is directly related to low perceived control in anxiety-prone individuals. Perceived control thus may constitute an important treatment target to modulate insula activity during anxious anticipation in anxiety-disordered individuals. PMID:26125154

  13. Single anterior approach for cervical spine fractures at C5-T1 complicating ankylosing spondylitis.

    PubMed

    Guo, Qunfeng; Cui, Yidong; Wang, Liang; Lu, Xuhua; Ni, Bin

    2016-08-01

    To evaluate the outcomes of anterior approach for cervical spine fractures at C5-T1 in patients with ankylosing spondylitis (AS) and study the problems encountered in diagnosis and treatment. Ten patients with AS (all males; mean age 43.7±9.4 years) underwent anterior surgeries to treat fractures at C5-T1. Skull tractions were performed on patients with fracture dislocation preoperatively. After operation, all the patients wore a cervical collar for 3 months. Plain radiographs at follow-up were reviewed. If bone fusion could not be confirmed on plain radiograph, CT scan was employed. The pre- and postoperative neurological statuses were evaluated according to the Frankel grading system. Problems encountered in diagnosis and treatments were analyzed. The mean follow-up was 41.2±22.7months. After operation, the displacements of fractures were significantly reduced(P<0.05). Bone fusions were observed in 9 patients at final follow-up. Frankel grades improved by 1.0±0.7 grade (P>0.05). Posterior complications occurred in four patients, including implants failure (n=1), subsidence of cage (n=1), hoarse voice (n=1) and pneumonias (n=2). The patient with implants failure required revision surgery and anterior-posterior fixation. Patient with subsidence of the titanium cage achieved bone fusion with prolonged cervical collar immobilization. The diagnosis and treatment of cervical spine fractures at C5-T1 in AS patients are challenging, with high risk of neurological compromise and postoperative complications. The single anterior approach followed by postoperative immobilization with a cervical collar can yield acceptable results if the cases are properly selected. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Beyond the FFA: The Role of the Ventral Anterior Temporal Lobes in Face Processing

    PubMed Central

    Collins, Jessica A.; Olson, Ingrid R.

    2014-01-01

    Extensive research has supported the existence of a specialized face-processing network that is distinct from the visual processing areas used for general object recognition. The majority of this work has been aimed at characterizing the response properties of the fusiform face area (FFA) and the occipital face area (OFA), which together are thought to constitute the core network of brain areas responsible for facial identification. Although accruing evidence has shown that face-selective patches in the ventral anterior temporal lobes (vATLs) are interconnected with the FFA and OFA, and that they play a role in facial identification, the relative contribution of these brain areas to the core face-processing network has remained unarticulated. Here we review recent research critically implicating the vATLs in face perception and memory. We propose that current models of face processing should be revised such that the ventral anterior temporal lobes serve a centralized role in the visual face-processing network. We speculate that a hierarchically organized system of face processing areas extends bilaterally from the inferior occipital gyri to the vATLs, with facial representations becoming increasingly complex and abstracted from low-level perceptual features as they move forward along this network. The anterior temporal face areas may serve as the apex of this hierarchy, instantiating the final stages of face recognition. We further argue that the anterior temporal face areas are ideally suited to serve as an interface between face perception and face memory, linking perceptual representations of individual identity with person-specific semantic knowledge. PMID:24937188

  15. Bariatric surgery revisions and private health insurance.

    PubMed

    Meyer, Samantha B; Thompson, Campbell; Hakendorf, Paul; Horwood, Chris; McNaughton, Darlene; Gray, John; Ward, Paul R; Mwanri, Lillian; Booth, Sue; Kow, Lilian; Chisholm, Jacob

    2017-05-12

    To identify: 1. The percentage of bariatric procedures that are revisions; 2. What proportion of bariatric revision procedures in public hospitals are for patients whose primary weight loss procedure occurred in a private hospital; 3. The age, sex and level of socioeconomic disadvantage of patients needing revisions. An analysis of patient level admission data from the Integrated South Australian Activity Collection (ISAAC) was performed. Data were collected on all revisions for weight loss related procedures at all South Australian public and private hospitals, between 2000-2015 using the ISAAC codes for revision procedures. 12,606 bariatric procedures occurred in hospitals; ∼27% of which represent a revision (n=3366). Of these revisions, ∼82% occurred in a private hospital (n=2771), and ∼18% occurred in a public hospital (n=595). Of the 595 revisions in a public hospital, 51% of patients had their original bariatric procedure performed in a private hospital. The majority of patients who had a revision procedure are female (≥82%) with a mean age of ∼45. Individuals from the lowest 2 IRSD quintiles were over-represented for public hospital revisions and primary bariatric procedures. Further investigation is needed to identify: 1. Why 27% of bariatric procedures are revisions; 2. Why at least 51% of revisions in public hospitals are on patients whose original primary bariatric procedure was done in a private hospital; 3. The impact that revision procedures in public hospitals, particularly for originally private weight loss procedures, is having on public hospital wait times; 4. The impact of socioeconomic disadvantage on weight loss procedure outcomes. Copyright © 2017 Asia Oceania Association for the Study of Obesity. All rights reserved.

  16. Constancy and characteristics of the anterior cutaneous branch of the first intercostal nerve: correcting the descriptions in human anatomy texts.

    PubMed

    Miyawaki, Makoto

    2006-12-01

    Human anatomy texts state that the anterior cutaneous branch of the first intercostal nerve (Rca-Th1) does not exist or that, even if it does, it is poorly developed. However, an anterior cutaneous branch in the first intercostal space (Rca-1) was observed in 74.8% of cases examined (104/139 sides) and was not poorly developed at all. Some of the observed Rca-I were even larger than the anterior cutaneous branches in the second intercostal space (Rca-ll). The segment of origin of the Rca-I was analyzed in 37 sides and 66.2% (49/74 branches) were confirmed to be from Th1. As a result, in contrast with traditional beliefs, it was shown that Rca-Th1 exists. The Rca-I was classified into two types according to the course and distribution: (i) an anterior cutaneous branch that appeared at the anterior end of the first intercostal space (ICS), ran through the pectoralis major muscle and extended in the first ICS (Rca-1); and (ii) another branch that appeared at the same place but ran downward along the anterior surface of the second costal cartilage, deep to the pectoralis major muscle, to reach the inferior edge of the second costal cartilage or the second ICS, passed through the pectoralis major muscle and extended to the second rib or the second ICS (pseudo Rca-2). It was found that 77.8% (35/45 branches) of Rca-1 and 48.3% (14/29 branches) of pseudo Rca-2 were derived from Th1. Accordingly, the author suggests that the description in human anatomy texts should be revised to read, '... the Rca-Th1 exists quite constantly and some of appear at a position resembling Rca-Th2'.

  17. [Anterior cruciate ligament injuries in children].

    PubMed

    Tercier, S; Zambelli, P-Y

    2013-07-17

    An increasing number of anterior cruciate ligament injuries are now seen in children and girls seem to be equally affected. Such neglected or untreated lesions could be the cause of early degenerative changes. Recently, many authors support the trend toward early surgical management in skeletally immature patients with complex meniscal tear or recurrent knee instability after proper rehabilitation. Improvement in pediatric knowledge and surgical techniques tend to support a tendency for more surgical treatment in children. The type of management is choosing according to history and physical examination. Magnetic resonance imaging is a useful tool not only for diagnosis but also for surgical treatment planning. We usually recommend anterior cruciate ligament reconstruction in children with knee instability or with further damages to the joint.

  18. Supraorbital keyhole approach for anterior circulation aneurysms.

    PubMed

    Tang, Chao; Sun, Jun; Xue, Hongli; Yu, Yong; Xu, Feng

    2013-01-01

    Supraorbital keyhole approach provides access to the major part of the anterior circulation aneurysms. Herein, our surgical experience of supraorbital keyhole approach and its some modification have been proposed. Out of a series of 76 patients harboring 80 aneurysms operated on via a supraorbital keyhole approach with a superciliar or front wrinkle skin incision, there are 70 patients with subarachnoidal bleeding, others are nonruptured aneurysms, Intraoperative rupture occurred in 8 cases, and 4 had multiple aneurysms. There was a good cosmetic results with less approach-related complications .Of 80 aneurysms, 75 aneurysms were clipped successfully by the supraorbital route. Good Glasgow Outcome Scale scores of 4 or 5 were achieved in 95% of the patients at the time of discharge. 2 patients of Grade IV died in the postoperative period due vasospasm. The supraorbital route is recommended for selected anterior circulation aneurysms based on the improved surgical instruments and microsurgical skills.

  19. Anterior cruciate ligament reconstruction without drill holes.

    PubMed

    Brief, L P

    1991-01-01

    Anterior cruciate ligament (ACL) reconstruction in adolescents with open physes remains a difficult problem for the orthopedic surgeon, especially in view of growing teenage participation in contact sports. Traditionally, treatment of ACL tears in adolescents has been conservative; the patient is advised to delay surgery up to several years for fear of damaging physes by drilling holes across them. Unfortunately, this waiting period may inflict irreparable knee damage. This paper suggests an ACL reconstruction technique that utilizes no drill holes, thus causing no harm to physes or other essential knee structures. A graft consisting of semitendinosus and gracilis (SG) tendons is passed under the anterior horn of the medial meniscus through the knee joint, then brought out through the posterior capsule and secured to the lateral femoral metaphysis. The graft is augmented with an iliotibial band tenodesis. Designed primarily but not exclusively for teenagers with open physes, the procedure has produced encouraging results thus far in a small series.

  20. Cataract Surgery in Anterior Megalophthalmos: A Review

    PubMed Central

    GALVIS, Virgilio; TELLO, Alejandro; M. RANGEL, Carlos

    2015-01-01

    Anterior megalophthalmos is characterized by megalocornea associated with a very broad anterior chamber and ciliary ring elongation. It is also called X-linked megalocornea. It is accompanied by early development of cataracts, zonular anomalies, and, rarely, vitreoretinal disorders. Subluxation of a cataract can occur in cataract surgery because of zonular weakness. In addition, in most patients, standard intraocular lens (IOL) decentration is a risk because of the enlarged sulcus and capsular bag. These unique circumstances make cataract surgery challenging. To date, several approaches have been developed. Implantation of a retropupillary iris-claw aphakic intraocular lens may be a good option because it is easier than suturing the IOL and can have better and more stable anatomic and visual outcomes, compared to other techniques. PMID:27350950

  1. [Esthetic restorations of primary anterior teeth].

    PubMed

    Elqadir, A Jamil; Shapira, J; Ziskind, K; Ram, D

    2013-04-01

    Esthetic treatment of primary teeth is one of the greatest challenges to pediatric dentists. A variety of restorative options using full coverage are available for anterior primary teeth. In the last half century the emphasis on treatment of severely decayed primary teeth shifted from extraction to restoration. In the past, restorations consisted of placement of stainless steel crowns on severely decayed teeth. However, they are esthetically unacceptable today. Over the last decade parents expect a higher esthetic standard for their children's primary teeth. Thus, the restoration should provide esthetic appearance and durability in addition to restoring function. The purpose of this review is to describe the types of full coverage options for anterior primary teeth currently available.

  2. Anterior Insular Cortex and Emotional Awareness

    PubMed Central

    Gu, Xiaosi; Hof, Patrick R.; Friston, Karl J.; Fan, Jin

    2014-01-01

    This paper reviews the foundation for a role of the human anterior insular cortex (AIC) in emotional awareness, defined as the conscious experience of emotions. We first introduce the neuroanatomical features of AIC and existing findings on emotional awareness. Using empathy, the awareness and understanding of other people’s emotional states, as a test case, we then present evidence to demonstrate: 1) AIC and anterior cingulate cortex (ACC) are commonly coactivated as revealed by a meta-analysis, 2) AIC is functionally dissociable from ACC, 3) AIC integrates stimulus-driven and top-down information, and 4) AIC is necessary for emotional awareness. We propose a model in which AIC serves two major functions: integrating bottom-up interoceptive signals with top-down predictions to generate a current awareness state and providing descending predictions to visceral systems that provide a point of reference for autonomic reflexes. We argue that AIC is critical and necessary for emotional awareness. PMID:23749500

  3. Lethal arthrogryposis with anterior horn cell disease.

    PubMed

    Vuopala, K; Ignatius, J; Herva, R

    1995-01-01

    Fifteen infants (11 families) with lethal arthrogryposis and anterior horn motor neuron loss are described. The clinical presentation was the fetal akinesia deformation sequence (FADS) with multiple contractures and facial anomalies. At autopsy neurogenic muscular atrophy was present in all infants. The spinal cord showed a paucity of anterior horn motor neurons in the 12 infants studied. Both male and female infants were affected. Nine cases were sporadic, whereas in two families there were three affected cases. Consanguinity between the parents was reported in one family with one affected child. This and the recurrence of the condition speak for autosomal recessive inheritance. Detailed neuropathological examination and documentation of the clinical features are needed for a better delineation of and genetic counseling for perinatally lethal arthrogryposis.

  4. Endoscopic anterior tarsal tunnel release: a case report.

    PubMed

    Lui, Tun Hing

    2014-01-01

    Anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle. We report a patient with anterior tarsal tunnel syndrome who was successfully treated with endoscopic anterior tarsal tunnel release. Our endoscopic technique, because it preserves the inferior extensor retinaculum, is potentially less traumatic than traditional surgical techniques for repairing this entrapment neuropathy.

  5. An OCT Study of Anterior Nodular Episcleritis and Scleritis

    PubMed Central

    2017-01-01

    Anterior scleritis and episcleritis are a well-known presentation in tuberculosis. The case of a female patient with presumed tuberculous anterior scleritis and episcleritis is discussed in this article. Anterior segment OCT was efficient in diagnosis and evaluation of the therapeutic outcome. Antituberculosis chemotherapy was sufficient to achieve clinical remission. PMID:28348907

  6. Anorgasmia in anterior spinal cord syndrome.

    PubMed Central

    Berić, A; Light, J K

    1993-01-01

    Three male and two female patients with anorgasmia and dissociated sensory loss due to an anterior spinal cord syndrome are described. Clinical, neurophysiological and quantitative sensory evaluation revealed preservation of the large fibre dorsal column functions from the lumbosacral segments with concomitant severe dysfunction or absence of the small fibre neospinothalamic mediated functions. These findings indicate a role for the spinothalamic system in orgasm. PMID:8505649

  7. A direct approach to restore anterior teeth.

    PubMed

    Denehy, G E

    2000-11-01

    When selecting the correct treatment for a patient with anterior esthetic problems, the dentist must choose between direct and indirect procedures. With situations allowing conservative treatment, direct resin restoration should be given strong consideration. Advances in materials and techniques that can positively affect this choice include pre-restorative bleaching procedures, new bonding agents, and new highly esthetic direct resin systems. A procedure is described to maximize esthetics and minimize finishing time during direct resin placement.

  8. Gravity orientation tuning in macaque anterior thalamus.

    PubMed

    Laurens, Jean; Kim, Byounghoon; Dickman, J David; Angelaki, Dora E

    2016-12-01

    Gravity may provide a ubiquitous allocentric reference to the brain's spatial orientation circuits. Here we describe neurons in the macaque anterior thalamus tuned to pitch and roll orientation relative to gravity, independently of visual landmarks. We show that individual cells exhibit two-dimensional tuning curves, with peak firing rates at a preferred vertical orientation. These results identify a thalamic pathway for gravity cues to influence perception, action and spatial cognition.

  9. Imaging of the anterior cruciate ligament

    PubMed Central

    Ng, Wing Hung Alex; Griffith, James Francis; Hung, Esther Hiu Yee; Paunipagar, Bhawan; Law, Billy Kan Yip; Yung, Patrick Shu Hang

    2011-01-01

    The anterior cruciate ligament (ACL) is an important structure in maintaining the normal biomechanics of the knee and is the most commonly injured knee ligament. However, the oblique course of the ACL within the intercondylar fossa limits the visualization and assessment of the pathology of the ligament. This pictorial essay provides a comprehensive and illustrative review of the anatomy and biomechanics as well as updated information on different modalities of radiological investigation of ACL, particularly magnetic resonance imaging. PMID:22474639

  10. Anterior longitudinal aortotomy in aortic valve replacement.

    PubMed

    Matsuzaki, Kanji; Kudo, Yohei; Ikeda, Akihiko; Konishi, Taisuke; Jikuya, Tomoaki

    2016-02-01

    We adopted an anterior longitudinal aortotomy in some cases of aortic valve replacement (AVR), and report them here. The potential of this method is also discussed. We analyzed the data on 24 patients (75.5 ± 7.8 years of age) who had undergone AVR through anterior longitudinal aortotomy. The indications for surgery were prosthetic valve complication in 5 patients, aortic stenosis (AS) with left ventricular outflow tract stenosis (LVOTS) in 16 patients, and aortic regurgitation with moderately dilated ascending aorta in 3 patients. The Konno procedure was performed in 6 cases with small aortic annuli. A longitudinal aortotomy was made at the aortic root along the left side of the right coronary ostium, and extended beyond the right coronary annulus to the interventricular septum as needed. Bioprostheses (21.1 ± 1.7 mm) were used in 23 patients and a 21-mm mechanical valve for one (a 59-year-old man). One high-risk patient died of low output syndrome, leading to a mortality rate of 4.2 %. All other patients recovered well, though atrioventricular block occurred in 2 cases. Anterior longitudinal aortotomy provides a good field of vision at the aortic annulus and the flexibility to develop into anterior annular enlargement. Major indications for this approach are small sino-tubular junction and very small aortic annulus. This approach could be an attractive option in AVR for cases of AS with small aortic annuli and LVOTS. It could also be useful for AVR cases with moderately dilated ascending aorta requiring aortoplasty.

  11. Symptomatic anterior subtalar arthrosis after ankle arthrodesis

    PubMed Central

    Lui, Tun Hing

    2014-01-01

    A 76-year-old man reported right lateral heel pain 11 years after ankle arthrodesis. Clinically, there was tenderness in the right sinus tarsi and over the junction point between the talonavicular and calcaneocuboid joints. Radiographs showed that the joint spaces of the posterior subtalar joint and the talonavicular joint were preserved although there were osteophytes at both joints. Arthroscopic findings showed degeneration of the anterior subtalar and talonavicular joints. The symptoms subsided after arthroscopic debridement. PMID:24825553

  12. Cervical vertebral fusion with anterior meningocele

    PubMed Central

    Chavredakis, Emmanuel; Carter, David; Bhojak, Manesh; Jenkinson, Michael D; Clark, Simon R

    2015-01-01

    We present the first described case of cervical vertebral fusion associated with anterior meningocele and syringomyelia. A 45-year-old woman presented with minor trauma, and plain cervical spine radiographs highlighted a congenital deformity of the cervical vertebral bodies. She had a normal neurological examination; however, further imaging revealed a meningocele and syringomyelia. This case highlights the importance of thorough imaging investigation when presented with a congenital deformity in order to detect and prevent development of degenerative spinal cord pathologies. PMID:25923673

  13. Mechanisms of Noncontact Anterior Cruciate Ligament Injury

    PubMed Central

    Shimokochi, Yohei; Shultz, Sandra J

    2008-01-01

    Objective: To examine and summarize previous retrospective and observational studies assessing noncontact anterior cruciate ligament (ACL) injury mechanisms and to examine such reported ACL injury mechanisms based on ACL loading patterns due to knee loadings reported in in vivo, in vitro, and computer simulation studies. Data Sources: We searched MEDLINE from 1950 through 2007 using the key words anterior cruciate ligament + injury + mechanisms; anterior cruciate ligament + injury + mechanisms + retrospective; and anterior cruciate ligament + injury + mechanisms + video analysis. Study Selection: We selected retrospective studies and observational studies that specifically examined the noncontact ACL injury mechanisms (n  =  7) and assessed ACL loading patterns in vivo, in vitro, and using computer simulations (n  =  33). Data Extraction: The motion patterns reported as noncontact ACL injury mechanisms in retrospective and observational studies were assessed and critically compared with ACL loading patterns measured during applied external or internal (or both) forces or moments to the knee. Data Synthesis: Noncontact ACL injuries are likely to happen during deceleration and acceleration motions with excessive quadriceps contraction and reduced hamstrings co-contraction at or near full knee extension. Higher ACL loading during the application of a quadriceps force when combined with a knee internal rotation moment compared with an external rotation moment was noted. The ACL loading was also higher when a valgus load was combined with internal rotation as compared with external rotation. However, because the combination of knee valgus and external rotation motions may lead to ACL impingement, these combined motions cannot be excluded from the noncontact ACL injury mechanisms. Further, excessive valgus knee loads applied during weight-bearing, decelerating activities also increased ACL loading. Conclusions: The findings from this review lend support to ACL

  14. Prosthetic Anterior Cruciate Ligament Repairs: Current Status.

    DTIC Science & Technology

    1985-01-01

    patellar tendon was (dev eloped to augment or reconstruct the repaired anteriormenu cruciate ligamnent.’ The purpose of this app~roach was to provide an...intercondvlar niotch in the manner of Eriksson. ’ Thus the transfe~rred patellar tendon lay adjacent to the repairedI anterior cruciate ligament and supportedl...splint.’ B y using a hiode- hinli(tionl).ly gradable ligament. autogenous tissue grafts. such ats at portion of the, patella tendon . at asfied with would

  15. Symptomatic anterior subtalar arthrosis after ankle arthrodesis.

    PubMed

    Lui, Tun Hing

    2014-05-13

    A 76-year-old man reported right lateral heel pain 11 years after ankle arthrodesis. Clinically, there was tenderness in the right sinus tarsi and over the junction point between the talonavicular and calcaneocuboid joints. Radiographs showed that the joint spaces of the posterior subtalar joint and the talonavicular joint were preserved although there were osteophytes at both joints. Arthroscopic findings showed degeneration of the anterior subtalar and talonavicular joints. The symptoms subsided after arthroscopic debridement.

  16. Posterolateral Corner Reconstruction Alone Using a Fibular-Based Technique in a Patient with Persistent Unstable Revision Total Knee Arthroplasty

    PubMed Central

    Cline, Joseph T.; Alentorn-Geli, Eduard; Choi, J. H. James; Stuart, Joseph J.; Kruger, Terry; Moorman III, Claude T.

    2015-01-01

    Posterolateral rotatory instability is a relatively uncommon cause of unstable total knee arthroplasty (TKA). In most cases, surgical treatment requires revision TKA into a more constrained design or thicker polyethylene liner. We present a case of a patient with unstable TKA who remained unstable after increasing thickness of the polyethylene liner and undergoing more constrained TKA. After several revision surgeries, the patient was still unstable. Posterolateral corner reconstruction with a fibular-based technique using a tibialis anterior allograft was performed. At 1-year follow-up, the patient was stable and asymptomatic and with excellent function. A soft-tissue procedure only (fibular-based posterolateral corner reconstruction) can be effective at restoring posterolateral rotatory stability in a patient with persistent instability after revision TKA. PMID:26881160

  17. Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation

    PubMed Central

    Pike, Andrew N.; Bryant, Tim; Ogura, Takahiro; Minas, Tom

    2017-01-01

    Background: Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects. Hypothesis: ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures. Results: Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (all Ps <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with

  18. Anterior septal deviation and contralateral alar collapse.

    PubMed

    Schalek, P; Hahn, A

    2011-01-01

    Septal deviation is often found in conjunction with other pathological conditions that adversely affect nasal patency. Anterior septal deviation, together with contralateral alar collapse, is a relatively rare type of anatomical and functional incompetence. In our experience, it can often be resolved with septoplasty, without the necessity of surgery involving the external valve. The aim of this paper was to verify this hypothesis prospectively. Twelve patients with anterior septal deviation and simultaneous alar collapse on the opposite side were prospectively enrolled in the study. Subjective assessment of nasal patency was made on post-operative day 1, and again 6 months after surgery, using a subjective evaluation of nasal breathing. The width of the nostril (alar-columellar distance) on the side with the alar collapse was measured during inspiration pre-operatively, 1 day after surgery and again 6 months after surgery. Immediately after surgery, all patients reported improved or excellent nasal breathing on the side of the original septal deviation. On the collapsed side, one patient reported no change in condition. With the exception of one patient, all measurements showed some degree of improvement in the extension of the alar-columellar distance. The average benefit 6 months after surgery was an improvement of 4.54 mm. In our group of patients (anterior septal deviation and simultaneous contralateral alar collapse and no obvious structural changes of the alar cartilage) we found septoplasty to be entirely suitable and we recommend it as the treatment of choice in such cases.

  19. The thoracic anterior spinal cord adhesion syndrome

    PubMed Central

    Taylor, T R; Dineen, R; White, B; Jaspan, T

    2012-01-01

    Objectives This study included a series of middle-aged male and female patients who presented with chronic anterior hemicord dysfunction progressing to paraplegia. Imaging of anterior thoracic cord displacement by either a dural adhesion or a dural defect with associated cord herniation is presented. Methods This is a retrospective review of cases referred to a tertiary neuroscience centre over a 19-year period. Imaging series were classified by two experienced neuroradiologists against several criteria and correlated with clinical examination and/or findings at surgery. Results 16 cases were available for full review. Nine were considered to represent adhesions (four confirmed surgically) and four to represent true herniation (three confirmed surgically). In the three remaining cases the diagnosis was radiologically uncertain. Conclusion The authors propose “thoracic anterior spinal cord adhesion syndrome” as a novel term to describe this patient cohort and suggest appropriate clinicoradiological features for diagnosis. Several possible aetiologies are also suggested, with disc rupture and inflammation followed by disc resorption and dural pocket formation being a possible mechanism predisposing to herniation at the extreme end of a clinicopathological spectrum. PMID:22665931

  20. Can arthroscopic revision surgery for shoulder instability be a fair option?

    PubMed

    De Giorgi, Silvana; Garofalo, Raffaele; Tafuri, Silvio; Cesari, Eugenio; Rose, Giacomo Delle; Castagna, Alessandro

    2014-04-01

    the aim of this study was to evaluate the role of arthroscopic capsuloplasty in the treatment of failed primary arthroscopic treatment of glenohumeral instability. we retrospectively examined at a minimum of 3-years follow-up 22 patients who underwent arthroscopic treatment between 1999 and 2007 who had recurrent anterior shoulder instability with a post-surgical failure. A statistical analysis was performed to evaluate which variable could influence the definitive result and clinical outcomes at final follow-up. A p value of less than 0.05 was considered significant. we observed after revision surgery an overall failure rate of 8/22 (36.4%) including frank dislocations, subluxations and also apprehension that seriously inhibit the patient's quality of life. No significant differences were observed in the examined parameters. according to our outcomes we generally do not recommend an arthroscopic revision procedure for failed instability surgery.

  1. A Rare Embryologic Variation: Anterior Communicating Artery Aneurysm Associated with Carotid—Anterior Cerebral Artery Anastomosis or Infraoptic Course of the Anterior Cerebral Artery

    PubMed Central

    Yurt, Alaattin; Uçar, Kubilay; Özer, Füsun; Oran, İsmail; Arda, Nuri

    2008-01-01

    Aneurysms of the complex of the anterior cerebral artery are frequently associated with anatomic variations of the circle of Willis. We describe a case of aneurysmal rupture of the anterior communicating artery, a variant of the anterior cerebral artery. The aneurysm appeared to be situated on this vessel proximal to the infered site of the AcoA. Surgery was performed at the 6th day after hemorrhage. The anterior communicating artery aneurysm was clipped. The post operative course was unventful, with complete recovery. In our case, an extremely rare variation of the proximal tract of the anterior cerebral artery, i.e. an infraoptic course of the proximal precommunicating tract under the optic nerve, with the distal A1 tract anterior to the chiasm and positioned between the optic nerves, is presented. PMID:24179361

  2. Medium to long-term follow-up after ACL revision.

    PubMed

    Lind, Martin; Lund, Bent; Faunø, Peter; Said, Sinan; Miller, Lene Lindberg; Christiansen, Svend Erik

    2012-01-01

    The aim of the present study is to present epidemiology and clinical outcome after revision anterior cruciate ligament (ACL) reconstruction with an intermediate follow-up time of up to 9 years. A retrospective study of patients treated with ACL revision from 2001 to 2007 at a university referral clinic was conducted. Study follow-up was performed in 2010; this follow-up included objective IKDC scores, KOOS, Tegner and SANE subjective scores, KT-1000 knee laxity measurements and registration of reoperations and complications. One hundred and twenty-eight patients were available for follow-up. Median follow-up time was 6 (2-9) years. Mean age was 32 years, 50% were men. Eleven percent required staged procedures, 30% were reconstructed with allograft tendons and 23% had collateral ligament reconstruction in combination with the ACL revision. SANE knee global score (0-100) was 74 at follow-up, KOOS sub-scores were preoperatively 66, 69, 77, 42 and 39 for pain, symptoms, activity of daily living, sports and quality of life, respectively. At follow-up, scores were 70, 76, 81, 50 and 50, respectively. Sport and quality of life scores increased significantly. KT-1000 was 6.2 mm preoperatively and 2.5 at follow-up (P < 0.05). Six percent were re-revised and 2 patients had total knee replacements. Despite objective findings of acceptable sagittal knee stability at follow-up, subjective outcome scores indicate significant knee impairment with low scores in sport and quality of life. A re-revision rate of 6% after 6 years is acceptable. It is imperative that patients eligible for ACL revision receive proper counseling in terms of outcome expectancies. Retrospective case series, Level IV.

  3. Video-assisted ALIF with cage and anterior plate fixation for L5-S1 spondylolisthesis.

    PubMed

    Aunoble, Stephane; Hoste, David; Donkersloot, Peter; Liquois, Frederic; Basso, Yann; Le Huec, Jean-Charles

    2006-10-01

    patients had a soft brace for 8 weeks postoperatively. There was no retrograde ejaculation for the 9 men and no sexual dysfunction reported by the women. One patient had no pain relief and was reoperated for posterior pedicular screw fixation. It was obvious that there was a pseudarthrosis even after the posterior fixation and an anterior transperitoneal revision was performed with the removal of the interbody device and iliac crest bone graft packing alone. A propioni bacterium acnes germ was found responsible for the anterior nonunion. This revision surgery with antibiotics treatment was successful. One of the patients with grade 2 had an additional posterior screw fixation with a minimally invasive pedicle screw system (Sextant, Medtronic, Memphis). Nineteen patients had a good fusion at 2 years follow-up (95%), mean Oswestry score improved from 74% preoperative to 21% postoperative at the last follow-up. Visual analog score (VAS) for back pain improved from 6.5 to 2.7 and VAS for leg pain improved from 6.2 to 3.4. Satisfaction rate was 90%. All active patients except two, were back to work at an average of 5.5 months (6 wk to 1 y). The 2 patients still not working were the nonunion and a work compensation. The results of this technique compare favorably with posterior stabilization and fusion (posterior lumbar interbody fusion and postero-lateral fusion) reported in the literature. Unlike posterior lumbar interbody fusion, however, it seems that the complication rate due to the approach is much lower, the fusion rate is similar. Grade 2 SPL is the limitation of the technique. The main advantage of the technique is to avoid posterior muscle damage and a quick recovery with no blood loss. Preservation of adjacent level disease can be assessed only after long-term follow-up.

  4. Pseudophakic flat anterior chamber following retinal detachment repair.

    PubMed

    Taylor, B C; Winslow, R L

    1981-09-01

    Flat anterior chambers were caused by varying mechanisms in 10 of 70 consecutive pseudophakic eyes operated on for retinal detachment. With iris or capsular implant fixation, three of 46 (7%) developed flat anterior chambers, and with anterior chamber lenses, the occurrence was seven of 24 (29%). Events initiating flat chambers included wound leak, pupillary block, and choroidal detachment. In eyes with flat anterior chambers, the retina could not be reattached in one case, extensive peripheral anterior synechia with persistent intraocular pressure elevation occurred in another case, and bullous keratopathy remained in two additional instances. Endothelial cell densities were obtained in eight eyes and were low on an age-related basis.

  5. ACL Revision in Synthetic ACL graft failure

    PubMed Central

    Etcheto, H. Rivarola; Zordán, J.; Escobar, G.; Collazo, C.; Palanconi, M.; Autorino, C.; Salinas, E. Alvarez

    2017-01-01

    The development of synthetic grafts as an alternative to biological grafts for reconstruction of the anterior cruciate ligament dates from 1980. The interest is awakened due to the potential advantages of: The absence of morbidity associated with donor site, and early return to sport. However, this surgical technique has had multiple complications associated with graft: mechanical failures (synthetic graft failure, loss of fixation), synovial foreign body reaction, recurrent stroke, recurrent instability and ultimately, early osteoarthritis. Objectives: We describe the synthetic graft failure LCA, intraoperative findings and details of surgical technique. Methods: Patient 35 years old, with a history of ACL reconstruction four years of evolution in another health center, consultation with the Service knee arthroscopy for acute knee pain left knee during secondary sporting event to a rotation mechanism with fixed foot. On physical examination, presents and positive Lachman maneuver Pivot. Radiografia in a widening of the tibial tunnel is observed. NMR shows a discontinuity of fibers of synthetic graft. Results: First time arthroscopic revision where synthetic plastic LCA identifies with Disruption fiber pattern. Intraoperatively, hypertrophic chronic synovitis localized predominantly in intercóndilo is observed. debridement thereof is performed, and proceeds to the extraction of the synthetic ligament. Then he was made prior cruentado and revival of the edges of the tunnel, filling them with non-irradiated structural bone allograft. At four months as planned and after confirmation by studies incorporating bone graft was performed the second time with the new plastic ACL. It was planned like a primary graft surgery with autologous hamstring prepared in fourfold form, and fixation with modified transtibial technique Biotransfix system proximal and distal screw Biocomposite (arthrex®). A quadruple graft 9 mm was obtained, making good positioning of tunnels and stable

  6. Final Revisions Rule Significant Contribution Assessment TSD

    EPA Pesticide Factsheets

    This Technical Support Document (TSD) presents quantitative assessments of the relationship between final revisions to the Transport Rule and the original analysis conducted for the final Transport Rule.

  7. Revision rhinoplasty for the Asian nose.

    PubMed

    Lam, Samuel M

    2008-08-01

    Revision rhinoplasty of the Asian nose requires a combination of cultural sensitivity and unique surgical strategies to achieve a successful outcome. Cultural sensitivity means understanding some of the folkloric motivations to undergo rhinoplasty and divergent ethnic standards of beauty. Basic techniques for Asian rhinoplasty are reviewed as a prerequisite knowledge for revision rhinoplasty of the Asian nose, specifically a combination technique of expanded polytetrafluoroethylene for bridge augmentation and autogenous cartilage tip grafting. Revision Asian nose surgery oftentimes involves removal of a previously placed solid silicone implant, which remains the most popular option for augmentation rhinoplasty in Asia. Strategies for revision rhinoplasty in the Asian nose are then reviewed.

  8. Food safety: revising the statute.

    PubMed

    Kessler, D A

    1984-03-09

    There is increasing recognition that federal food safety laws and policies need to be revised. Congressional debate on proposed amendments to the Food, Drug, and Cosmetic Act has generated several different perspectives on how the food safety laws should be changed. Before a consensus can be reached, scientists, regulators, the food industry, and consumers will have to review such complex and controversial issues as the level of acceptable risk, the value of risk-benefit analysis, the proper role of independent scientific review, and the reliability of quantitative risk assessment.

  9. Revision and product generation software

    USGS Publications Warehouse

    ,

    1997-01-01

    The U.S. Geological Survey (USGS) developed revision and product generation (RevPG) software for updating digital line graph (DLG) data and producing maps from such data. This software is based on ARC/INFO, a geographic information system from Environmental Systems Resource Institute (ESRI). RevPG consists of ARC/INFO Arc Macro Language (AML) programs, C routines, and interface menus that permit operators to collect vector data using aerial images, to symbolize the data on-screen, and to produce plots and color-separated files for use in printing maps.

  10. Revision and Product Generation Software

    USGS Publications Warehouse

    ,

    1999-01-01

    The U.S. Geological Survey (USGS) developed revision and product generation (RevPG) software for updating digital line graph (DLG) data and producing maps from such data. This software is based on ARC/INFO, a geographic information system from Environmental Systems Resource Institute (ESRI). RevPG consists of ARC/INFO Arc Macro Language (AML) programs, C routines, and interface menus that permit operators to collect vector data using aerial images, to symbolize the data onscreen, and to produce plots and color-separated files for use in printing maps.

  11. The revised Flat Galaxy Catalogue.

    NASA Astrophysics Data System (ADS)

    Karachentsev, I. D.; Karachentseva, V. E.; Kudrya, Yu. N.; Sharina, M. E.; Parnovskij, S. L.

    The authors present a new improved and completed version of the Flat Galaxy Catalogue (FGC) named the Revised Flat Galaxy Catalogue (RFGC) containing 4236 thin edge-on spiral galaxies and covering the whole sky. The Catalogue is intended to study large-scale cosmic streamings as well as other problems of observational cosmology. The dipole moment of distribution of the RFGC galaxies (l = 273°, b = +19°) lies within statistical errors (±10°) in the direction of the Local Group motion towards the Microwave Background Radiation.

  12. [Spinal column: implants and revisions].

    PubMed

    Krieg, S M; Meyer, H S; Meyer, B

    2016-03-01

    Non-fusion spinal implants are designed to reduce the commonly occurring risks and complications of spinal fusion surgery, e.g. long duration of surgery, high blood loss, screw loosening and adjacent segment disease, by dynamic or movement preserving approaches. This principle could be shown for interspinous spacers, cervical and lumbar total disc replacement and dynamic stabilization; however, due to the continuing high rate of revision surgery, the indications for surgery require as much attention and evidence as comparative data on the surgical technique itself.

  13. The influence of anterior coupling on mandibular movement.

    PubMed

    Brose, M O; Tanquist, R A

    1987-03-01

    The need for and use of anterior coupling in occlusal rehabilitation has been discussed. The anterior teeth can often be coupled to the posterior controls by modifying contours with selective grinding, full or partial coverage restorations, or composite. When anterior guidance is provided, the anterior teeth should harmonize with the TMJs so that the posterior teeth will disclude in excursive mandibular movements. Significant functional, esthetic, and phonetic alterations that change the anterior guidance must be carefully planned because the anterior guidance affects all excursive tooth contacts. Anterior coupling, as described, is often an overlooked entity in restorative dentistry. Evidence of its role in separating the posterior teeth, reducing parafunctional activity, and harmonizing the temporomandibular complex has been presented.

  14. Absent anterior communicating artery and varied distribution of anterior cerebral artery.

    PubMed

    Ozturk, Hakan A; Sanli, Emine C; Kurtoglu, Zeliha

    2008-10-01

    During the cerebral dissection of a 67-year-old male cadaver, a unique combination of variations at the circle of Willis and anterior cerebral artery (ACA) distribution were encountered. The A1 segment of both ACA were fused without an anterior communicating artery (ACoA), forming an X shape and giving rise to a common pericallosal artery (CPA), an incomplete distal ACA, and an incomplete distal anterior cerebral artery (IACA). The IACA had an unusual course, which may be important from the surgical point of view. The CPA continued as the A2 and A3 segments, and bifurcated into 2 pericallosal arteries. Branching patterns of the varied arteries to the interhemispheric region were evaluated, and results were discussed. Additionally, both posterior communicating arteries were hypoplastic. There was no aneurysm formation at the circle of Willis and its branches.

  15. Revising Lecture Notes: How Revision, Pauses, and Partners Affect Note Taking and Achievement

    ERIC Educational Resources Information Center

    Luo, Linlin; Kiewra, Kenneth A.; Samuelson, Lydia

    2016-01-01

    Note taking has been categorized as a two-stage process: the recording of notes and the review of notes. We contend that note taking might best involve a three-stage process where the missing stage is revision. This study investigated the benefits of revising lecture notes and addressed two questions: First, is revision more effective than…

  16. 78 FR 63883 - Promulgation of State Implementation Plan Revisions; Revision to Prevention of Significant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-25

    ... AGENCY 40 CFR Part 52 Promulgation of State Implementation Plan Revisions; Revision to Prevention of... submitted by the State of Utah on March 14, 2012. This submission revises Utah's Prevention of Significant... Prevention of Significant Deterioration. (viii) The initials SIP mean or refer to State Implementation Plan...

  17. Extra-Articular Lateral Tenodesis for Anterior Cruciate Ligament Deficient Knee: A Case Report

    PubMed Central

    García-Germán, Diego; Menéndez, Pablo; de la Cuadra, Pablo; Rodríguez-Arozena, Ricardo

    2013-01-01

    We present the case of an extra-articular lateral tenodesis for an anterior cruciate ligament (ACL) deficient knee. A 46-year-old male patient sustained an ACL graft rupture after a motorcycle accident. He complained of rotational instability and giving-way episodes. His previous graft was fixed by an intra-articular femoral staple that was not possible to remove at the time of the ACL revision. A modified Lemaire procedure was then performed. He gained rotational stability and was able to resume his sporting activities. We believe that isolated extra-articular reconstructions may still have a role in selected indications including moderate-demand patients complaining of rotational instability after ACL graft failure. PMID:24369517

  18. Complications Following Direct Anterior Hip Procedures: Costs to Both Patients and Surgeons.

    PubMed

    Lee, Gwo-Chin; Marconi, Dante

    2015-09-01

    A systematic review of the literature on clinical outcomes following direct anterior approach (DAA) hip arthroplasty was performed. An aggregated 11,810 hip procedures were analyzed for intraoperative and early postoperative complications. The most common complication following DAA hip arthroplasty was nerve dysfunction (2.8%) followed by intraoperative fractures (2.3%). Postoperative dislocation, wound complications, and revision THA within the first 12 months were reported in 1.2% of cases. Thus, while DAA hip arthroplasty can be successfully performed, it is not without complications. Without definitive evidence of clinical superiority, surgeons considering switching to DAA should benchmark their personal complication rates against published reports. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. An anterior signaling center patterns and sizes the anterior neuroectoderm of the sea urchin embryo.

    PubMed

    Range, Ryan C; Wei, Zheng

    2016-05-01

    Anterior signaling centers help specify and pattern the early anterior neuroectoderm (ANE) in many deuterostomes. In sea urchin the ANE is restricted to the anterior of the late blastula stage embryo, where it forms a simple neural territory comprising several types of neurons as well as the apical tuft. Here, we show that during early development, the sea urchin ANE territory separates into inner and outer regulatory domains that express the cardinal ANE transcriptional regulators FoxQ2 and Six3, respectively. FoxQ2 drives this patterning process, which is required to eliminate six3 expression from the inner domain and activate the expression of Dkk3 and sFRP1/5, two secreted Wnt modulators. Dkk3 and low expression levels of sFRP1/5 act additively to potentiate the Wnt/JNK signaling pathway governing the positioning of the ANE territory around the anterior pole, whereas high expression levels of sFRP1/5 antagonize Wnt/JNK signaling. sFRP1/5 and Dkk3 levels are rigidly maintained via autorepressive and cross-repressive interactions with Wnt signaling components and additional ANE transcription factors. Together, these data support a model in which FoxQ2 initiates an anterior patterning center that implements correct size and positions of ANE structures. Comparisons of functional and expression studies in sea urchin, hemichordate and chordate embryos reveal striking similarities among deuterostome ANE regulatory networks and the molecular mechanism that positions and defines ANE borders. These data strongly support the idea that the sea urchin embryo uses an ancient anterior patterning system that was present in the common ambulacrarian/chordate ancestor. © 2016. Published by The Company of Biologists Ltd.

  20. Injury to the Anterior Tibial Artery during Bicortical Tibial Drilling in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kim, Sang Bum; Lim, Jin Woo; Seo, Jeong Gook

    2016-01-01

    Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case. PMID:26929808

  1. Gross, Arthroscopic, and Radiographic Anatomies of the Anterior Cruciate Ligament: Foundations for Anterior Cruciate Ligament Surgery.

    PubMed

    Irarrázaval, Sebastián; Albers, Marcio; Chao, Tom; Fu, Freddie H

    2017-01-01

    The anterior cruciate ligament (ACL) is one of the more studied structures in the knee joint. It is not a tubular structure, but is much narrower in its midsubstance and broader at its ends, producing an hourglass shape. The ACL is composed of 2 functional bundles, the anteromedial and posterolateral bundles, that are named for their location of insertion on the anterior surface of the tibial plateau. Although the relative contribution in terms of total cross-sectional area of the ACL has been noted to be equal in regards to each bundle, dynamically these bundles demonstrate different properties for knee function.

  2. Revision of IAU Style Manual

    NASA Astrophysics Data System (ADS)

    Wilkins, G. A.

    The 1989 edition of the "IAU Style Manual" is in need of revision to reflect the changes in practice that have taken place since its preparation. These changes include the use of desk-top systems for the production of high-quality copy, the electronic transmission of text with embedded typesetting codes and the electronic publication of papers and reports, which may contain numerical data and images. The Manual should give advice and recommendations about the new procedures and typographical formats, but it is more important than ever that it should give clear and appropriate recommendations on matters that affect the quality of the content of all astronomical publications. The Manual should provide especially for the needs of astronomers who do not have English as their first language and it should include advice to them on the oral presentation of their papers. The editor. G. A. Wilkins, would be pleased to have the assistance of astronomers and others who are concerned with the quality of astronomical publications and who would be willing to participate in any aspect of the revision.

  3. 42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

  4. 42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

  5. 42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

  6. 42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

  7. 42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

  8. Early failure of bioabsorbable anterior cervical fusion plates: case report and failure analysis.

    PubMed

    Brkaric, Mario; Baker, Kevin C; Israel, Raj; Harding, Trevor; Montgomery, David M; Herkowitz, Harry N

    2007-05-01

    Case report with forensic failure analysis. To determine the failure modes of 3 explanted 70:30 PLDLA Mystique (Medtronic Sofamor Danek, Memphis, TN) graft containment plates retrieved from revision surgery for early device failure. To reduce the problems of stress-shielding and radiopacity associated with metallic systems, bioabsorbable polymers have been used in anterior cervical discectomy and fusion procedures. Degradation of mechanical properties in vivo is a major concern when using bioabsorbable systems. Three of 6 patients who underwent anterior cervical discectomy with instrumented fusion, using Mystique graft containment systems experienced early failure requiring revision to alternate hardware. Devices were retrieved after failure and analyzed by light microscopy and environmental scanning electron microscopy. Simulations were performed with an unused plating system to induce damage for comparison with the retrieved devices. A detailed case review was performed to identify possible sources of extraordinary loading or damage. One plating system failed at 6 weeks postimplantation due to fatigue fracture of the screws. Crack initiation sites were identified at the interface of the thread root and mold line of the screw. Another plating system failed at 16 weeks postimplantation due to the coalescence of radial microcracking between holes in the plate, leading to catastrophic failure of the plate. The final plating system failed during the implantation surgery, when the screw fractured in torsion. Stress concentrations at the screw head-shaft interface and thread-shaft interface reduce the fatigue performance of bioabsorbable screws. Hydrolysis of the polymer may also play a role in the reduction of resistance to crack initiation and propagation.

  9. Serratus anterior in vivo contractile force study.

    PubMed

    Lifchez, Scott D; Gasparri, Mario G; Sanger, James R; LoGiudice, John A; Godat, David M; Tisol, William B; Matloub, Hani S

    2005-09-01

    A major limitation of functional muscle transfer for facial and intrinsic hand reanimation is the inability to predict the force that will be generated by the transplanted muscle. The authors studied the contractile force of the slips of the serratus anterior in situ in 10 patients and tested the gracilis muscle in four subjects as a control. Mean contractile force generated by each serratus slip was 0.178 pound (range, 0.019 to 0.797 pound). This compares favorably with the maximum force generated by smiling (0.307 pound). Muscle strength correlated strongly with age (r = -0.805, p = 0.005). The lowest slip generated less force than those above it (0.133 pound versus 0.191 pound); this difference did not reach statistical significance. When the strength of the lowest slip is compared with the more superior slips as a percentage of total force generated by the slips (to compensate for the effect of age on muscle strength), the lowest slip was significantly weaker (18.6 percent of total force versus 25.5 percent of total force, p = 0.013). Mean contractile force generated by the gracilis was 0.963 pound, significantly different from that generated by a serratus anterior slip (p = 0.009). Each serratus slip could potentially be used to generate a separate force vector for facial reanimation. Further separation of the flap along preexisting fascial planes may allow generation of up to 10 independent force vectors, making the serratus anterior muscle flap an attractive option for facial reanimation and possibly intrinsic hand muscle reconstruction.

  10. Post operative voiding efficacy after anterior colporrhaphy.

    PubMed

    Kokabi, Roya; Fereidouni, Zhila; Meshkibaf, Mohammad Hassan; Miladpoor, Behnoosh

    2010-01-01

    The aim of this study was to determine the most effective and suitable time to remove the urinary catheter (Foley) after anterior and posterior colporrhaphy surgery. Patients who experience anterior Colporrhaphy operation for genuine stress incontinency or pelvic organ prolapsed will have post operative voiding dysfunction. These patients need postoperative drainage. One of the methods preferred for this purpose is to apply Foley Catheter, but there is no particular regimen available for the exact time of catheter removal in these patients. We have tried to find out the best time to remove Foley catheter after which the repeated Foley catheter is not required or minimized. One hundred and eighty nine patients who have been undergone Colporrhaphy have been selected randomly and divided into three groups' as 1, 2 and 4 days of catheter removal. The number of patients in each group was 62, 63 and 64 respectively. In all three groups, before removing urinary catheter, it was clamped every 4 hrs, for 3 times. After removing of Foley, the patients were guided for urination; the voiding and residual volume was measured. In the patients with an increase of residual volume, the repeated Foley requirement was increased. However, 5.6 % of the patients with residual volume of < or = 33 percent and 23.9% of the patients with residual volume between 33 to 68 percent, and finally 64.8% of the patients with residual volume of > or = 68% had repeated Foley insertion. When considering the number of days, 85, 65 and 35.7 percent of the patients needed repeated Foley after 1, 2, and 4 days of catheter removal respectively. Interestingly, in the third group (4 days of the catheter removal) with residual volume of < or = 33% the repeated Foley requirement was nil, with no increase risk of urinary infection. We suggest that the best time to remove the urinary Foley catheter after anterior and posterior Colporrhaphy is the day four.

  11. Risk Factors for Anterior Cruciate Ligament Injury

    PubMed Central

    Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra

    2012-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) of the knee are immediately debilitating and can cause long-term consequences, including the early onset of osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 1 of a 2-part series, highlights what is known and still unknown regarding anatomic and neuromuscular risk factors for injury to the ACL from the current peer-reviewed literature. Data Sources: Studies were identified from MEDLINE (1951–March 2011) using the MeSH terms anterior cruciate ligament, knee injury, and risk factors. The bibliographies of relevant articles and reviews were cross-referenced to complete the search. Study Selection: Prognostic studies that utilized the case-control and prospective cohort study designs to evaluate risk factors for ACL injury were included in this review. Results: A total of 50 case-control and prospective cohort articles were included in the review, and 30 of these studies focused on neuromuscular and anatomic risk factors. Conclusions: Several anatomic and neuromuscular risk factors are associated with increased risk of suffering ACL injury—such as female sex and specific measures of bony geometry of the knee joint, including decreased intercondylar femoral notch size, decreased depth of concavity of the medial tibial plateau, increased slope of the tibial plateaus, and increased anterior-posterior knee laxity. These risk factors most likely act in combination to influence the risk of ACL injury; however, multivariate risk models that consider all the aforementioned risk factors in combination have not been established to explore this interaction. PMID:23016072

  12. [Anterior semicircular canal Benign Paroxysmal Positional Vertigo].

    PubMed

    Alzuphar, Stephen Jacques; Maire, Raphaël

    2016-10-05

    Anterior semicircular canal Benign Paroxysmal Positional Vertigo (antBPPV) is the rarest form of semicircular canalolithiasis, corresponding to about 1-2 % of the BPPV. The diagnosis is obtained by either the Dix-Hallpike maneuver or the straight head hanging positioning maneuver, which provoke a characteristic positional down-beating nystagmus. This vertical nystagmus can be associated with a torsional component that helps in localizing the affected side. The differential diagnosis of antBPPV includes the various central lesions that produce vertical down beating nystagmus (posterior fossa). Several liberatory maneuvers have been proposed for the treatment of antBPPV, but still need standardization.

  13. Management of trauma of the anterior segment.

    PubMed

    Neubauer, H

    1978-04-01

    Since the introduction of the operating microscope the technique of wound repair has improved from purely reconstructive to preventive principles. In dealing with severe injuries of the anterior segment, the performance of vitrectomy seems to be the main problem. Secondary damage of the vitreous base has to be avoided, especially in children and juveniles. Prophylactic measurements against retinal detachment has proved to be useful. Using a light interference technique, the mode of action of different cutting instruments in the vitreous can be demonstrated. The guillotine technique seems to have the least distant effect. The scheme of surgical treatment has to be adapted to the individual situation and to the capability of the surgeon.

  14. 78 FR 44559 - Effective Date of Revised Company Registration Requirements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-24

    ... Energy Regulatory Commission Effective Date of Revised Company Registration Requirements AGENCY: Federal... of the Revised Company Registration Requirements. The Commission issued a Notice in the Federal..., anthony.barracchini@ferc.gov . SUPPLEMENTARY INFORMATION: Notice of Effective Date of Revised...

  15. EPA Approves Revisions to Pueblo of Pojoaque Water Quality Standards

    EPA Pesticide Factsheets

    DALLAS - (Dec. 16, 2015) The U.S. Environmental Protection Agency (EPA) approved revisions to the Pueblo of Pojoaque's water quality standards. The Clean Water Act revisions included revised aquatic life criteria and updates to technical references.

  16. [Anterior commissure status in patients with larynx cancer].

    PubMed

    Balcerowiak, Andrzej; Kruk-Zagajewska, Aleksandra; Iwanik, Katarzyna

    2013-01-01

    Assessment of directions and ways of cancer spreading in the anterior commissure of the larynx, depending on the tumor location, age, sex of patients in a clinical trial and in microscopic serial section study. The study included 50 larynx preparations obtained from open partial and total laryngectomies (F-7; M-43). For the assessment of larynx anterior commissure microscopic status 28 larynx preparations with macroscopic free anterior commissure were used. For study of the directions and ways of tumor spreading in the anterior commissure served 22 larynx with macroscopic infiltration of anterior commissure. Anterior Commissure (AC) and TNM classifications was used to determine the location and tumor stage. Larynx anterior commissure was extracted and divided into 3 subregions: supraglottic, glottic and subglottic. The direction and the way of cancer propagation in larynx anterior commissure structures is dependent on morphological changes that occur with aging. Cancer spreads in the anterior commissure along the fibers anchoring voice muscle within the Broyles ligament and is seen in tumor cells microembolism. In patients with cancer of the larynx without macroscopically visible neoplastic lesions in the anterior commissure, cannot be excluded its microinfilration. Changed with age anterior commissure' Broyles ligament by the process of neovascularization and ossification is not an effective protection against the spread of cancer. Directions and the ways of cancer spread in the anterior commissure is similar in men and women. AC classification can be important in qualifying patients for organ preservation surgery and should be supplemented by an additional AC4 degree, taking into account subglottic changes in the anterior commissure of the larynx. Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

  17. 48 CFR 315.307 - Proposal revisions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Source Selection 315.307 Proposal revisions. (b) Final proposal revisions are subject to— (1) A final evaluation of price or cost and other salient factors by the Contracting Officer and Project Officer, with assistance from a cost/price analyst, as...

  18. 25 CFR 276.14 - Budget revision.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Budget revision. 276.14 Section 276.14 Indians BUREAU OF... UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS § 276.14 Budget revision. Criteria and procedures to be followed by grantees in reporting deviations from grant budgets and requesting approval for budget...

  19. 76 FR 4258 - Occupational Radiation Protection; Revision

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-25

    ... Part 835 RIN 1901-AA-95 Occupational Radiation Protection; Revision AGENCY: Department of Energy...) proposes to revise the values in an appendix to its Occupational Radiation Protection requirements. The... requirements in title 10, Code of Federal Regulations, part 835 (10 CFR part 835), Occupational...

  20. 50 CFR 37.25 - Revision.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... WILDLIFE REFUGE SYSTEM GEOLOGICAL AND GEOPHYSICAL EXPLORATION OF THE COASTAL PLAIN, ARCTIC NATIONAL WILDLIFE REFUGE, ALASKA Exploration Plans § 37.25 Revision. (a) A permittee may request the Regional... 50 Wildlife and Fisheries 9 2013-10-01 2013-10-01 false Revision. 37.25 Section 37.25 Wildlife and...

  1. 50 CFR 37.25 - Revision.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... WILDLIFE REFUGE SYSTEM GEOLOGICAL AND GEOPHYSICAL EXPLORATION OF THE COASTAL PLAIN, ARCTIC NATIONAL WILDLIFE REFUGE, ALASKA Exploration Plans § 37.25 Revision. (a) A permittee may request the Regional... 50 Wildlife and Fisheries 9 2014-10-01 2014-10-01 false Revision. 37.25 Section 37.25 Wildlife and...

  2. 50 CFR 37.25 - Revision.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... WILDLIFE REFUGE SYSTEM GEOLOGICAL AND GEOPHYSICAL EXPLORATION OF THE COASTAL PLAIN, ARCTIC NATIONAL WILDLIFE REFUGE, ALASKA Exploration Plans § 37.25 Revision. (a) A permittee may request the Regional... 50 Wildlife and Fisheries 9 2012-10-01 2012-10-01 false Revision. 37.25 Section 37.25 Wildlife and...

  3. 50 CFR 37.25 - Revision.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... WILDLIFE REFUGE SYSTEM GEOLOGICAL AND GEOPHYSICAL EXPLORATION OF THE COASTAL PLAIN, ARCTIC NATIONAL WILDLIFE REFUGE, ALASKA Exploration Plans § 37.25 Revision. (a) A permittee may request the Regional... 50 Wildlife and Fisheries 8 2011-10-01 2011-10-01 false Revision. 37.25 Section 37.25 Wildlife and...

  4. How Mind Works To Revise Compositions.

    ERIC Educational Resources Information Center

    Lin, Deh-nan

    This study investigated cognitive processes involved in English-as-a-Second-Language (ESL) students' correcting and revising drafts after receiving oral feedback from their teachers, noting factors that led to better written products and factors that did not improve student writing. The study examined what kinds of revision strategies students…

  5. 44 CFR 65.7 - Floodway revisions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... by communities participating in the NFIP). (4) Engineering analysis for the revised floodway, as... submitted. (2) Engineering analysis for the revised floodway, as described below: (i) The original hydraulic... alternate model has been calibrated so as to reproduce the original water surface profile of the original...

  6. Evaluating Writing: Effects of Feedback on Revision.

    ERIC Educational Resources Information Center

    Chaudron, Craig

    The effect of evaluation method on English as second language (ESL) learners' revisions of their compositions was investigated. Teacher comments, peer evaluations, and English-speaking peer reformulations were compared. Judges rated the revised compositions of 9 advanced and 14 intermediate college ESL students using the ESL Composition Profile.…

  7. Phonetic Aspects of Children's Elicited Word Revisions.

    ERIC Educational Resources Information Center

    Paul-Brown, Diane; Yeni-Komshian, Grace H.

    A study of the phonetic changes occurring when a speaker attempts to revise an unclear word for a listener focuses on changes made in the sound segment duration to maximize differences between phonemes. In the study, five-year-olds were asked by adults to revise words differing in voicing of initial and final stop consonants; a control group of…

  8. The Teacher Observation Form: Revisions and Updates

    ERIC Educational Resources Information Center

    Peters, Scott J.; Gates, Jillian C.

    2010-01-01

    This article discusses the original development and subsequent updates and revisions made to the Teacher Observation Form (TOF). The TOF is a 12-item form to be used by evaluators in the observation of teachers of gifted and talented students. After nearly 25 years of use, the original TOF was revised based on input from content experts and…

  9. Sequenced Peer Revision: Creating Competence and Community

    ERIC Educational Resources Information Center

    Bowman, Ingrid K.; Robertson, John

    2013-01-01

    Mastering techniques of self- and peer revision is a valuable tool for all writers, especially US-educated Generation 1.5 students, whose near fluency enables them to dialogue successfully about their writing. Using action research, 2 academic writing instructors systematically trained students to more responsibly and effectively revise their…

  10. 30 CFR 5.50 - Fee revisions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Fee revisions. 5.50 Section 5.50 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR TESTING, EVALUATION, AND APPROVAL OF MINING PRODUCTS FEES FOR TESTING, EVALUATION, AND APPROVAL OF MINING PRODUCTS § 5.50 Fee revisions. Each...

  11. 30 CFR 5.50 - Fee revisions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Fee revisions. 5.50 Section 5.50 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR TESTING, EVALUATION, AND APPROVAL OF MINING PRODUCTS FEES FOR TESTING, EVALUATION, AND APPROVAL OF MINING PRODUCTS § 5.50 Fee revisions. Each...

  12. 50 CFR 37.25 - Revision.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... WILDLIFE REFUGE SYSTEM GEOLOGICAL AND GEOPHYSICAL EXPLORATION OF THE COASTAL PLAIN, ARCTIC NATIONAL WILDLIFE REFUGE, ALASKA Exploration Plans § 37.25 Revision. (a) A permittee may request the Regional Director for permission to revise its approved exploration plan. Until the Regional Director grants the...

  13. 48 CFR 315.307 - Proposal revisions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Proposal revisions. 315.307 Section 315.307 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Source Selection 315.307 Proposal revisions....

  14. Revised standards for sterilisation: the changes.

    PubMed

    Hoxey, E; Strain, P; Harries, J; Kirk, B

    2007-01-01

    The standards for the three main methods of sterilising medical devices, ethylene oxide, radiation and moist heat, have been revised. This article discusses the major changes in the requirements, which will need to be addressed to demonstrate compliance with the revised standards.

  15. Revised State Budget Sells Kids Short

    ERIC Educational Resources Information Center

    Children Now, 2012

    2012-01-01

    The Administration's May Revision of the 2012-2013 state budget addresses a $15.7 billion shortfall through funding shifts, cuts, and new revenue sources that place children squarely in harms way. California's kids are already grossly underserved relative to the rest of the nation's children. If the May Revise budget is passed by the Legislature,…

  16. Anterior Cruciate Ligament Reconstruction Using a Combination of Autograft and Allograft Tendon

    PubMed Central

    Darnley, James E.; Léger-St-Jean, Benjamin; Pedroza, Angela D.; Flanigan, David C.; Kaeding, Christopher C.; Magnussen, Robert A.

    2016-01-01

    Background: Anterior cruciate ligament (ACL) reconstruction with hamstring autografts less than 8.5 mm in diameter is associated with worse patient-reported outcome scores and increased risk of revision surgery compared with reconstructions performed with larger grafts. One proposed solution to small autograft harvest is to create a hybrid graft by augmenting autografts with allograft tissue to increase graft diameter. Purpose: To compare hybrid autograft/allograft ACL reconstruction to autograft ACL reconstruction, specifically analyzing the patient-reported outcome scores and the risk of revision surgery at 2 years postoperative. Study Design: Cohort study; Level of evidence, 3. Methods: From the years 2002 to 2009, a total of 34 patients were identified from a prospectively collected database as having undergone hybrid ACL reconstruction. Twenty-seven of 34 (79.4%) patients had a 2-year follow-up. These 27 patients were matched by age (within 1 year) and sex to 27 patients who underwent hamstring autograft ACL reconstruction during the same period. At the 2-year mark, revision surgery risk and patient-reported outcome scores were compared between the 2 groups. Results: The mean age for the hybrid and matched groups (±SD) was 20.9 ± 7.0 years. Both the hybrid and control groups had 17 males and 10 females. There was no significant difference in preoperative patient-reported outcome scores, meniscus tears, or cartilage lesions between the 2 groups. Graft size was larger in the hybrid group (9.5 ± 0.6 mm) than in the autograft group (8.4 ± 0.9 mm) (P < .001). At 2 years postoperative, patient-reported outcome scores were similar between the hybrid and autograft groups. Revision surgery was required in 5 (18.5%) patients who underwent hybrid reconstruction compared with 2 (7.4%) of those who underwent autograft reconstruction (P = .26). Conclusion: Patients who undergo ACL reconstruction with hybrid hamstring grafts and hamstring autografts report similar

  17. Anterior vitrectomy and partial capsulectomy via anterior approach to treat chronic postoperative endophthalmitis

    PubMed Central

    Güler, Mete; Yılmaz, Turgut

    2013-01-01

    AIM To describe the results of vitrectomy and partial capsulectomy via anterior approach surgical technique in treatment of chronic postoperative endophthalmitis (CPE). METHODS Clinical records of 9 patients treated for CPE between 2006 and 2010 were reviewed retrospectively. All of these patients were treated with vitrectomy and partial capsulectomy via anterior approach. RESULTS Six of 9 patients were male. The average patients' age was (60±8.1) years. The average period between cataract extraction and onset of signs and symptoms was (3.6±1.3) weeks. The average presenting visual acuity was 0.3±0.1 and the average final post operative visual acuity was 0.7±0.2. The mean follow-up period was (28.1±8.9) weeks. In all patients, the inflammation subsided after surgery. CONCLUSION Our results suggest that anterior vitrectomy and partial capsulectomy via anterior approach may be considered as potentially useful and relatively less invasive technique to treat CPE. PMID:23550103

  18. Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly.

    PubMed

    Zhao, Jie; Lian, Xiao Feng; Hou, Tie Sheng; Ma, Hui; Chen, Zhi Ming

    2007-12-01

    Between 2000 and 2004, 40 cases (average age 38, range 16-65 years) of spinal tuberculosis were treated with anterior debridement and iliac bone graft with one-stage anterior or posterior instrumentation in our unit. All patients received at least 2 weeks of regular antituberculous chemotherapy before surgery. We followed up all patients for 12-48 months (mean 22 months). Local symptoms of all patients were relieved significantly 1-3 weeks postoperatively; 23 of 25 cases (92%) with neurogical deficit had excellent or good clinical results. Erythrocyte sedimentation rates (ESR) returned from 51 mm/h to 32 mm/h (average) two weeks postoperatively. Kyphosis degrees were corrected by a mean of 16 degrees . Fusion rate of the grafting bone was 72.5% one year postoperatively and 90% two years postoperatively. Severe complications did not occur. We therefore believe that patients undergoing anterior debridement and iliac bone grafting with one-stage anterior or posterior instrumentation achieve satisfactory clinical and radiographic outcomes.

  19. INFLUENCE OF ANTERIOR PAIN ON RESULTS FROM ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    PubMed Central

    Vasconcelos, Wilson; Santos, Claudinei; Ferracini, Antonio Marcos; Dejour, David

    2015-01-01

    Objective: To examine the impact of residual pain on functional outcomes two years after arthroscopic anterior cruciate ligament (ACL) reconstruction and compare the types of graft used during the procedure (patellar vs. flexor). Method: A retrospective epidemiological study on 129 ACL reconstructions with a mean follow-up of 28 months was conducted. The presence, intensity and location of the anterior pain were investigated. Pain provocation tests were conducted, sensitivity was analyzed and functional scores were applied (IKDC, femoropatellar and SF-36), comparing the results with the type of graft used. Results: Anterior pain was present in 28% of patients with a mean intensity of 2.9 in 10. When pain was present, the functional scores decreased significantly. Abnormalities of knee sensitivity and gait occurred frequently with use of the patellar tendon, but there was no statistical difference regarding the presence of pain. Conclusion: The presence of anterior pain in ACL reconstructions, even if minimal, has a deleterious effect on the final outcome over the medium term. Because of the influence of graft harvesting on the presence of abnormalities of knee sensitivity and gait, choosing the graft should take into account the patient's professional and sports activities. PMID:27026984

  20. Anterior segment spectral domain optical coherence tomography imaging of patients with anterior scleritis.

    PubMed

    Levison, Ashleigh L; Lowder, Careen Y; Baynes, Kimberly M; Kaiser, Peter K; Srivastava, Sunil K

    2016-08-01

    The purpose of the study was to describe the findings seen on anterior segment spectral domain optical coherence tomography (SD-OCT) in patients with anterior scleritis and determine the feasibility of using SD-OCT to image and grade the degree of scleral inflammation and monitor response to treatment. All patients underwent slit lamp examination by a uveitis specialist, and the degree of scleral inflammation was recorded. Spectral domain OCT imaging was then performed of the conjunctiva and scleral tissue using a standardized acquisition protocol. The scans were graded and compared to clinical findings. Twenty-eight patients with anterior scleritis and ten patients without ocular disease were included in the study. Seventeen of the scleritis patients were followed longitudinally. Common findings on SD-OCT in patients with active scleritis included changes in hyporeflectivity within the sclera, nodules, and visible vessels within the sclera. There was significant variation in findings on SD-OCT within each clinical grade of active scleritis. These changes on SD-OCT improved with treatment and clinical improvement. SD-OCT imaging provided various objective measures that could be used in the future to grade inflammatory activity in patients with anterior scleritis. Longitudinal imaging of patients with active scleritis demonstrated that SD-OCT may have great utility in monitoring response to treatment.

  1. Rostral anterior cingulate activity generates posterior versus anterior theta activity linked to agentic extraversion.

    PubMed

    Chavanon, Mira-Lynn; Wacker, Jan; Stemmler, Gerhard

    2011-06-01

    Recent research using the resting electroencephalogram (EEG) showed that posterior versus anterior theta activity (around 4-8 Hz) is consistently associated with agency, reflecting the dopaminergic core of extraversion (i.e., incentive motivation, positive emotion). Neuroimaging studies using various methodologies and experimental paradigms have converged on the anterior cingulate cortex (ACC) as a neurophysiological correlate of extraversion. The aim of the present study is integrate these lines of research by testing the hypothesis that posterior versus anterior EEG theta is at least partly based on ACC theta activity. Resting EEG data were analyzed in N = 78 healthy, male participants extremely high or low in agentic extraversion (aE). Using the low-resolution electromagnetic tomography algorithm, we localized the sources of aE-dependent intracerebral theta activity within rostral subdivisions of the ACC. The posterior versus anterior index and theta current density within the rostral ACC were significantly correlated (r = -.52), and both displayed high retest stability across 5 hr and were associated with traits from the aE spectrum. These neurophysiological correlates of aE and their possible functional significance are discussed.

  2. Late spontaneous resolution of a double anterior chamber post deep anterior lamellar keratoplasty.

    PubMed

    Passani, Andrea; Sframeli, Angela Tindara; Loiudice, Pasquale; Nardi, Marco

    2017-01-01

    A 31-year-old healthy male underwent deep anterior lamellar keratoplasty with big-bubble technique for treatment of keratoconus in his right eye. One week after surgery, he presented with detachment of the endothelium-Descemet complex with formation of a double anterior chamber, despite the apparent absence of an intraoperative Descemet membrane rupture. A subsequent intervention with the intent to relocate the corneal graft button was not effective, because the detachment appeared again one day later. The authors hypothesized that, at the time of the stromal dissection with big bubble technique, a small amount of air penetrated into the anterior chamber, creating a false pathway through the trabecular meshwork. The aqueous humor then penetrated the graft flowing through the false pathway, causing the endothelium-Descemet detachment. The persistence of that pathway, even after the intervention of graft repositioning, caused the failure of the latter procedure and persistence of the double chamber. We decided to wait and observe. The double anterior chamber spontaneously resolved in approximately three months.

  3. Anterior chamber angle in the exfoliation syndrome.

    PubMed Central

    Wishart, P K; Spaeth, G L; Poryzees, E M

    1985-01-01

    The gonioscopic findings of 76 patients with the exfoliation syndrome were reviewed. A high frequency of narrowness of the anterior chamber (AC) angle was found (32%). 18% had angles considered occludable, and 14% had obvious angle-closure glaucoma as shown by the presence of peripheral anterior synechias (PAS). Increased pigmentation of the posterior trabecular meshwork (PTM) was noted in all cases. When this pigmentation was markedly asymmetrical, unilateral exfoliation with glaucoma was common in the more pigmented eye. In addition heavy angle pigmentation in the absence of exfoliation was noted in the fellow eye of patients with characteristic exfoliated material in the other eye. Increased pigmentation of the PTM may be the earliest detectable sign of the exfoliation syndrome (ES). The clinical significance of our estimating PTM pigmentation at the 12 o'clock position is discussed. In view of the accelerated optic nerve damage associated with the development of glaucoma secondary to ES, routine estimation of the pigmentation of the PTM at 12 o'clock is recommended in the hope of early detection of cases of otherwise inapparent ES. Images PMID:3966996

  4. Anterior cruciate ligament reconstruction: principles of treatment

    PubMed Central

    Paschos, Nikolaos K.; Howell, Stephen M.

    2016-01-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures in sports medicine. Several areas of controversy exist in ACL tear management which have engaged surgeons and researchers in debates towards identifying an ideal approach for these patients. This instructional review discusses the principles of ACL reconstruction in an attempt to provide guidelines and initiate a critical thinking approach on the most common areas of controversy regarding ACL reconstruction. Using high-level evidence from the literature, as presented in randomised controlled trials, systematic reviews, and meta-analyses, operative versus conservative treatment, timing of surgery, and rehabilitation are discussed. Also, the advantages and disadvantages of the most common types of autografts, such as patellar tendon and hamstrings as well as allografts are presented. Key considerations for the anatomical, histological, biomechanical and clinical data (‘IDEAL’) graft positioning are reviewed. Cite this article: Paschos NK, Howell SM. Anterior cruciate ligament reconstruction: principles of treatment. EFORT Open Rev 2016;398-408. DOI: 10.1302/2058-5241.1.160032. PMID:28461919

  5. Adjacent Segment Pathology after Anterior Cervical Fusion

    PubMed Central

    Chung, Jae Yoon; Park, Jong-Beom; Seo, Hyoung-Yeon

    2016-01-01

    Anterior cervical fusion has become a standard of care for numerous pathologic conditions of the cervical spine. However, subsequent development of clinically significant disc disease at levels adjacent to fused discs is a serious long-term complication of this procedure. As more patients live longer after surgery, it is foreseeable that adjacent segment pathology (ASP) will develop in increasing numbers of patients. Also, ASP has been studied more intensively with the recent popularity of motion preservation technologies like total disc arthroplasty. The true nature and scope of ASP remains poorly understood. The etiology of ASP is most likely multifactorial. Various factors including altered biomechanical stresses, surgical disruption of soft tissue and the natural history of cervical disc disease contribute to the development of ASP. General factors associated with disc degeneration including gender, age, smoking and sports may play a role in the development of ASP. Postoperative sagittal alignment and type of surgery are also considered potential causes of ASP. Therefore, a spine surgeon must be particularly careful to avoid unnecessary disruption of the musculoligamentous structures, reduced risk of direct injury to the disc during dissection and maintain a safe margin between the plate edge and adjacent vertebrae during anterior cervical fusion. PMID:27340541

  6. Clear anterior rhinorrhea in the population.

    PubMed

    Rodriguez, Kenneth; Rubinstein, Elaine; Ferguson, Berrylin J

    2015-11-01

    Clear anterior rhinorrhea is commonly observed in older adults and is widely known as "senile rhinorrhea." Although appreciated in the literature, no studies support that clear rhinorrhea increases with age. Our goal was to determine the prevalence of clear rhinorrhea in adults and the variation between young and old. Additionally, we sought to determine if clear rhinorrhea was bothersome enough for patients to seek treatment. A questionnaire was randomly distributed to 158 adults, 76 young adults on the University of Pittsburgh Undergraduate campus, and 82 older adults at Longwood Retirement Community in 2011. Older subjects reported more drip and an increase in rhinorrhea over time regardless of gender (p < 0.05). Participants wanting to seek treatment reported drip occurred more often, that they used more tissues, and were more bothered by drip compared to those not wanting treatment (p < 0.05). Clear, anterior rhinorrhea affects older adults regardless of gender significantly more often and more severely than young adults (p < 0.05). The more frequent and bothersome the nasal drip, the more likely individuals would elect treatment. © 2015 ARS-AAOA, LLC.

  7. Anterior insular cortex and emotional awareness.

    PubMed

    Gu, Xiaosi; Hof, Patrick R; Friston, Karl J; Fan, Jin

    2013-10-15

    This paper reviews the foundation for a role of the human anterior insular cortex (AIC) in emotional awareness, defined as the conscious experience of emotions. We first introduce the neuroanatomical features of AIC and existing findings on emotional awareness. Using empathy, the awareness and understanding of other people's emotional states, as a test case, we then present evidence to demonstrate: 1) AIC and anterior cingulate cortex (ACC) are commonly coactivated as revealed by a meta-analysis, 2) AIC is functionally dissociable from ACC, 3) AIC integrates stimulus-driven and top-down information, and 4) AIC is necessary for emotional awareness. We propose a model in which AIC serves two major functions: integrating bottom-up interoceptive signals with top-down predictions to generate a current awareness state and providing descending predictions to visceral systems that provide a point of reference for autonomic reflexes. We argue that AIC is critical and necessary for emotional awareness. Copyright © 2013 Wiley Periodicals, Inc.

  8. Risk Factors for Anterior Cruciate Ligament Injury

    PubMed Central

    Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra; Beynnon, Bruce D.

    2012-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) are immediately disabling and are associated with long-term consequences, such as posttraumatic osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 2 of a 2-part series, highlights what is known and still unknown regarding hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors for ACL injury. Data Sources: Studies were identified from MEDLINE (1951–March 2011) using the MeSH terms anterior cruciate ligament, knee injury, and risk factors. The bibliographies of relevant articles and reviews were cross-referenced to complete the search. Study Selection: Prognostic case-control and prospective cohort study designs to evaluate risk factors for ACL injury were included in this review. Results: A total of 50 case-control and prospective cohort articles were included in parts 1 and 2. Twenty-one focused on hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors. Conclusions: Several risk factors are associated with increased risk of suffering ACL injury—such as female sex, prior reconstruction of the ACL, and familial predisposition. These risk factors most likely act in combination with the anatomic factors reviewed in part 1 of this series to influence the risk of suffering ACL injury. PMID:23016083

  9. Proximal anterior cruciate ligament tears: the healing response technique versus conservative treatment.

    PubMed

    Wasmaier, Johann; Kubik-Huch, Rahel; Pfirrmann, Christian; Grehn, Holger; Bieg, Christian; Eid, Karim

    2013-08-01

    The healing response technique (HRT) is a nonreconstructive method to promote healing in proximal anterior cruciate ligament (ACL) tears. The study reviews clinical and radiological long-term results. Thirty patients (average age 31 years) were treated according to the protocol described by Steadman et al. For comparison, an age- and gender-matched control group of conservatively treated patients (CST; n = 127) was selected. At follow-up (mean: 4 years), all patients were evaluated using Kneelax-3-arthrometer, magnetic resonance imaging (MRI), and by clinical examination. Two HRT patients were lost to follow-up and 10 (36%) patients needed definitive ACL reconstruction. The rate of secondary ACL reconstruction in the initial CST group was 56% (71 of 127). Nineteen of the conservatively treated patients were selected according to above-mentioned criteria. The average Lysholm score in the HRT group was 91 (CST group = 90), and the Orthopaedische Arbeitsgemeinschaft Knie score was 93 (CST group = 92). Tegner score decreased from 6.8 before injury to 5.7 at the time of follow-up (CST group: 6.0 to 5.1). Kneelax-3-arthrometer showed a significant higher anterior knee laxity compared with the noninjured side in both groups. MRI showed improvement of the ACL in both groups. HRT in adult patients is associated with a high revision rate of 36% secondary ACL reconstruction, comparable with primary conservative treatment (p = 0.056). For the remaining patients (64%), HRT did not result in better outcomes than conservative treatment.

  10. The direct anterior approach in hemiarthroplasty for displaced femoral neck fractures.

    PubMed

    Schneider, Kerstin; Audigé, Laurent; Kuehnel, Stefanie-Peggy; Helmy, Naeder

    2012-09-01

    Hip replacement is the most common treatment for displaced femoral neck fractures in the elderly, and minimally invasive surgery is popular in the field of orthopaedic surgery. This study evaluated the outcome of monopolar hemiarthroplasty by the direct anterior approach over a postoperative period up to 2.5 years. A total of 86 patients with displaced femoral neck fractures were included (mean age of 86.5 years). Surviving patients were reviewed three months (retrospectively) and one to 2.5 years (prospectively) after surgery. One-year mortality was 36 %. For all stems, implant positioning with respect to stem alignment, restoration of leg length and femoral offset was correct. Acetabular protrusion was observed in 55 % of the patients one to 2.5 years postoperatively. Subsidence and intraoperative periprosthetic fractures occurred in three patients (3 %) each. All revision stems for postoperative periprosthetic fractures could be implanted using the initial surgical technique without extension of the previous approach. The mean Harris hip score was 85 points at the one to 2.5-year follow-up; 85 % of the patients were satisfied with their hip and 57 % returned to their preoperative level of mobility. Based on these findings, hemiarthroplasty for hip fractures can be performed safely and effectively via the direct anterior approach with good functional outcome and high patient satisfaction.

  11. Quantification of tibial bone loss in antegrade versus retrograde tunnel placement for anterior cruciate ligament reconstruction.

    PubMed

    Osti, Michael; Krawinkel, Alessa; Hoffelner, Thomas; Benedetto, Karl Peter

    2015-08-01

    Tibial bone destruction during primary graft tunnel placement and tibial bone loss following tunnel enlargement represent major challenges in revision reconstruction of the anterior cruciate ligament (ACL). Initial all-inside ACL reconstruction facilitates the preparation of tibial bone sockets rather than full tunnels that potentially preserve tibial bone stock. The purpose of this study was to comparatively assess length, diameter and volume of tibial graft tunnels following all-inside and conventional ACL reconstruction. Postoperative computed tomography (CT) scans of 59 patients were assessed following ACL reconstruction. In 35 patients we used conventional antegrade tibial tunnel drilling and in 24 all-inside retrograde tibial bone sockets. Imaging analysis included total, minimal and maximal tunnel length and tunnel diameter. Tunnel volumes were calculated corresponding to these parameters. Statistically significant group differences (p < 0.01) could be detected for tibial tunnel volume, length and diameter between conventional antegrade and all-inside retrograde tibial bone tunnels and sockets, respectively. Compared with conventional techniques, all-inside retrograde drilling of tibial bone sockets is effective in preserving significant bone stock, which might be beneficial for revision reconstruction in cases of eventual primary graft failure.

  12. Laparoscopic revision surgery for gastroesophageal reflux disease

    PubMed Central

    Celasin, Haydar; Genc, Volkan; Celik, Suleyman Utku; Turkcapar, Ahmet Gökhan

    2017-01-01

    Abstract Laparoscopic antireflux surgery is a frequently performed procedure for the treatment of gastroesophageal reflux in surgical clinics. Reflux can recur in between 3% and 30% of patients on whom antireflux surgery has been performed, and so revision surgery can be required due to recurrent symptoms or dysphagia in approximately 3% to 6% of the patients. The objective of this study is to evaluate the mechanism of recurrences after antireflux surgery and to share our results after revision surgery in recurrent cases. From 2001 to 2014, revision surgery was performed on 43 patients (31 men, 12 women) between the ages of 24 and 70 years. The technical details of the first operation, recurrence symptoms, endoscopy, and manometry findings were evaluated. The findings of revision surgery, surgical techniques, morbidity rates, length of hospitalization, and follow-up period were also recorded and evaluated. The first operation was Nissen fundoplication in 34 patients and Toupet fundoplication in 9 patients. Mesh hiatoplasty was performed for enforcement in 18 (41.9%) of these patients. The period between the first operation and the revision surgery ranged from 4 days to 60 months. The most common finding was slipped fundoplication and presence of hiatal hernia during revision surgery. Revision fundoplication and hernia repair with mesh reinforcement were used in 33 patients. The other techniques were Collis gastroplasty, revision fundoplication, and hernia repair without mesh. The range of follow-up period was from 2 to 134 months. Recurrence occurred in 3 patients after revision surgery (6.9%). Although revision surgery is difficult and it has higher morbidity, it can be performed effectively and safely in experienced centers. PMID:28072725

  13. 77 FR 73454 - Revision of Information Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-10

    ... requirements; revise the Grant Application Narrative questions to clarify new concepts; Simplify language and... alignment between narrative sections and the performance measures work plans. The proposed revisions do...

  14. Radiological control manual. Revision 1

    SciTech Connect

    Kloepping, R.

    1996-05-01

    This Lawrence Berkeley National Laboratory Radiological Control Manual (LBNL RCM) has been prepared to provide guidance for site-specific additions, supplements and interpretation of the DOE Radiological Control Manual. The guidance provided in this manual is one methodology to implement the requirements given in Title 10 Code of Federal Regulations Part 835 (10 CFR 835) and the DOE Radiological Control Manual. Information given in this manual is also intended to provide demonstration of compliance to specific requirements in 10 CFR 835. The LBNL RCM (Publication 3113) and LBNL Health and Safety Manual Publication-3000 form the technical basis for the LBNL RPP and will be revised as necessary to ensure that current requirements from Rules and Orders are represented. The LBNL RCM will form the standard for excellence in the implementation of the LBNL RPP.

  15. Laser scar revision: A review.

    PubMed

    Khatri, Khalil A; Mahoney, Danielle L; McCartney, Melissa J

    2011-04-01

    Surgery, burns, wounds, and inflammatory processes can lead to the development of a variety of different scars. Scars are categorized as hypertrophic, keloid, atrophic and acne scars. Different treatments are utilized for each scar type. The evolution of scar treatment has led to the advancement of lasers for the improvement of all scar types. Non-ablative lasers such as the pulsed dye laser have been shown to be effective in the treatment of hypertrophic and erythematous scars. Ablative lasers, the carbon dioxide (CO(2)) and erbium:YAG (Er:YAG), were some of the first lasers that were proven to be effective in the treatment of atrophic acne scars. Further developments in laser technology have led to non-ablative and ablative fractional devices that improve scar appearance and are better tolerated than ablative CO(2) and Er:YAG. This article will review scars and the laser options for scar revision.

  16. Analysis of postoperative monitoring of patients undergoing shoulder arthroscopy for anterior instability.

    PubMed

    Almeida, Alexandre; Menegotto, Samuel Millán; Almeida, Nayvaldo Couto de; Agostini, Ana Paula; Almeida, Letícia Agostini de

    2017-01-01

    Analyze the postoperative follow-up of patients undergoing shoulder arthroscopy for treatment of anterior instability and correlate with the prevalence of recurrence. A six-question survey was applied by phone and mail to 65 patients, seeking information on the current result of the surgical procedure. All patients were treated arthroscopically for anterior shoulder instability, with at least 12 months of postoperative time. Patients with associated posterior labial lesions and revision surgeries were not included. At the time of the survey the patients had a median of 56 (IQR: 34.5-110.5) postoperative months. The mean sample age was 24.6 years (maximum = 47, minimum = 12; SD = 7.3). Complaint of pain in the shoulder was observed in 20 patients (30.7%). Dislocation recurrence was observed in 10 patients (15.3%). Forty-four patients (67.6%) considered their shoulder normal, which was more frequent in non-recurrence patients (p < 0.001). Forty-three patients (66.1%) returned to their previous level of sport and there was no difference between recurrence and non-recurrence patients (p = 0.456). It was found that the prevalence of recurrence was 5.6 (95% CI: 1.30-24.46) times higher in individuals who abandoned monitoring before six months postoperatively (p = 0.012). The abandonment of postoperative monitoring in the early stages, when the patients receive orientation for muscle strengthening, proprioceptive education, and dangerous movements to avoid, can increase the rates of recurrent shoulder dislocation in patients treated for anterior instability by arthroscopy.

  17. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table.

    PubMed

    Matta, Joel M; Shahrdar, Cambize; Ferguson, Tania

    2005-12-01

    Dislocation remains the leading early complication of total hip arthroplasty; surgical approach and implant positioning have been recognized as factors influencing total hip arthroplasty stability. We describe a total hip arthroplasty technique done through a single, tissue sparing anterior approach that allows implantation of the femoral and acetabular components without detaching or sectioning any of the muscles and tendons around the hip joint. A series of 437 consecutive, unselected patients who had 494 primary total hip arthroplasty surgeries done through an anterior approach on an orthopaedic table from September 1996 to September 2004 was reviewed. There were 54 hybrid and 442 uncemented hips in the 437 patients (57 bilateral). The average patient age was 64 years. Radiographic analysis showed an average abduction angle of 42 degrees , with 96% in the range of 35 degrees to 50 degrees abduction. The average cup anteversion was 19 degrees with 93% within the target range of 10 degrees to 25 degrees . Postoperative leg length discrepancy averaged 3 +/- 2 mm (range, 0-26 mm). Three patients sustained dislocations for an overall dislocation rate of 0.61%, and no patients required revision surgery for recurrent dislocation. There were 17 operative complications, including one deep infection, three wound infections, one transient femoral nerve palsy, three greater trochanter fracture, two femoral shaft fractures four calcar fractures, and three ankle fractures. Operative time averaged 75 minutes (range 40-150 minutes), and the average blood loss was 350 mL (range, 100-1300 mL). The mean hospital stay was 3 days (range, 1-17 days). The anterior approach on the orthopaedic table is a minimally invasive technique applicable to all primary hip patients. This technique allows accurate and reproducible component positioning and leg-length restoration and does not increase the rate of hip dislocation. Therapeutic study, Level IV-1 (case series). See the Guidelines for

  18. Anterior segment imaging in glaucoma: An updated review

    PubMed Central

    Maslin, Jessica S; Barkana, Yaniv; Dorairaj, Syril K

    2015-01-01

    Anterior segment imaging allows for an objective method of visualizing the anterior segment angle. Two of the most commonly used devices for anterior segment imaging include the anterior segment optical coherence tomography (AS-OCT) and the ultrasound biomicroscopy (UBM). AS-OCT technology has several types, including time-domain, swept-source, and spectral-domain-based configurations. We performed a literature search on PubMed for articles containing the text “anterior segment OCT,” “ultrasound biomicroscopy,” and “anterior segment imaging” since 2004, with some pertinent references before 2004 included for completeness. This review compares the advantages and disadvantages of AS-OCT and UBM, and summarizes the most recent literature regarding the importance of these devices in glaucoma diagnosis and management. These devices not only aid in visualization of the angle, but also have important postsurgical applications in bleb and tube imaging. PMID:26576519

  19. [Revision of failed ankle arthrodeses].

    PubMed

    Eingartner, Christoph; Weise, Kuno

    2005-10-01

    Ankle arthrodesis with the foot at 90 degrees with minimal as possible leg shortening. Regain of a pain-free use of the limb. Failure of arthrodesis, septic or aseptic in origin, accompanied by pain interfering with weight bearing. General surgical or anesthesiologic risks. Acute reflex sympathetic dystrophy. Significant arterial circulatory disturbances or extensive neurologic deficits. Extensive bone or soft-tissue defects after previous surgeries. Approach using existing scars. Resection of nonunion making allowance for the planned position of arthrodesis. Removal of all necrotic bony and soft tissue. Posterior translation of talus by 1 cm. Autogenous bone grafting of major defects. Temporary fixation with a Kirschner wire with the foot at 90 degrees in the sagittal plane, in 0 degrees in the frontal plane, and 10-20 degrees of external rotation. Application of an external fixator, removal of Kirschner wire and compression of resection surfaces. If needed, apposition of cancellous bone harvested from iliac crest. Suction drain. Wound closure. Revision of arthrodesis in 13 men and three women (average age 48 years [27-76 years]). Average follow-up 10.8 months (3-26 months). In spite of problematic preoperative conditions (local infection eight times, malposition five times) a bony consolidation occurred in 15 of 16 patients, 14 times in a perfect position. Average leg shortening 2.8 cm (1-8.5 cm). Satisfactory soft-tissue healing in twelve patients. Superficial ulceration in two patients, fistula in one. Successful repeat revision of arthrodesis in one patient on account of persisting nonunion and infection.

  20. Winging of scapula due to serratus anterior tear.

    PubMed

    Singh, Varun Kumar; Vargaonkar, Gauresh Shantaram

    2014-01-01

    Winging of scapula occurs most commonly due to injury to long thoracic nerve supplying serratus anterior muscle. Traumatic injury to serratus anterior muscle itself is very rare. We reported a case of traumatic winging of scapula due to tear of serratus anterior muscle in a 19-year-old male. Winging was present in neutral position and in extension of right shoulder joint but not on "push on wall" test. Patient was managed conservatively and achieved satisfactory result.

  1. Evaluation of anterior segment parameters during and after pregnancy.

    PubMed

    Ataş, Mustafa; Duru, Necati; Ulusoy, Döndü Melek; Altınkaynak, Hasan; Duru, Zeynep; Açmaz, Gökhan; Ataş, Fatma Kaya; Zararsız, Gökmen

    2014-12-01

    To compare the anterior segment parameters during pregnancy and post-pregnancy. Fifty-four healthy pregnant women in their third trimester with ages ranging from 18 to 38 years were included in the study. All of the patients underwent comprehensive ophthalmologic examinations, including refraction, anterior segment, and fundus examinations, intraocular pressure, and axial length measurements. In addition, anterior chamber angle, anterior chamber depth, anterior chamber volume, corneal volume, central corneal thickness, and keratometry values were measured by Pentacam Scheimpflug camera. All measurements were measured again 3 months after delivery. The mean intraocular pressure, anterior chamber angle, anterior chamber depth, anterior chamber volume, corneal volume, central corneal thickness, and keratometry measurements were significantly different during pregnancy and post-pregnancy (p<0.05 for all); however, the mean spherical refraction, cylindrical refraction, and axial length were not statistically significantly different during pregnancy and post-pregnancy (p>0.05 for all). We found that there is an increase in the anterior chamber parameters, corneal volume, corneal thickness, and corneal curvature and a decrease in intraocular pressure in the third trimester. Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  2. Application of Anterior Segment Optical Coherence Tomography in Pediatric Ophthalmology

    PubMed Central

    Cauduro, Ricardo Salles; Ferraz, Caroline do Amaral; Morales, Maira Saad Ávila; Garcia, Patricia Novita; Lopes, Yara Cristina; Souza, Paulo Henrique; Allemann, Norma

    2012-01-01

    Purpose. Application of anterior segment optical coherence (AS-OCT) in pediatric ophthalmology. Methods. Retrospective clinical study case series of 26 eyes of 19 pediatric patients throughout a 21-month period, presenting anterior segment pathologies, were submitted to AS-OCT examination (OCT Visante, 1310 nm, Zeiss), noncontact technique, no sedation requirement. Results. AS-OCT images were obtained from 19 patients (range: 2 months to 12 years). Clinical diagnosis of anterior segment abnormalities included cornea disease (n = 7), congenital anterior segment conditions (n = 10), ocular trauma (n = 1), anterior segment surgeries (n = 2), iridocorneal angle abnormalities (n = 4), intermediate uveitis (n = 2). The most common OCT findings were corneal hyperreflectivity and thickening (n = 15), shallow anterior chamber with iris-lens diaphragm anterior displacement (n = 4), atypical corneal curvature (n = 4), corneal thinning (n = 4), peripheral synechiae with angle closure (n = 3), increased anterior chamber depth (n = 2), and proximal portion of glaucoma drainage tube (n = 2). Conclusion. In the present study, noncontact AS-OCT demonstrated to be a feasible technique to evaluate the anterior segment providing anatomic details and useful to clarify diagnosis in the pediatric population. PMID:22934156

  3. Radiographic features of the development of the anterior tibial tuberosity.

    PubMed

    Vergara-Amador, E; Davalos Herrera, D; Moreno, L Á

    2016-01-01

    Few studies have evaluated the radiologic characteristics of the development of the anterior tibial tuberosity. This study aimed to evaluate the radiologic characteristics of the anterior tibial tuberosity in a pediatric population broken down into age groups. We assessed 210 plain-film X-rays of the knee from patients aged from 10 to 17 years, divided into groups according to age and sex, for the presence of ossification of the anterior tibial tuberosity, the distance between the anterior tibial tuberosity and the metaphysis, and fusion with the epiphysis. At 10 years of age, the anterior tibial tuberosity was ossified in 50% of the girls but in only 25% of the boys. In all the girls, the anterior tibial tuberosity was ossified at 11 years, fusion of the anterior tibial tuberosity with the epiphysis had started at 12 years, and fusion was complete by 17 years. In boys, the process is delayed by one year compared to girls. A single center of ossification was found in all cases. The ossification of the anterior tibial tuberosity starts distally, then the proximal part fuses with the rest of the epiphysis, and finally the distal part fuses with the tibia. The results of this study help enable a better analysis of the anterior tibial tuberosity in cases of knee pain. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Anterior capsule cleaning with an ultrasound irrigating scratcher.

    PubMed

    Meucci, G; Esente, S; Esente, I

    1991-01-01

    Ultrasound anterior capsule cleaning was performed in 22 intercapsular cataract extraction cases. These eyes were compared with 24 others which had the intercapsular procedure performed by the same surgeon without ultrasound capsule cleaning. Eyes were randomly assigned to one procedure from a group of 62 cataract patients. Histologic specimens of the anterior capsule flap removed from the optical zone at the end of the procedure were examined. The anterior capsules cleaned by ultrasound appeared more transparent, without residual lens fibers with fewer epithelial cells. Ultrasound cleaning seems effective in preventing anterior capsular fibrosis and opacification.

  5. Isolated Right Ventricular Infarction Mimicking Anterior ST-Segment Elevation

    PubMed Central

    Oktay, Veysel; Coskun, Ugur; Yildiz, Ahmet; Gurmen, Tevfik

    2016-01-01

    Acute coronary syndromes in patients with presence of ST-segment elevation in the anterior precordial leads indicates left anterior descending coronary artery occlusion. However, anterior ST-segment elevation has also been described in right ventricular myocardial infarction and is thought to be due to right coronary artery (RCA) occlusion. We present a rare case of isolated RVMI presenting with anterior ST-segment elevation due to proximal occlusion of a right coronary artery that was treated by primary coronary angioplasty. Primary coronary angioplasty and stenting of this artery was performed resulting in resolution of the chest pain and ST- segment elevation. PMID:27190867

  6. No volumetric differences in the anterior cingulate of psychopathic individuals

    PubMed Central

    Glenn, Andrea L.; Yang, Yaling; Raine, Adrian; Colletti, Patrick

    2010-01-01

    Functional imaging studies of psychopathy have demonstrated reduced activity in the anterior cingulate, yet it is unclear whether this region is structurally impaired. In this study, we used structural MRI to examine whether volumetric differences exist in the anterior cingulate between psychopathic (n=24) and control (n=24) male participants. We found no group differences in the volume of the anterior cingulate or its dorsal and ventral subregions. Our findings call into question whether the anterior cingulate is impaired in psychopathy, or whether previous findings of reduced activity may result from reduced input from other deficient regions. PMID:20630717

  7. Endoscopic Resection of the Tibialis Anterior Tendon Bursa.

    PubMed

    Lui, Tun Hing

    2016-10-01

    The tibialis anterior tendon bursa is located between the tibialis anterior tendon and the medial cuneiform bone and close to the tendon insertion. Bursitis can occur as a result of excessive local friction, infection, arthritides, or direct trauma. Endoscopic resection of the bursa is indicated in case of symptomatic bursitis that is not responding to conservative treatment or infection is suspected. It is contraindicated if there is skin infection at the portal sites. The purpose of this technical note is to describe a minimally invasive approach of endoscopic resection of the tibialis anterior tendon bursa through anterior tibial tendoscopy.

  8. The anterior hypothalamus in cluster headache.

    PubMed

    Arkink, Enrico B; Schmitz, Nicole; Schoonman, Guus G; van Vliet, Jorine A; Haan, Joost; van Buchem, Mark A; Ferrari, Michel D; Kruit, Mark C

    2016-08-16

    To evaluate the presence, localization, and specificity of structural hypothalamic and whole brain changes in cluster headache and chronic paroxysmal hemicrania (CPH). We compared T1-weighted magnetic resonance images of subjects with cluster headache (episodic n = 24; chronic n = 23; probable n = 14), CPH (n = 9), migraine (with aura n = 14; without aura n = 19), and no headache (n = 48). We applied whole brain voxel-based morphometry (VBM) using two complementary methods to analyze structural changes in the hypothalamus: region-of-interest analyses in whole brain VBM, and manual segmentation of the hypothalamus to calculate volumes. We used both conservative VBM thresholds, correcting for multiple comparisons, and less conservative thresholds for exploratory purposes. Using region-of-interest VBM analyses mirrored to the headache side, we found enlargement (p < 0.05, small volume correction) in the anterior hypothalamic gray matter in subjects with chronic cluster headache compared to controls, and in all participants with episodic or chronic cluster headache taken together compared to migraineurs. After manual segmentation, hypothalamic volume (mean±SD) was larger (p < 0.05) both in subjects with episodic (1.89 ± 0.18 ml) and chronic (1.87 ± 0.21 ml) cluster headache compared to controls (1.72 ± 0.15 ml) and migraineurs (1.68 ± 0.19 ml). Similar but non-significant trends were observed for participants with probable cluster headache (1.82 ± 0.19 ml; p = 0.07) and CPH (1.79 ± 0.20 ml; p = 0.15). Increased hypothalamic volume was primarily explained by bilateral enlargement of the anterior hypothalamus. Exploratory whole brain VBM analyses showed widespread changes in pain-modulating areas in all subjects with headache. The anterior hypothalamus is enlarged in episodic and chronic cluster headache and possibly also in probable cluster headache or CPH, but not in migraine.

  9. Roscovitine treatment improves synchronization of donor cell cycle in G0/G1 stage and in vitro development of handmade cloned buffalo (Bubalus bubalis) embryos.

    PubMed

    Selokar, Naresh L; Saini, Monika; Muzaffer, Mushariffa; Krishnakanth, G; Saha, Ambika P; Chauhan, Manmohan S; Manik, Radheysham; Palta, Prabhat; Madan, Pavneesh; Singla, Suresh K

    2012-04-01

    This study investigated the effects of serum-starvation, total confluence, and roscovitine treatment on cell-cycle synchronization of buffalo ear skin fibroblasts to the G0/G1 stage and on the developmental competence of cloned embryos. Serum starvation of total confluence cultures for 24 h had a higher (p<0.05) proportion of cells at G0/G1 stage (94.4%) compared with serum starved cyclic and nonstarved confluent cultures (76.8 and 86.0%, respectively), whereas differences between cyclic cells with or without serum starvation were not significant. The proportion of cells at G0/G1 was higher (p<0.05) with 20 and 30 μM roscovitine treatment than that with 10 μM (94.4, 96.4, and 86.6%, respectively), which was similar to that for total confluence (86.0%). MTT assay showed that cell viability decreased as dose of roscovitine increased. The blastocyst rate was significantly higher (p<0.05) when nuclear transfer embryos were reconstructed using donors cells from total confluence, confluence serum starved, and roscovitine-treated (20 and 30 μM) groups (48.8, 48.9, 57.9, and 62.9%, respectively) compared to nontreated cyclic cells (20.2%). However, the cleavage rate and total cell number of cloned embryos were similar for all the groups. The number of ICM cells was improved by 30 μM roscovitine treatment (45.25 ± 2.34). The cryosurvival rate of blastocysts derived from cells synchronized with 20 or 30 μM roscovitine was higher compared to that for total confluence group (33.6, 37.8 vs. 23.8%). In conclusion, treatment with 30 μM roscovitine is optimal for harvesting G0/G1 stage cells for producing high quality cloned buffalo embryos, and that it is better than serum-starvation or total confluence for cell synchronization.

  10. Scar Revision Surgery: The Patient's Perspective.

    PubMed

    Miranda, Benjamin H; Allan, Anna Y; Butler, Daniel P; Cussons, Paul D

    2015-11-01

    Insufficient satisfaction outcome literature exists to assist consultations for scar revision surgery; such outcomes should reflect the patient's perspective. The aim of this study was to prospectively investigate scar revision patient satisfaction outcomes, according to specified patient-selection criteria. Patients (250) were randomly selected for telephone contacting regarding scar revisions undertaken between 2007-2011. Visual analogue scores were obtained for scars pre- and post-revision surgery. Surgery selection criteria were; 'presence' of sufficient time for scar maturation prior to revision, technical issues during or wound complications from the initial procedure that contributed to poor scarring, and 'absence' of site-specific or patient factors that negatively influence outcomes. Patient demographics, scar pathogenesis (elective vs. trauma), underlying issue (functional/symptomatic vs. cosmetic) and revision surgery details were also collected with the added use of a real-time, hospital database. Telephone contacting was achieved for 211 patients (214 scar revisions). Satisfaction outcomes were '2% worse, 16% no change, and 82% better'; a distribution maintained between body sites and despite whether surgery was functional/symptomatic vs. cosmetic. Better outcomes were reported by patients who sustained traumatic scars vs. those who sustained scars by elective procedures (91.80% vs. 77.78%, P=0.016) and by females vs. males (85.52% vs. 75.36%, P<0.05), particularly in the elective group where males (36.17%) were more likely to report no change or worse outcomes versus females (16.04%) (P<0.01). Successful scar revision outcomes may be achieved using careful patient selection. This study provides useful information for referring general practitioners, and patient-surgeon consultations, when planning scar revision.

  11. Chronic Dissection of the Anterior Tibial Artery

    PubMed Central

    De Salazar, Alvaro Ortiz; Muñoz, Fernando; Antoñana, Mirel; Aramendi, José I.; Castellanos, Enrique; Loizate, Alberto; Calderon, Antonio; Llorente, Alberto; Serrano, Alberto

    1991-01-01

    We present a clinical case of chronic dissection of the anterior tibial artery leading to acute aneurysmal dilatation. Our patient, a 22-year-old man, had a history of trauma at the middle third of his left leg. Because of impending ischemia, he was diagnosed by emergency arteriography. We ligated the proximal and distal ends of the dissection and used a reversed saphenous vein for a short end-to-end bypass. Although the evolution of this dilatation had been silent, its clinical presentation was spectacular. The case is worthy of attention because of its extreme rarity, both as a dissection of a peripheral artery caused by trauma and as an aneurysmal dilatation at tibial level. (Texas Heart Institute Journal 1991;18:223-5) Images PMID:15227485

  12. Essentials of anterior cruciate ligament rupture management.

    PubMed

    Klinge, Stephen A; Sawyer, Gregory A; Hulstyn, Michael J

    2013-05-01

    Anterior cruciate ligament (ACL) rupture is a common knee injury and an understanding of current medical knowledge regarding its management is essential. Accurate and prompt diagnosis requires an awareness of injury mechanisms and risk factors, common symptoms and physical/radiologic findings. Early mobilization and physical therapy improves outcomes regardless of treatment modality. Many older patients regain sufficient stability and function after non-operative rehabilitation. Early ACL reconstruction is appropriate for younger patients and those who engage in activities requiring frequent pivoting and rapid direction changes. ACL surgery involves reconstruction of the torn ligament tissue with various replacement graft options, each with advantages and disadvantages. The guidance of a knowledgeable and experienced therapist is required throughout an intensive and prolonged rehabilitation course. Generally excellent outcomes and low complication rates are expected, but treatment does not prevent late osteoarthritis.

  13. Alternaria Keratitis after Deep Anterior Lamellar Keratoplasty

    PubMed Central

    Naik, Mekhla; Mohd. Shahbaaz; Sheth, Jay; Sunderamoorthy, S. K.

    2014-01-01

    To describe a case of Alternaria keratitis in a 30-year-old male patient who presented with bilateral vascularised central corneal opacity and underwent deep anterior lamellar keratoplasty (DALK) in the left eye. Patient was treated for recurrent epithelial defect with a bandage contact lens in the follow-up visits after DALK. Subsequently, patient presented with pigmented fungal keratitis, which on culture examination of the corneal scrapping demonstrated Alternaria species. Patient had to undergo a repeat DALK as the keratitis did not resolve with medical therapy alone. Patient did not have a recurrence for 11 months following the regraft. This case report highlights the importance of considering the Alternaria species as a possibile cause of non-resolving fungal keratitis after DALK. PMID:24669155

  14. Alternaria keratitis after deep anterior lamellar keratoplasty.

    PubMed

    Naik, Mekhla; Mohd Shahbaaz; Sheth, Jay; Sunderamoorthy, S K

    2014-01-01

    To describe a case of Alternaria keratitis in a 30-year-old male patient who presented with bilateral vascularised central corneal opacity and underwent deep anterior lamellar keratoplasty (DALK) in the left eye. Patient was treated for recurrent epithelial defect with a bandage contact lens in the follow-up visits after DALK. Subsequently, patient presented with pigmented fungal keratitis, which on culture examination of the corneal scrapping demonstrated Alternaria species. Patient had to undergo a repeat DALK as the keratitis did not resolve with medical therapy alone. Patient did not have a recurrence for 11 months following the regraft. This case report highlights the importance of considering the Alternaria species as a possibile cause of non-resolving fungal keratitis after DALK.

  15. Anterior cruciate ligament reconstruction and knee osteoarthritis

    PubMed Central

    Paschos, Nikolaos K

    2017-01-01

    Anterior cruciate ligament (ACL) injury is a traumatic event that can lead to significant functional impairment and inability to participate in high-level sports-related activities. ACL reconstruction is considered the treatment of choice for symptomatic ACL-deficient patients and can assist in full functional recovery. Furthermore, ACL reconstruction restores ligamentous stability to normal, and, therefore, can potentially fully reinstate kinematics of the knee joint. As a consequence, the natural history of ACL injury could be potentially reversed via ACL reconstruction. Evidence from the literature is controversial regarding the effectiveness of ACL reconstruction in preventing the development of knee cartilage degeneration. This editorial aims to present recent high-level evidence in an attempt to answer whether ACL injury inevitably leads to osteoarthritis and whether ACL reconstruction can prevent this development or not. PMID:28361013

  16. Molecular inroads into the anterior heart field.

    PubMed

    Kelly, Robert G

    2005-02-01

    In 2001, three research groups described a previously unrecognized population of progenitor cells in pharyngeal mesoderm that gives rise to myocardium at the arterial pole of the heart. In the last 4 years, the major importance of the cellular contribution of pharyngeal mesoderm to normal and pathologic heart development has become apparent. Lineage-tracing experiments have defined the extent to which pharyngeal progenitor cells colonize the heart, revealing a contribution to venous, as well as arterial, pole myocardium; in addition, major molecular inroads have been made into understanding gene regulation in pharyngeal myocardial progenitor cells, implicating forkhead, Gata, LIM homeodomain, MEF2, SMAD, and T-box transcription factors. The key role of the anterior heart field during normal heart development is underscored by the demonstration that both direct and indirect perturbation of myocardial progenitor cells in pharyngeal mesoderm result in congenital heart disease.

  17. Anterior Skull Base Glomangioma-Induced Osteomalacia

    PubMed Central

    Gresham, Malia S.; Shen, Steven; Zhang, Yi J.; Gallagher, Kelly

    2017-01-01

    Oncogenic osteomalacia (OO) is an uncommon but treatable cause of osteomalacia related to tumor production of FGF23, usually caused by benign mesenchymal neoplasms. Paranasal sinus glomangiomas are a rare cause of OO, with only one previously reported case. Here we describe a second case (first reported in English) of paranasal sinus glomangioma-induced osteomalacia in a 42-year-old man. He presented with weakness and multiple spontaneous fractures, and was found to have an ethmoid sinus glomangioma with intracranial extension. The tumor was removed via endoscopic endonasal approach to the anterior skull base, which resulted in complete resolution of symptoms and no further evidence of disease 1 year postoperatively. PMID:28180054

  18. Pectoralis major transfer for serratus anterior paralysis.

    PubMed

    Steinmann, Scott P; Wood, Michael B

    2003-01-01

    Serratus anterior paralysis can result in winging of the scapula and weakness of arm elevation. The etiology of the condition is injury to the long thoracic nerve. There are many proposed causes of long thoracic nerve injury including acute trauma, Parsonage-Turner syndrome, or viral illness. The long length of the long thoracic nerve makes it prone to compression injury along the chest wall. Most patients recover nerve function with conservative treatment. In those in whom nerve function fails to recover, surgical treatment involving pectoralis major transfer may be beneficial. In this study 9 patients underwent pectoralis major transfer with a fascia lata extension graft. The symptoms of most were improved, with correction of the winging and improved movement in the affected shoulder.

  19. Sacro-anterior haemangiopericytoma: a case report.

    PubMed

    Ge, Xiu-Hong; Liu, Shuai-Shuai; Shan, Hu-Sheng; Wang, Zhi-Min; Li, Qian-Wen

    2014-06-01

    Haemangiopericytoma (HPC) is a rare vascular tumor with borderline malignancy, considerable histological variability, and unpredictable clinical and biological behavior. HPC can present a diagnostic challenge because of its indeterminate clinical, radiological, and pathological features. HPC generally presents in adulthood and is equally frequent in both sexes. HPC can arise in any site in the body as a slowly growing and painless mass. The precise cell type origin of HPC is uncertain. One third of HPCs occur in the head and neck areas. Exceptional cases of hemangioblastoma arising outside the head and neck areas have been reported, but little is known about their clinicopathologic and immunohistochemical features. This study reports on a case of a large sacro-anterior HPC in a 65-year-old male.

  20. Anterior Ischemic Optic Neuropathy Associated with Udenafil

    PubMed Central

    Kim, In-Gun

    2012-01-01

    We report a case of anterior ischemic optic neuropathy associated with udenafil. A 54-year-old male presented with an acute onset visual field defect of the right eye after udenafil use. Examination revealed a relative afferent pupillary defect and a swollen disc. Automated visual fields revealed an enlarged blind spot and a narrowed visual field. Fluorescein angiography revealed both an inferior choroidal filling delay and an inferior sector filling delay of the optic disc in the arteriovenous phase as well as diffuse leakage of the optic disc in the late phase. Optical coherent tomography revealed increased thickness of the retinal nerve fiber layer, especially in the area of the inferior disc. The patient was counseled to discontinue the use of udenafil and to monitor his blood pressure regularly. The disc swelling was resolved with residual optic atrophy one month after discontinuing the use of udenafil. PMID:22670084

  1. Foreign Body Embedded in Anterior Chamber Angle

    PubMed Central

    Graffi, Shmuel; Tiosano, Beatrice; Ben Cnaan, Ran; Bahir, Jonathan; Naftali, Modi

    2012-01-01

    Introduction. We present a case of a metallic foreign body embedded in the anterior chamber angle. After standing in close proximity to a construction worker breaking a tile, a 26-year-old woman using soft contact lens for the correction of mild myopia presented to emergency department for evaluation of a foreign body sensation of her right eye. Methods and Results. Diagnosis was confirmed by gonioscopic examination and a noncontrast CT scan of head and orbits. The foreign body was removed by an external approach without utilizing a magnet. The patient's final outcome was favorable. Discussion. The above is a rare clinical situation, which is impossible to detect on slit-lamp examination without a gonioscopic view. Proper imaging and a specific management are mandatory in order to achieve favorable outcome. PMID:23091762

  2. Foreign body embedded in anterior chamber angle.

    PubMed

    Graffi, Shmuel; Tiosano, Beatrice; Ben Cnaan, Ran; Bahir, Jonathan; Naftali, Modi

    2012-01-01

    Introduction. We present a case of a metallic foreign body embedded in the anterior chamber angle. After standing in close proximity to a construction worker breaking a tile, a 26-year-old woman using soft contact lens for the correction of mild myopia presented to emergency department for evaluation of a foreign body sensation of her right eye. Methods and Results. Diagnosis was confirmed by gonioscopic examination and a noncontrast CT scan of head and orbits. The foreign body was removed by an external approach without utilizing a magnet. The patient's final outcome was favorable. Discussion. The above is a rare clinical situation, which is impossible to detect on slit-lamp examination without a gonioscopic view. Proper imaging and a specific management are mandatory in order to achieve favorable outcome.

  3. Infections in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Stucken, Charlton; Garras, David N.; Shaner, Julie L.; Cohen, Steven B.

    2013-01-01

    Context: Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome. Evidence Acquisition: Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters. Results: Treatment with culture-specific antibiotics and debridement with graft retention is recommended as initial treatment, but with persistent infection, consideration should be given to graft removal. Graft type likely has no effect on infection rates. Conclusion: The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis. PMID:24427432

  4. Postoperative Infection After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Gobbi, Alberto; Karnatzikos, Georgios; Chaurasia, Sanyam; Abhishek, Mudhigere; Bulgherhoni, Erica; Lane, John

    2015-01-01

    Context: Infection after anterior cruciate ligament reconstruction (ACLR) is uncommon; if it occurs, it can lead to disastrous complications. Objective: To analyze post-ACLR infections and identify related complications to provide the most effective treatment protocol. Study Design: Clinical review. Level of Evidence: Level 4. Results: Among approximately 1850 ACLRs performed by a single surgeon over the past 20 years, 7 cases of post-ACLR infection were identified (incidence, 0.37%). Five patients presenting with low-severity infection were successfully treated without any complication or residual functional disability. The remaining 2 patients, although successfully treated, presented with minor residual limitations. From a literature review, 16 studies including 246 cases of infection were reported among 35,795 ACLRs, making the rate of infection 0.68% (range, 0.14%-2.6%). Conclusion: With proper treatment protocols, post-ACLR infection is rare but can compromise outcomes. PMID:26603553

  5. Anterior Cruciate Ligament Injuries in Growing Skeleton

    PubMed Central

    AlHarby, Saleh W.

    2010-01-01

    Anterior cruciate ligament (ACL) injuries in the adult patients are thoroughly studied and published in orthopedic literature. Until recently, little was known about similar injuries in skeletally growing patients. The more frequent involvement of this age group in various athletic activities and the improved diagnostic modalities have increased the awareness and interest of ACL injuries in skeletally immature patients. ACL reconstruction in growing skeleton is controversial and carries some risks to the tibial and femoral growth plate. A guarded approach to ACL reconstruction is recommended in skeletally immature patients. Modification of activity of ACL injured young patient, proper rehabilitation and prudent planning of adolescent age ACL reconstruction carries the least risks of growth plate violation. PMID:21475528

  6. Shortening reaction of human tibialis anterior.

    PubMed

    Berardelli, A; Hallett, M

    1984-02-01

    The shortening reaction of tibialis anterior was observed in 6 of 25 normal subjects, in 6 of 40 patients with upper motor neuron syndromes, and in 11 of 17 patients with Parkinson's disease. The latency of the shortening reaction was comparable with that of the latter part of the long-latency stretch reflexes. The magnitude of the shortening reaction increased with the velocity of the movement that produced it and increased with background voluntary force of plantar flexion in all but the patients with Parkinson's disease. It was not affected by vibration in the patients with Parkinson's disease. The presence of the shortening reaction was not correlated with the clinical impression of increased tone.

  7. Effect of an anterior-sloped brace joint on anterior tibial translation and axial tibial rotation: a motion analysis study.

    PubMed

    Yeow, C H; Gan, W L; Lee, P V S; Goh, J C H

    2010-12-01

    Anterior tibial translation and axial tibial rotation are major biomechanical factors involved in anterior cruciate ligament injuries. This study sought to evaluate a brace prototype designed with an anterior-sloped joint, in terms of its efficacy in attenuating anterior tibial translation and axial tibial rotation during landing, using a motion analysis approach. Ten healthy male subjects performed single-leg landing tasks from a 0.6-m height with and without the brace prototype. Ground reaction force and kinematics data were obtained using a motion-capture system and force-plates. Anterior tibial translation and axial tibial rotation were determined based on tibial and femoral marker reference frames. Vertical and anterior-posterior ground reaction forces, hip, knee and ankle joint range-of-motions and angular velocities, anterior tibial translation and axial tibial rotation were compared between unbraced and braced conditions using Wilcoxon signed-rank test. We found no significant difference in peak vertical and anterior-posterior ground reaction forces (p=0.770 and p=0.332 respectively) between unbraced and braced conditions. Knee joint range-of-motion and angular velocity were lower (p=0.037 and p=0.038 respectively) for braced condition than unbraced condition. Anterior tibial translation and axial tibial rotation were reduced (p=0.027 and p=0.006 respectively) in braced condition, compared to unbraced condition. The anterior-sloped brace joint helps to attenuate anterior tibial translation and axial tibial rotation present in the knee joint during landing. It is necessary to test the brace prototype in a sporting population with realistic sports landing situations in order to assess its effectiveness in lowering anterior cruciate ligament injury risk. Copyright © 2010 Elsevier Ltd. All rights reserved.

  8. Alternative grafts in anterior cervical fusion.

    PubMed

    Chen, Fangxiang; He, Wenzhuan; Mahaney, Kelly; Noeller, Jennifer; Mhanna, Nakhle; Viljoen, Stephen; Torner, James; Hitchon, Patrick

    2013-10-01

    The present retrospective study was conducted to compare the clinical and radiographic outcomes in patients undergoing anterior cervical discectomy with fusion (ACDF) using carbon fiber reinforced polymer (CFRP) cages, or allograft. We retrospectively reviewed cases of ACDF using allograft in 20 patients, and CFRP in 19 who had sequential radiographs before and after surgery, and at 1 year. There were no apparent significant differences between the 2 groups in age (p=0.057), gender (p=0.635), or complications (p=0.648). At 12 months, there were no cases of construct failure, and fusion appeared to have been achieved in patients of both groups. Lordosis was increased significantly in both groups after surgery (p<0.001 in allograft and p=0.025 in CFRP), and was maintained up until 1 year (p<0.018 in allograft and p=0.05 in CFRP) without a difference between groups (p=0.721). Anterior interbody height was significantly increased (p<0.001 in both groups at each time points) after surgery, without a significant difference between groups (p>0.21). This increase in height was greatest in magnitude immediately after surgery, and declined with the passage of time. There was no detectable health-related quality of life difference between allograft and CFRP group after surgery (p>0.05). The present study demonstrates that CFRP cages appear to have comparable fusion rates, restoration of lordosis and disc space height, and complication rates to patients who undergo ACDF with allograft. Copyright © 2013 Elsevier B.V. All rights reserved.

  9. Physiotherapy after reconstruction of anterior cruciate ligament.

    PubMed

    Pereira, Maitê; Vieira, Neiva de Souza; Brandão, Eduardo da Rosa; Ruaro, João Afonso; Grignet, Rodrigo Juliano; Fréz, Andersom Ricardo

    2012-12-01

    The purpose of this study was to evaluate the existence of differences in the rehabilitation of patients after ACL reconstruction using bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts, through a literature revision. The researched databases were MEDLINE, EMBASE, LILACS, COCHRANE and PEDro. The inclusion criteria were published studies with methodology draw from randomized clinical trials with or without meta-analysis, individuals with ACL injury, associated or not to meniscal injury, submitted to ligamentoplasty using the bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts and physiotherapy; clinical trials comparing the differences in the rehabilitation of these patients, in Portuguese, English and Spanish, from 1990 to June, 2011. Five clinical trials were reviewed. No difference was observed between the techniques, however, with a recommendation for a less aggressive rehabilitation and greater attention to the strengthening of the hamstring when they are used as grafts.

  10. Revision of texts with word-processing.

    PubMed

    Nuvoli, G

    2000-12-01

    The aim of the research was to study the use of a word processor to improve writing and revising skill by 28 pairs of primary school children. Analysis confirmed greater difficulty in the drafting of texts than with traditional handwriting, but the increase in the number of words and errors does not imply improvement in lexical and orthographical aspects. The guided revision of texts on a word processor may support beginning writers' expression and, with increasing ease, allow them to use greater precision in the process of revision.

  11. The Salto Talaris XT Revision Ankle Prosthesis.

    PubMed

    Roukis, Thomas S

    2015-10-01

    The Salto Talaris XT Revision Ankle Prosthesis is an anatomically designed fixed-bearing prosthesis available in the United States based on the design of previous Salto systems. The Salto Talaris XT Revision Ankle Prosthesis design optimizes surface area, cortical contact, and ultrahigh-molecular-weight polyethylene conformity. Two tibial component designs, both with the same base plate dimensions, are available, the standard conical fixation plug affixed to a short keel and a long-stemmed version. The author presents an overview of the Salto Talaris XT Revision Ankle Prosthesis surgical technique and pearls for successful application.

  12. Combined operative technique with anterior surgical approach and video-assisted thoracoscopic surgical lobectomy for anterior superior sulcus tumours.

    PubMed

    Yokoyama, Yuhei; Chen, Fengshi; Aoyama, Akihiro; Sato, Toshihiko; Date, Hiroshi

    2014-11-01

    Video-assisted thoracoscopic surgery (VATS) has been widely used, but surgical resections of superior sulcus tumours remain challenging because of their anatomical location. For such cases, less-invasive procedures, such as the anterior transcervical-thoracic and transmanubrial approaches, have been widely performed because of their excellent visualization of the subclavian vessels. Recently, a combined operative technique with an anterior surgical approach and VATS for anterior superior sulcus tumours has been introduced. Herein, we report three cases of anterior superior sulcus tumours successfully resected by surgical approaches combined with a VATS-based lobectomy. In all cases, operability was confirmed by VATS, and upper lobectomies with hilar and mediastinal lymph node dissections were performed. Subsequently, dissections of the anterior inlet of the tumours were performed using the transmanubrial approach in two patients and the anterior trans-cervical-thoracic approach in one patient. Both approaches provided excellent access to the anterior inlet of the tumour and exposure of the subclavian vessels, resulting in radical resection of the tumour with concomitant resection of the surrounding anatomical structures, including the chest wall and vessels. In conclusion, VATS lobectomy combined with the anterior surgical approach might be an excellent procedure for the resection of anterior superior sulcus tumours.

  13. Short-Term Outcomes of Glenoid Bone Block Augmentation for Complex Anterior Shoulder Instability in a High-Risk Population.

    PubMed

    Waterman, Brian R; Chandler, Philip J; Teague, Edward; Provencher, Matthew T; Tokish, John M; Pallis, Mark P

    2016-09-01

    To describe the short-term clinical outcomes of glenoid bone block augmentation in a high-demand population, as well as to describe its clinical success and complications at greater than 2 years' follow-up in an at-risk military population. All patients undergoing anterior capsulorrhaphy with coracoid process transfer or anterior bone block augmentation (Current Procedural Terminology code 23662 or 23460) for shoulder instability between 2006 and 2012 were isolated from the Military Health System Management Analysis and Reporting Tool. Demographic and occupational parameters were identified, and multiple surgical factors and clinical outcomes were extracted from the medical record and US Defense Manpower Data Center. A total of 64 service members (65 shoulders) underwent anterior bone block procedures, including coracoid transfer (n = 59, 90.8%), distal tibial allograft (n = 3, 4.6%), and autologous or allograft iliac crest bone graft (n = 3, 4.6%). This group was predominately comprised of men (n = 59), and the mean age was 25.9 years (range, 19 to 45 years). A total of 19 perioperative complications, including 8 neurologic injuries, 6 infections, and 4 hardware failures, occurred in 16 patients (25%). At a mean 2.4-year follow-up, 21 patients (32.8%) reported persistent shoulder pain and 15 patients (23.4%) disclosed subjective apprehension or recurrent instability. Secondary surgical procedures were performed in 12 patients (18.8%), including 4 revisions (6.3%). Ultimately, 20 patients (31.3%) underwent a medical discharge for persistent shoulder disability. Univariate analysis showed that the presence of a perioperative complication (P = .049) and tobacco use (P = .038) were associated with increased risk of subsequent surgical failure. Anterior glenoid bone block procedures for shoulder instability with concomitant bone loss enable a return to high-demand physical function. The short-term complication profile (25%), recurrence rate (23%), and

  14. Anterior humeral circumflex artery avulsion with brachial plexus injury following an isolated traumatic anterior shoulder dislocation.

    PubMed

    Shah, Rohi; Koris, Jacob; Wazir, Akhlaq; Srinivasan, Shyamsundar S

    2016-03-11

    A 70-year-old man presented to accident and emergency with an isolated anteriorly dislocated shoulder, in the absence of a concomitant fracture. There was no neurovascular deficit at presentation, and the shoulder was reduced under sedation, using the Kocher's technique. Following this, the patient developed signs of hypovolaemic shock. Clinical examination revealed an expanding fullness in the deltopectoral area, with compromise of the limb neurovascular status. CT imaging confirmed an expanding haematoma from the axillary vessels, restricting left lung expansion. Once resuscitated, the patient was transferred to theatre for exploration of the bleeding vessels. Intraoperative findings included an avulsed anterior circumflex humeral artery that was subsequently ligated. Postoperatively, the patient developed axillary, radial, median and ulnar nerve neuropraxia, which improved clinically prior to discharge. The patient was ultimately discharged home after a lengthy inpatient stay. 2016 BMJ Publishing Group Ltd.

  15. Conjoint activity of anterior insular and anterior cingulate cortex: awareness and response

    PubMed Central

    Critchley, Hugo D.

    2010-01-01

    There is now a wealth of evidence that anterior insular and anterior cingulate cortices have a close functional relationship, such that they may be considered together as input and output regions of a functional system. This system is typically engaged across cognitive, affective, and behavioural contexts, suggesting that it is of fundamental importance for mental life. Here, we review the literature and reinforce the case that these brain regions are crucial, firstly, for the production of subjective feelings and, secondly, for co-ordinating appropriate responses to internal and external events. This model seeks to integrate higher-order cortical functions with sensory representation and autonomic control: it is argued that feeling states emerge from the raw data of sensory (including interoceptive) inputs and are integrated through representations in conscious awareness. Correspondingly, autonomic nervous system reactivity is particularly important amongst the responses that accompany conscious experiences. Potential clinical implications are also discussed. PMID:20512367

  16. Quantum Field Theory, Revised Edition

    NASA Astrophysics Data System (ADS)

    Mandl, F.; Shaw, G.

    1994-01-01

    Quantum Field Theory Revised Edition F. Mandl and G. Shaw, Department of Theoretical Physics, The Schuster Laboratory, The University, Manchester, UK When this book first appeared in 1984, only a handful of W± and Z° bosons had been observed and the experimental investigation of high energy electro-weak interactions was in its infancy. Nowadays, W± bosons and especially Z° bosons can be produced by the thousand and the study of their properties is a precise science. We have revised the text of the later chapters to incorporate these developments and discuss their implications. We have also taken this opportunity to update the references throughout and to make some improvements in the treatment of dimen-sional regularization. Finally, we have corrected some minor errors and are grateful to various people for pointing these out. This book is designed as a short and simple introduction to quantum field theory for students beginning research in theoretical and experimental physics. The three main objectives are to explain the basic physics and formalism of quantum field theory, to make the reader fully proficient in theory calculations using Feynman diagrams, and to introduce the reader to gauge theories, which play such a central role in elementary particle physics. The theory is applied to quantum electrodynamics (QED), where quantum field theory had its early triumphs, and to weak interactions where the standard electro-weak theory has had many impressive successes. The treatment is based on the canonical quantization method, because readers will be familiar with this, because it brings out lucidly the connection between invariance and conservation laws, and because it leads directly to the Feynman diagram techniques which are so important in many branches of physics. In order to help inexperienced research students grasp the meaning of the theory and learn to handle it confidently, the mathematical formalism is developed from first principles, its physical

  17. Anterior visceral endoderm SMAD4 signaling specifies anterior embryonic patterning and head induction in mice.

    PubMed

    Li, Cuiling; Li, Yi-Ping; Fu, Xin-Yuan; Deng, Chu-Xia

    2010-09-27

    SMAD4 serves as a common mediator for signaling of TGF-β superfamily. Previous studies illustrated that SMAD4-null mice die at embryonic day 6.5 (E6.5) due to failure of mesoderm induction and extraembryonic defects; however, functions of SMAD4 in each germ layer remain elusive. To investigate this, we disrupted SMAD4 in the visceral endoderm and epiblast, respectively, using a Cre-loxP mediated approach. We showed that mutant embryos lack of SMAD4 in the visceral endoderm (Smad4(Co/Co);TTR-Cre) died at E7.5-E9.5 without head-fold and anterior embryonic structures. We demonstrated that TGF-β regulates expression of several genes, such as Hex1, Cer1, and Lim1, in the anterior visceral endoderm (AVE), and the failure of anterior embryonic development in Smad4(Co/Co);TTR-Cre embryos is accompanied by diminished expression of these genes. Consistent with this finding, SMAD4-deficient embryoid bodies showed impaired responsiveness to TGF-β-induced gene expression and morphological changes. On the other hand, embryos carrying Cre-loxP mediated disruption of SMAD4 in the epiblasts exhibited relatively normal mesoderm and head-fold induction although they all displayed profound patterning defects in the later stages of gastrulation. Cumulatively, our data indicate that SMAD4 signaling in the epiblasts is dispensable for mesoderm induction although it remains critical for head patterning, which is significantly different from SMAD4 signaling in the AVE, where it specifies anterior embryonic patterning and head induction.

  18. Anterior Visceral Endoderm SMAD4 Signaling Specifies Anterior Embryonic Patterning and Head Induction in Mice

    PubMed Central

    Li, Cuiling; Li, Yi-Ping; Fu, Xin-Yuan; Deng, Chu-Xia

    2010-01-01

    SMAD4 serves as a common mediator for signaling of TGF-β superfamily. Previous studies illustrated that SMAD4-null mice die at embryonic day 6.5 (E6.5) due to failure of mesoderm induction and extraembryonic defects; however, functions of SMAD4 in each germ layer remain elusive. To investigate this, we disrupted SMAD4 in the visceral endoderm and epiblast, respectively, using a Cre-loxP mediated approach. We showed that mutant embryos lack of SMAD4 in the visceral endoderm (Smad4Co/Co;TTR-Cre) died at E7.5-E9.5 without head-fold and anterior embryonic structures. We demonstrated that TGF-β regulates expression of several genes, such as Hex1, Cer1, and Lim1, in the anterior visceral endoderm (AVE), and the failure of anterior embryonic development in Smad4Co/Co;TTR-Cre embryos is accompanied by diminished expression of these genes. Consistent with this finding, SMAD4-deficient embryoid bodies showed impaired responsiveness to TGF-β-induced gene expression and morphological changes. On the other hand, embryos carrying Cre-loxP mediated disruption of SMAD4 in the epiblasts exhibited relatively normal mesoderm and head-fold induction although they all displayed profound patterning defects in the later stages of gastrulation. Cumulatively, our data indicate that SMAD4 signaling in the epiblasts is dispensable for mesoderm induction although it remains critical for head patterning, which is significantly different from SMAD4 signaling in the AVE, where it specifies anterior embryonic patterning and head induction. PMID:20941375

  19. Transphyseal anterior cruciate ligament reconstruction in a skeletally immature knee using anterior tibialis allograft.

    PubMed

    Cho, Yool; Jang, Soo-Jin; Son, Jung-Hwan

    2011-05-18

    Anterior cruciate ligament (ACL) injury in the skeletally immature individual is being recognized with increasing frequency. Nonoperative treatment of ACL injuries in skeletally immature patients have not been favorable. Surgical treatment options for complete ACL tears include primary ligament repair, extraarticular tenodesis, transphyseal reconstruction, partial transphyseal reconstruction, and physeal-sparing reconstruction. The advantage of transphyseal reconstruction is placement of the graft tissue in an isometric position, which provides better results, according to the literature. The potential disadvantage is angular or limb-length discrepancy caused by physeal violation. Controversy exists in allograft selection about whether bone or soft tissue passes into physes. The use of standard tunnels provides reliable results, but carries the risk of iatrogenic growth disturbance from physeal injury.This article presents 4 cases of transphyseal ACL reconstruction using anterior tibialis allograft in skeletally immature patients that had satisfactory functional outcomes with no growth disturbances. This is the first report of transphyseal ACL reconstruction using anterior tibialis allograft in skeletally immature patients in the English-speaking literature. All patients underwent transphyseal ACL reconstruction using anterior tibialis tendon allograft. None of the patients had angular deformities. No early physeal arrest was measured between the preoperative and postoperative radiographs. At last follow-up, the results of the Lachman test were normal for 3 patients and nearly normal for 1 patient. All patients demonstrated full range of knee motion (comparing the reconstructed knee to the contralateral knee). The results of the pivot-shift test were normal for 3 patients and nearly normal for 1 patient. No patients reported giving way.

  20. Revision surgery after pregnancy in a patient with congenital kyphoscoliosis

    PubMed Central

    Li, Zhikun; Wang, Fei; Xu, Wei; Li, Yifan; Zhu, Xiaodong

    2016-01-01

    Abstract Rationale: Rod breakage during pregnancy and delivery has never been described in a patient who has undergone surgery for congenital scoliosis (CS). Here, we present an unusual but significant case of revision surgery. Patient concerns: A 29-year-old woman presented with low back pain during pregnancy after posterior osteotomy, correction and fusion at T9 to L5 for CS. Radiographs during follow-up, 4 months after the patient gave birth, demonstrated rod breakage. Diagnoses: Rod breakage after orthopaedic surgery of congenital kyphoscoliosis Interventions: The patient was taken into the operating room for replacement of the broken rods, recovery of sagittal balance, bone graft fusion, and improvement of stability by cross-connection. The patient recovered fully by the 3-month postoperative follow-up. Outcomes: In follow-up, the instruments were in good condition, the orthopedic effect was not lost, and low back pain relief was observed. Lessons: We opine that the rod breakage during pregnancy resulted from weight gain and a lack of an anterior approach to the supportive bone graft. Therefore, female patients with spinal surgery should visit the hospital for advice before pregnancy. PMID:27930594

  1. Emotion recognition from dynamic emotional displays following anterior cingulotomy and anterior capsulotomy for chronic depression.

    PubMed

    Ridout, Nathan; O'Carroll, Ronan E; Dritschel, Barbara; Christmas, David; Eljamel, Muftah; Matthews, Keith

    2007-04-09

    Four patients that had received an anterior cingulotomy (ACING) and five patients that had received both an ACING and an anterior capsulotomy (ACAPS) as an intervention for chronic, treatment refractory depression were presented with a series of dynamic emotional stimuli and invited to identify the emotion portrayed. Their performance was compared with that of a group of non-surgically treated patients with major depression (n=17) and with a group of matched, never-depressed controls (n=22). At the time of testing, four of the nine neurosurgery patients had recovered from their depressive episode, whereas five remained depressed. Analysis of emotion recognition accuracy revealed no significant differences between depressed and non-depressed neurosurgically treated patients. Similarly, no significant differences were observed between the patients treated with ACING alone and those treated with both ACING and ACAPS. Comparison of the emotion recognition accuracy of the neurosurgically treated patients and the depressed and healthy control groups revealed that the surgically treated patients exhibited a general impairment in their recognition accuracy compared to healthy controls. Regression analysis revealed that participants' emotion recognition accuracy was predicted by the number of errors they made on the Stroop colour-naming task. It is plausible that the observed deficit in emotion recognition accuracy was a consequence of impaired attentional control, which may have been a result of the surgical lesions to the anterior cingulate cortex.

  2. Multilevel anterior thoracic discectomies and anterior interbody fusion using a microsurgical thoracoscopic approach. Case report.

    PubMed

    Dickman, C A; Mican, C A

    1996-01-01

    A video-assisted thoracoscopic microsurgical approach was performed to treat a myelopathic patient with a severe kyphotic deformity caused by chronic nonunion of compression fractures of the T7-9 vertebrae. The kyphotic deformity was treated by combined operative procedures. First, an anterior release was performed using a thoracoscopic technique, sectioning the anterior longitudinal ligament and performing multilevel thoracic discectomies. Next, a posterior reduction and internal fixation of the deformity was achieved using hook-rod instrumentation. Finally, bone graft harvested during the posterior approach was used for interbody fusion via a thoracoscopic approach. Microsurgical thoracoscopic techniques potentially can be used in a variety of spinal surgeries. Compared to transthoracic and posterolateral approaches, this technique presents distinct advantages to treatment of anterior spinal pathology. The small incisions made into the intercostal spaces without retracting the ribs may reduce postoperative pain, shorten the length of hospitalization, and allow early return to activity. The operative techniques used in this case are described in detail. This report demonstrates that thoracoscopic discectomies and interbody fusion are technically feasible and can be effectively performed with acceptable results.

  3. Anterior tibial translation during different isokinetic quadriceps torque in anterior cruciate ligament deficient and nonimpaired individuals.

    PubMed

    Kvist, J; Karlberg, C; Gerdle, B; Gillquist, J

    2001-01-01

    Factorial quasi-experimental design. To quantify the effect of different levels of isokinetic concentric and eccentric knee extensor torques on the anterior tibial translation in subjects with anterior cruciate ligament (ACL) deficiency. Electromyogram (EMG) activity of 4 leg muscles was recorded in order to detect any co-activation of extensors and flexors. The rehabilitation after an ACL injury is of importance for the functional outcome of the patient. In order to construct a rehabilitation program after that injury, it is important to understand the in vivo relationships between muscle force and tibial translation. Twelve patients with unilateral ACL injury and 11 uninjured volunteers performed 36 repetitions of a quadriceps contraction at different isokinetic concentric and eccentric torque levels, on a KinCom machine (60 degrees x s(-1)), with simultaneous recordings of tibial translation (CA-4000) and EMG activity from quadriceps and hamstrings muscles. Tibial translations and EMG levels were normalized to the maximum of each subject. The individual anterior tibial translation increased with increased quadriceps torque in a similar manner in both quadriceps contraction modes in all legs tested. During concentric mode, translation was similar in all groups, but during eccentric mode, the mean translation was 38% larger in the ACL injured knees. No quadriceps-hamstrings co-activation occurred in any test or group. An ACL deficient knee can limit the translation within a normal space during concentric muscle activity but not during eccentric activity. That limitation depends on other mechanisms than hamstrings co-activation.

  4. Anterior ethmoidal artery emerging anterior to bulla ethmoidalis: An abnormal anatomical variation in Waardenburg's syndrome

    PubMed Central

    Wong, Danny K. C.; Shao, Angus; Campbell, Raewyn

    2014-01-01

    In endoscopic sinus surgery, the anterior ethmoidal artery (AEA) is usually identified as it traverses obliquely across the fovea ethmoidalis, posterior to the bulla ethmoidalis and anterior to or within the ground lamella's attachment to the skull base. Injury to the AEA may result in hemorrhage, retraction of the AEA into the orbit, and a retrobulbar hematoma. The resulting increase in intraorbital pressure may threaten vision. Waardenburg's syndrome (WS) is a rare congenital, autosomal dominantly inherited disorder, distinguished by characteristic facial features, pigmentation abnormalities, and profound, congenital, sensorineural hearing loss. We present a case of AEAs located anterior to the bulla ethmoidalis in a 36-year-old male with WS and chronic rhinosinusitis. The anatomic abnormality was not obvious on a preoperative computed tomography scan and was discovered intraoperatively when the left AEA was injured, resulting in a retrobulbar hematoma. The hematoma was immediately identified and decompressed endoscopically without lasting complications. The AEA on the right was identified intraoperatively and preserved. The characteristic craniofacial features in WS were probably associated with the abnormal vascular anatomy. Endoscopic sinus surgeons should be aware of these potential anatomic anomalies in patients with abnormal craniofacial development. PMID:25565054

  5. Anterior Tibial Translation in Collegiate Athletes with Normal Anterior Cruciate Ligament Integrity

    PubMed Central

    Rosene, John M.; Fogarty, Tracey D.

    1999-01-01

    Objective: To examine differences in anterior tibial translation (ATT) among sports, sex, and leg dominance in collegiate athletes with normal anterior cruciate ligament integrity. Design and Setting: Subjects from various athletic teams were measured for ATT in right and left knees. Subjects: Sixty subjects were measured for ATT with a KT-1000 knee arthrometer. Measurements: Statistical analyses were computed for each sex and included a 2 × 3 × 4 mixed-factorial analysis of variance (ANOVA) for anterior cruciate ligament displacement, right and left sides, and force and sport. A 2 × 2 × 3 mixed-factorial ANOVA was computed to compare means for sex and force. A 2 × 3 mixed-factorial ANOVA was computed to compare sex differences across 3 forces. Results: For males and females, no significant interactions were found among leg, force, and sport for mean ATT, for leg and sport or leg and force, or for translation values between dominant and nondominant legs. Males had a significant interaction for force and sport, and a significant difference was found for side of body, since the right side had less translation than the left side. Females had greater ATT than males at all forces. Conclusions: Sex differences exist for ATT, and differences in ATT exist among sports for both sexes. Differences between the right and left sides of the body should be expected when making comparisons of ligamentous laxity. ImagesFigure 2.Figure 3.Figure 5. PMID:16558565

  6. Anterior Versus Posterior Approaches for Odontoid Fracture Stabilization in Patients Older Than 65 Years: 30-day Morbidity and Mortality in a National Database.

    PubMed

    Patterson, Joseph T; Theologis, Alexander A; Sing, David; Tay, Bobby

    2017-10-01

    Retrospective cohort analysis. To compare 30-day perioperative clinical outcomes of surgical odontoid stabilization by an anterior or posterior operative approach in elderly patients. Surgical stabilization of odontoid fractures is superior to nonoperative management in geriatric patients. How elderly patients with odontoid fractures fare after anterior and posterior approaches, however, is not well defined. Retrospective review of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program database (2005-2013). Elderly patients (≥65 y) with odontoid fractures who underwent odontoid stabilization through anterior or posterior approaches were identified by International Classification of Diseases 9th Revision/Common Procedure Terminology codes. Exclusion criteria included concomitant subaxial spine surgery, instrumentation noncontiguous with the atlantoaxial interval, and combined approaches. Baseline demographics and perioperative details were compared. Adverse events, mortality, reoperation, discharge, and readmission rates within 30 days of operation were compared using bivariate and multivariate generalized linear regressions. One hundred forty-one patients (male-81; female-60; average age: 77.8±6.5 y; anterior approach-48; posterior approach-93) were analyzed. Patients scheduled to have a posterior approach had significantly more nonunions preoperatively and higher body mass indices. Operative times for posterior surgeries were significantly longer. Age, comorbidities, functional dependence, time to surgery, and length of hospital stay were similar between groups. There were no significant differences in the relative risk (RR) of the composite outcome of "any adverse event" after adjusting for differences in baseline characteristics. Patients who underwent an anterior approach were more likely to have an unplanned hospital readmission (RR=8.95; 95% confidence interval, 2.21-36.29; P=0.002) and have significantly

  7. Nevada Test Site Radiological Control Manual. Revision 1

    SciTech Connect

    None, None

    2010-02-09

    This document supersedes DOE/NV/25946--801, “Nevada Test Site Radiological Control Manual,” Revision 0 issued in October 2009. Brief Description of Revision: A minor revision to correct oversights made during revision to incorporate the 10 CFR 835 Update; and for use as a reference document for Tenant Organization Radiological Protection Programs.

  8. A Comparative Study of Three Revision Methods in EFL Writing

    ERIC Educational Resources Information Center

    Srichanyachon, Napaporn

    2011-01-01

    In an attempt to explore effective instruction in the English as a Foreign Language (EFL) setting, this study investigated language errors identified by students and teachers in three different revision stages: self-revision, peer revision, and teacher revision. It gave the focus to the effects of the three different methods on learners' writing…

  9. 20 CFR 261.7 - Effect of revised decision.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Effect of revised decision. 261.7 Section 261.7 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD RETIREMENT ACT ADMINISTRATIVE FINALITY § 261.7 Effect of revised decision. A revised decision is binding unless: (a) The revised decision is reconsidered or appealed in...

  10. Real Revision: Authors' Strategies to Share with Student Writers

    ERIC Educational Resources Information Center

    Messner, Kate

    2011-01-01

    How do you show students that revision is more than a classroom exercise to please the teacher? Take them into the real world of writing for publication. In Real Revision, award-winning author and teacher Kate Messner demystifies the revision process for teachers and students alike and provides tried-and-true revision strategies, field tested by…

  11. Introductory Business Textbook Revision Cycles: Are They Getting Shorter?

    ERIC Educational Resources Information Center

    Zinser, Brian; Brunswick, Gary

    2010-01-01

    The rate of textbook revision cycles is examined in light of the recent trend towards more rapid revisions (and adoptions of textbooks). The authors conduct background research to better understand the context for textbook revision cycles and the environmental forces that have been influencing what appears to be more rapid textbook revisions. A…

  12. Reduced Anterior Cingulate Cortex Glutamatergic Concentrations in Childhood Major Depression

    ERIC Educational Resources Information Center

    Mirza, Yousha; Tang, Jennifer; Russell, Aileen; Banerjee, S. Preeya; Bhandari, Rashmi; Ivey, Jennifer; Rose, Michelle; Moore, Gregory J.; Rosenberg, David R.

    2004-01-01

    Objective: To examine in vivo glutamatergic neurochemical alterations in the anterior cingulate cortex of children with major depressive disorder (MDD). Method: Single-voxel proton magnetic resonance spectroscopic ([.sup.1]H-MRS) examinations of the anterior cingulate cortex were conducted in 13 psychotropic-naive children and adolescents with MDD…

  13. Review for the generalist: evaluation of anterior knee pain

    PubMed Central

    Houghton, Kristin M

    2007-01-01

    Anterior knee pain is common in children and adolescents. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of chronic anterior knee pain in the pediatric population with a focus on patellofemoral pain. PMID:17550634

  14. Reduced Anterior Cingulate Cortex Glutamatergic Concentrations in Childhood Major Depression

    ERIC Educational Resources Information Center

    Mirza, Yousha; Tang, Jennifer; Russell, Aileen; Banerjee, S. Preeya; Bhandari, Rashmi; Ivey, Jennifer; Rose, Michelle; Moore, Gregory J.; Rosenberg, David R.

    2004-01-01

    Objective: To examine in vivo glutamatergic neurochemical alterations in the anterior cingulate cortex of children with major depressive disorder (MDD). Method: Single-voxel proton magnetic resonance spectroscopic ([.sup.1]H-MRS) examinations of the anterior cingulate cortex were conducted in 13 psychotropic-naive children and adolescents with MDD…

  15. Modified Anchor Shaped Post Core Design for Primary Anterior Teeth

    PubMed Central

    Rajesh, R.; Baroudi, Kusai; Reddy, K. Bala Kasi; Praveen, B. H.; Kumar, V. Sumanth; Amit, S.

    2014-01-01

    Restoring severely damaged primary anterior teeth is challenging to pedodontist. Many materials are tried as a post core but each one of them has its own drawbacks. This a case report describing a technique to restore severely damaged primary anterior teeth with a modified anchor shaped post. This technique is not only simple and inexpensive but also produces better retention. PMID:25379294

  16. Modified anchor shaped post core design for primary anterior teeth.

    PubMed

    Rajesh, R; Baroudi, Kusai; Reddy, K Bala Kasi; Praveen, B H; Kumar, V Sumanth; Amit, S

    2014-01-01

    Restoring severely damaged primary anterior teeth is challenging to pedodontist. Many materials are tried as a post core but each one of them has its own drawbacks. This a case report describing a technique to restore severely damaged primary anterior teeth with a modified anchor shaped post. This technique is not only simple and inexpensive but also produces better retention.

  17. Anterior commissure absence without callosal agenesis: a new brain malformation.

    PubMed

    Mitchell, T N; Stevens, J M; Free, S L; Sander, J W; Shorvon, S D; Sisodiya, S M

    2002-04-23

    The authors report a novel human brain malformation characterized by the absence of the anterior commissure without callosal agenesis, but associated with gross unilateral panhemispheric malformation incorporating subependymal heterotopia, subcortical heterotopia, and gyral abnormalities including temporal malformation and polymicrogyria. In contrast, a normal anterior commissure was found in 125 control subjects and in 113 other subjects with a range of brain malformations.

  18. Application of anterior segment optical coherence tomography in glaucoma.

    PubMed

    Sharma, Reetika; Sharma, Ajay; Arora, Tarun; Sharma, Sourabh; Sobti, Amit; Jha, Bhaskar; Chaturvedi, Neha; Dada, Tanuj

    2014-01-01

    Optical coherence tomography (OCT) is a cross-sectional, three-dimensional, high-resolution imaging modality that uses low coherence interferometry to achieve axial resolution in the range of 3-20 μm. Two OCT platforms have been developed: time domain (TD-OCT) and spectral (or Fourier) domain (SD/FD-OCT). Visante anterior segment OCT (Carl Zeiss Meditec) is a TD-OCT widely used for anterior segment imaging. The SD-OCT systems with both posterior and anterior segment imaging capabilities include the RTVue, iVue (Optovue), the Cirrus (Carl Zeiss Meditec), and the Spectralis (Heidelberg Engineering, Inc.). Each of the SD-OCTs has a wavelength in the range of 820-879 nm. Anterior segment OCT is a non-contact method providing high resolution tomographic cross-sectional imaging of anterior segment structures. Anterior segment OCT provides qualitative and quantitative assessment of the anterior segment structures important to the pathogenesis and the anatomical variations of glaucoma, and the approach to and success of treatment. We summarize the clinical applications of anterior segment OCT in glaucoma.

  19. Anterior temporal lobe degeneration produces widespread network-driven dysfunction.

    PubMed

    Guo, Christine C; Gorno-Tempini, Maria Luisa; Gesierich, Benno; Henry, Maya; Trujillo, Andrew; Shany-Ur, Tal; Jovicich, Jorge; Robinson, Simon D; Kramer, Joel H; Rankin, Katherine P; Miller, Bruce L; Seeley, William W

    2013-10-01

    The neural organization of semantic memory remains much debated. A 'distributed-only' view contends that semantic knowledge is represented within spatially distant, modality-selective primary and association cortices. Observations in semantic variant primary progressive aphasia have inspired an alternative model featuring the anterior temporal lobe as an amodal hub that supports semantic knowledge by linking distributed modality-selective regions. Direct evidence has been lacking, however, to support intrinsic functional interactions between an anterior temporal lobe hub and upstream sensory regions in humans. Here, we examined the neural networks supporting semantic knowledge by performing a multimodal brain imaging study in healthy subjects and patients with semantic variant primary progressive aphasia. In healthy subjects, the anterior temporal lobe showed intrinsic connectivity to an array of modality-selective primary and association cortices. Patients showed focal anterior temporal lobe degeneration but also reduced physiological integrity throughout distributed modality-selective regions connected with the anterior temporal lobe in healthy controls. Physiological deficits outside the anterior temporal lobe correlated with scores on semantic tasks and with anterior temporal subregion atrophy, following domain-specific and connectivity-based predictions. The findings provide a neurophysiological basis for the theory that semantic processing is orchestrated through interactions between a critical anterior temporal lobe hub and modality-selective processing nodes.

  20. [Bilateral anterior uveiopapillitis, suspicious of Lyme disease--case report].

    PubMed

    Nicula, Cristina; Nicula, D; Rusu, Ioana; Popescu, Raluca

    2013-01-01

    We present the case of a patient which associated bilateral anterior uveitis manifestations with those of bilateral anterior inflammatory optic neuropathy. We followed the evolution of the case under treatment and we discussed the differential diagnosis and the association of the two ocular pathologies.

  1. Extensor retinaculum augmentation reinforces anterior talofibular ligament repair.

    PubMed

    Aydogan, Umur; Glisson, Richard R; Nunley, James A

    2006-01-01

    Repair of the anterior talofibular ligament often is augmented with the inferior extensor retinaculum because it is thought to reinforce the primary ligament repair. The additional dissection and suturing extend the duration of surgery, and not all surgeons routinely include inferior extensor retinaculum augmentation in anterior talofibular ligament repairs. To determine whether there is a reasonable basis for this surgery, we ascertained the degree to which inferior extensor retinaculum augmentation reinforced the primary anterior talofibular ligament repair. Matched pairs of cadaveric ankles had controlled inversion while monitoring resistance to inversion, first with the anterior talofibular ligament sectioned, then with primary anterior talofibular ligament repair alone or with inferior extensor retinaculum augmentation. The resistance to ankle inversion was greater at 5 degrees, 10 degrees, 15 degrees, 20 degrees, and 25 degrees rotation in ankles that had inferior extensor retinaculum augmentation. Anterior talofibular ligament failure occurred at similar inversion angles in both treatment groups, but the primary anterior talofibular ligament repair required more torque to fail in the augmented group. With these ankle loading conditions, inferior extensor retinaculum augmentation provided protection to the primary anterior talofibular ligament repair, indicating that broader clinical use of augmentation may be warranted.

  2. Bilateral agenesis of the anterior cruciate ligament: MRI evaluation.

    PubMed

    Bedoya, Maria A; McGraw, Michael H; Wells, Lawrence; Jaramillo, Diego

    2014-09-01

    Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed.

  3. Revision in the Providence Public Schools

    ERIC Educational Resources Information Center

    Shinn, Ridgway F.

    1971-01-01

    Curriculum revision of the school systems K-12 social studies program involves a model built around a geo-historical unit developed through the joint efforts of many specialists. Social science concepts were introduced through an interdisciplinary approach. (CB)

  4. Revised Certification Standards for Pesticide Applicators

    EPA Pesticide Factsheets

    EPA has finalized stronger standards for people who apply restricted use pesticides (RUPs). These revisions to the Certification of Pesticide Applicators rule will reduce the likelihood of harm from the misapplication of toxic pesticides.

  5. Revised Total Coliform Rule Lab Sampling Form

    EPA Pesticide Factsheets

    This form should be completed when a water system collects any required Revised Total Coliform Rule (RTCR) samples. It should also be used when collecting “Special” non-compliance samples for the RTCR.

  6. 78 FR 59982 - Revisions to Radiation Protection

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-30

    ... From the Federal Register Online via the Government Publishing Office ] NUCLEAR REGULATORY COMMISSION Revisions to Radiation Protection AGENCY: Nuclear Regulatory Commission. ACTION: Standard review... Reports for Nuclear Power Plants: LWR Edition'': Section 12.1, ``Assuring that Occupational...

  7. Lead and Copper Rule Revisions White Paper

    EPA Pesticide Factsheets

    The Lead and Copper Rule (LCR) Revisions White Paper provides examples of regulatory options to improve the existing rule. The paper highlights key challenges, opportunities, and analytical issues presented by these options.

  8. CSAPR June Revisions Rule (77 FR 34830)

    EPA Pesticide Factsheets

    EPA takes final action on revisions to the final Transport Rule (Federal Implementation Plans: Interstate Transport of Fine Particulate Matter and Ozone and Correction of SIP Approvals, published August 8, 2011).

  9. Revised Nuffield Chemistry: October 1979 School Survey.

    ERIC Educational Resources Information Center

    Dawson, B. E.

    1980-01-01

    Presents some of the preliminary results of a survey study about the use of both the revised publications and GCE O-Level examinations for Nuffield Chemistry in 495 British schools and colleges in 1979. (HM)

  10. New and revised standards for coke production

    SciTech Connect

    G.A. Kotsyuba; M.I. Alpatov; Y.G. Shapoval

    2009-07-15

    The need for new and revised standards for coke production in Ukraine and Russia is outlined. Such standards should address improvements in plant operation, working conditions, environmental protection, energy conservation, fire and explosion safety, and economic indices.

  11. Facial Scar Revision: Understanding Facial Scar Treatment

    MedlinePlus

    ... Contact Us Trust your face to a facial plastic surgeon Facial Scar Revision Understanding Facial Scar Treatment When ... face like the eyes or lips. A facial plastic surgeon has many options for treating and improving facial ...

  12. Bladder tear during revision total hip arthroplasty.

    PubMed

    Grauer, Jonathan N; Halim, Andrea; Keggi, Kristaps J

    2014-08-01

    Total hip arthroplasty (THA) and revision total hip arthroplasty are among the most commonly performed orthopedic procedures. There are many reported complications of THA, but intrapelvic complications are a rare subset. Bladder injuries have infrequently been described in association with this common procedure. We present an unusual case of a bladder tear occurring intraoperatively during a revision THA. It is suspected that the patient's history of multiple prior hip procedures caused adhesions of the bladder to the pelvic floor and predisposed the bladder to injury during acetabular revision. Previous reports of bladder injury relating to THA have described thermal necrosis, component migration, and occasional direct perforation. There are no prior case reports describing bladder tears related to adhesions occurring intraoperatively during revision THA. This case report highlights the importance of surgeon awareness of an unusual complication. In this case, intraoperative and postoperative recognition of a hematuria diagnosis led to the appropriate treatment, and this patient had an acceptable outcome.

  13. Revision rhinoplasty: panel discussion, controversies, and techniques.

    PubMed

    Adamson, Peter A; Warner, Jeremy; Becker, Daniel; Romo, Thomas J; Toriumi, Dean M

    2014-02-01

    What is the single most difficult challenge in revision rhinoplasty and how do you address it? During revision rhinoplasty, when dorsal augmentation is necessary and septal and ear cartilage is not available, what is the best substance for correcting the problem? If rib cartilage is used for dorsal augmentation during revision rhinoplasty, what is the technique to prevent warping of the graft? Alloplast in the nose--when, where, and for what purpose? Does the release and reduction of the upper lateral cartilages from the nasal dorsal septum always require spreader graft placement to prevent mid-one-third nasal pinching in reductive rhinoplasty?' Over the past 5 years, how has your technique evolved or what have you observed and learned in performing revision rhinoplasty? Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Revised Total Coliform Webinar for Primacy Agencies

    EPA Pesticide Factsheets

    This webinar was created to assist Primacy Agencies in the implementation of the Revised Total Coliform Rule. It provides an overview of the requirements in the rule and implementation guidance for Primacy Agencies.

  15. Revised positions for CIG galaxies

    NASA Astrophysics Data System (ADS)

    Leon, S.; Verdes-Montenegro, L.

    2003-12-01

    We present revised positions for the 1051 galaxies belonging to the Karachentseva Catalog of Isolated Galaxies (CIG). New positions were calculated by applying SExtractor to the Digitized Sky Survey CIG fields with a spatial resolution of 1 arcsper 2. We visually checked the results and for 118 galaxies had to recompute the assigned positions due to complex morphologies (e.g. distorted isophotes, undefined nuclei, knotty galaxies) or the presence of bright stars. We found differences between older and newer positions of up to 38 arcsec with a mean value of 2 arcsper 96 relative to SIMBAD and up to 38 arcsec and 2 arcsper 42 respectively relative to UZC. Based on star positions from the APM catalog we determined that the DSS astrometry of five CIG fields has a mean offset in (alpha , delta ) of (-0 arcsper 90, 0 arcsper 93) with a dispersion of 0 arcsper 4. These results have been confirmed using the 2MASS All-Sky Catalog of Point Sources. The intrinsic errors of our method combined with the astrometric ones are of the order of 0 arcsper 5. Full Table 1 is only available in electronic form at the CDS via anonymous ftp to cdsarc.u-strasbg.fr (130.79.128.5) or via http://cdsweb.u-strasbg.fr/cgi-bin/qcat?J/A+A/411/391

  16. HLW system plan - revision 2

    SciTech Connect

    Not Available

    1994-01-14

    The projected ability of the Tank Farm to support DWPF startup and continued operation has diminished somewhat since revision 1 of this Plan. The 13 month delay in DWPF startup, which actually helps the Tank Farm condition in the near term, was more than offset by the 9 month delay in ITP startup, the delay in the Evaporator startups and the reduction to Waste Removal funding. This Plan does, however, describe a viable operating strategy for the success of the HLW System and Mission, albeit with less contingency and operating flexibility than in the past. HLWM has focused resources from within the division on five near term programs: The three evaporator restarts, DWPF melter heatup and completion of the ITP outage. The 1H Evaporator was restarted 12/28/93 after a 9 month shutdown for an extensive Conduct of Operations upgrade. The 2F and 2H Evaporators are scheduled to restart 3/94 and 4/94, respectively. The RHLWE startup remains 11/17/97.

  17. Revision total knee arthroplasty using a custom tantalum implant in a patient following multiple failed revisions.

    PubMed

    McNamara, Colin A; Gösthe, Raúl G; Patel, Preetesh D; Sanders, Kristopher C; Huaman, Gustavo; Suarez, Juan C

    2017-03-01

    The number of revision total knee arthroplasty procedures performed annually is increasing and, subsequently, so is the number of patients presenting following a failed revision. Rerevising a total knee arthroplasty after one or more failed revision procedures presents many challenges, including diminished bone stock for prosthetic fixation. "Off the shelf" implants may not offer the best alternative for reconstruction. We present the case of a 55-year-old patient who required a rerevision total knee arthroplasty following multiple failed revisions with severe femoral and tibia bone loss. We describe a novel technique we employed to improve component fixation within the compromised bone stock.

  18. Revised FIGO staging system for endometrial cancer.

    PubMed

    Lewin, Sharyn N

    2011-06-01

    In 1988 the International Federation of Gynecologists and Obstetricians (FIGO) developed a surgical staging system for endometrial cancer. The FIGO staging system was recently revised in 2009 to reflect our growing understanding of the natural history of endometrial cancer. In this review, we describe the revised 2009 FIGO staging system for tumors of the uterine corpus and examine the effect of the new changes in the staging criteria.

  19. Revision of failed humeral head resurfacing arthroplasty

    PubMed Central

    Streubel, Philipp N.; Simone, Juan P.; Cofield, Robert H.; Sperling, John W.

    2016-01-01

    Purpose: The purpose of this study is to assess the outcomes of a consecutive series of patients who underwent revision surgery after humeral head resurfacing (HHR). Our joint registry was queried for all patients who underwent revision arthroplasty for failed HHR at our institution from 2005 to 2010. Eleven consecutive patients (average age 54 years; range 38-69 years) that underwent revision of 11 resurfacing arthroplasties were identified. The primary indication for resurfacing had been osteoarthritis in six, glenoid dysplasia in two, a chondral lesion in two, and postinstability arthropathy in one patient. The indication for revision was pain in 10 and infection in one patient. Seven patients had undergone an average of 1.9 surgeries prior to resurfacing (range 1-3). Materials and Methods: All patients were revised to stemmed arthroplasties, including one hemiarthroplasty, two reverse, and eight anatomic total shoulder arthroplasties at a mean 33 months after primary resurfacing (range 10-131 months). A deltopectoral approach was used in seven patients; four patients required an anteromedial approach due to severe scarring. Subscapularis attenuation was found in four cases, two of which required reverse total shoulder arthroplasty. Bone grafting was required in one glenoid and three humeri. Results: At a mean follow-up of 3.5 years (range 1.6-6.9 years), modified Neer score was rated as satisfactory in five patients and unsatisfactory in six. Abduction and external rotation improved from 73° to 88° (P = 0.32) and from 23° to 32° (P = 0.28) respectively. Reoperation was required in two patients, including one hematoma and one revision for instability. Conclusion: Outcomes of revision of HHR arthroplasty in this cohort did not improve upon those reported for revision of stemmed humeral implants. A comparative study would be required to allow for definitive conclusions to be made. PMID:26980986

  20. Impact biomechanics of lateral knee bracing. The anterior cruciate ligament.

    PubMed

    Paulos, L E; Cawley, P W; France, E P

    1991-01-01

    We evaluated the effects of six different prophylactic braces on ACL ligament strain under dynamic valgus loads using a mechanical surrogate limb validated against human cadaveric specimens. Medical collateral ligament and anterior cruciate ligament peak forces, medial collateral ligament and anterior cruciate ligament tension initiation times, and impact safety factors were calculated for both braced and unbraced conditions. These tests were conducted to determine whether or not application of a prophylactic brace might provide protection to the anterior cruciate ligament under valgus loading conditions. The results of this study indicate that those braces that increased impact duration appear to differentially protect the anterior cruciate ligament more than the medial collateral ligament, and that most of the braces tested appear to provide some degree of protection to the anterior cruciate ligament under direct lateral impacts. These findings should be confirmed clinically.

  1. Early implicit contextual change detection in anterior prefrontal cortex.

    PubMed

    Pollmann, Stefan; Manginelli, Angela A

    2009-03-31

    The anterior prefrontal cortex is usually associated with high-level executive functions. In contrast, we show anterior prefrontal involvement in implicit change detection processes. A variant of the contextual cueing paradigm was used, in which repeated distractor configurations are implicitly learned and facilitate target search. After only six repetitions, the target location was changed in displays with repeated distractor configurations. We observed selective post-change signal increases in the anterior prefrontal cortex in repeated, but not novel displays. The data support the view that the anterior prefrontal cortex is involved in implicit change detection. This change detection is not dependent on extensive prior learning. Thus, anterior prefrontal involvement in complex cognitive tasks may be due to more basic processes than previously thought.

  2. Anterior endoderm and head induction in early vertebrate embryos.

    PubMed

    de Souza, F S; Niehrs, C

    2000-05-01

    Early work on the formation of the vertebrate body axis indicated the existence of separate head- and trunk-inducing regions in Spemann's organizer of the amphibian gastrula. In mammals some head-organizing activity may be located in anterior visceral (extraembryonic) endoderm (AVE). By analogy, the equivalent structure in the Xenopus laevis gastrula, the anterior endoderm, has been proposed to be the amphibian head organizer. Here we review recent data that challenge this notion and indicate that the involvement of AVE in head induction seems to be an exclusively mammalian characteristic. In X. laevis and chick, it is the prechordal endomesoderm that is the dominant source of head-inducing signals during early gastrulation. Furthermore, head induction in mammals needs a combination of signals from anterior primitive endoderm, prechordal plate, and anterior ectoderm. Thus, despite the homology of vertebrate anterior primitive endoderm, a role in head induction seems not to be conserved.

  3. Method for measuring anterior chamber volume by image analysis

    NASA Astrophysics Data System (ADS)

    Zhai, Gaoshou; Zhang, Junhong; Wang, Ruichang; Wang, Bingsong; Wang, Ningli

    2007-12-01

    Anterior chamber volume (ACV) is very important for an oculist to make rational pathological diagnosis as to patients who have some optic diseases such as glaucoma and etc., yet it is always difficult to be measured accurately. In this paper, a method is devised to measure anterior chamber volumes based on JPEG-formatted image files that have been transformed from medical images using the anterior-chamber optical coherence tomographer (AC-OCT) and corresponding image-processing software. The corresponding algorithms for image analysis and ACV calculation are implemented in VC++ and a series of anterior chamber images of typical patients are analyzed, while anterior chamber volumes are calculated and are verified that they are in accord with clinical observation. It shows that the measurement method is effective and feasible and it has potential to improve accuracy of ACV calculation. Meanwhile, some measures should be taken to simplify the handcraft preprocess working as to images.

  4. Tibiofemoral Osteoarthritis After Surgical or Nonsurgical Treatment of Anterior Cruciate Ligament Rupture: A Systematic Review.

    PubMed

    Harris, Kyle P; Driban, Jeffrey B; Sitler, Michael R; Cattano, Nicole M; Balasubramanian, Easwaran; Hootman, Jennifer M

    2017-06-02

      To determine if surgical or nonsurgical treatment of anterior cruciate ligament rupture affects the prevalence of posttraumatic tibiofemoral osteoarthritis (OA).   Studies published between 1983 and April 2012 were identified via EBSCOhost and OVID. Reference lists were then screened in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.   Studies were included if (a) treatment outcomes focused on a direct comparison of surgical versus nonsurgical treatment of anterior cruciate ligament rupture, (b) the prevalence of tibiofemoral OA was reported, and (c) they were written in English. Studies were excluded if (a) the included patients were treated with cast immobilization after surgery, (b) the mean follow-up was less than 10 years, or (c) the patients underwent anterior cruciate ligament revision surgery.   Two independent investigators reviewed the included articles using the Newcastle-Ottawa Scale. Frequency of OA, surgical procedure, nonsurgical treatments, and participant characteristics were extracted and summarized. We calculated prevalence (%) and 95% confidence intervals for treatment groups for each individual study and overall. We developed 2 × 2 contingency tables to assess the association between treatment groups (exposed had surgery, referent was nonsurgical treatment) and the prevalence of OA.   Four retrospective studies were identified (140 surgical patients, 240 nonsurgical patients). The mean Newcastle-Ottawa Scale score was 5 (range = 4-6 [of 10] points). Average length of follow-up was 11.8 years (range = 10-14 years). The prevalence of OA for surgically treated patients ranged from 32.6% to 51.2% (overall = 41.4%, 95% confidence interval = 35.0%, 48.1%) and for nonsurgical patients ranged from 24.5% to 42.3% (overall = 30.9%, 95% confidence interval = 24.4%, 38.3%).   Although OA prevalence was higher in the surgical treatment group at a mean follow-up of 11.8 years, no

  5. Glenoid Reconstruction in Revision Shoulder Arthroplasty

    PubMed Central

    Elhassan, Bassem; Ozbaydar, Mehmet; Higgins, Lawrence D.

    2008-01-01

    Failed shoulder arthroplasty associated with glenoid bony deficiency is a difficult problem. Revision surgery is complex with unpredictable outcome. We asked whether revision shoulder arthroplasty with glenoid bone grafting could lead to good outcome. We retrospectively reviewed 21 patients who underwent glenoid bone grafting using corticocancellous bone grafting or impaction grafting using cancellous bone graft. Three patients underwent revision TSA, five patients hemiarthroplasty, 10 patients hemiarthroplasty with biologic resurfacing of the glenoid, and three patients revision to reverse TSA. The patients had minimum 25 months followup (average, 45 months; range, 25–92 months). All patients had improvement in their range of motion and the Constant-Murley score. Most improvement occurred in patients with glenoid reimplantation. Patients who underwent revision reverse TSA had improvement in shoulder flexion but decrease in external rotation motion. We conclude revision shoulder arthroplasty with glenoid bone grafting can produce good short-term outcome and glenoid component reinsertion should be attempted whenever possible. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18213509

  6. Revision of the DELFIC Particle Activity Module

    SciTech Connect

    Hooper, David A; Jodoin, Vincent J

    2010-09-01

    The Defense Land Fallout Interpretive Code (DELFIC) was originally released in 1968 as a tool for modeling fallout patterns and for predicting exposure rates. Despite the continual advancement of knowledge of fission yields, decay behavior of fission products, and biological dosimetry, the decay data and logic of DELFIC have remained mostly unchanged since inception. Additionally, previous code revisions caused a loss of conservation of radioactive nuclides. In this report, a new revision of the decay database and the Particle Activity Module is introduced and explained. The database upgrades discussed are replacement of the fission yields with ENDF/B-VII data as formatted in the Oak Ridge Isotope Generation (ORIGEN) code, revised decay constants, revised exposure rate multipliers, revised decay modes and branching ratios, and revised boiling point data. Included decay logic upgrades represent a correction of a flaw in the treatment of the fission yields, extension of the logic to include more complex decay modes, conservation of nuclides (including stable nuclides) at all times, and conversion of key variables to double precision for nuclide conservation. Finally, recommended future work is discussed with an emphasis on completion of the overall radiation physics upgrade, particularly for dosimetry, induced activity, decay of the actinides, and fractionation.

  7. Anterior commissure versus corpus callosum: A quantitative comparison across mammals.

    PubMed

    Ashwell, Ken W S

    2016-04-01

    Mammals rely on two major pathways to transfer information between the two hemispheres of the brain: the anterior commissure and the corpus callosum. Metatheria and monotremes rely exclusively on the anterior commissure for interhemispheric transfer between the isocortices and olfactory allocortices of each side, whereas Eutheria use a combination of the anterior commissure and an additional pathway exclusive to Eutheria, the corpus callosum. Midline cross-sectional area of the anterior commissure and corpus callosum were measured in a range of mammals from all three infraclasses and plotted against brain volume to determine how midline anterior commissure area and its size relative to the corpus callosum vary with brain size and taxon. In Metatheria, the square root of anterior commissure area rises in almost direct proportion with the cube root of brain volume (i.e. the ratio of the two is relatively constant), whereas among Eutheria the ratio of the square root of anterior commissure area to the cube root of brain volume declines slightly with increasing brain size. The total of isocortical and olfactory allocortical commissure area rises more rapidly with increasing brain volume among Eutheria than among Metatheria. This means that the midline isocortical and olfactory allocortical commissural area of metatherians with large brains (about 70 ml) is only about 50% of that among eutherians with similarly sized brains. On the other hand, isocortical and olfactory allocortical commissural area is similar in Metatheria and Eutheria at brain volumes around 1 ml. Among the Eutheria, some groups make less use of the anterior commissure pathway than do others: soricomorphs, rodents and cetaceans have smaller anterior commissures for their brain size than do afrosoricids, erinaceomorphs and proboscideans. The findings suggest that use of the anterior commissural route for isocortical commissural connections may have placed limitations on interhemispheric transfer of

  8. Nociceptive Processing by Anterior Cingulate Pyramidal Neurons

    PubMed Central

    Shyu, Bai-Chuang; Sikes, Robert W.; Vogt, Brent A.

    2010-01-01

    Although the cingulate cortex is frequently activated in acute human pain studies, postsynaptic responses are not known nor are links between nociceptive afferents, neuronal responses, and outputs to other structures. Intracellular potentials were recorded from neurobiotin-injected, pyramidal neurons in anterior cingulate area 24b following noxious stimulation of the sciatic nerve in anesthetized rabbits. Layer IIIc pyramids had extensive and horizontally oriented basal dendrites in layer IIIc where nociceptive afferents terminate. They had the longest excitatory postsynaptic potentials (EPSPs; 545 ms) that were modulated with hyperpolarizing currents. Pyramids in layer V had an intermediate tuft of oblique apical dendrites in layer IIIc that were 150–350 μm from somata in layer Va and 351–550 μm in layer Vb. Although average EPSP durations were short in layers II–IIIab (222 ± 31), Va (267 ± 65), and Vb (159 ± 31), there were five neurons in layers IIIab–Va that had EPSP durations lasting >300 ms (548 ± 63 ms). Neurons in layers IIIc, Va, and Vb had the highest amplitude EPSPs (6.25, 6.84 ± 0.58, and 6.4 ± 0.47 mV, respectively), whereas those in layers II–IIIab were 5 ± 0.56 mV. Nociceptive responses in layer Vb were complex and some had initial inhibitory postsynaptic potentials with shorter-duration EPSPs. Layers II–IIIab had dye-coupled pyramids and EPSPs in these layers had short durations (167 ± 33 ms) compared with those in layers IIIc–Va (487 ± 28 ms). In conclusion there are two populations of anterior cingulate cortex pyramids with EPSPs of significantly different durations, although their dendritic morphologies do not predict EPSP duration. Short-duration EPSPs are thalamic-mediated, nociceptive responses lasting ≤200 ms. Longer, “integrative” EPSPs are >350 ms and are likely modulated by intracortical axon collateral discharges. These findings suggest that links between nociception and projections to cortical and motor

  9. [Anterior shoulder instability--the current situation].

    PubMed

    Schofer, M D; Diehl, A; Theisen, C; Timmesfeld, N; Heyse, T J; Fuchs-Winkelmann, S; Efe, T

    2010-01-01

    The aim of the study was to survey the current state of the conservative and operative treatment of anterior shoulder instability and its rehabilitation in German hospitals. A previously evaluated online questionnaire was sent out to all German hospitals with orthopaedic or trauma surgery departments. The Federal Statistical Office's hospital list was the basis for the selection of hospitals. The questions referred to the year 2007. The survey, including 3 reminders, was conducted over 3 months. The questionnaire consisted of 6 response categories: always (100%), almost always (99-81%), predominantly (80-51%), rarely (50-21%), almost never (20-1%) and never (0%). The response rate was 41% and 67% of these had carried out shoulder stabilisations. In total, 99.2% of the 67% were evaluable. The proportion of shoulder surgery was 8.4% of the total number of operations. Shoulder stabilisations represented 10.6% of these operations. A specialised shoulder department existed in 22.9%. Conservative treatment was carried out with an immobilisation of the arm "predominantly", "almost always" and "always" for internal rotation in 70.8% and in 23.4% for external rotation. The shoulders were "predominantly", "almost always" and "always" stabilised in an arthroscopic technique in 68.2% and in an open one in 31.8% of the clinics. With 92.9%, the Bankart repair was the most common operation. Shoulder instability was principally treated with the arthroscopic technique, regardless of the care level and department and is considered the best surgical technique. Physiotherapy was prescribed "always" and "almost always" in 99.3%. The rate of reluxation after conservative treatment was estimated at 35.5%, after operative open anterior shoulder stabilisation at 9.1% and after arthroscopic shoulder stabilization at 10.6%. Nevertheless, 49.4% of respondents expected the best results after arthroscopic treatment. Participants, who mainly applied the arthroscopic technique, expected a lower

  10. Temporal patterns of hiatus hernia recurrence and hiatal failure: quality of life and recurrence after revision surgery.

    PubMed

    Suppiah, A; Sirimanna, P; Vivian, S J; O'Donnell, H; Lee, G; Falk, G L

    2017-04-01

    Antireflux and paraesophageal hernia repair surgery is increasingly performed and there is an increased requirement for revision hiatus hernia surgery. There are no reports on the changes in types of failures and/or the variations in location of crural defects over time following primary surgery and limited reports on the outcomes of revision surgery. The aim of this study is to report the changes in types of hernia recurrence and location of crural defects following primary surgery, to test our hypothesis of the temporal events leading to hiatal recurrence and aid prevention. Quality of life scores following revision surgery are also reported, in one of the largest and longest follow-up series in revision hiatus surgery. Review of a single-surgeon database of all revision hiatal surgery between 1992 and 2015. The type of recurrence and the location of crural defect were noted intraoperatively. Recurrence was diagnosed on gastroscopy and/or contrast study. Quality of life outcomes were measured using Visick, dysphagia, atypical reflux symptoms, satisfaction scores, and Gastrointestinal Quality of Life Index (GIQLI). Two-hundred eighty four patients (126 male, 158 female), median age 60.8(48.2-69.1), underwent revision hiatal surgery. Median follow-up following primary surgery was 122.8(75.3-180.3) and 91.6(40.5-152.5) months after revision surgery. The most common type of hernia recurrence in the early period after primary surgery was 'telescope'(42.9%), but overall, fundoplication apparatus transhiatal migration was consistently the predominant type of recurrence at 1-3 years (54.3%), 3-5 years (42.5%), 5-10 years (45.1%), and >10 years (44.1%). The location of crural defects changed over duration following primary surgery as anteroposterior defects was most common in the early period (45.5% in <1 year) but decreased over time (30.3% at 1-3 years) while anterior defects increased in the long term with 35.9%, 40%, and 42.2% at 3-5 years, 5-10 years, and >10 years

  11. Anterior cruciate ligament injury in professional dancers.

    PubMed

    Meuffels, Duncan E; Verhaar, Jan A N

    2008-08-01

    Anterior cruciate ligament injury (ACL) is a common sport injury; however, there are no data concerning dance and ACL injury. We report the incidence, injury mechanism, and clinical follow-up of ACL injury in professional dancers. In a retrospective cohort study involving the three major dance companies in the Netherlands, by interviewing all 253 dancers who had had a full-time contract during 1991-2002, dancers with symptomatic ACL injury or past ACL reconstruction were identified and examined. 6 dancers (2 of whom were women) had had a symptomatic ACL rupture and reconstruction. Interestingly, all had been on the left side and had had a similar trauma mechanism: while dancing a classical variation they landed, after a jump, on their left leg, in the turned out position with a valgus force on their knee. There was a higher risk of ACL injury in the classical company than in the two contemporary companies. The risk of dancers having a rupture of the left ACL during a 10-year career in this classical company was 7%. ACL injuries are not an infrequently seen type of injury in professional classical dancers, with a very specific mechanism of injury--a landing on the left leg in exorotation. More attention and prophylactic measures should be given to this specific injury mechanism.

  12. Intraoperative anterior cruciate ligament graft contamination.

    PubMed

    Pasque, Charles B; Geib, Timothy M

    2007-03-01

    Intraoperative anterior cruciate ligament graft contamination is a rare but potentially devastating occurrence for any surgeon to encounter. Most instances in our experience have happened when a surgeon first enters practice or is operating in a new environment with new staff. Based on the currently available literature and the senior author's personal experience with 3 cases, intraoperative cleansing of the graft followed by implantation is a reasonable option. The protocol used successfully in these 3 cases includes getting the graft off of the floor immediately, removing any suture material in the graft, cleansing the graft for 15 to 30 minutes each in chlorohexidine and triple antibiotic solution, followed by a normal saline rinse. All graft sutures should then be replaced. The graft should then be resized and the tibial and femoral tunnels adjusted if needed. After implantation of the graft, additional intraoperative and postoperative intravenous antibiotic and/or oral antibiotic administration is also recommended for the first 1 to 2 weeks. Close clinical follow-up is also very important the first 6 weeks postoperatively and should include candid communication with the patient and family.

  13. Surgery for distal anterior cerebral artery aneurysms.

    PubMed

    Lee, Jae Whan; Lee, Kyu Chang; Kim, Yong Bae; Huh, Seung Kon

    2008-08-01

    Because DACA aneurysms are located in the narrow interhemispheric space surrounded by the corpus callosum and bilateral cingulate gyri with intervening falx cerebri, they are considered some of the most difficult anterior circulation aneurysms to surgically treat. Moreover, because of their rare occurrence and the emerging nonsurgical treatment options, neurosurgeons are limited in their ability to surgically treat DACA aneurysms due to their lack of experience. This article describes details of the preoperative considerations, operative techniques, and surgical results for DACA aneurysms. Medical records, including imaging studies, surgeon's hand drawings and descriptions of microsurgical findings, microphotographs, and video records of operative procedures, were reviewed. Among 3577 patients with intracranial aneurysms treated since 1975, 126 (3.5%) patients with DACA aneurysms were identified. They were treated either by surgery (117 patients) or endovascular treatment (9 patients). The results of surgical treatment for the 117 patients with DACA aneurysms were favorable in 94% (90.6% good and 3.4% fair) and unfavorable in 6% (5.1% poor and 0.9% dead). All unfavorable outcomes occurred in patients who were of preoperative grades 4 or 5. Successful surgical management of DACA aneurysms depends on precise understanding of their unique microsurgical anatomy, avoidance of pitfalls, and the surgeon's experience. Sufficient brain relaxation, accurate localization of the aneurysm, early identification of the proximal A2 segment, and preservation of the major draining veins are necessary for a safe surgery.

  14. Anterior cutaneous nerve entrapment syndrome: management challenges

    PubMed Central

    Chrona, Eleni; Kostopanagiotou, Georgia; Damigos, Dimitrios; Batistaki, Chrysanthi

    2017-01-01

    Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly underdiagnosed and undertreated chronic state of pain. This syndrome is characterized by the entrapment of the cutaneous branches of the lower thoracoabdominal intercostal nerves at the lateral border of the rectus abdominis muscle, which causes severe, often refractory, chronic pain. This narrative review aims to identify the possible therapeutic strategies for the management of the syndrome. Seventeen studies about ACNES therapy were reviewed; of them, 15 were case–control studies, case series, or case reports, and two were randomized controlled trials. The presently available management strategies for ACNES include trigger point injections (diagnostic and therapeutic), ultrasound-guided blocks, chemical neurolysis, and surgical neurectomy, in combination with systemic medication, as well as some emerging techniques, such as radiofrequency ablation and neuromodulation. An increased awareness of the syndrome and the use of specific diagnostic criteria for its recognition are required to facilitate an early and successful management. This review compiles the proposed management strategies for ACNES. PMID:28144159

  15. Principles of postoperative anterior cruciate ligament rehabilitation

    PubMed Central

    Saka, Tolga

    2014-01-01

    It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, “ossified” knowledge or modalities really prove themselves in the literature? Could questions such as “is postoperative brace use really necessary?”, “what are the benefits of early restoration of the range of motion (ROM)?”, “to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?”, “how early can proprioception training and open chain exercises begin?”, “should strengthening training start in the immediate postoperative period?” be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521

  16. Anterior cruciate ligament surgery in the rabbit

    PubMed Central

    2013-01-01

    Background Various methods regarding allograft knee replacements have been described. The animal models, which are generally used for this purpose include sheep, dogs, goats, and pigs, and accrue significant costs for study protocols. The authors herein describe an efficient and cost-effective model to study either native or tissue-engineered allografts for anterior cruciate ligament (ACL) replacement in a New Zealand rabbit model with the potential for transgenic and cell migration studies. Methods ACL reconstructions were performed in rabbits under general anesthesia. For fresh allograft implantations, two animals were operated in parallel. Each right extensor digitorum longus tendon was harvested and prepared for implantation. After excision of the ACL, tibial and femoral bone tunnels were created to implant each graft in the native ACL position. Results During a 2-year period, the authors have successfully undertaken this surgery in 61 rabbits and have not noticed any major complications attributed to this surgical technique. In addition, the authors have observed fast recovery in the animals postoperatively. Conclusion The authors recommend this surgical procedure as an excellent model for the study of knee surgery. PMID:23957941

  17. Meningiomas involving the anterior clinoid process.

    PubMed

    Risi, P; Uske, A; de Tribolet, N

    1994-01-01

    We report a series of 34 clinoidal meningiomas treated surgically and analyse the results according to cavernous sinus involvement. Fifteen tumours extended into the cavernous sinus. Only four of these could be resected completely, and global outcome was improved or stable in 10 cases. Overall, 20 tumours had a total resection and 14 had a partial resection. Complete removal of the sphenoid wing, including the anterior clinoid and part of the planum sphenoidale, allows early devascularization of the tumour and minimizes brain retraction when associated with resection of the zygomatic arch. The most frequent postoperative complication was transient CSF leak, occurring in three patients. Two patients died postoperatively, and three suffered permanent complications. There was no recurrence after total removal, but five patients showed signs of progressive tumour growth after partial removal, treated by radiotherapy in three and by surgery in two cases. Twenty patients showed preoperative visual impairment. Outcome of vision was improved or stable in 13 (68%) and worse in six cases (32%). We suggest that progressive visual impairment should lead to aggressive surgical treatment, especially when complete resection of cavernous sinus involvement can be performed.

  18. Focal Atrial Tachycardia Surrounding the Anterior Septum

    PubMed Central

    Wang, Zulu; Ouyang, Jinge; Liang, Yanchun; Jin, Zhiqing; Yang, Guitang; Liang, Ming; Li, Shibei; Yu, Haibo

    2015-01-01

    Background— Focal atrial tachycardias (ATs) surrounding the anterior atrial septum (AAS) have been successfully ablated from the right atrial septum (RAS), the aortic cusps, and the aortic mitral junction. However, the strategy for mapping and ablation of AAS-ATs has not been well defined. Methods and Results— Of 227 consecutive patients with AT, 47 (20.7%; mean age, 56.3±11.6 years) with AAS-ATs were studied; among them, initial ablation was successful at RAS in only 5 of 14 patients and at noncoronary cusp (NCC) in 28 of 33 patients. In 45 of the 47 patients, the 46 of 48 AAS-ATs were eliminated at RAS in 8 patients, NCC in 35 patients (earliest activation time at NCC was later than that at RAS by 5–10 ms in 6 patients), and aortic mitral junction in 3 patients (all with negative P wave in lead aVL and positive P wave in the inferior leads), including 1 patient whose 2 ATs were eliminated separately from the NCC and the aortic mitral junction. Conclusions— Most of the ATs surrounding the AAS can be eliminated from within the NCC, which is usually the preferential ablation site. Ablation at the RAS and aortic mitral junction should be considered when supported by P-wave morphologies on surface ECG and results of activation mapping and ablation. PMID:25908691

  19. Restoring primary anterior teeth: updated for 2014.

    PubMed

    Waggoner, William F

    2015-01-01

    The purpose of this paper was to review the current literature associated with the techniques and materials for the restoration of primary anterior teeth and make clinical recommendations based upon the available literature. A variety of esthetic restorative materials are available to utilize for restoring primary incisors. Awareness of the specific strengths, weakness, and properties of each material can enhance the clinician's ability to make the best choice of selection for each individual situation. Intracoronal restorations of primary teeth may utilize resin composites, glass ionomer cements, resin-modified ionomers, or polyacid-modified resins. Full coronal restoration of primary incisors may be indicated for a number of reasons. Crowns available for restoration of primary incisors include those that are directly bonded onto the tooth, which generally are a resin material, and crowns that are luted onto the tooth and are either some type of stainless steel or zirconia crown. There is insufficient controlled, clinical data to suggest that one type of restoration is superior to another. Operator preferences, esthetic demands by parents, the child's behavior, the amount of tooth structure remaining, and moisture and hemorrhage control are all variables that affect the decision and ultimate outcome of whatever restorative solution is chosen.

  20. Guideline on anterior cruciate ligament injury

    PubMed Central

    2012-01-01

    The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steering group of the Dutch Orthopaedic Association. What is the role of physical examination and additional diagnostic tools? Which patient-related outcome measures should be used? What are the relevant parameters that influence the indication for an ACL reconstruction? Which findings or complaints are predictive of a bad result of an ACL injury treatment? What is the optimal timing for surgery for an ACL injury? What is the outcome of different conservative treatment modalities? Which kind of graft gives the best result in an ACL reconstruction? What is the optimal postoperative treatment concerning rehabilitation, resumption of sports, and physiotherapy? These 8 questions were answered and recommendations were made, using the “Appraisal of Guidelines for Research and Evaluation” instrument. This instrument seeks to improve the quality and effectiveness of clinical practical guidelines by establishing a shared framework to develop, report, and assess. The steering group has also developed 7 internal indicators to aid in measuring and enhancing the quality of the treatment of patients with an ACL injury, for use in a hospital or practice. PMID:22900914

  1. Anterior cruciate ligament replacement: a review.

    PubMed

    Silver, F H; Tria, A J; Zawadsky, J P; Dunn, M G

    1991-01-01

    The anterior cruciate ligament (ACL) is the major intra-articular mechanical element that limits motion of the tibia with respect to the femur. It is a multi-fasciculated structure composed of crimped aligned collagen fibers. The purpose of this paper is to review the literature on ACL structure and mechanical properties in an effort to stimulate the development of a new generation of more effective replacement devices. Replacement of the ACL is achieved using biologic and synthetic grafts. Biologic grafts include illiotibial band, semitendinosus and gracilis tendons, patellar tendon, and meniscus. Bone-patellar-bone complexes used to replace the ACL are revascularized and ultimately replaced by neo-ligament. Synthetic implants including the Integraft, Leads-Keio ligament, Gore-Tex¿ ligament and Kennedy Ligament Augmentation Device (LAD) have either not been approved or approved by the FDA for limited use as a replacement for the ACL. The Kennedy LAD has been found to increase the strength of autogenous tissue during revascularization. Based on the success of autografts and the Kennedy LAD, we conclude that the next generation of ACL replacement devices will consist of a scaffold and a biodegradable augmentation device. The scaffold will have a structure that mimics the normal ACL as well as stimulates revascularization and healing. A biodegradable augmentation device will be employed to mechanically reinforce the scaffold without stress shielding the neo-ligament. By combining the advantages of autografts and a biodegradable augmentation device, a new generation of ACL replacements will be achieved.

  2. MRI of anterior cruciate ligament healing

    SciTech Connect

    Ihara, Hidetoshi; Miwa, Megumi; Deya, Keizo; Torisu, Kenji

    1996-03-01

    The purpose of this study was to evaluate using MRI the natural healing of the anterior cruciate ligament (ACL) when treated conservatively by early protective motion. Consecutive acute complete intraligamentous ruptures of the ACL in 50 cases that were allowed to heal without surgery were evaluated before and after 3 month treatment by MRI, arthroscopy, and stress radiographs. Twenty-nine of the 50 patients were also reevaluated 11 months from the initial injury, of which 7 were reevaluated again 24 months from the initial injury by MRI. The MR appearance of the treated ACL was categorized into four grades depending on homogeneity, straight band, and size. MR assessment of the ACL after 3 month treatment demonstrated a well defined normal-sized straight band in 37 cases (74%). There was a significant relationship between the 3 and 11 month MR evaluations (r. = 0.801, p < 0.0001). There were also significant relationships between the MR and arthroscopic evaluations (r, = 0.455, p < 0.005) and between the MR and stress radiographic evaluations (r, = 0.348, p < 0.025) after the 3 month treatment. MRI can demonstrate ACL healing when treated conservatively with early protective mobilization. 40 refs., 3 figs., 2 tabs.

  3. Natural History of Anterior Shoulder Instability

    PubMed Central

    Carpinteiro, Eduardo Palma; Barros, Andre Aires

    2017-01-01

    Background: The shoulder is the most complex joint in the body. The large freedom of motion in this joint is the main cause of instability. Instability varies in its degree, direction, etiology and volition and there is a large spectrum of conditions. Methods: Based on literature research and also in our own experience, we propose to elucidate the reader about the natural history of instability and its importance for the appropriate management of this pathology, by answering the following questions: What happens in the shoulder after the first dislocation? Which structures suffer damage? Who are the patients at higher risk of recurrence? How does the disease evolve without treatment? Will surgical treatment avoid future negative outcomes and prevent degenerative joint disease? Who should we treat and when? Results: 80% of anterior-inferior dislocations occur in young patients. Recurrent instability is common and multiple dislocations are the rule. Instability is influenced by a large number of variables, including age of onset, activity profile, number of episodes,delay between first episode and surgical treatment. Conclusion: Understanding the disease and its natural evolution is determinant to decide the treatment in order to obtain the best outcome. It is crucial to identify the risk factors for recurrence. Delay in surgical treatment, when indicated, leads to worse results. Surgical technique should address the type and severity of both soft tissue and bone lesions, when present.

  4. Natural History of Anterior Shoulder Instability.

    PubMed

    Carpinteiro, Eduardo Palma; Barros, Andre Aires

    2017-01-01

    The shoulder is the most complex joint in the body. The large freedom of motion in this joint is the main cause of instability. Instability varies in its degree, direction, etiology and volition and there is a large spectrum of conditions. Based on literature research and also in our own experience, we propose to elucidate the reader about the natural history of instability and its importance for the appropriate management of this pathology, by answering the following questions: What happens in the shoulder after the first dislocation? Which structures suffer damage? Who are the patients at higher risk of recurrence? How does the disease evolve without treatment? Will surgical treatment avoid future negative outcomes and prevent degenerative joint disease? Who should we treat and when? 80% of anterior-inferior dislocations occur in young patients. Recurrent instability is common and multiple dislocations are the rule. Instability is influenced by a large number of variables, including age of onset, activity profile, number of episodes,delay between first episode and surgical treatment. Understanding the disease and its natural evolution is determinant to decide the treatment in order to obtain the best outcome. It is crucial to identify the risk factors for recurrence. Delay in surgical treatment, when indicated, leads to worse results. Surgical technique should address the type and severity of both soft tissue and bone lesions, when present.

  5. Distal tendinosis of the tibialis anterior tendon.

    PubMed

    Beischer, Andrew D; Beamond, Ben M; Jowett, Andrew J L; O'Sullivan, Richard

    2009-11-01

    Disorders of the tibialis anterior (TA) tendon have infrequently been reported but spontaneous rupture of this tendon is well recognized. The clinical presentation of tendinosis without rupture of the distal TA has not previously been reported and is the basis of this paper. A study of 29 patients diagnosed with distal TA tendinosis was undertaken. Data collected included, patient demographics, weight, height, pain profile and examination findings. All patients underwent MRI of the symptomatic foot. Operative findings of those patients undergoing surgery for this condition were collected. Twenty-nine patients (32 feet) were included in the study group. Their mean age was 62 years and 27 patients were female. Twenty-one patients were overweight. The usual presenting symptom was burning medial midfoot pain that was often reported to be worst at night. Swelling over the TA tendon was frequently observed. On MRI the TA was thickened in all patients. Longitudinal split tears were observed in 19 feet. Chondral thinning and/or osteophyte formation at the first tarsometatarsal or medial naviculocuneiform joints was observed in 11 feet. Eleven feet underwent surgery. Universally the TA tendon was macroscopically thickened and had lost its normal fibrillary appearance. Longitudinal split tears were observed in eight tendons. Pathology was typical of a degenerative tendinosis. Distal TA tendinosis is a condition that seems to predominantly affect overweight elderly women. It often presents with nocturnal burning medial midfoot pain.

  6. A revision of Bremia graminicola.

    PubMed

    Thines, Marco; Göker, Markus; Spring, Otmar; Oberwinkler, Franz

    2006-06-01

    Bremia graminicola (Chromista, Peronosporales) is a common downy mildew pathogen of Arthraxon spp. (Poaceae) in Central to East Asia and the only species of Bremia parasitic on grasses. Despite its widespread occurrence and apparent differences in host range and morphology compared with other species of the genus, its placement in Bremia has not been challenged for the past 90y. Its current taxonomic position is revised based on sporangiophore morphology and ultrastructure, haustorium morphology, and nu-rDNA sequence analysis. Haustorium morphology and sporangiophore ultrastructure indicate that B. graminicola is not a member of the genus Bremia, which shows affinities to Plasmopara and Paraperonospora. Based on haustorium morphology, B. graminicola appears to be more closely related to Viennotia oplismeni, although the sporangiophore morphology is strikingly different between these two taxa. This is supported by molecular analyses based on a near-representative sample of nuLSU rDNA sequences of downy mildew genera, whereby B. graminicola is revealed as the sister taxon of V. oplismeni with 100 % BS support under all phylogenetic optimality criteria applied. Relationships of this clade to other groups are less clear. However, network and reduced-consensus analyses show that this lack of resolution is mainly due to the ambiguous molecular affinities of Sclerospora graminicola. Omitting this highly divergent taxon results in considerable support for a clade comprised of taxa with globose to pyriform haustoria, including B. lactucae, and for the sister-group relationship of B. graminicola and V. oplismeni with Hyaloperonospora. Consequently, a new genus, Graminivora, is described to accommodate B. graminicola.

  7. Physiotherapy after reconstruction of anterior cruciate ligament

    PubMed Central

    Pereira, Maitê; Vieira, Neiva de Souza; Brandão, Eduardo da Rosa; Ruaro, João Afonso; Grignet, Rodrigo Juliano; Fréz, Andersom Ricardo

    2012-01-01

    The purpose of this study was to evaluate the existence of differences in the rehabilitation of patients after ACL reconstruction using bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts, through a literature revision. The researched databases were MEDLINE, EMBASE, LILACS, COCHRANE and PEDro. The inclusion criteria were published studies with methodology draw from randomized clinical trials with or without meta-analysis, individuals with ACL injury, associated or not to meniscal injury, submitted to ligamentoplasty using the bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts and physiotherapy; clinical trials comparing the differences in the rehabilitation of these patients, in Portuguese, English and Spanish, from 1990 to June, 2011. Five clinical trials were reviewed. No difference was observed between the techniques, however, with a recommendation for a less aggressive rehabilitation and greater attention to the strengthening of the hamstring when they are used as grafts. PMID:24453634

  8. Direct anterior approach for total hip arthroplasty with a novel mobile traction table -a prospective cohort study.

    PubMed

    Nakamura, Junichi; Hagiwara, Shigeo; Orita, Sumihisa; Akagi, Ryuichiro; Suzuki, Takane; Suzuki, Masahiko; Takahashi, Kazuhisa; Ohtori, Seiji

    2017-01-31

    The purpose of this prospective cohort study was to clarify the safety and efficacy of total hip arthroplasty via the direct anterior approach in the supine position with a novel mobile traction table. The first experience of consecutive surgeries by a single surgeon using the direct anterior approach with a traction table is described with a two-year follow-up period. Of 121 patients, 100 patients without previous hip surgeries, severe deformity, or cemented implants were divided into two groups comprising the first 50 patients and the second 50 patients. The implant survival rate was 99% at the two-year follow-up. Revision surgery was required for periprosthetic femoral fracture in one patient. The complication rate possibly related to the traction table was 5% (5 patients): three anterior dislocations, one periprosthetic femoral fracture, and one intraoperative perforation caused by femoral rasping. The complication rate tended to decrease in the second group compared to the first group (4% versus 6%). Mean surgical time (72.0 minutes versus 82.5 min, p = 0.027), rate of allogeneic blood transfusion (2% versus 24%, p = 0.001), and cup alignment in the safe zone (100% versus 88%, p = 0.027) were significantly improved in the second group compared to the first group. The direct anterior approach with a novel mobile traction table showed a positive learning curve for surgical time, rate of allogeneic blood transfusion, and cup alignment in the safe zone.

  9. Anterior dental microwear texture analysis of the Krapina Neandertals

    NASA Astrophysics Data System (ADS)

    Krueger, Kristin L.; Ungar, Peter S.

    2012-12-01

    Some Neandertal anterior teeth show unusual and excessive gross wear, commonly explained by non-dietary anterior tooth use, or using the anterior dentition as a tool, clamp, or third hand. This alternate use is inferred from aboriginal arctic populations, who used their front teeth in this manner. Here we examine anterior dental microwear textures of the Krapina Neandertals to test this hypothesis and further analyze tooth use in these hominins. Microwear textures from 17 Krapina Dental People were collected by white-light confocal profilometry using a 100x objective lens. Four adjacent scans were generated, totaling an area of 204x276 μm, and were analyzed using Toothfrax and SFrax SSFA software packages. The Neandertals were compared to six bioarchaeological/ethnographic samples with reported variation in diet, abrasive load, and non-dietary anterior tooth use. Results indicate that Krapina anterior teeth lack extreme microwear textures expected of hominins exposed to heavy abrasives or those that regularly generated high stresses associated with intense use of the front teeth as tools. Krapina hominins have microwear attributes in common with Coast Tsimshian, Aleut, and Puye Pueblo samples. Collectively, this suggests that the Krapina Neandertals faced moderate abrasive loads and only periodically used their anterior teeth as tools for non-diet related behaviors.

  10. Anterior dental microwear texture analysis of the Krapina Neandertals

    NASA Astrophysics Data System (ADS)

    Krueger, Kristin; Ungar, Peter

    2012-12-01

    Some Neandertal anterior teeth show unusual and excessive gross wear, commonly explained by non-dietary anterior tooth use, or using the anterior dentition as a tool, clamp, or third hand. This alternate use is inferred from aboriginal arctic populations, who used their front teeth in this manner. Here we examine anterior dental microwear textures of the Krapina Neandertals to test this hypothesis and further analyze tooth use in these hominins. Microwear textures from 17 Krapina Dental People were collected by white-light confocal profilometry using a 100x objective lens. Four adjacent scans were generated, totaling an area of 204x276 μm, and were analyzed using Toothfrax and SFrax SSFA software packages. The Neandertals were compared to six bioarchaeological/ethnographic samples with reported variation in diet, abrasive load, and non-dietary anterior tooth use. Results indicate that Krapina anterior teeth lack extreme microwear textures expected of hominins exposed to heavy abrasives or those that regularly generated high stresses associated with intense use of the front teeth as tools. Krapina hominins have microwear attributes in common with Coast Tsimshian, Aleut, and Puye Pueblo samples. Collectively, this suggests that the Krapina Neandertals faced moderate abrasive loads and only periodically used their anterior teeth as tools for non-diet related behaviors.

  11. Assessment of anterior suspended flaps modification for external dacryocystorhinostomy.

    PubMed

    Tetikoglu, Mehmet; Sagdik, Haci Murat; Ozcura, Fatih; Aktas, Serdar

    2015-05-01

    The aim of this study was to evaluate the functional and/or anatomic success rate as well as complications of anterior suspended flaps modification for external dacryocystorhinostomy (DCR). This is a retrospective study that included 50 eyes of 47 patients who underwent anterior suspended flap external DCR surgery for nasolacrimal duct obstruction. Diagnosis of nasolacrimal duct obstruction was made through irrigation of the nasolacrimal drainage system. Anterior flaps of lacrimal sac and nasal mucosa, as large as possible, were created in all patients. Posterior flaps of lacrimal sac and exposed nasal mucosa were excised. After suturing the anterior flaps with two 6-0 Vicryl sutures, the third suture was passed through the orbicularis oculi at the subcutaneous level on 1 edge of incision, then from the middle of the anterior flaps and the other edge of the incision to the suspended anterior flaps. The success rate of 50 surgeries was 96%. In 37 eyes, no problems were reported during the surgery and the modified external DCR was performed successfully. The success rate of the modified external DCR was 100% in those patients. The average operation time was 34 ± 8.2 minutes. These results suggest that anterior suspended flap external DCR is a simple, safe technique with a very high success rate and a satisfactory surgical time.

  12. The Effects of a Systematic Revision Model on Revisers in Terms of Student Outcomes.

    ERIC Educational Resources Information Center

    Dupont, Daniel; Stolovitch, Harold D.

    1983-01-01

    Describes the process by which Learner Verification and Revision (LVR) transforms information gathered during learner verification into revision prescriptions for the development of instructional materials. Robinson's and Gropper's procedural models for formative evaluation are also discussed and a study comparing the effectiveness of materials…

  13. Analyzing the Benefits of Revision Memos during the Writing and Revision Process

    ERIC Educational Resources Information Center

    Bardine, Bryan Anthony; Fulton, Anthony

    2008-01-01

    In this article, the authors examine the role revision memos played in composition classrooms. Both authors used the memos to help students reflect on their writing and continue revising. The memos also served as guides for the instructors as they responded to their students' writing. The memos were a reminder that the instructors needed to focus…

  14. Results of Wagner SL revision stem with impaction bone grafting in revision total hip arthroplasty

    PubMed Central

    Singh, Somesh P; Bhalodiya, Haresh P

    2013-01-01

    Background: As the number of total hip arthroplasties (THAs) performed increases, so do the number of required revisions. Impaction bone grafting with Wagner SL Revision stem is a good option for managing bone deficiencies arising from aseptic osteolysis. We studied the results of cementless diaphyseal fixation in femoral revision after total hip arthroplasty and whether there was spontaneous regeneration of bone stock in the proximal femur after the use of Wagner SL Revision stem (Zimmer, Warsaw, IN, USA) with impaction bone grafting. Materials and Methods: We performed 53 hip revisions using impaction bone grafting and Wagner SL Revision stems in 48 patients; (5 cases were bilateral) for variety of indications ranging from aseptic osteolysis to preiprosthetic fractures. The average age was 59 years (range 44-68 years). There were 42 male and 6 female patients. Four patients died after surgery for reasons unrelated to surgery. 44 patients were available for complete analysis. Results: The mean Harris Hip Score was 42 before surgery and improved to 86 by the final followup evaluation at a mean point of 5.5 years. Of the 44 patients, 87% (n=39) had excellent results and 10% (n=5) had good results. The stem survival rate was 98% (n=43). Conclusion: Short term results for revision THA with impaction bone grafting and Wagner SL revision stems are encouraging. However, it is necessary to obtain long term results through periodic followup evaluation, as rate of complications may increase in future. PMID:23960279

  15. Japanese Learners' Self Revisions and Peer Revisions of Their Written Compositions in English

    ERIC Educational Resources Information Center

    Suzuki, Manami

    2008-01-01

    The current study examined 24 Japanese university students' processes of negotiation in conditions of self revision and of peer revision about their English as a foreign language (EFL) writing. Analyzing their negotiation episodes and text changes, I categorized within a common coding scheme the types of negotiation from (a) think-aloud protocols…

  16. Orthographic Revision: A Developmental Study of How Revisers Check Verbal Agreements in Written Texts

    ERIC Educational Resources Information Center

    Largy, Pierre; Dedeyan, Alexandra; Hupet, Michel

    2004-01-01

    Background: Writing is a complex activity involving various cognitive processes in the planning, the transcription and the revision of written texts. The present study focused on the revision of written texts within a developmental approach. Aims: The study aimed to examine whether children and adults use different procedures to detect and revise…

  17. Clinical outcomes of revision biceps tenodesis

    PubMed Central

    Gregory, J. M.; Harwood, D. P.; Gochanour, E.; Sherman, S. L.; Romeo, A. A.

    2012-01-01

    Purpose: Biceps tenotomy and tenodesis are effective treatment options for biceps pathology, but outcomes of revision surgery are not known. This study examines the clinical outcomes of patients who have undergone a revision biceps tenodesis. Materials and Methods: A retrospective review of all patients since 2004 (N = 21) who had undergone a revision biceps tenodesis with greater than 6-month follow-up was completed. A follow-up survey was carried out, and the visual analog scale (VAS), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), and University of California – Los Angeles (UCLA) scores were obtained, along with SF-12 Mental (MCS-12) and Physical Component Summaries (PCS-12). Results: Indications for revision surgery were continued pain (14) and ruptured biceps (7). Complete follow-up examinations were performed in 15 of 21 patients (71.4%). Average follow-up was 33.4 ± 23.5 months. The mean postoperative scores were 1.9 out of 10, VAS; 79 out of 100, SANE; 10.2 out of 12, SST; 83 out of 100, ASES; 29 out of 35, UCLA; 44, PCS- 12; and 47.1, MCS- 12. Five patients were considered failures with a UCLA score below 27. Seventeen of twenty-one patient underwent concomitant procedures. Complete preoperative and postoperative data were collected for 14 patients. All scores demonstrated highly significant improvement from preoperative levels (P < 0.005), except for the MCS-12. There was no statistically significant difference in the outcomes of revision due to rupture and revision due to persistent pain. Conclusions: The results suggest that revision subpectoral biceps tenodesis provides significant pain relief and improvement in functional outcomes at a mean follow-up of 33.4 months. Level of Evidence: Case Series, Level 4. PMID:22787333

  18. Anterior opening wedge osteotomy of the proximal tibia for anterior knee pain in idiopathic hyperextension knees

    PubMed Central

    van Raaij, T. M.

    2006-01-01

    We analysed 20 patients with 24 knees affected by idiopathic genu recurvatum who were treated with an anterior opening wedge osteotomy of the proximal tibia because of anterior knee pain. We managed to attain full satisfaction in 83% of the patients with a mean follow-up of 7.4 years. The mean Hospital for Special Surgery score was 90.3 (range 70.5–99.5), and the mean Knee Society score score was 94.6 (70–100) for function and 87.7 (47–100) for pain. The mean Western Ontario and McMaster University Osteoarthritis Index score for knee function was 87.5 (42–100), for stiffness 82.8 (25–100) and for pain 87.3 (55–100). Radiographs showed a significant increase in posterior tibial slope of 9.4 deg and a significant decrease of patellar height according to the Blackburne–Peel method of 0.16 postoperatively. No cases of non-union, deep infection or compartment syndrome were seen. No osteoarthritic changes in the lateral or medial knee compartment were found with more than 5 years’ follow-up in 16 patients with 19 affected knees. Three out of the four dissatisfied patients had a patella infera which led to patellofemoral complaints. One patient in the study underwent a secondary superior displacement of the patella with excellent results. We conclude that in a selected group of patients with idiopathic genu recurvatum and anterior knee pain an opening wedge osteotomy of the proximal tibia can be beneficial. PMID:16521014

  19. Usefulness of intravenous propranolol in predicting left anterior descending blood flow during anterior myocardial infarction.

    PubMed

    Gold, H K; Leinbach, R C; Harper, R W

    1984-08-01

    The effect of propranolol on precordial ST-segment elevation was studied in 24 patients with acute anterior myocardial infarction. The electrocardiographic response to the drug was correlated with the early angiographic appearance of the left anterior descending coronary artery (LAD). After a 30-minute observation period, intravenous propranolol (average dose 3.5 +/- 2.2 mg) was given a mean of 2.8 +/- 1.9 hours after the onset of persistent chest pain. Coronary angiography was performed 3.6 +/- 2.0 hours after the onset of symptoms. Patients were classified into 2 groups according to the angiographic findings. Group A consisted of 7 patients with a stenotic but patent LAD and 1 patient with excellent collateral blood flow to that area. Group B consisted of 16 patients with a completely occluded LAD and poor or absent collateral blood flow. Patients in group A showed a mean reduction in precordial ST-segment elevation of 77 +/- 18% and patients in group B showed a mean reduction of 13 +/- 14% (p less than 0.005). Left ventricular ejection fraction at discharge was 0.6 +/- 0.07 in group A and 0.37 +/- 0.08 in group B (p less than 0.001). Thus, the electrocardiographic response to intravenous propranolol given early in the course of acute anterior myocardial infarction predicts the presence of blood flow to the infarcting zone. The combination of residual blood flow and reduction of ST-segment elevation secondary to propranolol is associated with preservation of ventricular function.

  20. Measurement of anterior chamber volume with rotating scheimpflug camera and anterior segment optical coherence tomography.

    PubMed

    Fu, Jing; Li, Shu-ning; Wang, Xiao-zhen; Wu, Ge-wei; Mu, Da-peng; Wang, Jian; Wang, Ning-li

    2010-01-20

    Measurement of anterior segment parameters plays an important role in diagnosis and treatment of glaucoma. The objective of this study was to evaluate the repeatability and reproducibility of anterior chamber volume (ACV) measurements with rotating scheimpflug camera (RSC) and to examine agreement with anterior segment optical coherence tomography (AS-OCT). Thirty nine healthy normal subjects were recruited from the Eye Center of Tongren Hospital. ACV was measured using RSC and AS-OCT in a randomly selected eye for each subject. For RSC measurements, both automatic and manual ACV measurements and 2 independent operators' ACV measurements were obtained. All subjects were invited for 3 visits within a week to evaluate repeatability and reproducibility of ACV measurement by RSC. Agreement was evaluated between RSC and AS-OCT. Good repeatability and reproducibility were found for both automatic and manual ACV measurements obtained by RSC. For intrasession repeatability, coefficient of variation (CVw) and intraclass correlation coefficient (ICC) values for automatic were 3.52% and 0.98; the values for manual were 3.44% and 0.97, respectively. For intersession reproducibility, the respective CVw and ICC values were 3.96% and 0.96. Good agreement was also found in 2 operators for both automatic and manual ACV measurements; nevertheless, poor agreement was found between RSC and AS-OCT (95% confidence interval (CI) for agreement of automatic RSC measurement versus AS-OCT were -96.3 to 72.8 microl and 95% CI for agreement of manual RSC measurement versus AS-OCT were between -41.7 to 10.1 microl). Both RSC automatic and manual ACV measurements showed good repeatability and reproducibility, and showed comparable agreement between 2 independent operators, but poor agreement was found between RSC and AS-OCT.