bluuebunny/crossref_metadata_2025 huggingface dataset:
The influence of approach side on facet preservation in microscopic bilateral decompression via a unilateral approach for degenerative lumbar scoliosis
Authors: Matsumura Akira , Namikawa Takashi , Terai Hidetomi , Tsujio Tadao , Suzuki Akinobu , Dozono Sho , Yasuda Hiroyuki , Nakamura Hiroaki
Published: December 2010

Object

The authors compared the clinical outcomes of microscopic bilateral decompression via a unilateral approach (MBDU) for the treatment of degenerative lumbar scoliosis (DLS) and for lumbar canal stenosis (LCS) without instability. The authors also compared postoperative spinal instability in terms of different approach sides (concave or convex) following the procedure.

Methods

The authors retrospectively reviewed data obtained in 50 consecutive patients (25 in the DLS group and 25 in the LCS group) who underwent MBDU; the minimum follow-up period was 2 years. Patients with DLS were divided into 2 subgroups according to the surgical approach side: a concave group (23 segment) and a convex group (17 segments). The Japanese Orthopaedic Association Scale scores for the assessment of low-back pain were evaluated before surgery and at final follow-up. The Japanese Orthopaedic Association Scale scores and recovery rates were compared between the DLS and LCS groups, and between the convex and concave groups. Cobb angle and scoliotic wedging angle (SWA) were evaluated on standing radiographs before surgery and at final follow-up. Facet joint preservation (the percentage of preservation) was assessed on pre- and postoperative CT scans, compared between the LCS and DLS groups, and compared between the concave and convex groups. The influence of approach side on postoperative progression of segmental instability was also examined in the DLS group.

Results

The mean recovery rate was 58.7% in the DLS and 62.0% in the LCS group. The mean recovery rate was 58.6% in the convex group and 60.6% in the concave group. There were no significant differences in recovery rates between the LCS and DLS groups, or between the DLS subgroups. The mean Cobb angles in the DLS group were significantly increased from 12.7° preoperatively to 14.1° postoperatively (p < 0.05), and mean preoperative SWAs increased significantly from 6.2° at L3–4 and 4.1° at L4–5 preoperatively to 7.4° and 4.9°, respectively, at final follow-up (p < 0.05). There was no significant difference in percentage of preservation between the DLS and LCS groups. The mean percentages of preservation on the approach side in the DLS group at L3–4 and L4–5 were 89.0% and 83.1% in the convex group, and those in the concave group were 67.3% and 77.6%, respectively. The percentage of preservation at L3–4 was significantly higher in the convex than the concave group. The mean SWA had increased in the concave group (p = 0.01) but not the convex group (p = 0.15) at final follow-up.

Conclusions

The MBDU can reduce postoperative segmental spinal instability and achieve good postoperative clinical outcomes in patients with DLS. The convex approach provides surgeons with good visibility and improves preservation of facet joints.
Percutaneous computed tomography fluoroscopy–guided conformal ultrasonic ablation of vertebral tumors in a rabbit tumor model
Authors: Sciubba Daniel M. , Burdette E. Clif , Cheng Jennifer J. , Pennant William A. , Noggle Joseph C. , Petteys Rory J. , Alix Christopher , Diederich Chris J. , Fichtinger Gabor , Gokaslan Ziya L. , Murphy Kieran P.
Published: December 2010

Object

Radiofrequency ablation (RFA) has proven to be effective for treatment of malignant and benign tumors in numerous anatomical sites outside the spine. The major challenge of using RFA for spinal tumors is difficulty protecting the spinal cord and nerves from damage. However, conforming ultrasound energy to match the exact anatomy of the tumor may provide successful ablation in such sensitive locations. In a rabbit model of vertebral body tumor, the authors have successfully ablated tumors using an acoustic ablator placed percutaneously via computed tomography fluoroscopic (CTF) guidance.

Methods

Using CTF guidance, 12 adult male New Zealand White rabbits were injected with VX2 carcinoma cells in the lowest lumbar vertebral body. At 21 days, a bone biopsy needle was placed into the geographical center of the lesion, down which an acoustic ablator was inserted. Three multisensor thermocouple arrays were placed around the lesion to provide measurement of tissue temperature during ablation, at thermal doses ranging from 100 to 1,000,000 TEM (thermal equivalent minutes at 43°C), and tumor volumes were given a tumoricidal dose of acoustic energy. Animals were monitored for 24 hours and then sacrificed. Pathological specimens were obtained to determine the extent of tumor death and surrounding tissue damage. Measured temperature distributions were used to reconstruct volumetric doses of energy delivered to tumor tissue, and such data were correlated with pathological findings.

Results

All rabbits were successfully implanted with VX2 cells, leading to a grossly apparent spinal and paraspinal tissue mass. The CTF guidance provided accurate placement of the acoustic ablator in all tumors, as corroborated through gross and microscopic histology. Significant tumor death was noted in all specimens without collateral damage to nearby nerve tissue. Tissue destruction just beyond the margin of the tumor was noted in some but not all specimens. No neurological deficits occurred in response to ablation. Reconstruction of measured temperature data allowed accurate assessment of volumetric dose delivered to tissues.

Conclusions

Using a rabbit intravertebral tumor model, the authors have successfully delivered tumoricidal doses of acoustic energy via a therapeutic ultrasound ablation probe placed percutaneously with CTF guidance. The authors have thus established the first technical and preclinical feasibility study of controlled ultrasound ablation of spinal tumors in vivo.
Biomechanical comparison between C-7 lateral mass and pedicle screws in subaxial cervical constructs
Authors: Xu Risheng , McGirt Matthew J. , Sutter Edward G. , Sciubba Daniel M. , Wolinsky Jean-Paul , Witham Timothy F. , Gokaslan Ziya L. , Bydon Ali
Published: December 2010

Object

The aim of this study was to conduct the first in vitro biomechanical comparison of immediate and postcyclical rigidities of C-7 lateral mass versus C-7 pedicle screws in posterior C4–7 constructs.

Methods

Ten human cadaveric spines were treated with C4–6 lateral mass screw and C-7 lateral mass (5 specimens) versus pedicle (5 specimens) screw fixation. Spines were potted in polymethylmethacrylate bone cement and placed on a materials testing machine. Rotation about the axis of bending was measured using passive retroreflective markers and infrared motion capture cameras. The motion of C-4 relative to C-7 in flexion-extension and lateral bending was assessed uninstrumented, immediately after instrumentation, and following 40,000 cycles of 4 Nm of flexion-extension and lateral bending moments at 1 Hz. The effect of instrumentation and cyclical loading on rotational motion across C4–7 was analyzed for significance.

Results

Preinstrumented spines for the 2 cohorts were comparable in bone mineral density and range of motion in both flexion-extension (p = 0.33) and lateral bending (p = 0.16). Lateral mass and pedicle screw constructs significantly reduced motion during flexion-extension (11.3°–0.26° for lateral mass screws, p = 0.002; 10.51°–0.30° for pedicle screws, p = 0.008) and lateral bending (7.38°–0.27° for lateral mass screws, p = 0.003; 11.65°–0.49° for pedicle screws, p = 0.03). After cyclical loading in both cohorts, rotational motion over C4–7 was increased during flexion-extension (0.26°–0.68° for lateral mass screws; 0.30°–1.31° for pedicle screws) and lateral bending (0.27°–0.39° and 0.49°–0.80°, respectively), although the increase was not statistically significant (p > 0.05). There was no statistical difference in postcyclical flexion-extension (p = 0.20) and lateral bending (0.10) between lateral mass and pedicle screws.

Conclusions

Both C-7 lateral mass and C-7 pedicle screws allow equally rigid fixation of subaxial lateral mass constructs ending at C-7. Immediately and within a simulated 6-week postfixation period, C-7 lateral mass screws may be as effective as C-7 pedicle screws in biomechanically stabilizing long subaxial lateral mass constructs.
Predictors of survival in patients with prostate cancer and spinal metastasis
Authors: Drzymalski Dan Michael , Oh William K. , Werner Lillian , Regan Meredith M. , Kantoff Philip , Tuli Sagun
Published: December 2010

Object

Prostate cancer is the second most common malignancy to cause death in men, with metastases to the spine being the most common site of metastatic burden. A retrospective observational study was performed to determine survival of patients in whom spinal metastasis from prostate cancer had been diagnosed.

Methods

The patient population was obtained from the Prostate Clinical Research Information System (CRIS) at the Dana-Farber Cancer Institute. Patients were observed over a period of 19 years, between June 1990 and April 2009. Clinical covariates were studied in their relationship to overall survival, the primary outcome, by using the Kaplan-Meier method and Cox regression.

Results

Of a total of 9010 patients in the Prostate CRIS database, 333 were identified as having developed spinal metastases. The median overall survival after diagnosis of spinal metastasis was 24 months (95% CI 21–28 months). The estimated 1-year overall survival was 73% (95% CI 67%–77%). In 85% of patients, at least 1 additional site of metastasis was documented. Among 28 patients who had no additional sites of metastases, the median survival was 55.9 months, whereas an increasing burden of disease was associated with shorter survival (p = 0.0001). The association was observed regardless of whether the metastatic burden was characterized as the presence of additional (nonspinal) bone metastasis, the presence of additional nonbone metastasis, or as the number of concomitant metastatic sites (all p = 0.0001). In multivariate analysis, a higher prostate-specific antigen level at the diagnosis of spinal metastasis, a longer duration between the diagnosis of prostate cancer and spinal metastasis, and the presence of additional metastasis at the time of diagnosis of spinal metastasis (all p = 0.0001) were independently associated with a shorter overall survival.

Conclusions

The results of this study are important for oncologists, neurosurgeons, and primary care physicians who have patients with prostate cancer that metastasizes to the spine, because these results can be used to form a prognosis and guide the physician in making appropriate decisions regarding the patient's treatment. Future work should include building a predictive model that accurately determines survival in patients with metastatic disease, because this would guide the physician in devising the most appropriate treatment plan for each patient.
Pathophysiology of persistent syringomyelia after decompressive craniocervical surgery
Authors: Heiss John D. , Suffredini Giancarlo , Smith René , DeVroom Hetty L. , Patronas Nicholas J. , Butman John A. , Thomas Francine , Oldfield Edward H.
Published: December 2010

Object

Craniocervical decompression for Chiari malformation Type I (CM-I) and syringomyelia has been reported to fail in 10%–40% of patients. The present prospective clinical study was designed to test the hypothesis that in cases in which syringomyelia persists after surgery, craniocervical decompression relieves neither the physiological block at the foramen magnum nor the mechanism of syringomyelia progression.

Methods

The authors prospectively evaluated and treated 16 patients with CM-I who had persistent syringomyelia despite previous craniocervical decompression. Testing before surgery included the following: 1) clinical examination; 2) evaluation of the anatomy using T1-weighted MR imaging; 3) assessment of the syrinx and CSF velocity and flow using cine phase-contrast MR imaging; and 4) appraisal of the lumbar and cervical subarachnoid pressures at rest, during a Valsalva maneuver, during jugular compression, and following the removal of CSF (CSF compliance measurement). During surgery, ultrasonography was performed to observe the motion of the cerebellar tonsils and syrinx walls; pressure measurements were obtained from the intracranial and lumbar intrathecal spaces. The surgical procedure involved enlarging the previous craniectomy and performing an expansile duraplasty with autologous pericranium. Three to 6 months after surgery, clinical examination, MR imaging, and CSF pressure recordings were repeated. Clinical examination and MR imaging studies were then repeated annually.

Results

Before reexploration, patients had a decreased size of the CSF pathways and a partial blockage in CSF transmission at the foramen magnum. Cervical subarachnoid pressure and pulse pressure were abnormally elevated. During surgery, ultrasonographic imaging demonstrated active pulsation of the cerebellar tonsils, with the tonsils descending during cardiac systole and concomitant narrowing of the upper pole of the syrinx. Three months after reoperation, patency of the CSF pathways was restored and pressure transmission was improved. The flow of syrinx fluid and the diameter of the syrinx decreased after surgery in 15 of 16 patients.

Conclusions

Persistent blockage of the CSF pathways at the foramen magnum resulted in increased pulsation of the cerebellar tonsils, which acted on a partially enclosed cervical subarachnoid space to create elevated cervical CSF pressure waves, which in turn affected the external surface of the spinal cord to force CSF into the spinal cord through the Virchow-Robin spaces and to propel the syrinx fluid caudally, leading to syrinx progression. A surgical procedure that reestablished the CSF pathways at the foramen magnum reversed this pathophysiological mechanism and resolved syringomyelia. Elucidating the pathophysiology of persistent syringomyelia has implications for its primary and secondary treatment.
Harvey Cushing's experience with cranial deformity
Authors: Maher Cormac O. , Buchman Steven R. , O'Hara Edward , Cohen-Gadol Aaron A.
Published: December 2010

Surgery for cranial deformity was associated with significant surgical morbidity during the early part of the 20th century. For this reason, Harvey Cushing was initially not in favor of surgical treatment of craniosynostosis. Later in his career, Cushing began to operate on these children, although it never became a major focus of his practice. Several examples of his patients with cranial deformity are presented, and his limited role in the development of this field is discussed.
Patients with moyamoya disease presenting with movement disorder
Authors: Pandey Paritosh , Bell-Stephens Teresa , Steinberg Gary K.
Published: December 2010

Moyamoya disease is a rare cerebrovascular disease characterized by idiopathic bilateral stenosis or occlusion of bilateral internal carotid arteries and the development of characteristic leptomeningeal collateral vessels at the base of the brain. Typical presentations include transient ischemic attacks or stroke, and hemorrhage. Presentation with movement disorders is extremely rare, especially in the pediatric population. The authors describe the cases of 4 children with moyamoya disease who presented with movement disorders.

Among 446 patients (118 pediatric) with moyamoya disease surgically treated by the senior author, 4 pediatric patients had presented with movement disorders. The clinical records, imaging studies, surgical details, and postoperative clinical and imaging data were retrospectively reviewed.

The initial presenting symptom was movement disorder in all 4 patients: chorea in 2, hemiballismus in 1, and involuntary limb shaking in 1. All the patients had watershed infarcts involving the frontal subcortical region on MR imaging. Additionally, 1 patient had a ganglionic infarct. Single-photon emission computed tomography studies showed frontoparietal cortical and subcortical hypoperfusion in all patients. Three patients had bilateral disease, whereas 1 had unilateral disease. All the patients underwent superficial temporal artery–middle cerebral artery bypass. Postoperatively, all 4 patients had complete improvement in their symptoms. The SPECT scans revealed normal perfusion in 3 patients and a small residual perfusion deficit in 1.

Movement disorders are a rare presenting feature of moyamoya disease. Hypoperfusion of the frontal cortical and subcortical region was seen in all patients, and the symptomatology was attributed to ischemic dysfunction and imbalance in the cortical-subcortical-ganglionic-thalamic-cortical circuitry. Combined revascularization with superficial temporal artery–middle cerebral artery bypass and encephaloduroarteriosynangiosis leads to excellent results.
Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults
Authors: Piatt Joseph H.
Published: December 2010

Object

Myelomeningocele is the most severe congenital malformation of the CNS that is compatible with survival. From the time of the development of practical treatment for hydrocephalus in the late 1950s, affected individuals began to survive into adulthood in substantial numbers. Data on the neurological status of these individuals are sparse, as are descriptions of their continuing requirements for neurosurgical care.

Methods

A review of the literature was undertaken using the PubMed database maintained by the National Library of Medicine. Formal grading of the quality of evidence was not attempted, but methodological issues affecting validity or generalizability were noted.

Results

Observations from 2 major longitudinal studies of cohorts of patients treated without selection using contemporary neurosurgical techniques have been published at intervals beginning in the mid-1970s. Numerous cross-sectional, institutional reviews have focused on neurosurgical issues in adulthood: hydrocephalus, Chiari malformation Type II and syringomyelia, and secondary spinal cord tethering. The organization of medical services for adults with myelomeningocele has received limited study.

Conclusions

Surviving adults with myelomeningocele achieve a wide range of neurological and functional outcomes, the most critical and adverse determinant of which is symptomatic CSF shunt failure. From a neurosurgical standpoint, adults with myelomeningocele remain clinically active indefinitely, and they deserve periodic neurosurgical surveillance.
A Comparative Study of Benzylpenicillin Versus Ceftriaxone in the Treatment of Adult Pyogenic Meningitis
Authors: Wazib A , Hossain MZ , Hasan R , Alam MB
Published: December 2010

This prospective study was conducted in Dhaka Medical College Hospital during July 2006 to June 2007. 100 patients were included in the study among which forty seven received benzylpenicillin and fifty three was treated with ceftriaxone. The result of this study showed that mortality was similar in both groups but ceftriaxone had better outcome regarding duration of clinical features and hospital-stay. Key words: pyogenic meningitis; benzylpenicillin; ceftriaxone. DOI: 10.3329/jdmc.v17i2.6583J Dhaka Med Coll. 2008; 17(2) : 59-61
Regulation, Cross-border Trade and Practical Norms in West Nile, North-Western Uganda
Authors: Titeca Kristof , Herdt Tom de
Published: December 2010

This article describes how cross-border trade in West Nile, north-western Uganda to a large extent takes place outside of the legal framework. This does not mean that this trade is unregulated. We make use of the concept of ‘practical norms’ to show the existence of regulation within this trade, which diverges both from official norms and social norms (‘moral economy’). The article describes how these practical norms emerged and how they are enforced. First, it is shown how the moral economy of cross-border trade plays an important role in their articulation. Second, we ask which practical concerns play a role in sustaining these norms and how deviations from them activate open power struggles. And third, we show how concrete events have played a role in their emergence.
Proteomic Profiles of Mesenchymal Stem Cells Induced by a Liver Differentiation Protocol
Authors: Leelawat Kawin , Narong Siriluck , Chaijan Suthidarak , Sa-ngiamsuntorn Khanit , Disthabanchong Sinee , Wongkajornsilp Adisak , Hongeng Suradej
Published: November 2010

The replacement of disease hepatocytes and the stimulation of endogenous or exogenous regeneration by human mesenchymal stem cells (MSCs) are promising candidates for liver-directed cell therapy. In this study, we isolated MSCs from adult bone marrow by plastic adhesion and induced differentiation with a liver differentiation protocol. Western blot analyses were used to assess the expression of liver-specific markers. Next, MSC-specific proteins were analyzed with two-dimensional (2D) gel electrophoresis and peptide mass fingerprinting matrix-assisted laser desorption/ionization (MALDI)-time of flight (TOF)-mass spectrometry (MS). To confirm the results from the proteomic study, semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) analyses were performed. We demonstrated that MSCs treated with the liver differentiation protocol expressed significantly more albumin, CK19 and CK20, than did undifferentiated cells. In addition the results of proteomic study demonstrated increases expression of FEM1B, PSMC2 and disulfide-isomerase A3 in MSCs treated with the liver differentiation protocol. These results from proteomic profiling will not only provide insight into the global responses of MSCs to hepatocyte differentiation, but will also lead to in-depth studies on the mechanisms of proteomic changes in MSCs.
Platycoside N: A New Oleanane-Type Triterpenoid Saponin from the Roots of Platycodon grandiflorum
Authors: Li Wei , Zhang Wei , Xiang Lan , Wang Zi , Zheng Yi-Nan , Wang Ying-Ping , Zhang Jing , Chen Li
Published: November 2010

A new oleanane-type triterpenoid saponin, named platycoside N (1), together with six known saponins, was isolated from the roots of Platycodon grandiflorum. On the basis of acid hydrolysis, comprehensive spectroscopic data analyses and comparison with the spectral data of the known compounds, its structure was elucidated as 3-O-β-D-glucopyranosyl-(1→6)-β-D-glucopyranosyl-2β,3β,16α,23-tetrahydroxyolean-12-en-28-oic acid 28-O-β-L-rhamnopyranosyl-(1→2)-α-L-arabinopyranoside. The six known compounds were platycodin D (2), deapioplatycodin D (3), platycodin D3 (4), deapio- platycodin D3 (5), platycoside E (6) and deapioplatycoside E (7).
Economic Functions of Monasticism in Cyprus: The Case of the Kykkos Monastery
Authors: Roudometof Victor , Michael Michalis N.
Published: December 2010

The article presents a comprehensive overview of the various economic activities performed by the Kykkos Monastery in Cyprus in its long history (11th–20th centuries). The article begins with a brief review of the early centuries of Cypriot monasticism and the foundation of the monastery in the 11th century. Then, the analysis focuses on the economic activities performed during the period of the Ottoman rule (1571–1878). Using primary sources from the monastery’s archives, this section offers an overview of the various types of monastic land holdings in the Ottoman era and the strategies used to purchase them. Using 19th century primary sources, it further presents a detailed account of the multifaceted involvement and illustrates the prominent role of the monastery in the island’s economic life (land ownership, stockbreeding activities, lending of money, etc.). Next, it examines the changes in monastic possessions caused by the legislation enacted by the post-1878 British colonial administration. The legislation caused the loss of extensive land holdings and was the subject of extensive controversy.
Improvement of Hydraulic and Water Quality Renovation Functions by Intermittent Aeration of Soil Treatment Areas in Onsite Wastewater Treatment Systems
Authors: Amador José A. , Potts David A. , Loomis George W. , Kalen David V. , Patenaude Erika L. , Görres Josef H.
Published: December 2010

We tested intermittent aeration of the soil treatment area (STA) of onsite wastewater treatment systems (OWTS) for its ability to restore and maintain STA hydraulic flow and improve the water quality functions of conventional OWTS. Evaluation was conducted on hydraulically-failed conventional OWTS at three state-owned medical group homes in Washington County, RI, USA. Testing was conducted in two phases, with Phase I (before intermittent soil aeration (ISA)) comprising the first 6 months of the study, and Phase II (during ISA) the remaining 7 months. Intermittent soil aeration restored STA hydraulic function in all three systems despite a marked reduction in the STA total infiltrative surface. Soil pore water was collected from 30 and 90 cm below the STA during both phases and analyzed for standard wastewater parameters. Although the STA infiltrative surface was reduced—and the contaminant load per unit of area increased—after installation of the ISA system, no differences were observed between phases in concentration of total N, NO3, total P, or dissolved organic carbon (DOC). Apparent removal rates—which do not account for dilution or differences in infiltrative area—for total N, total P, and DOC remained the same or improved during Phase II relative to the pre-operation phase. Furthermore, intermittent soil aeration enhanced actual removal rates —which do account for dilution and differences in infiltrative area. The effects of ISA on actual removal of contaminants from STE increased with increasing hydraulic load—a counterintuitive phenomenon, but one that has been previously observed in laboratory studies. The results of our study suggest that intermittent soil aeration can restore and maintain hydraulic flow in the STA and enhance carbon and nutrient removal in conventional OWTS.
Effectiveness of a Web-Based Automated Cell Distribution System
Authors: Niland Joyce C. , Stiller Tracey , Cravens James , Sowinski Janice , Kaddis John , Qian Dajun
Published: November 2010

In recent years, industries have turned to the field of operations research to help improve the efficiency of production and distribution processes. Largely absent is the application of this methodology to biological materials, such as the complex and costly procedure of human pancreas procurement and islet isolation. Pancreatic islets are used for basic science research and in a promising form of cell replacement therapy for a subset of patients afflicted with severe type 1 diabetes mellitus. Having an accurate and reliable system for cell distribution is therefore crucial. The Islet Cell Resource Center Consortium was formed in 2001 as the first and largest cooperative group of islet production and distribution facilities in the world. We previously reported on the development of a Matching Algorithm for Islet Distribution (MAID), an automated web-based tool used to optimize the distribution of human pancreatic islets by matching investigator requests to islet characteristics. This article presents an assessment of that algorithm and compares it to the manual distribution process used prior to MAID. A comparison was done using an investigator's ratio of the number of islets received divided by the number requested pre- and post-MAID. Although the supply of islets increased between the pre- versus post-MAID period, the median received-to-requested ratio remained around 60% due to an increase in demand post-MAID. A significantly smaller variation in the received-to-requested ratio was achieved in the post- versus pre-MAID period. In particular, the undesirable outcome of providing users with more islets than requested, ranging up to four times their request, was greatly reduced through the algorithm. In conclusion, this analysis demonstrates, for the first time, the effectiveness of using an automated web-based cell distribution system to facilitate efficient and consistent delivery of human pancreatic islets by enhancing the islet matching process.
L'adolescent converti
Authors: Cornalba Vincent
Published: November 2010

Résumé L’objet de cet article est l’étude du travail de conversion dans la dialectique portée par tout phénomène rituel. L’obligation est faite au sujet de changer, mais sans pour autant oblitérer la décision qui lui revient. L’auteur aborde l’effet de conversion comme une part active à l’égard de laquelle tout sujet confronté au rite est tenu de se prononcer. La conversion se manifeste à travers la recherche d’une autre façon de dire, susceptible de traduire à la fois la correspondance et l’écart existant entre la promesse d’un nouveau statut et le postulat de bases subjectales immuables. Car pour que la conversion permette au rite d’opérer, il faudrait conjointement un effet de chute avec, concurremment, le passage au crible d’un certain rapport à soi-même et au monde.
La place de la subjectivité dans le champ de la médecine
Authors: Guerra Giovanni
Published: November 2010

Résumé Le développement de la médecine moderne a entraîné d’une manière apparemment inévitable l’éclipse du sujet du champ clinique, en donnant aussi l’impression que la médecine est un discours totalitaire. L’article s’interroge sur la possibilité de trouver une place à la subjectivité tout en restant à l’intérieur des axes portants de la médecine. La référence à la biologie évolutive et spécifiquement au thème de l’adaptation permet un parcours à la fin duquel on propose qu’ignorer la subjectivité du malade serait ignorer un élément technique majeur. On peut découvrir aussi que les logiques du processus thérapeutique dans la clinique médicale et psychanalytique sont beaucoup plus proches de ce qu’on peut penser habituellement.
Psychanalyse, institution psychanalytique et démocratie
Authors: De Neuter Patrick
Published: November 2010

Résumé L’auteur compare tout d’abord au point de vue de la recherche, de la formation et de la pratique psychanalytiques les avantages et les inconvénients de deux types d’institutions psychanalytiques. Les premières ont pour socle le transfert sur un Maître occupant une place d’exception, les secondes ont adopté un fonctionnement plus démocratique. Cohésion, facilités des décisions, liberté de parole et de pensée, abord critique et religieux de la théorie, créativité, identification au Maître, allègement de la névrose de transfert sont ainsi passés en revue. Dans un second temps, tirant les conclusions du premier temps, il indique quelques caractéristiques d’un fonctionnement souhaitable d’une institution psychanalytique.
L'enfant et le secret
Authors: Bernard David
Published: November 2010

Résumé Il s’agira ici d’étudier comment l’enfant advient à ses premiers secrets, ceux qu’il suppose d’abord à l’Autre parental, puis en retour, ceux qu’il se constituera pour lui-même. Nous soulignerons alors comment la possibilité du secret est nécessaire à ce qu’advienne un sujet. Enfin, nous en déduirons comment le secret, en son centre, est toujours fait d’un impossible à dire.
Épistémologie de l'acouphène : histoire d'une controverse scientifique
Authors: Dauman Nicolas , Keller Pascal-Henri
Published: November 2010

Résumé La clinique contemporaine de l’acouphène est résolument marquée par l’audiométrie et l’épidémiologie. L’ajustement de ces sifflements de l’oreille à de faibles valeurs en décibels et la minorité de sujets en grande souffrance ont ainsi fondé un modèle d’habituation comportementale, qui conteste à la plainte subjective la juste appréciation de la détresse éprouvée. L’urgence avec laquelle certains sujets demandent de l’aide impose au contraire aux cliniciens une épistémologie rigoureuse de ce symptôme, à partir d’études psychoacoustiques qui soulignent son caractère dynamique et variable. L’ébauche d’une clinique du transfert sous influence de l’acouphène est proposée ici, sachant que personne ne peut apporter au patient, qu’il soit professionnel ou profane, un soulagement acoustique qu’il sollicite pourtant ardemment.
Cholera in Haiti
Authors: Pfrimmer Dale M.
Published: November 2010

Prior to the 7.1 magnitude earthquake that struck on January 12, 2010, conditions were dire in Haiti. Now, nearly a year later and with the emergency phase long since over, a cholera epidemic has hit Haiti.
Ee-Chats: The Seven Components of Nursing Debriefing
Authors: Overstree Maria
Published: November 2010

Debriefing fosters clinical decision making, critical thinking, and clinical judgment.
CPR Decision Making and Older Adults
Authors: Cadogan Mary P.
Published: November 2010

Originally developed in 1960 as an emergency intervention for individuals who unexpectedly went into cardiac arrest, cardiopulmonary resuscitation (CPR) is now in widespread use. With broader use of CPR over the past several decades, some limitations and unintended consequences of the procedure have been identified. In addition, accumulated data have demonstrated low probabilities of survival and uneven success rates of CPR for certain subgroups. Despite advances in the understanding of CPR outcomes, the general public and many health professionals significantly overestimate the benefits and underestimate any negative consequences. As a result, CPR decision making is often based on incomplete or inaccurate information. This article discusses the “rest of the story” about CPR, namely the existing evidence about CPR survival and potential complications of CPR. The article also highlights how nurses can help promote informed decision making about CPR to older adults and their families.
The Effect of Nursing Students’ Health Beliefs on Their Willingness to Seek Treatment for Test Anxiety
Authors: Markman Uri , Balik Chaya , Braunstein-Bercovitz Hedva , Ehrenfeld Malka
Published: November 2010

Test anxiety is common among students and reaches its peak in higher education. It can not only hinder test performance and affect an entire program of studies but also restrict personal development. Many forms of therapy are available, and most are highly successful, but participation rates are low. This study identifies the two factors responsible for nonadherence, practical obstacles and perceived ineffectiveness of treatment, and shows how they can be targeted to increase therapy enrollment rates.
Functional Magnetic Resonance Imaging of Binocular Interactions in Visual Cortex in Strabismus
Authors: Chen Vincent J. , Tarczy-Hornoch Kristina
Published: November 2010

Purpose:

To observe changes in primary visual cortical activation associated with perceptual suppression in individuals with strabismus, using functional magnetic resonance imaging (fMRI).

Methods:

In Phase 1, pilot data were collected from 1 control and 8 strabismic participants, including 5 with amblyopia. In Phase 2, results were collected from 7 participants with strabismus (2 recalled and 5 new), including 2 with amblyopia. fMRI compared primary visual cortex activation in two conditions: visual stimuli presented to both eyes, to evoke perceptual suppression of one eye in individuals with strabismus, and visual stimulation presented only to one eye.

Results:

Visual cortical activity modulations positively correlated with perceptual suppression were seen in 3 of 5 non-amblyopic Phase 2 study participants, but not in amblyopic subjects.

Conclusion:

Cortical activity modulations correlated with modulation of strabismic suppression are detectable in non-amblyopic individuals using fMRI, suggesting a neural basis for strabismic suppression in primary visual cortex.
Pure Horizontal Strabismus in Inferior Oblique Inclusion Syndrome
Authors: Lee Joo-Yeon , Seo Ji-Young , Kim Seung-Hyun
Published: November 2010

Inferior oblique inclusion is a rare complication following lateral rectus surgery. It is caused by inadvertent incorporation of the inferior oblique muscle into the lateral rectus muscle during surgery. The authors demonstrate two cases of inferior oblique inclusion with different manifestations and suggest the detection and proper management of this rare complication.
[J Pediatr Ophthalmol Strabismus 2010;47:e1–e4.]
Promoting Adherence to Psychotropic Medication for Youth—Part 2
Authors: McGuinness Teena M. , Worley Julie
Published: November 2010

Although prescriptions for psychotropic medications for children are at an all-time high, medication adherence rates for children are often low. In Part 1 of this article set, literature regarding adherence to psychotropic medications for children was reviewed. Important issues related to adherence included parental and child attitudes, complex dosing schedules, and barriers to communication between parents and providers. In Part 2, the focus will be on strategies to improve medication adherence, including communication, education, and behavioral strategies.
Use of Endocrine Hormones for Treating Depression
Authors: Howland Robert H.
Published: November 2010

Disturbances in some endocrine hormones have been implicated in the pathophysiology of depression. Some of these hormones (and drugs that affect hormone function) have been used as therapeutic agents for the treatment of depression, especially adrenal, thyroid, and gonadal axis hormones. Open-label and controlled studies of various drugs that directly suppress or inhibit adrenal axis function have shown some benefit for the treatment of major depression, including treatment-resistant depression. Thyroid hormone augmentation is effective for nonresponders to antidepressant agents, although it has not been studied extensively. Estrogen may improve mild mood symptoms in perimenopausal women but may not be effective alone for major depression. Evidence of the antidepressant effects of testosterone in men is inconsistent, with mixed results from controlled studies. The adrenal steroid hormone dehydroepiandrosterone has an important role in mood regulation and may have significant antidepressant effects.
Management of Corneal Ectasia After LASIK with Combined, Same-Day, Topography-Guided Partial Transepithelial PRK and Collagen Cross-Linking: The Athens Protocol
Authors: Kanellopoulos Anastasios John , Binder Perry S.
Published: November 2010

Purpose:

To evaluate a series of patients with corneal ectasia after LASIK that underwent the Athens Protocol: combined topography-guided photorefractive keratectomy (PRK) to reduce or eliminate induced myopia and astigmatism followed by sequential, same-day ultraviolet A (UVA) corneal collagen cross-linking (CXL).

Methods:

Thirty-two consecutive corneal ectasia cases underwent transepithelial PRK (WaveLight ALLEGRETTO) immediately followed by CXL (3 mW/cm
2
) for 30 minutes using 0.1% topical riboflavin sodium phosphate. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent, keratometry, central ultrasonic pachymetry, corneal tomography (Oculus Pentacam), and endothelial cell counts were analyzed. Mean follow-up was 27 months (range: 6 to 59 months).

Results:

Twenty-seven of 32 eyes had an improvement in UDVA and CDVA of 20/45 or better (2.25 logMAR) at last follow-up. Four eyes showed some topographic improvement but no improvement in CDVA. One of the treated eyes required a subsequent penetrating keratoplasty. Corneal haze grade 2 was present in 2 eyes.

Conclusions:

Combined, same-day, topography-guided PRK and CXL appeared to offer tomographic stability, even after long-term follow-up. Only 2 of 32 eyes had corneal ectasia progression after the intervention. Seventeen of 32 eyes appeared to have improvement in UDVA and CDVA with follow-up >1.5 years. This technique may offer an alternative in the management of iatrogenic corneal ectasia.
High-Resolution OCT Imaging of RPE Degeneration in Bilateral Diffuse Uveal Melanocytic Proliferation
Authors: Besirli Cagri G. , Comer Grant M.
Published: November 2010

Bilateral diffuse uveal melanocytic proliferation is a rare paraneoplastic syndrome that presents with bilateral progressive loss of vision. A 70-year-old woman presented with a 3-month history of progressive, bilateral vision loss. The patient had bilateral, diffuse, shallow, subretinal fluid with patchy, reddish-brown lesions at the level of the retinal pigment epithelium (RPE) that showed significant early hyperfluorescence on fluorescein angiography and a corresponding loss of autofluorescence. Optical coherence tomography of both eyes revealed complete RPE and inner segment/outer segment junction loss with adjacent areas of thickening at the level of the RPE. Bilateral diffuse uveal melanocytic proliferation was diagnosed based on these clinical findings, and a systemic evaluation for malignancy revealed metastatic endometrial adenocarcinoma. Both autofluorescence and optical coherence tomography demonstrated unique imaging characteristics that correlated with the reported histopathology of bilateral diffuse uveal melanocytic proliferation. These imaging modalities can contribute to the rapid and accurate diagnosis of bilateral diffuse uveal melanocytic proliferation.
Adult-Onset Vitelliform Detachment Unresponsive to Monthly Intravitreal Ranibizumab
Authors: Kandula Sushma , Zweifel Sandrine , Freund K. Bailey
Published: November 2010

A 72-year-old woman with decreased visual acuity secondary to an adult-onset vitelliform detachment was treated with three monthly intravitreal injections of 0.5 mg of ranibizumab. Treatment response was monitored by visual acuity and by the eye-tracking feature of the Heidelberg Spectralis spectral domain optical coherence tomography (Heidelberg Engineering, Inc., Carlsbad, CA). There was no improvement in functional or anatomic outcome after three monthly injections of ranibizumab. The eye-tracking feature of the spectral domain optical coherence tomography system was highly accurate in making comparisons between serial optical coherence tomography examinations.
Vitreopapillary Traction Diagnosed by Spectral Domain Optical Coherence Tomography
Authors: Nomura Yoko , Tamaki Yasuhiro , Yanagi Yasuo
Published: November 2010

This report describes a case of vitreopapillary traction with right inferior altitudinal defect similar to anterior ischemic optic neuropathy. A 35-year-old man with inferior altitudinal defect in his right eye was referred. The right optic disc was elevated and the superior disc margin was blurred. Spectral domain optical coherence tomography (SD-OCT) of the right optic disc showed the vitreous cortex was highly reflective and pulling the optic disc margin superiorly. The posterior hyaloid membrane on the nasal side of the optic disc was less reflective than that superior to the disc, suggesting that vitreopapillary traction contributed to this condition. During a careful 12-month observation, no change was noted in the optic disc appearance or visual field. Thus, SD-OCT was useful in visualizing the posterior hyaloid membrane and was helpful in the diagnosis of vitreopapillary traction syndrome.
Fenretinide-Associated Multilayered Retinal Hemorrhage in a Patient with Hairy Cell Leukemia
Authors: Salehi-Had Hani , Puliafito Carmen A.
Published: November 2010

Intravenous fenretinide (4-HPR), a cytotoxic retinoid, is being evaluated as part of a phase I clinical trial for patients with hematologic malignancies. In its orally administered form, it is also being evaluated for the treatment of various malignancies and geographic atrophy in subjects with the dry form of age-related macular degeneration. The authors report a case of acute large subretinal and intraretinal hemorrhage noted immediately after initiation of intravenous fenretinide therapy in a patient with hairy cell leukemia. This case highlights the importance of considering multilayered retinal hemorrhage as a possible side effect of fenretinide therapy, especially in patients with underlying hematologic abnormalities.
Effect of Saline Conditions on the Tensile Strength of Ophthalmic Sutures
Authors: Brauner Stacey C. , Berry Jesse L. , Pye James , Lee Edwin G. , Rhee Douglas J.
Published: November 2010

Background and Objective:

The purpose of this study was to compare the tensile strength of sutures commonly used for ophthalmic surgery and the role of physiologically balanced saline comparable to the ocular environment to material failure.

Materials and Methods:

Ophthalmic sutures (9-0 and 10-0 nylon, 7-0 and 8-0 polyglactin 910, and 10-0 polypropylene) were tested using a tensiometer. Wet conditions were defined by soaking the suture in balanced salt solution for 24 hours or 7 days prior to testing.

Results:

The 9-0 nylon was approximately 30% stronger than 10-0 nylon (
P
< .01), whereas 7-0 polyglactin was 60% and 85% stronger than 8-0 polyglactin under dry and 24 hours of wet conditions (
P
= .0014 and .004), respectively. There was no difference in tensile strength between 10-0 nylon and polypropylene sutures. The 8-0 polyglactin suture lost 11% of tensile strength after 7 days of saline exposure.

Conclusion:

The relative difference of suture strength between the difference gauge sutures is not a simple relationship to differences in the diameter. Tensile strength was not affected by saline conditions for the nylon, polypropylene, and 7-0 polyglactin sutures. The 8-0 polyglactin suture had a decrease in tensile strength after 7 days of exposure to saline. Surgeons should be aware of this limitation with 8-0 polyglactin.
AS-OCT as a Tool for Flap Thickness Measurement After Femtosecond-Assisted LASIK
Authors: Kucumen Raciha Beril , Yenerel Nursal Melda , Gorgun Ebru , Oral Deniz , Altunsoy Muhsin , Utine Canan Asli , Ciftci Ferda
Published: November 2010

Background and Objective:

To investigate the efficacy of anterior segment optical coherence tomography (AS-OCT) for calculating flap thickness in femtosecond laser-assisted laser in situ keratomileusis.

Patients and Methods:

Fifty-one eyes of 26 patients with myopia and myopic astigmatism were included in this prospective study. High-resolution corneal images were evaluated at 1 week and 1 month postoperatively. Images along the horizontal meridian were measured with the flap tool at seven points.

Result:

Measurements at vertex and at 1 mm nasally and temporally from the vertex were indistinct but easily defined. Although statistically not significant, flaps were found to be thinner in the central cornea and thicker in the periphery (
P
> .05).

Conclusion:

AS-OCT provides detailed high-resolution images for quantitative evaluation of the flap–stroma relationship, but it may not be precise in the central 2-mm area of the cornea. Despite this, AS-OCT is an imaging tool with significant utility.
The Efficacy of Low-Energy Selective Laser Trabeculoplasty
Authors: Tang Min , Fu Yang , Fu Ming-shui , Fan Ying , Zou Hai-dong , Sun Xiao-dong , Xu Xun
Published: November 2010

Background and Objective:

To analyze the efficacy of low-energy selective laser trabeculoplasty (SLT) in patients.

Patients and Methods:

In 74 patients (74 eyes) with ocular hypertension, suspected glaucoma, or primary open-angle glaucoma, SLT was the first-choice treatment. Thirty-nine patients in the low-energy group received treatment using half of conventional laser energy over 360° of the trabecular meshwork (at 100 points). Thirty-five patients in the control group received conventional laser energy. Patients were observed for 1 year. Complications and intraocular pressure (IOP) were observed.

Results:

Postoperative transient IOP spike (≥ 3 mm Hg) occurred in three eyes on the day of treatment and partial peripheral anterior synechiae occurred in one eye 1 month after treatment only in the control group. Effective rates of treatment (≥ 20% IOP reduction) at week 2 and month 1, 3, 6, and 12 after treatment were 69.23%, 64.10%, 61.54%, 53.85%, and 48.72% in the low-energy group and 71.43%, 71.43%, 60%, 51.43%, and 48.57% in the control group, respectively. There was no statistically significant difference between the two groups at various time points (
P
= .836, .501, .892, .835, .990).

Conclusion:

Compared with SLT using conventional laser energy, low-energy SLT lowers IOP with fewer complications, making it a safe and effective option.