bluuebunny/crossref_metadata_2025 huggingface dataset:
Fracture failure analysis and bias tearing strength criterion for a laminated fabric
Authors: Chen Jianwen , Chen Wujun , Zhou Han , Zhao Bing , Wang Mingyang , Sun Weiwei , He Shizan
Published: February 2017

This paper deals with the fracture failure analysis on plain woven laminated fabrics used in stratospheric airship structures. A series of uniaxial tensile and central slit tearing tests were carefully conducted on bias specimens, and the corresponding tensile and tearing properties, including failure mechanisms and material strengths, of a laminated fabric were discussed. Results show that laminated fabrics are typical direction-depended materials, and their failure characteristics vary greatly with the bias angles. Typical tearing stress–displacement curves of the laminated fabric could be defined as four characteristic regions: a co-deformation region, a yarn extension region (or shear deformation region), a plateau region, and a post peak region. Among bias specimens, there are many obvious differences in tearing behaviors in terms of maximum displacement, damage mode, curve slope, and number of stress peaks, which could be attributed to the material orthotropy and different failure mechanism of constituent materials. Unlike results of tensile strength, there is a W-shaped relationship between tearing strength and off-axis angle, with a local strength peak at 45° angle. Based on the Tsai-hill criterion, a new tearing strength criterion consisting of two parts, including a U-shaped and an inverted V-shaped part, is proposed for this laminated fabric. Comparisons between the experimental and calculated results for the laminated fabric are performed, and the strong agreements demonstrate that the proposed criterion is feasible and accurate.
Body-Machine Interface Enables People With Cervical Spinal Cord Injury to Control Devices With Available Body Movements: Proof of Concept
Authors: Abdollahi Farnaz , Farshchiansadegh Ali , Pierella Camilla , Seáñez-González Ismael , Thorp Elias , Lee Mei-Hua , Ranganathan Rajiv , Pedersen Jessica , Chen David , Roth Elliot , Casadio Maura , Mussa-Ivaldi Ferdinando
Published: February 2017

This study tested the use of a customized body-machine interface (BoMI) for enhancing functional capabilities in persons with cervical spinal cord injury (cSCI). The interface allows people with cSCI to operate external devices by reorganizing their residual movements. This was a proof-of-concept phase 0 interventional nonrandomized clinical trial. Eight cSCI participants wore a custom-made garment with motion sensors placed on the shoulders. Signals derived from the sensors controlled a computer cursor. A standard algorithm extracted the combinations of sensor signals that best captured each participant’s capacity for controlling a computer cursor. Participants practiced with the BoMI for 24 sessions over 12 weeks performing 3 tasks: reaching, typing, and game playing. Learning and performance were evaluated by the evolution of movement time, errors, smoothness, and performance metrics specific to each task. Through practice, participants were able to reduce the movement time and the distance from the target at the 1-second mark in the reaching task. They also made straighter and smoother movements while reaching to different targets. All participants became faster in the typing task and more skilled in game playing, as the pong hit rate increased significantly with practice. The results provide proof-of-concept for the customized BoMI as a means for people with absent or severely impaired hand movements to control assistive devices that otherwise would be manually operated.
The Accuracy of Common Hand Injections With and Without Ultrasound: An Anatomical Study
Authors: To Philip , McClary Kaylan N. , Sinclair Micah K. , Stout Brittany A. , Foad Mohab , Hiratzka Shannon , Stern Peter J.
Published: February 2017

Background: The aim of the study is to determine the accuracy of hand injections with and without the aid of ultrasound (U/S) into the carpal tunnel, thumb carpometacarpal (CMC) joint, first dorsal compartment (DC) and the radiocarpal (RC) joint. Methods: Four participants of various level of experience injected the carpal tunnel, thumb CMC, first DC, and RC joint into 40 fresh frozen cadaver specimens with blue dye and radiographic contrast. Participants 1 and 2 were injected without U/S guidance, and participants 3 and 4 were injected with U/S guidance. A successful injection was determined by both fluoroscopy and dissection/direct observation. Additional information was recorded for each injection such as median nerve infiltration and evidence of thumb CMC arthrosis. Results: The overall accuracy for carpal tunnel, thumb CMC, first DC, and RC injections were 95%, 63%, 90%, and 90%, respectively. Success was compared with and without U/S guidance. Success rates were similar for each injection site, except the thumb CMC joint, where U/S participants had 25% higher accuracy. In the setting of thumb CMC arthrosis, the incidence of success was 38% for participants with no U/S aid and 72% for participants with U/S aid. There was a significant difference between participants who used U/S with the participant with more U/S experience being more successful. Conclusion: Carpal tunnel, first DC, and RC injections had an accuracy of greater than 90%. Thumb CMC injections have a lower accuracy (63%) and one can improve accuracy with U/S. The accuracy of U/S-guided injections is dependent on the user and their experience.
The use of a stent-retriever to cause mechanical dilatation of a vasospasm secondary to iatrogenic subarachnoid haemorrhage
Authors: Bhogal Pervinder , Paraskevopoulos Dimitris , Makalanda Hegoda LD
Published: February 2017

Objective

To report the use of a stent-retriever in the management of vasospasm secondary to craniopharyngioma resection. Postoperative improvement was seen both clinically and on perfusion imaging.

Methods

A patient was admitted for resection of a large craniopharygioma. On day 6 postoperatively the patient had an acute hemiparesis. A computed tomography angiogram and perfusion scan demonstrated acute right-sided cerebral vasospasm and a perfusion defect in the territory of the middle cerebral artery (MCA).

Results

A pREset 4 × 20 mm stent-retriever was used to dilate the M1 and proximal M2 segments of the right MCA mechanically. This resulted in immediate dilatation of the spastic segment and improvement in the transit time on the angiogram. There was an improvement in the clinical status post-procedure and a computed tomography perfusion performed 24 hours after the procedure showed symmetrical perfusion. A computed tomography angiogram and magnetic resonance imaging performed 1 week later showed a symmetrical appearance to the MCA and no evidence of restricted diffusion.

Conclusion

The use of commercially available stent-retrievers can cause mechanical dilatation of vasospastic vessels. The stents do not need to be deployed for a prolonged period nor do they need to be implanted to have a prolonged dilatory effect on the spastic vessels.
Collective Dominance within the Context of EU Electronic Communications Regulation
Authors: Hou Liyang
Published: February 2017

The Regulatory Framework concerning electronic communications networks and services in the European Union transposes the concept of collective dominance under Article 82 of the EC Treaty into electronic communications regulation as collective significant market power. However, it is of academic and also practical interest to see how the regulatory authorities to apply this concept under the regulatory regime, given a fact that collective dominance is still developing in the area of competition law. This article empirically examines the application of collective dominance by the national regulatory authorities based on the European Commission decisions according to Article 7 of the Framework Directive, with an aim to interpret the four economic factors to assess collective dominance, i.e. (1) oligopolistic market characteristics conductive to coordinate, (2) incentives to coordinate, (3) abilities to retaliate, and (4) abilities to resist market constraints, by concrete legal examples.
Is the French Case Illustrating That Competing Operators and Regulatory Strategies Force Telecom Services to Become a Commodity?
Authors: Le Goff Richard , Rojas José Alejandro
Published: February 2017

Voice services were the main source of revenue for French fixed and mobile telecommunications operators in the early 2000s. This situation has progressively changed. Nowadays broadband services are the main source of revenues for fixed line operators and the same phenomenon is taking place in the mobile sector. As operators launch new services, they maintain the existing ones in their commercial plans, while allowing consumers an unlimited usage of the feature for no extra charge. We refer to this trend as commoditization. In order to explain the rationale behind this phenomenon, we will study the causes and effects of fixed and mobile voice services commoditization on the various operators by examining the links between market structure, regulatory decisions and operators' corporate strategies. Our goal is to determine to what level commoditization process is the result of operators' corporate strategies, and to assess the role played by regulatory decisions in the process.
Fatal and serious complications associated with cosmetic suction lipectomy
Authors: Brown S Lori , Bacsanyi Janos T , Purvis-Wynn Sherry L
Published: February 2017

Liposuction is the most commonly performed cosmetic surgery procedure in the United States. The medical devices and drugs used in the performance of liposuction are regulated by the Food and Drug Administration. Serious liposuction-related complications, including death, are reported in the literature. A review of reported complications and causes of deaths related to liposuction is presented. Prospective studies examining potential risk factors for complications, such as amount of fatty tissue removed and extent of body surface area affected, concomitant surgeries, method of anesthesia, impact of physician training and site of surgery, are needed to clarify the risks involved in liposuction. Studies are required to establish the risk-benefit profile of this procedure to allow patients and physicians to be adequately informed. Adverse events have been under-reported to the Food and Drug Administration despite numerous reports in the medical literature of serious complications associated with the use of medical devices in the performance of liposuction.
The effect of transcutaneous electrical nerve stimulation on the viability of random skin flaps in rats
Authors: Liebano Richard Eloin , Ferreira Lydia Masako , Neto Miguel Sabino
Published: February 2017

The aim of this study was to determine the role of transcutaneous electrical nerve stimulation (TENS) in the viability of random skin flaps. In 30 Wistar-EPM rats, a random 10×4 cm skin flap was raised and a plastic barrier was interposed between the flap and its bed. Immediately after surgery and for two subsequent days, the rats in group 1 (the control group) were anesthetized for 1 h with the electrodes positioned in the base of the flap and without the administration of the electric stimulus. The rats in group 2 (the treatment group) were submitted to TENS for 1 h immediately after the surgery and for two subsequent days.

The percentage of necrotic area (averages of 43.11% in the rats in group 1 and 23.52% in the rats in group 2) was calculated on the seventh postoperative day in both groups.

Statistical analysis proved that TENS was more efficient in increasing random skin flap viability than was the method used in the control group.
Breast reconstruction in Nova Scotia: Rate, trends and influencing factors
Authors: Koshi Edvin B , Andreou Pantelis , Morris Steven F
Published: February 2017

Background

During their lifetime, approximately 10% of Canadian women will develop breast cancer. An increased awareness of breast reconstruction in patients undergoing mastectomy appears to have increased the demand for breast reconstructive surgery.

Objectives

To study the rate of breast reconstructive surgeries performed in the province of Nova Scotia to determine whether the breast reconstructive services now offered are adequate to meet the needs of the population of this area.

Methods

The number of breast reconstruction procedures and mastectomies completed in the province of Nova Scotia during the time period of 1992 to 2001 was reviewed. The data were obtained from Maritime Medical Care Incorporated, the provincial medical plan. Information available on patients coded as undergoing breast surgeries was reviewed (n=10, 056). The data on the trends and demographics of the Nova Scotia population were obtained from Statistics Canada. The data on incidence, prevalence and trends of breast cancer were obtained from the Canadian Cancer Society and the National Cancer Institute of Canada.

Results and Conclusions

There is strong evidence of an increasing trend in the number of reconstructive surgeries among the women who underwent mastectomy. The number of breast reconstruction procedures increased 15 fold during the study period. This is mainly attributed to the increased awareness of women undergoing mastectomy and improved education by surgeons, family physicians and breast cancer support groups. Health sector employees must evaluate these trends to determine if the breast reconstructive services currently offered in this region are adequate. Reconstructive surgery was negatively associated with increasing age. Place of residency (urban versus rural) seems to play a role in women's decisions to proceed with breast reconstruction.
A Review of Materials Currently Used in Orbital Floor Reconstruction
Authors: Mok David , Lessard Lucie , Cordoba Carlos , Harris Patrick G , Nikolis Andreas
Published: February 2017

Orbital fractures are common fractures of the midface. As such, numerous techniques and materials exist for the repair of this region, each with inherent advantages and disadvantages. But does the ideal implant material exist? Should we stop and simply use readily available materials, or should the cycle of need and discovery continue? a comprehensive review of materials used in orbital reconstruction and possible new directions in orbital floor reconstruction are presented.
A Mature and Fast-Forming Fibrous Capsule Using Tetracycline: A Preliminary Report
Authors: Ayhan Meltem , Hacilar Atilla , Deren Orgun , Aytug Zeynep , Erdogan Bülent
Published: February 2017

The most frequently used method in two-stage reconstruction of a tendon is the placement of a silicone rod, forming a canal where the tendon can glide easily, that is subsequently replaced with a tendon graft. However, there is a disadvantage in that the formation of a qualified gliding canal requires at least three months after the placement of the silicone rod. In the present report, the authors evaluated the effects of tetracycline on the time period required for the formation of a qualified gliding canal in rats after the placement of a silicone rod. Tetracycline was administered through an 18 gauge needle inserted into the silicone rod in the test side (right) and saline solution was administered in the same fashion to the control side (left) in each rat. Histopathological and macroscopic examinations at weeks 1, 2, 3, 4 and 8 after the operation showed that a significantly thicker and more mature sheath was formed after two weeks in the sides that had been treated with tetracycline.
Analysis of Reporting Return to Work in Studies Comparing Open with Endoscopic Carpal Tunnel Release: A Review of Randomized Controlled Trials
Authors: Ayeni Olubimpe , Thoma Achilleas , Haines Ted , Sprague Sheila
Published: February 2017

Background

In studies comparing open with endoscopic carpal tunnel release, return to work (RTW) is often cited as a primary outcome.

Objective

The present study assessed the reporting of RTW and evaluated its usefulness in studies comparing these two methods of carpal tunnel release.

Methods

A computerized search was conducted to find randomized controlled trials that compared open with endoscopic carpal tunnel release, with RTW as an outcome measure. The factors that were compared across the studies included definition of RTW, units quantifying RTW, measures of hand function, patients’ type of employment, worker's compensation or insurance status, patients’ handedness, unilateral or bilateral carpal tunnel release, and use of rehabilitation.

Results

Fifteen studies met the inclusion criteria for the present systematic review. of the 15 studies reviewed, there were seven definitions of RTW. All studies defined whether the patients underwent unilateral or bilateral carpal tunnel release but there was variability in the calculation of RTW when bilateral releases were performed. The impact of worker's compensation or insurance, type of work, handedness and rehabilitation were inconsistently addressed as factors affecting RTW.

Conclusions

Although RTW ideally reflects function and recovery, it is inadequately measured and reported. The present review revealed that, in studies comparing open carpal tunnel release with endoscopic carpal tunnel release, there is lack of uniformity in reporting RTW, which may contribute to the inconclusive results for RTW. Future research needs to ensure that RTW is used in a consistent manner.
A Review of 2975 Consecutive Operations By One Surgeon in An Accredited Outpatient Plastic Surgicentre: A Canadian Experience
Authors: Chasmar Leslie R
Published: February 2017

The present paper constitutes a retrospective review of 2975 consecutive operations performed by the author, one of the three owners of the Saskatoon Plastic Surgicentre. The unit opened in 1987; therefore, the study spans 17 years. Patients are not kept overnight, and the Surgicentre is approved and equipped as a level C facility for general anesthesia. Only patients who score 1 or 2 according to the American Association of Anesthesiologists are treated. Only certified anesthesiologists are used. of the patients with postoperative complications, only two required transfer to a hospital. One developed a pneumothorax, which was treated on arrival at the intensive care unit with no sequelae. The other collapsed following facelift surgery. She was transferred to University of Saskatchewan hospital and died later that evening with a massive pulmonary embolus. In a properly established outpatient centre, a large number of patients can be safely treated with very few complications. However, despite placing patient safety as the first consideration and adhering strictly to the highest standards, death can occur.
Sterile Versus Nonsterile Clean Dressings
Authors: Alqahtani Moraya , Lalonde Donald H
Published: February 2017

Background

Many patients cannot afford sterile dressings. In St John, New Brunswick, clean dressings have been used instead of sterile dressings for years, with no apparent ill effects. No previous studies have compared the sterility and cost of clean versus sterile dressing materials.

Objectives

The goals of the present study were to answer the following questions: how much more sterile are sterile dressings than clean dressings; and how much does this extra sterility cost?

Methods

Sterility and cost of sterile gauze, panty liners, sanitary napkins, diapers and Coban tape (3M, USA) were compared. Samples, 2 cm × 2 cm in size, were cut out of each material under aseptic conditions, and delivered to the microbiology laboratory in sterile urine containers. The samples were then cultured and organisms were identified using conventional means.

Results

The cost for one month, using one 20 cm × 5 cm wound dressing daily, was calculated and compared with panty liners ($2.43), sanitary napkins ($5.55), diapers ($9.39) and Coban tape ($0.66), which were much cheaper than sterile dressings ($16.50). How sterile were the dressings? None of the 20 sanitary napkins grew bacteria, one of the 20 panty liners grew bacteria (coagulase-negative Staphylococcus), two of 20 sterile dressings grew bacteria (one coagulase-negative Staphylococcus and one nonhemolytic Streptococcus), 15 of 20 diapers grew bacteria (all bacillus) and two of five Coban rolls grew bacteria (one bacillus and one coagulase-negative Staphylococcus).

Conclusion

The panty liners, sanitary napkins and Coban tape studied were cheaper than, and had a comparible sterility with, the sterile gauze examined.
Treatment of congenital epulis (granular cell tumour) with excision and gingivoperiosteoplasty
Authors: Narasimhan Kailash , Arneja Jugpal S , Rabah Rajah
Published: February 2017

Congenital epulis, or granular cell tumour, is a rare, benign intraoral tumour present on the mucosa of the alveolar ridge, with the potential to interfere with respiration and feeding. Treatment involves surgical excision, and recurrences are rare. The management of the alveolar deficiency associated with this tumour has not previously been addressed. In the present report, a patient with a typical epulis, treated surgically with excision and extrapolation of Millard's gingivoperiosteoplasty technique to reconstruct the associated alveolar defect with restoration of alveolar ridge continuity, is presented. The differential diagnosis and complications of this tumour are discussed.
Nodular Fasciitis of the Zygoma: A Case Report
Authors: Vyas Tarren , Bullock Martin J , Hart Robert D , Trites Jonathan R , Taylor S Mark
Published: February 2017

Nodular fasciitis (NF), a benign proliferation of fibroblasts, commonly presents as a solitary, well-circumscribed, rapidly growing soft tissue mass. It is most commonly located in the upper extremities, particularly on the volar aspect of the elbow, and on the chest and trunk. In adults, NF is rarely found in the head and neck region. Although benign, it can often be confused with a more malignant process and therefore must be properly diagnosed histologically. The cause of NF is unknown but an association with trauma may be present. Treatment is most commonly by local surgical excision, and recurrence is rare. A case of NF over the zygoma in a 60-year-old man not associated with trauma is presented.
Short-term vasculoprotective effects of imatinib mesylate on intimal hyperplasia of arterial anastomosis: An experimental study using a rabbit model
Authors: Sevim Kamuran Zeynep , Silistreli Ozlem , Gorgu Metin , Sevim Osman , Ergur Bekir
Published: February 2017

Background

Since the beginning of the ‘microvascular era’, the success rates of microvascular procedures have increased to more than 90% in most series. The main reason for failure, however, is the healing of microarterial anastomosis, which is dependent on the status of endothelial cells and affects the rate of arterial thrombosis. In 80% of arterial thrombosis cases, complications are primarily observed during the first 72 h after surgery. Healing of arterial anastomosis results in intimal hyperplasia in which myofibroblasts comprise the predominant cell type. Intimal hyperplasia has been described previously as an adaptive process that occurs in response to hemodynamic stress or injuries to the vascular bed. During wound healing, fibroblasts proliferate, migrate and differentiate into myofibroblasts – a process that takes one to three days. Imatinib mesylate (ST1571-Gleevec, Novartis, Germany) is a specific platelet-derived growth factor receptor blocker that has found use as an adjunct to sirolimus in cardiovascular surgery for restenosis. However, its potential utility in preventing arterial thrombosis in microvascular surgery has not been evaluated in routine plastic surgery practice.

Methods

Twenty-four randomly selected, male, white New Zealand rabbits were divided into six groups (A to F), and the femoral artery model was used for arterial anastomosis. Following anastomosis, groups A, B and C received phosphate-buffered saline orogastrically. In groups D, E and F, imatinib mesylate was administered via an orogastric tube twice per day at a dose of 10 mg/kg starting two days before arterial anastomosis. Following anastomosis, imatinib mesylate was administered for one, three and seven days, and the regression of intimal hyperplasia was recorded.

Results

In groups administered imatinib mesylate (ie, groups D, E and F), intimal hyperplasia decreased by up to 50%, which represented a statistically significant difference. Histological analysis confirmed smooth muscle cell migration from the tunica intima to media on days 3 and 7 in groups E and F.

Conclusion

The present study revealed that imatinib mesylate, which was initiated as a prophylactic, systemic pretreatment and continued for seven days, gradually decreased intimal hyperplasia at the anastomosis site.
Use of External Fixation to Simplify Postoperative Care of Free Flap to the Leg
Authors: Harris Patrick G , Mosher John F , Loftus Jon B
Published: February 2017

PG Harris, JF Mosher, JB Loftus. Use of external fixation to simplify postoperative care of free flap to the leg. Can J Plast Surg 1994;2(3): 133-134. External fixation is recommended instead of the combination of a bulky dressing and a posterior splint to facilitate postoperative care of free flap surgery to the lower extremity. Balanced suspension of external skeletal fixation allows adequate elevation, minimal dressing, unobstructed view of the flap for monitoring and freedom from pressure points. The slightly longer operative time required is justified by the easier postoperative care. No complications have been associated with the use of external fixation.
Influence of Specialist Title On Perceived Surgical Ability
Authors: Kreidstein Michael L , Thomson Hugh G , Neligan Peter C
Published: February 2017

ML Kreidstein, HG Thomson, PC Neligan. Influence of specialist title on perceived surgical ability. Can J Plast Surg 1994;2(4):149-154. This study was conducted to test the hypothesis that patients associate specialist titles with superior surgical ability, and that operative results are viewed more favorably if believed to be the handiwork of a specialist. Subjects (n=130) were randomly selected from among patients at a medical walk-in clinic. All subjects were presented with an identical set of ‘before and after’ photographs depicting six unrelated facial operations. However, each set of photographs was attributed at random to one of the following surgeons: plastic surgeon, plastic surgery resident, aesthetic plastic surgeon, facial plastic surgeon, ear nose and throat/ head and neck surgeon, cosmetic surgeon. Subjects completed a questionnaire evaluating the quality of the result from each operation, and then for each operation indicated which of the above surgeons was likely to achieve the best operative result. The attribution of identical operative results to the different surgeons resulted in evaluations that were not statistically different (P>0.05). Cosmetic surgeons were chosen most frequently as the type of surgeon likely to perform the best quality rhytidectomy or rhinoplasty, and facial plastic surgeons were chosen most frequently as best for repairs of facial lacerations or removal of skin tumours on the face (P<0.00l). Plastic surgeons and ear nose and throat surgeons received intermediate ratings, and aesthetic plastic surgeons and plastic surgery residents received low ratings. As hypothesized, specialist titles were associated with superior surgical ability, with cosmetic surgeons thought to provide the best cosmetic procedures, and facial plastic surgeons thought to provide the best reconstructive procedures. Despite this bias, evaluations of the operative results were not influenced by the type of surgeon credited with the operation, refuting the hypothesis of a placebo-type effect.
Tissue Expansion for Closure of the Donor Site of a Distant Pedicle Flap
Authors: Zuker Ronald M , Fielding Craig , Beatty Steve
Published: February 2017

RM Zuker, C Fielding, S Beatty. Tissue expansion for closure of the donor site of a distant pedicle flap. Can J Plast Surg 1994; 2(4):155-158. Tissue expansion continues to provide new and exciting applications in reconstructive surgery. Tissue expansion has allowed for an increase in size of specialized tissue, particularly about the head and neck. It has also been demonstrated that the blood supply of pedicle flaps can be augmented, thus extending the surviving length of expanded flaps. Recently tissue expansion has been used with free flap transfer to expand the amount of tissue to be transferred and to facilitate donor site closure. In certain situations free tissue transfer may not be recommended and pedicle flap and particularly cross leg and cross thigh flaps are required. In addition to the prolonged unnatural positioning of the patient, the donor defect of these flaps has been harshly criticized. In this report tissue expansion is used to provide adequate tissue for direct closure of the donor defect thus minimizing the deformity.
Conservative management of transverse partial flexor digitorum profundus tendon lacerations in zone 2
Authors: Al-Qattan Mm , Clarke Hm , Bowen V
Published: February 2017

The experience with six patients managed conservatively following transverse partial flexor digitorum profundus tendon lacerations in zone 2 is presented. Four patients who were mobilized using elastic traction experienced no triggering; however, two patients who had unrestricted mobilization immediately following injury developed triggering. The mechanism of triggering and tendon flap formation in the clinical cases is discussed.
Kimura's disease: A clinical case related to a mosquito bite
Authors: De Chalain Tristan Mb , Culbertson Jack
Published: February 2017

Kimura's disease is a benign, but locally injurious disease with a marked predilection for the head and neck. Of uncertain etiology, its tendency to present as a discrete, enlarging mass with associated lymphadenopathy makes it a condition of interest to clinicians who see head and neck pathology. Although rare, there are increasing numbers of reports of the condition and it should become part of the standard differential diagnosis. A typical case of this rare disease, apparently originating from a mosquito bite several years before presentation is presented.
Modification of tension band wiring of displaced intra-articular phalangeal fractures
Authors: Pugh Margaret , Richards Robert S
Published: February 2017

Numerous techniques have been described for internal fixation of displaced intra-articular fractures of the phalanges, including percutaneous pinning, microplating, interosseous wiring and tension banding techniques. One method, described by Rayhack and Bottke, is a modified tension banding method using a K-wire and a stainless steel wire. Although this technique has been found to be very useful, certain complications have led to the development of a modification of this technique.
Development and Validation of a Genomic Knowledge Scale to Advance Informed Decision-Making Research in Genomic Sequencing
Authors: Langer Michelle M. , Roche Myra I. , Brewer Noel T. , Berg Jonathan S. , Khan Cynthia M. , Leos Cristina , Moore Elizabeth , Brown Michelle , Rini Christine
Published: February 2017

Background: This study evaluated the psychometric properties of a new, comprehensive measure of knowledge about genomic sequencing, the University of North Carolina Genomic Knowledge Scale (UNC-GKS). Methods: The UNC-GKS assesses knowledge in four domains thought to be critical for informed decision making about genomic sequencing. The scale was validated using classical test theory and item response theory in 286 adult patients and 132 parents of pediatric patients undergoing diagnostic whole exome sequencing (WES) in the NCGENES study. Results: The UNC-GKS assessed a single underlying construct (genomic knowledge) with good internal reliability (Cronbach’s α = 0.90). Scores were most informative (able to discriminate between individuals with different levels of genomic knowledge) at one standard deviation above the scale mean or lower, a range that included most participants. Convergent validity was supported by associations with health literacy and numeracy (rs = 0.41–0.46). The scale functioned well across subgroups differing in sex, race/ethnicity, education, and English proficiency. Discussion: Findings supported the promise of the UNC-GKS as a valid and reliable measure of genomic knowledge among people facing complex decisions about WES and comparable sequencing methods. It is neither disease- nor population-specific, and it functioned well across important subgroups, making it usable in diverse populations.
The response of Ewing's sarcoma to sequential cyclophosphamide and adriamycin induction therapy.
Authors: Hayes F A , Thompson E I , Hustu H O , Kumar M , Coburn T , Webber B
Published: February 2017

Twenty-four consecutive patients with Ewing's sarcoma were treated in a protocol designed to deliver induction chemotherapy with postinduction surgical-pathologic evaluation of the primary tumor site. This was followed by delayed radiotherapy, the dose and port of which was dependent on the response to induction chemotherapy. All patients received 5 courses of sequential cyclophosphamide and adriamycin during the 3-mo induction period. Nineteen of 23 evaluable patients had no gross residual tumor following this therapy. Of the remaining 4, 2 had complete surgical excision of residual gross disease. Of the 22 patients who were free of gross tumor following induction chemotherapy and surgery, 5 received no radiotherapy, 16 received moderate-dose limited port radiotherapy (3000-3500 R), and 1 received high-dose limited port radiotherapy (5000 R). All 14 patients with localized disease attained remission and are surviving 9-41+ mo (median 21+) with 2 local recurrences occurring after 10 and 33 mo of remission. Of the 10 patients presenting with metastatic disease, 8 attained complete remission with 4 of the 8 remaining disease-free 12-34+ mo from diagnosis. This study indicates that Ewing's sarcoma is very sensitive to moderate-dose 2 drug chemotherapy of low toxicity and that it is possible to delay radiotherapy and any extensive surgical procedure until remission is induced.
Marrow cytogenetic and cell-culture analyses of the myelodysplastic syndromes: insights to pathophysiology and prognosis.
Authors: Gold E J , Conjalka M , Pelus L M , Jhanwar S C , Broxmeyer H , Middleton A B , Clarkson B D , Moore M A
Published: February 2017

Marrow cytogenetic and granulocyte-macrophage colony formation (CFU-GM) studies were performed on 34 previously untreated patients with documented myelodysplastic syndromes seen between January 1978 and June 1982. All patients were managed without chemotherapy until progression to acute leukemia was observed. All 10 patients with exclusively abnormal marrow metaphases developed acute leukemia (100%) while only one (7%) of 14 patients with solely normal marrow metaphases subsequently developed leukemia (p less than 0.001). Three (42%) of the seven patients with both normal and abnormal marrow metaphases developed acute leukemia. Fifteen (86%) of the 19 patients with either large cluster or no growth patterns developed acute leukemia while only two (13%) of 15 patients with either small cluster or colony forming growth patterns developed acute leukemia (p less than 0.001). Abnormal marrow cytogenetic status correlated with abnormal marrow CFU-GM growth pattern (p less than 0.05). Analysis of CFU-GM sensitivity to inhibition by prostaglandin E was performed in 12 patients. Nine patients showed CFU-GM refractoriness to inhibition by prostaglandin E. Seven of these patients eventually developed leukemia. Three patients had CFU-GMs which were initially sensitive to prostaglandin E inhibition. In these three patients, a loss of CFU-GM sensitivity to prostaglandin E was observed prior to their progression to morphologically identifiable acute leukemia.
Prospective randomized trial of one-hour sequential versus simultaneous methotrexate plus 5-fluorouracil in advanced and recurrent squamous cell head and neck cancer.
Authors: Browman G P , Archibald S D , Young J E , Hryniuk W M , Russell R , Kiehl K , Levine M N
Published: February 2017

Results from experimental systems suggest that the combination of methotrexate (MTX) and 5-fluorouracil (5-FU) produces synergistic cytotoxic effects that are dependent on the sequence of drug administration. Biochemical studies have demonstrated plausible mechanisms of a synergistic effect when MTX precedes 5-FU. A variety of phase I and phase II studies have employed this sequential combination with promising but inconclusive results. In this study, 79 evaluable patients with squamous cell head and neck cancer were randomized to receive MTX (200 mg/m2 IV) and 5-FU (600 mg/m2 IV) either simultaneously or sequentially with MTX preceding 5-FU by one hour. All patients were ambulatory and patients were stratified as to whether they presented with primary disease or with recurrence after prior radiation and/or surgical therapy. The overall response rate was superior for simultaneous therapy (62%) compared with sequential therapy (38%) (p less than 0.06). Among patients with primary head and neck cancer, the stage of the disease influenced the response rate. Eight of nine stage III patients who received simultaneous therapy responded while none of the four patients who received sequential therapy responded (p less than 0.01). This study demonstrates that one-hour sequential MTX plus 5-FU is not superior to simultaneous treatment in patients with squamous cell head and neck cancer.
Serial cranial computed-tomography scans in children with leukemia given two different forms of central nervous system therapy.
Authors: Ochs J J , Parvey L S , Whitaker J N , Bowman W P , Ch'ien L , Campbell M , Coburn T
Published: February 2017

Cranial computed tomography (CT) was used to estimate the frequency and permanence of brain abnormalities in 108 consecutive children with acute lymphoblastic leukemia (ALL). Fifty-five patients received cranial irradiation (1,800 rad) with intrathecal methotrexate (RT group) and 53 patients received intravenous and intrathecal methotrexate without irradiation (IVIT group). Continuation treatment included sequential drug pairs for the RT group and periodic IVIT methotrexate for the other group. After 12 to 24 months of serial evaluation, five (9%) of the 55 patients in the RT group have had CT scan abnormalities, compared to 10 (19%) of 52 in the IVIT group (p = 0.171). Fourteen of the 15 patients with CT scan abnormalities had focal or diffuse white-matter hypodensity; these have reverted to normal in most cases, reflecting a dynamic process. While such CT findings are of concern and may be an early indicator of central nervous system toxicity, this remains to be proven. Therapy should not be altered on the basis of abnormal CT scans alone but in the context of the entire clinical situation.
Large cell lymphomas of the stomach: improved prognosis with complete resection of all intrinsic gastrointestinal disease.
Authors: Paulson S , Sheehan R G , Stone M J , Frenkel E P
Published: February 2017

Thirty-seven consecutive patients with large cell lymphoma involving the stomach were evaluated between 1974 and 1980. All seven stage IE patients underwent complete resection of the stomach and all patients are alive 21-41 mo after resection. Of 18 stage IIE, 11 underwent complete resection. Two resected patients without postoperative therapy died of their disease. Six patients treated with chemotherapy are alive and well, and two of three patients treated with radiotherapy remain alive without disease. Seven patients had incomplete resection or biopsy, and only one remains alive at 34 mo. Of eight stage IV patients, four had complete resection and chemotherapy without recurrence of their disease. All four patients who were not resected have died of their disease. This study strongly supports the role of early surgery in the management of gastric large cell lymphomas.
Treatment of primary osteosarcoma with intra-arterial and intravenous high-dose methotrexate.
Authors: Jaffe N , Prudich J , Knapp J , Wang Y M , Bowman R , Cangir A , Ayala A , Chuang V , Wallace S
Published: February 2017

In an effort to achieve high concentrations and prolonged exposure times, high-dose methotrexate (MTX) was administered by the intra-arterial route over 6 hours at a dose of 12.5 g/m2 to nine patients with osteosarcoma. This was followed by citrovorum factor (CF) rescue, which was initiated 12 hours after completion of the infusion (MTX-CF). The regimen achieved high local concentrations over a finite period. No toxicity was encountered. Treatment was administered at weekly intervals, during which intravenous MTX-CF was interposed if facilities for intra-arterial administration were not available. However, despite increases in local venous concentrations and exposure times, only four of nine patients (44%) responded. This is similar to responses achieved with 7.5 g/m2 (48%) with CF initiated 2 hours after completion of the infusion. Higher MTX doses, intra-arterial administration, and prolongation of cytotoxic exposure time did not confer a therapeutic advantage as opposed to "conventional" intravenous high doses.
Local installation of small doses of streptokinase for treatment of thrombotic occlusions of long-term access catheters.
Authors: Rubin R N
Published: February 2017

Small doses of streptokinase were infused locally into occluded long-term venous access catheters in seven patients with neoplasia who required such access for the administration of chemotherapy and blood products. This technique resulted in prompt resolution of clot in all patients, was easy to perform, and caused no hemorrhagic side effects or coagulation changes.
The impact of primary irradiation treatment of localized breast cancer on the ability to administer systemic adjuvant chemotherapy.
Authors: Lippman M E , Lichter A S , Edwards B K , Gorrell C R , d'Angelo T , DeMoss E V
Published: February 2017

The impact of primary irradiation of localized breast cancer on the ability to administer Adriamycin-cytoxan adjuvant chemotherapy to patients with stage II breast cancer was examined. Patients were prospectively randomized to receive either irradiation or mastectomy as local therapy and did not differ with respect to other prognostic variables that might influence tolerance to chemotherapy. All of the patients received chemotherapy dose escalations (or reductions) until maximal tolerated drug doses were established. Patients receiving irradiation had minimally greater myelosuppression which was nearly totally explainable by lymphopenia. Irradiated patients required dose reduction nearly twice as often as mastectomy patients although commonly their dose could be reescalated. Patients managed with radiotherapy received slightly less drug than patients treated with mastectomy when treated to an identical degree of bone marrow suppression. The primary management of breast cancer by irradiation does not induce substantial changes in the ability of patients to tolerate adjuvant chemotherapy.
Serum beta 2-microglobulin in the initial staging and subsequent monitoring of monoclonal plasma cell disorders.
Authors: Garewal H , Durie B G , Kyle R A , Finley P , Bower B , Serokman R
Published: February 2017

Serum beta 2-microglobulin (beta 2-M) measurements were carried out in 97 patients with monoclonal plasma cell disorders. Twenty-six (87%) of 30 patients with monoclonal gammopathy of undetermined significance (MGUS) had increased beta 2-M levels and serial follow-up in seven patients showed a progressive increase with time. Of the 63 patients with active myeloma, pretreatment serum beta 2-M values were available in 25 for correlation with pretreatment stage. Stage III beta 2-M levels were significantly higher than stages I and II (p less than 0.001). Four patients with smoldering myeloma had beta 2-M values similar to stage I disease. There was, therefore, excellent correlation between beta 2-M and myeloma tumor burden. Levels of beta 2-M decreased with response to chemotherapy induction and low levels in stable remission (plateau phase) were associated with unusually good prognosis. Median survival for stage III patients in stable remission with low serum beta 2-M was greater than 48 months. Conversely, at relapse very high beta 2-M levels were associated with a very fulminant and refractory course. Serum beta 2-M, therefore, appears to be an extremely useful marker in initial stratification and follow-up of myeloma patients.
Leukemia following treatment of germ cell tumors in men.
Authors: Redman J R , Vugrin D , Arlin Z A , Gee T S , Kempin S J , Godbold J H , Schottenfeld D , Clarkson B D
Published: February 2017

We investigated the incidence of leukemia occurring subsequent to the treatment of germ cell tumors in men at our institution over a 30-year interval and found four patients with acute nonlymphocytic leukemia (ANLL) and one patient with chronic myelomonocytic leukemia. The relative risk (observed/expected cases) estimates for the development of leukemia ranged from 13.7 (P = .0005) in the total population to 50.1 (P = .0001) in the group treated with cytotoxic agents alone. All three patients with ANLL treated with contemporary antileukemic therapy had complete responses, with survivals of 7, 29, and 133 + months. In a review of the literature, 14 additional cases of germ cell tumors were found in which the men subsequently developed leukemia. It is concluded that leukemia following germ cell tumors is increased in incidence and is likely to be treatment induced. Complete responses and long-term survival are possible in secondary leukemia and aggressive antileukemic therapy should be given.
Cytogenetic studies in 77 patients with chronic lymphocytic leukemia: correlations with clinical, immunologic, and phenotypic data.
Authors: Han T , Sadamori N , Ozer H , Gajera R , Gomez G A , Henderson E S , Bhargava A , Fitzpatrick J , Minowada J , Bloom M L
Published: February 2017

Cytogenetic analyses by G-banding and/or Q-banding techniques of polyclonal B cell mitogen-stimulated peripheral blood lymphocytes in 77 patients with chronic lymphocytic leukemia were carried out in the present study. Adequate metaphases were obtained in 65 patients (84%). Of 29 patients with abnormal karyotypes, ten (34%) had trisomy 12 as the sole abnormality, eight (28%) had trisomy 12 in combination with other karyotypic changes, and the remaining 11 had various karyotypic changes other than trisomy 12. There was a significant relationship between the abnormal karyotype and disease status, clinical stage, lymphocyte count, bone marrow infiltration pattern, monoclonal IgM gammopathy, and urinary monoclonal-free light chain status. Six of seven patients (87%) with trisomy 12 only had stage 0-11 disease, whereas all eight patients with trisomy 12 with other changes had stage III or IV disease (P less than .02). However, of nine patients with other karyotypic changes without trisomy 12, five had stage 0-II and four had stage III or IV disease. These observations suggest that trisomy 12 may be the primary or the earliest karyotypic change in a majority of aneuploid patients with chronic lymphocytic leukemia, and that other karyotypic changes in addition to trisomy 12 may develop as a result of clonal evolution, dedifferentiation, or therapy. Of nine patients in whom autopsy studies were carried out, four were found to have diffuse histiocytic lymphoma or Richter's syndrome (three with trisomy 12 in combination with other chromosome changes and one with normal karyotype). Our findings clearly demonstrate that cytogenetic study may be of value in the clinical and prognostic evaluation of patients with chronic lymphocytic leukemia.