bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between results of in vitro susceptibility tests and outcomes following treatment with pirlimycin hydrochloride in cows with subclinical mastitis associated with gram-positive pathogens
Authors: Apparao Dhananjay , Oliveira Leane , Ruegg Pamela L.
Published: June 2009

Objective—To determine the association between results of in vitro antimicrobial susceptibility tests and outcomes in cows that received intramammary treatment with pirlimycin hydrochloride for subclinical mastitis associated with gram-positive pathogens.

Design—Case-control study.

Animals—132 dairy cows (178 mammary glands with subclinical mastitis caused by 194 pathogen isolates).

Procedures—Cows with positive results for a California mastitis test (CMT) were assigned to receive 50 mg of pirlimycin via intramammary administration into each CMT-positive mammary gland every 24 hours for 2 consecutive days or no treatment. Duplicate milk samples were collected before treatment and approximately 21 days later. Target pathogens included coagulase-negative Staphylococcus spp (n = 118 isolates), Streptococcus spp (28), Staphylococcus aureus (7), and other gram-positive cocci (30). Antimicrobial susceptibilities were determined via broth microdilution.

Results—Overall treatment success rate was 66% (128/194) for both groups. In vitro resistance to pirlimycin ranged from 0% (0/7 isolates of S aureus) to 50% (13/26 isolates of other gram-positive cocci). For the treated group, 62 of 94 (66%) target pathogens were classified as treatment successes and 32 (34%) were classified as failures. Similarly for the control group, 66 of 100 (66%) target pathogens were classified as treatment successes, whereas 34 (34%) were classified as failures.

Conclusions and Clinical Relevance—Many target pathogens from cows with subclinical mastitis were eliminated without treatment, and treatment with pirlimycin did not improve the treatment success rate. Results of in vitro antimicrobial susceptibility tests were not useful as predictors of treatment success following intramammary treatment with pirlimycin.
Ligament Reconstruction and Calcaneal Osteotomy for Osteoarthritis of the Ankle
Authors: Lee Ho Seong , Wapner Keith L. , Park Soo Sung , Kim Jin Sam , Lee Dong Ho , Sohn Dong Wook
Published: June 2009

Background: The purpose of this study was to investigate the clinical and radiological results of calcaneal osteotomy, joint debridement and ligament reconstruction for the treatment of early to moderate stage osteoarthritis of the ankle. Materials and Methods: Eleven cases with osteoarthritis of the ankle, four with stage 2 and seven with stage 3, underwent joint debridement, cheilectomy, calcaneal osteotomy, deltoid ligament release, and lateral ligament reconstruction. The mean followup was 22.3 (range, 15 to 42) months. The American Orthopaedic Foot and Ankle Society(AOFAS) clinical ankle-hindfoot scale was used to evaluate clinical function of the ankle. Weight-bearing anteroposterior and hindfoot alignment radiographs were evaluated for measuring of tibiotalar tilt angles, clear space ratio, heel alignment ratio preoperatively and at the last followup. Results: The mean AOFAS score improved from 42.8 points before surgery to 82.7 points at the last followup. The mean talar tilt angles improved from 7.4 degrees to 5.9 degrees. The mean medial clear space widened from 0.4 mm to 2.7 mm. The lateral clear space was narrowed from 6.8 mm to 4.8 mm. The medial to lateral clear space ratio of ankle was improved from 0.06 to 0.62. Heel alignment ratio was improved from 0.59 to 0.36. Conclusion: Calcaneal osteotomy with ligament reconstruction can be considered for treatment of the early stages of osteoarthritis of the ankle.
Osteochondral Lesions of Talus Associated with Ankle Fractures
Authors: Boraiah Sreevathsa , Paul Omesh , Parker Robert J. , Miller Anna N. , Hentel Keith D. , Lorich Dean G.
Published: June 2009

Background: Residual ankle pain and stiffness is not uncommon after ankle fractures. Proposed etiologies include ligamentous instability, joint arthrosis and osteochondral injuries. We studied the incidence of osteochondral lesions of the talus (OCLT) with various ankle fracture patterns and assessed their impact on functional outcome. Materials and Methods: Preoperative MRI of 153 patients with ankle fractures who underwent operative fixation was studied. Ligamentous structures around the ankle and OCLT were assessed by MRI. The OCLT was graded as follows: 0, normal; 1, hyperintense but morphologically intact cartilage; 2, fibrillations or fissures not extending into the bone; 3, cartilage flap or bone exposed; 4, loose undisplaced fragment; 5, displaced fragments. Functional outcome was assessed using Foot and Ankle Outcome Scoring (FAOS) at a minimum of 6 months. Outcome between the OCLT and non OCLT group with similar fracture pattern was compared using Fischer's exact test. Results: There were 26 (17%) associated OCLT; four grade I, five grade II, one grade III, eight grade IV, and eight grade V lesions. Three were associated with supination adduction, 21 with supination external rotation injuries and two with pronation external rotation injuries. In the OCLT and the non OCLT group, the average symptom score, pain score, activities of daily living score, sports/recreation score and quality of life score was 80, 72, 79, 45, 50 and 73, 73, 79, 60, 45, respectively. There was no statistically significant difference between the two groups ( p > 0.1). Conclusion: Osteochondral lesions were frequently associated with ankle fractures; however they had no significant impact on the functional outcome when associated with ankle fractures.
Medial Capsular Interpositional Arthroplasty for Severe Hallux Rigidus
Authors: Hahn Michael Patrick , Gerhardt Nels , Thordarson David B.
Published: June 2009

Background: Multiple surgical options have been described for severe hallux rigidus. One option is capsular interpositional arthroplasty. We report our initial results with a technique using the thicker medial capsule as our interpositional material instead of the dorsal capsule and extensor hallucis brevis (EHB). Materials and Methods: Twenty-two patients with grade IV hallux rigidus underwent minimal proximal phalanx resection (modified Keller) with preservation of the flexor hallucis brevis (FHB) insertion and medial capsular interpositional arthroplasty. Results: Postoperative AOFAS hallux MTP-IP scores (mean 77.8), and SF-36 scores (mean 68.7 on physical function, 79.5 role limitations) demonstrated clinical improvement compared to historical controls. Alignment and stability were well maintained (mean preoperative HV angle of 11.8 degrees, mean postoperative HV angle of 13.0 degrees). Dorsiflexion/plantarflexion arc of motion showed sustained improvement (mean 38.4 degrees preoperative, mean 62.3 degrees postoperative). Conclusion: These results are comparable to other forms of interpositional arthroplasty and arthrodesis for end stage arthritis of the hallux MTPJ.
Cryosurgery for the Treatment of Heel Pain
Authors: Cavazos G. Javier , Khan Khurram H. , D'Antoni Anthony V. , Harkless Lawrence B. , Lopez Danine
Published: June 2009

Background: Although cryosurgery has been used to treat certain conditions, its efficacy for the treatment of heel pain has not been established. The objective of this retrospective case series was to investigate both short- and long-term changes in heel pain after cryosurgery. Materials and Methods: A sample of 137 feet ( n = 137) was analyzed over a 24-month period after cryosurgery. The mean age was 56 years and the mean BMI was 33. Subjects in our analysis included only those who had failed 6 months of conservative care prior to cryosurgery. Pain was measured using a Numeric Pain Scale (NPS, zero to 10) at 3 weeks and 24 months. Statistics were calculated using SPSS version 12.0 (Chicago, IL). Results: A total of 106 subjects had successful pain relief and 31 subjects failed to gain relief; the success and failure rates were 77.4% and 22.6%, respectively. Mean pain before cryosurgery was 7.6, after cryosurgery at three weeks was 1.6 ( p < 0.0005), and after cryosurgery at 24 months was 1.1 ( p < 0.0005). Conclusion: In subjects who achieved successful pain relief, the significantly lower mean pain score at 3 weeks and 24 months, compared to the initial pain score prior to cryosurgery, suggests that cryosurgery was successful in resolving both short- and long-term heel pain.
Distal Tibiofibular Syndesmosis Reconstruction Using a Free Hamstring Autograft
Authors: Morris Matthew W. J. , Rice Paul , Schneider Timothy E.
Published: June 2009

Background: Chronic instability of the distal tibiofibular syndesmosis and its treatment is infrequently described in the literature. We report our results for treating this condition with a reconstruction based on restoration of near normal anatomy with a hamstring autograft. Materials and Methods: Eight patients, who had chronic distal tibiofibular syndesmosis instability diagnosed arthroscopically underwent reconstruction of the distal anterior tibiofibular ligament and the transverse interosseus ligament using a free semi-tendinosis hamstring autograft. A radiographic and clinical review of the patients was performed. The average followup was 39 (range, 9 to 86) months. Results: The postoperative visual analogue pain score was 19 out of 100 compared to 73 out of 100 preoperatively. The postoperative mean AOFAS score was 85.4 (range, 49 to 100), the SF-36 score was 81 (range, 56 to 92) and the Maryland foot score was 89.3 (range, 63 to 100). Conclusion: Chronic instability of the distal tibiofibular syndesmosis is an infrequent problem but disabling when it occurs. Our results show an improved VAS score for pain, improved swelling and instability symptoms as well as SF-36, AOFAS and Maryland scores. We would recommend this method to reconstruct the anterior tibiofibular ligament and the transverse interosseus ligament which has failed to respond to debridement alone.
Squamous Cell Carcinoma of the Foot
Authors: Potter Benjamin K. , Pitcher J. David , Adams Sheila C. , Temple H. Thomas
Published: June 2009

Background: Squamous cell carcinomas (SCC) of the foot are relatively common, but have been infrequently reported in the orthopaedic literature. Materials and Methods: Twelve patients with SCC of the foot treated at a single institution from 1998 to 2005 were studied retrospectively with regard to risk factors for the disease, treatment, and functional and oncologic outcomes. The mean duration of postoperative followup was 43 (range, 24 to 105) months. Results: Eight of the 12 patients had identifiable risk factors for SCC. Inadequate or inappropriate procedures had been previously performed in eight of the 12 cases, requiring more aggressive definitive treatment in at least four cases. Definitive operative treatment consisted of wide excision (4 patients), partial or complete toe amputation (4), partial foot amputation (3), and transtibial amputation (1). Two patients developed local recurrence of disease, and both ultimately required Syme amputations for local control. One patient with local recurrence died of metastatic disease and the other 11 patients are alive without evident disease. Musculoskeletal Tumor Society functional scores averaged 90 and were good or excellent in nine of the 11 surviving patients. Conclusion: Squamous cell carcinomas of the foot are likely underreported and frequently subject to inappropriate initial treatment. Most patients have identifiable risk factors for SCC that can aid in formulating an appropriate differential diagnosis. Despite frequent suboptimal initial treatment, most patients are candidates for complete or partial limb salvage, with generally good oncologic and functional outcomes expected.
Ankle and Foot Kinematics Associated with Stage II PTTD During Stance
Authors: Houck Jeff R. , Neville Christopher G. , Tome Josh , Flemister Adolph S.
Published: June 2009

Background: Subjects with stage II posterior tibial tendon dysfunction (PTTD) exhibit abnormal foot kinematics; however, how individual segment kinematics (hindfoot (HF) or first metatarsal (first MET) segments) influence global foot kinematics is unclear. The purpose of this study was to compare foot and ankle kinematics and sagittal plane HF and first MET segment kinematics between stage II PTTD and controls. Materials and Methods: Thirty patients with stage II PTTD and 15 healthy controls were evaluated. Kinematic data from the tibia, calcaneus, and first MET were collected during walking using three dimensional motion analysis techniques. A three-segment foot model (HF, calcaneus; first MET, first metatarsal, and tibia) was used to calculate relative angles (ankle, HF relative to tibia; midfoot, first MET relative to HF) and segment angles (HF and first MET relative to the global). A mixed effect ANOVA model was utilized to compare angles between groups for each variable. Results: Patients with PTTD showed greater ankle plantarflexion ( p = 0.02) by 6.8 degrees to 8.4 degrees prior to or at 74% of stance; greater HF eversion ( p < 0.01) across stance (mean difference = 4.5 degrees); and greater first MET dorsiflexion ( p < 0.01) across stance (mean difference = 8.8 degrees). HF and first MET segment angles revealed greater HF dorsiflexion ( p = 0.01) during early stance and greater first MET dorsiflexion ( p = 0.001) across stance. Conclusion: Abnormal HF and first MET segment kinematics separately influence both ankle and midfoot movement during walking in subjects with stage II PTTD. Clinical Relevance: These abnormal kinematics may serve as another measure of response to clinical treatment and/or guide for clinical strategies (exercise, orthotics, and surgery) seeking to improve foot kinematics.
Morphologic Variations of the Fibular Malleolar Groove with Recurrent Dislocation of the Peroneal Tendons
Authors: Adachi Nobuo , Fukuhara Kohei , Kobayashi Takaaki , Nakasa Tomoyuki , Ochi Mitsuo
Published: June 2009

Background: The shallow malleolar groove of the fibula is believed to be one of the important causes of dislocation of the peroneal tendons. However, no studies have investigated the morphological differences between patients with and without dislocation of the peroneal tendons. Materials and Methods: We investigated the morphological variations (concave, flat, or convex) of the malleolar groove of the fibula using magnetic resonance imaging (MRI) in 39 ankles from 36 patients with recurrent dislocation of the peroneal tendons, comparing them with 39 ankles in 39 patients without dislocation. We also evaluated the presence of the false pouch on the fibula surface and fibrocartilaginous ridge injury of the malleolar groove on MRI. Chi-square test was used for statistical analysis between the two groups. Results: MRI at 1 cm proximal from the tip of the fibula demonstrated that the malleolar grooves in patients with dislocation of the peroneal tendon were classified as concave in 4 patients, flat in 23, and convex in 12, whereas they were classified as concave in 6, flat in 22 and convex in 11 in the patients without dislocation of the peroneal tendons. No significant difference could be detected between the two groups. Conclusion: This study demonstrated that no significant difference could be detected in the morphological shape of the fibular malleolar groove between patients with and without dislocation of the peroneal tendons.
Biomechanical Properties of New Mini Compression Screws
Authors: Nguyen Chinh , Singh Dishan , Harrison Mark , Blunn Gordon , Herman Amir , Dudkiewicz Israel
Published: June 2009

Background: The aim of the current study was to compare the compression forces achieved by the new commercial mini compression screws in cortical and cancellous bone. Materials and Methods: The following screws were tested: AO partially threaded 4-mm cancellous screw, AO 3.5- and 2.7- mm cortical screws (Synthes - USA), self-tapping cannulated 3-mm VisAntares (EOS - France), 3- and 2.3-mm Omnitech (Biotech - France), 3-mm Barouk (DePuy - France), and 3-mm Bold screws (Newdeal - France). The compression forces of screws in bone were tested using a load cell between pieces of longitudinally-split sheep tibias as a cortical and cancellous bone model. Results: The AO 3.5-mm, 2.7-mm cortical and 4.0-mm partially threaded cancellous headed screws provided significantly ( p < = 0.05) better compression forces than all the tested headless screws, both in cortical and cancellous bone. A loss of compression was noted when the headless screws were totally countersunk. Conclusion: The cortical and cancellous screws with heads provided superior compression than headless screws. Clinical Relevance: Headed screws may be preferable to headless differential pitch screws in situations where compression is important ie, arthrodeses or fracture fixation. Care should be taken not to countersink the headless screws during insertion into cortical bone.
Influence of Knee Flexion on Plantarflexion Moments After Open or Percutaneous Achilles Tendon Repair
Authors: Dargel Jens , Ninck Jutta , Koebke Jürgen , Appell Hans-Joachim , Pennig Dietmar , Hillekamp Jörn
Published: June 2009

Background: The influence of the knee angle on plantarflexion moments after Achilles tendon repair has yet to be analyzed. It was hypothesized that flexion of the knee joint will disproportionately influence isometric plantarflexion moments after Achilles tendon repair. Materials and Methods: Isometric plantarflexion moments and functional heel rise performance were retrospectively assessed in 32 patients at a mean follow-up of 36.9 (±17.83) months after open or percutaneous repair of acute Achilles tendon rupture. Plantarflexion moments were measured with the knee joint in 0, 30, and 60 degrees of flexion and the ankle joint positioned in neutral, 15 degrees plantar flexion and 15 degrees dorsiflexion. Data were compared between the involved and the noninvolved leg as well as between open and percutaneous repair. Results: Flexion of the knee had no significant effect on isometric plantarflexion moments in either the involved or the noninvolved leg, while at any knee angle, plantarflexion moments decreased from dorsiflexion to plantar flexion. In accordance, dynamic heel rise performance revealed no significant strength deficits between the involved and the noninvolved limb. No overall differences in plantarflexion strength were observed between open and percutaneous Achilles tendon repair. Conclusion: The flexion angle of the knee had no influence on plantarflexion moments when comparing the involved with the noninvolved leg after open or percutaneous Achilles tendon repair. Weakness of plantarflexion after open or percutaneous Achilles tendon repair is determined by the position of the ankle joint rather than by the flexion angle of the knee.
Anatomy of the Plantarmedial Hallucal Nerve in Relation to the Medial Approach of the First Metatarsophalangeal Joint
Authors: Phisitkul Phinit , Sripongsai Ratthapol , Chaichankul Chaisiri , Femino John E.
Published: June 2009

Background: The medial approach has been widely utilized for various pathologies of the first metatarsophalangeal joint. Injury to the plantarmedial hallucal nerve has been cautioned but never been reported. This study evaluated the proximity of the plantarmedial hallucal nerve to the midline and the vertical capsulotomy through the medial approach. Materials and Methods: Nine fresh cadaver legs were dissected under loupe magnification after AP radiographs were obtained. The distances from the plantarmedial hallucal nerve to the midline and to the plantar extent of the vertical capsulotomy were measured. The nerves were documented for their course, branching, and integrity. Results: The average hallux valgus angle was 10.3 ± 3.8 degrees (Mean ± SD). The distances from the nerve to the midline and to the plantar extent of the vertical capsulotomy averaged 10.6 ± 3.2 mm and 2.4 ± 1.6 mm. One specimen demonstrated a partial nerve transection. All the nerves were found underneath the crural fascia and covered by vertical fibers investing the plantar fat pad at the level of the metatarsophalangeal joint. They gave off an average of seven terminal branches toward the pulp and tip of the hallux. Conclusion: The plantarmedial hallucal nerve is at risk for injury with the vertical capsulotomy during a medial approach to the first metatarsophalangeal joint due to its proximity to the plantar extent of the vertical capsulotomy. Clinical Relevance: Surgeons should be vigilant in doing the vertical capsulotomy of the first metatarsophalangeal joint especially if the plantarmedial hallucal nerve is not identified.
Role of tumor necrosis factor–α and matrix metalloproteinase–9 in blood-brain barrier disruption after peripheral thermal injury in rats
Authors: Reyes Raul , Guo Miao , Swann Kathryn , Shetgeri Siddharth U. , Sprague Shane M. , Jimenez David F. , Barone Constance M. , Ding Yuchuan
Published: June 2009

Object

A relationship has been found between peripheral thermal injury and cerebral complications leading to injury and death. In the present study, the authors examined whether tumor necrosis factor–α (TNF-α) and matrix metalloproteinase–9 (MMP-9) play a causative role in blood-brain barrier (BBB) disruption after peripheral thermal injury.

Methods

Thirty-two male Sprague-Dawley rats were subjected to thermal injury. One hour later, 8 rats were injected with TNF-α neutralizing antibody, and 8 were injected with doxycycline, an inhibitor of the MMP family proteins; 16 rats did not receive any treatment. Brain tissue samples obtained 7 hours after injury in the treated animals were examined for BBB function by using fluorescein isothiocyanate–dextran and by assessing parenchymal water content. Protein expression of basement membrane components (collagen IV, laminin, and fibronectin) was quantified on Western blot analysis, and MMP-9 protein expression and enzyme activity were determined using Western blot and gelatin zymography. Thermally injured rats that did not receive treatment were killed at 3, 7, or 24 hours after injury and tested for BBB functioning at each time point. Histological analysis for basement membrane proteins was also conducted in untreated rats killed at 7 hours after injury. Results of testing in injured rats were compared with those obtained in a control group of rats that did not undergo thermal injury.

Results

At 7 hours after thermal injury, a significant increase in the fluorescein isothiocyanate–dextran and water content of the brain was found (p < 0.05), but BBB dysfunction was significantly decreased in the rats that received TNF-α antibody or doxycycline (p < 0.05). In addition, the components of the basal lamina were significantly decreased at 7 hours after thermal injury (p < 0.01), and there were significant increases in MMP-9 protein expression and enzyme activity (p < 0.05). The basal lamina damage was reversed by inhibition of TNF-α and MMP-9, and the increase in MMP-9 protein was reduced in the presence of doxycycline (p < 0.05). The authors found that MMP-9 enzyme activity was significantly increased after thermal injury (p < 0.01) but decreased in the presence of either TNF-α antibody or doxycycline (p < 0.01).

Conclusions

The dual, inhibitory activity of both TNF-α and MMP-9 in brain injury suggests that a TNF-α and MMP-9 cascade may play a key role in BBB disruption. These results offer a better understanding of the pathophysiology of burn injuries, which may open new avenues for burn treatment beyond the level of current therapies.
Long-term results following titanium cranioplasty of large skull defects
Authors: Cabraja Mario , Klein Martin , Lehmann Thomas-Nikolas
Published: June 2009

Object

Decompressive craniectomy is an established procedure to lower intracranial pressure. Therefore, cranioplasty remains a necessity in neurosurgery as well. If the patient's own bone flap is not available, the surgeon can choose between various alloplast grafts. A review of the literature proves that 4–13.8% of polymethylmethacrylate plates and 2.6–10% of hydroxyapatite-based implants require replacement. In this retrospective study of large skull defects, the authors compared computer-assisted design/computer-assisted modeled (CAD/CAM) titanium implants for cranioplasty with other frequently used materials described in literature.

Methods

Twenty-six patients underwent cranioplasty with CAD/CAM titanium implants (mean diameter 112 mm). With the aid of visual analog scales, the patients' pain and cosmesis were evaluated 6–12 years (mean 8.1 years) after insertion of the implants.

Results

None of the implants had to be removed. Of all patients, 68% declared their outcomes as excellent, 24% as good, 0.8% as fair, and 0% as poor. There was no resulting pain in 84% of the patients, and 88% were satisfied with the cosmetic result, noting > 75 mm on the visual analog scale of cosmesis. All patients would have chosen cranioplasty again, stating an improvement in their quality of life by the calvarial reconstruction. Nevertheless, follow-up images obtained in 4 patients undergoing removal of meningiomas was only suboptimal.

Conclusions

With the aid of CAD technology, all currently used alloplastic materials are suited even for large skull defect cranioplasty. Analysis of the authors' data and the literature shows that cranioplasty with CAD/CAM titanium implants provides the lowest rate of complications, reasonable costs, and acceptable postoperative imaging. Polymethylmethacrylate is suited for primary cranioplasty or for long-term follow-up imaging of tumors. Titanium implants seem to be the material of choice for secondary cranioplasty of large skull defects resulting from decompressive craniectomy after trauma or infarction. Expensive HA-based ceramics show no obvious advantage over titanium or PMMA.
Decompressive surgery in malignant dural sinus thrombosis: report of 3 cases and review of the literature
Authors: Lanterna Luigi A. , Gritti Paolo , Manara Ornella , Grimod Gianluca , Bortolotti Gianmario , Biroli Francesco
Published: June 2009

Cerebral venous and dural sinus thrombosis (CVDST) is a rare cause of stroke in young and middle-aged adults. When the clinical course is complicated by uncontrollable intracranial hypertension and brainstem compression due to edema or cerebral hemorrhage, the prognosis is poor. The authors evaluated the therapeutic role of surgical decompression in patients with clinical signs of impending herniation. Cerebral venous and dural sinus thrombosis complicated by impending brain herniation a very rare, life-threatening but potentially treatable clinical condition.

Three patients with pupillary signs of transtentorial herniation due to brain edema and hemorrhage caused by CVDST (superior sagittal sinus in 1 patient and transverse and sigmoid sinus in 2 patients) were treated surgically. The intervention consisted of clot removal, infarcted tissue resection, and frontotemporoparietooccipital craniectomy with duraplasty. According to the Glasgow Outcome Scale, 2 patients were classified as having good recovery and 1, moderate disability. The results of neuropsychological assessment were normal in 2 patients and demonstrated a partial neuropsychological deficit (neglect) in the other.

Surgery may be indicated in selected patients with CVDST whose condition is deteriorating because of intractable intracranial hypertension and impending brain herniation.
Dynamics of subdural hygroma following decompressive craniectomy: a comparative study
Authors: Aarabi Bizhan , Chesler David , Maulucci Christopher , Blacklock Tiffany , Alexander Melvin
Published: June 2009

Object

This retrospective comparative cohort study was aimed at discovering the risk factors associated with subdural hygroma (SDG) following decompressive craniectomy (DC) to relieve intracranial hypertension in severe head injury.

Methods

Sixty-eight of 104 patients who had undergone DC during a 48-month period and survived > 30 days were eligible for this study. To assess the dynamics of subdural fluid collections, the authors compared CT scanning data from and the characteristics of 39 patients who had SDGs with the data in 29 patients who did not have hygromas. Variables significant in the appearance, evolution, and resolution of this complication were analyzed in a 36-week longitudinal study.

Results

The earliest imaging evidence of SDG was seen during the 1st week after DC. The SDG volume peaked between Weeks 3 and 4 post-DC and was gradually resolved by the 17th week. Among the mechanisms of injury, motor vehicle accidents were most often linked to the development of an SDG after DC (p < 0.0007), and falls were least often associated (p < 0.005). Moreover, patients with diffuse brain injury were more prone to this complication (p < 0.0299) than those with an evacuated mass (p < 0.0001). There were no statistically significant differences between patients with and without hygromas in terms of age, sex, Glasgow Coma Scale score, intraventricular and subarachnoid hemorrhage, levels of intracranial pressure and cerebral perfusion pressure, timing of decompression, and the need for CSF diversion. More than 90% of the SDGs were ipsilateral to the side of the craniectomy, and 3 (8%) of 39 SDGs showed evidence of internal bleeding at ~ 8 weeks postinjury. Surgical evacuation was needed in 4 patients with SDGs.

Conclusions

High dynamic accidents and patients with diffuse injury were more prone to SDGs. Close to 8% of SDGs converted themselves into subdural hematomas at ~ 2 months postinjury. Although SDGs developed in 39 (~ 60%) of 68 post-DC patients, surgical evacuation was needed in only 4.
Decompressive craniectomy in subarachnoid hemorrhage
Authors: Güresir Erdem , Schuss Patrick , Vatter Hartmut , Raabe Andreas , Seifert Volker , Beck Jürgen
Published: June 2009

Object

The aim of this study was to analyze decompressive craniectomy (DC) in the setting of subarachnoid hemorrhage (SAH) with bleeding, infarction, or brain swelling as the underlying pathology in a large cohort of consecutive patients.

Methods

Decompressive craniectomy was performed in 79 of 939 patients with SAH. Patients were stratified according to the indication for DC: 1) primary brain swelling without or 2) with additional intracerebral hematoma, 3) secondary brain swelling without rebleeding or infarcts, and 4) secondary brain swelling with infarcts or 5) with rebleeding. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months (mRS Score 0–3 favorable vs 4–6 unfavorable).

Results

Overall, 61 (77.2%) of 79 patients who did and 292 (34%) of the 860 patients who did not undergo DC had a poor clinical grade on admission (World Federation of Neurosurgical Societies Grade IV–V, p < 0.0001). A favorable outcome was attained in 21 (26.6%) of 79 patients who had undergone DC. In a comparison of favorable outcomes in patients with primary (28.0%) or secondary DC (25.5%), no difference could be found (p = 0.8). Subgroup analysis with respect to the underlying indication for DC (brain swelling vs bleeding vs infarction) revealed no difference in the rate of favorable outcomes. On multivariate analysis, acute hydrocephalus (p = 0.009) and clinical signs of herniation (p = 0.02) were significantly associated with an unfavorable outcome.

Conclusions

Based on the data in this study the authors concluded that primary as well as secondary craniectomy might be warranted, regardless of the underlying etiology (hemorrhage, infarction, or brain swelling) and admission clinical grade of the patient. The time from the onset of intractable intracranial pressure to DC seems to be crucial for a favorable outcome, even when a DC is performed late in the disease course after SAH.
Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases
Authors: Gooch M. Reid , Gin Greg E. , Kenning Tyler J. , German John W.
Published: June 2009

Object

Decompressive craniectomy is a potentially life-saving procedure used in the treatment of medically refractory intracranial hypertension, most commonly in the setting of trauma or cerebral infarction. Once performed, surviving patients are obligated to undergo a second procedure for cranial reconstruction. The complications following cranial reconstruction are not well described in the literature and may very well be underreported. A review of the complications would suggest measures to improve the care of these patients.

Methods

A retrospective chart review was undertaken of all patients who had undergone cranioplasty during a 7-year period. Demographic data, indications for craniectomy, as well as preoperative, intraoperative, and postoperative parameters following cranioplasty, were recorded. Perioperative and postoperative complications were also recorded. Patients were classified as having no complications, any complications, and complications requiring reoperation. The groups were compared to identify risk factors predictive of poor outcomes.

Results

The authors identified 62 patients who had undergone cranioplasty. The immediate postoperative complication rate was 34%. Of these, 46 patients did not require reoperation and 16 did. Of those requiring reoperation, 7 were due to infection, 2 from wound breakdown, 2 from intracranial hemorrhage, 3 from bone resorption, and 1 from a sunken cranioplasty, and 1 patient's cranioplasty procedure was prematurely ended due to intraoperative hypotension and bradycardia. The only factor statistically associated with need for reoperation was the presence of a bifrontal cranial defect (bifrontal: 8 [67%] of 12, requiring reoperation; unilateral: 8 [16%] of 49 requiring reoperation; p < 0.01)

Conclusions

Cranioplasty following decompressive craniectomy is associated with a high complication rate. Patients undergoing a bifrontal craniectomy are at significantly increased risk for postcranioplasty complications, including the need for reoperation.
Quality of life after hemicraniectomy for traumatic brain injury in adults
Authors: Danish Shabbar F. , Barone Dean , Lega Bradley C. , Stein Sherman C.
Published: June 2009

Decompressive hemicraniectomy is well accepted for the surgical treatment of intractable intracranial hypertension in cases in which medical management fails. Although it is performed as a life-saving procedure when death is imminent from intracranial hypertension, little is known about the functional outcomes for these patients on long-term follow-up. In this study, the authors performed a systematic review of the literature to examine neurological outcome after hemicraniectomy. A literature search revealed 29 studies that reported outcomes using GOS scores. The GOS scores were transformed to utility values for quality of life using a conversion method based on decision analysis modeling. Based on the literature, 1422 cases were analyzed. The average 6-month-postoperative mortality rate was 28.2%. The mean QOL value among survivors was 0.592, which corresponds roughly to a GOS score of 4. Although more studies are needed for validation of long-term neurological outcome after hemicraniectomy, the assumption that most patients remain in a vegetative state after this intervention is clearly incorrect.
Introduction: Decompressive craniectomy for trauma and cerebrovascular disease
Authors: Manley Geoffrey T.
Published: June 2009

Elevated intracranial pressure is one of the most common causes of death and disability following severe traumatic brain injury and ischemic stroke. Unfortunately, there have been no new medical treatments for cerebral edema and elevated intracranial pressure in more than 80 years. Decompressive craniectomy may be an appropriate surgical option in the face of elevated intracranial pressure that is refractory to medical treatment. When performed correctly, this procedure can reduce intracranial pressure and prevent cerebral herniation and death. The last decade has seen a renewed interest in the use of decompressive craniectomy, but many questions remain regarding patient selection, timing of surgery, surgical technique, timing of cranioplasty, and complications.
Complications of decompressive craniectomy for traumatic brain injury
Authors: Stiver Shirley I.
Published: June 2009

Decompressive craniectomy is widely used to treat intracranial hypertension following traumatic brain injury (TBI). Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI. Complications of this procedure have major ramifications on the risk-benefit balance in decision-making during evaluation of potential surgical candidates. To further evaluate the complications of decompressive craniectomy, a review of the literature was performed following a detailed search of PubMed between 1980 and 2009. The author restricted her study to literature pertaining to decompressive craniectomy for patients with TBI. An understanding of the pathophysiological events that accompany removal of a large piece of skull bone provides a foundation for understanding many of the complications associated with decompressive craniectomy. The author determined that decompressive craniectomy is not a simple, straightforward operation without adverse effects. Rather, numerous complications may arise, and they do so in a sequential fashion at specific time points following surgical decompression. Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI. Within the 1st week following decompression, CSF circulation derangements manifest commonly as subdural hygromas. Paradoxical herniation following lumbar puncture in the setting of a large skull defect is a rare, potentially fatal complication that can be prevented and treated if recognized early. During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed syndrome of the trephined. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy. The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed. Ongoing trials will define whether this balance supports surgical decompression as a first-line treatment for TBI.
Morbidity in epilepsy surgery: an experience based on 2449 epilepsy surgery procedures from a single institution
Authors: Tanriverdi Taner , Ajlan Abdulrazag , Poulin Nicole , Olivier Andre
Published: June 2009

Object

In this paper the authors aimed to provide information related to major and minor surgical and neurological complications encountered following stereoelectroencephalography and epilepsy surgery.

Methods

The authors performed a retrospective review of 491 and 1905 patients who underwent intracranial electrode implantation and epilepsy surgery, respectively, between 1976 and 2006 at the Montreal Neurological Institute. All intracranial electrode implantations and surgical procedures were performed by 1 surgeon (A.O.).

Results

A total of 6415 electrode implantations and 2449 surgical procedures were done. There were no deaths related to either procedure. There were no major complications after intracranial electrode implantation, and the risks of infection and intracranial hematoma were found to be 1.8 and 0.8%, respectively. The number of electrodes per lobe (p = 0.05) and number of lobes covered (p = 0.04) were significant risk factors for hematoma and infection. Regarding epilepsy surgery, there were no major surgical complications, and the overall minor complication rate was 2.9%. Infection was the most common complication (1.0%), followed by intracranial hematoma (0.7%). Significant risk factors associated with hematomas and infections were the number of reoperations (p = 0.001) and older patient age (p = 0.03). Minor and major neurological complication rates were 2.7 and 0.5%, respectively, and the rate of overall neurological morbidity was 3.3%. Hemiparesis was the most frequent neurological complication (1.5%).

Conclusions

Based on the authors' experience, intracranial electrode implantation is an effective method with an extremely low morbidity rate. Moreover, epilepsy surgery is safe, especially in experienced hands.
The Image of Thought
Authors: Martin Jean-Clet
Published: June 2009

The image of thought that Rembrandt proposes with his Philosopher in Meditation still wears the mask of the old philosophical pedagogy based on ascent and the heights, but it ushers in new percepts and affects corresponding to the philosopher's concept, fold, that Leibniz elevates to the status of the principle of Baroque variation. The fold unleashes a power that carries forms and statements over a variety of disjunctive statements.
Deleuze on Intensity Differentials and the Being of the Sensible
Authors: Rölli Marc
Published: June 2009

The present essay on the being of the sensible investigates the individuation of intensity differentials. This is Deleuze's theme in the fifth chapter of Difference and Repetition, where he places individuation in the context of his ‘transcendental empiricism’. The mechanisms of subjectivation are conceived as spatially-temporally determined actualisations (of the virtual) whose implicit intensity relations are neither accessible empirically nor are they governed by transcendental conditions (in the conventional sense). Central to the discussion is the distinction, stemming from Kant, between intensive and extensive magnitudes.
Violently Oscillating: Science, Repetition and Affective Transmutation in Fassbinder'sBerlin Alexanderplatz
Authors: del Río Elena
Published: June 2009

This essay looks at Fassbinder's Berlin Alexanderplatz to trace the  film's transformation of a mechanistic scientific discourse into  affective indeterminacy. Through patterns of repetition of a key event, the film considers its protagonist as a complex web of constantly shifting forces – a network of biological, social, political and semiotic flows coalescing in a body that exists in a state of perpetual oscillation between force and mutilation, ecstasy and pain. The role of physics and other materialist discourses in the film is thus not to fixate subjectivity, but rather to provide a passage into its affective transformations and the intense desubjectification that results.
If Not Here, Then Where? On the Location and Individuation of Events in Badiou and Deleuze
Authors: Williams James
Published: June 2009

This paper sets out a series of critical contrasts between Alain Badiou and Gilles Deleuze's philosophies of the event. It does so in the context of some likely objections to their positions from a broadly analytic position. These objections concern problems of individuation and location in space-time. The paper also explains Deleuze and Badiou's views on the event through a literary application on a short story by John Cheever. In conclusion it is argued that both thinkers have good answers to the objections, but that they diverge on the ontological commitments of their definitions of the event.
Speranza, the Wandering Island
Authors: Bogue Ronald
Published: June 2009

Michel Tournier's novel Friday is the subject of an important essay of Deleuze's, in which he presents the concept of the ‘a priori Other’. Alice Jardine and Peter Hallward have offered critiques of Deleuze via readings of this essay, but neither takes into consideration the full significance of Tournier's novel or Deleuze's commentary. Jardine and Hallward provide divergent and only partial perspectives on Deleuze. If there are several Deleuzes, each defined by a critical point of view, there is also a single Deleuzian problem that informs the Tournier essay and Deleuze's thought as a whole.
Pollination ecology of the high latitude, dioecious cloudberry (Rubus chamaemorus; Rosaceae)
Authors: Brown Adam O. , McNeil Jeremy N.
Published: June 2009

In a 3‐yr study, we examined the pollinator guild and intersexual floral characteristics of the dioecious, perennial cloudberry (Rubus chamaemorus), which flowers in early spring. The findings contribute to our general understanding of pollination ecology at high latitudes and provide important information for the commercialization of cloudberry. Female flowers were smaller than males but provided more nectar, although this resource was low in both sexes. Insects from 43 families visited cloudberry flowers, yet four families (Apidae, Halictidae, Muscidae, Syrphidae) represented ca. 87% of all visitors observed. Introduction experiments revealed that apids and muscids are significantly poorer pollinators (based on fruit production) than halictids and syrphids, but when fruit mass or seed set was considered, there were no significant differences between families. Pollinator importance, a product of flower visitation frequency and seed set effectiveness, revealed that the dipterans were of paramount importance to the pollination of cloudberry. Furthermore, they are limited to cloudberry because their lapping mouthparts exclude them from accessing the nutritional rewards of competing Ericaceae flowers. While the total number of pollinator families observed suggest a generalist pollination system, if one considers the dominant pollinators (flies) as a functional group, then this insect–flower relationship could be considered a specialized one.
Genetic diversity and structure in semiwild and domesticated chiles (Capsicum annuum; Solanaceae) from Mexico
Authors: Aguilar‐Meléndez Araceli , Morrell Peter L. , Roose Mikeal L. , Kim Seung‐Chul
Published: June 2009

The chile of Mesoamerica, Capsicum annuum, is one of five domesticated chiles in the Americas. Among the chiles, it varies the most in size, form, and color of its fruits. Together with maize, C. annuum is one of the principal elements of the neotropical diets of Mesoamerican civilizations. Despite the great economic and cultural importance of C. annuum both worldwide and in Mexico, however, very little is known about its geographic origin and number of domestications. Here we sampled a total of 80 accessions from Mexico (58 semiwild and 22 domesticated) and examined nucleotide sequence diversity at three single‐ or low‐copy nuclear loci, Dhn, G3pdh, and Waxy. Across the three loci, we found an average reduction of ca. 10% in the diversity of domesticates relative to semiwild chiles and geographic structure within Mexican populations. The Yucatan Peninsula contained a large number of haplotypes, many of which were unique, suggesting an important region of chile domestication and center of diversity. The present sampling of loci did not conclusively resolve the number and location of domestications, but several lines of evidence suggest multiple independent domestications from widely distributed progenitor populations.
Fine‐scale genetic structure enhances biparental inbreeding by promoting mating events between more related individuals in wild soybean (Glycine soja; Fabaceae) populations
Authors: Zhao Ru , Xia Hanbing , Lu Bao‐rong
Published: June 2009

Outcrossing between genetically distant individuals in a plant population enhances allelic heterozygosity—an important source for genetic diversity and adaptive evolution. Fine‐scale spatial genetic structure (FSGS) can interfere with outcrossing by promoting mating between more related individuals. To test the influence of FSGS on outcrossing, FSGS and outcrossing rates were analyzed with four wild soybean (Glycine soja) populations from different habitats, using simple sequence repeat (SSR) fingerprints. Spatial autocorrelation analysis indicated variable FSGS (15.44–25.87 m) in all four populations. Multilocus mixed‐mating analysis of 1605 progeny indicated substantial variation in single‐locus outcrossing (Ts = 6.3–12.6%) although the total outcrossing rates as estimated by multilocus outcrossing (Tm = 12.8–17%) did not vary significantly among populations. The comparison between FSGS and outcrossing rates demonstrated that strong FSGS with large genetic patch size can enhance biparental inbreeding by promoting mating between more related individuals in a population. The results suggest that patch size management can aid in situ conservation by avoiding formation of strong FSGS and encouraging true outcrossing among individuals.