bluuebunny/crossref_metadata_2025 huggingface dataset:
Distribution of Acer negundo L. in Altai Krai (Russia, Southern Siberia) and its coenotic role in pine forests
Authors: Silantyeva Marina M. , Ovcharova Natalia V. , Terekhina Tatiana A. , Nesterova Anastasia O. , Elesova Natalia V. , Kornievskaya Tatyana V. , Speranskaya Natalia Yu.
Published: April 2021

The article provides data on the distribution of the invasive boxelder maple in the Altai Krai.  The article specifically considers its coenotic role in pine forests by the example of the Barnaul ribbon pine forest. A GIS project was developed to assess the distribution of boxelder maple in Altai krai. Mapping was based on the species location data obtained from the herbarium material (more than 500 sheets of the herbarium) deposited to the Altai State University (ALTB), the N.I. Vavilov All-Russian Plant Research Institute (WIR) and the V.L. Komarov Botanical Institute of the Russian Academy of Sciences (LE). To map the boxelder maple distribution, an analysis of the forest stand maps of the Barnaul ribbon pine forest was also carried out (2010, 2018). For each maple location, the stratum, the stratum area, and the stand formula are taken into account. Over the ten-year observation period, the area of maple and mixed forests with the participation of Acer negundo has increased almost 6 times here. Monodominant maple forests and mixed forests with the participation of boxelder maple as well as with other invasive species are formed. This leads to a considerable anthropogenic transformation of pine forests and a decrease in their environment-forming, social-economic and ecological significance. The study reveals that generative plants were not found in every coenopopulation. If the plants reached the reproductive stage, then, on the whole, males prevailed fivefold in the coenopopulation. Most of the studied coenopopulations consisted of pre-generative individuals, with the exception of occasional young generative ones. Most of the trees in the studied populations reached the age of 10–15 years. For forest communities of the Barnaul forestry, two age periods of the ontogenetic state have been established – pre-generative and generative, which indicates a relatively early age of the phytoinvasion and its active stage.
A survey of Hebeloma (Hymenogastraceae) in Greenland
Authors: Eberhardt Ursula , Beker Henry J. , Borgen Torbjørn , Knudsen Henning , Schütz Nicole , Elborne Steen A.
Published: April 2021

This is the first study exclusively dedicated to the study ofHebelomain Greenland. It is based on almost 400 collections, the great majority of which were collected by three of the co-authors over a period of 40 years and were lodged in the fungarium of the Natural History Museum in Copenhagen. The material was identified using molecular and morphological methods. In total, 28 species were recognized, 27 belonging to three sections,H.sectsHebeloma,DenudataandVelutipes. One species sampled was new to science and is here described asH. arcticum. For all species, a description, a distribution map within Greenland and macro and microphotographs are presented. A key is provided for the 28 species. The distribution of species within Greenland is discussed. The findings are placed in the context of studies of arctic and alpineHebelomafrom other parts of the world where comparable data exist. Notably,H. grandisporum,H. louiseaeandH. islandicum, previously only known from Romania, Svalbard, Iceland or Norway, respectively, have been found in Greenland. The latter is also the only species encountered that does not belong to any of the above sections.Hebeloma excedensandH. colvinii– for the latter we here publish the first modern description – are to date only known from continental North America and now Greenland.
First records of lowland tapir, Tapirus terrestris (Perissodactyla, Tapiridae), outside conservation areas after 30 years, in Santa Catarina, southern Brazil
Authors: Ticiani Douglas , Onghero Jr. Osvaldo , Favretto Mario Arthur
Published: April 2021

Intense hunting pressure and habitat loss have significantly reduced populations of the lowland tapirTapirus terrestrisin southern Brazil. Remaining individuals inhabit mainly legally protected areas. Here we report the first records outside of conservation areas in the state of Santa Catarina, over the last 30 years. These records were found during a mammal monitoring program, developed between May 2018 and July 2020. The records provide new evidence of the distribution of the species in Santa Catarina and reinforce the relevance of connectivity between protected areas of the Serra do Mar Ecological Corridor.
Reproduction, development, asymmetry and late eye regression in the Brazilian cave catfish Ituglanis passensis (Siluriformes, Trichomycteridae): evidence contributing to the neutral mutation theory
Authors: Secutti Sandro , Trajano Eleonora
Published: April 2021

The troglobitic (exclusively subterranean source population) catfish Ituglanis passensis (Siluriformes, Trichomycteridae) is endemic to the Passa Três Cave, São Domingos karst area, Rio Tocantins basin, Central Brazil. This unique population presents variably reduced eyes and melanic pigmentation. We describe reproduction and early development in this species based on a spontaneous (non-induced) reproductive-event that occurred in the laboratory in January–February, 2009, while simultaneously comparing with data from the cave-habitat and a previous reproductive event. Egg laying was parceled. Egg-size and number were within variations observed in epigean congeners. Larvae behavior and growth is described. A single surviving specimen was monitored over two years. Eye-regression started late, one year after birth, and followed a pattern of stasis phases intercalated with slow growth and fluctuating asymmetric rates. Late eye regression, associated with asymmetry in eye development and intra-population variability of troglomorphic traits, as shown by several Brazilian subterranean fishes, provide support for the Neutral Mutation Theory.
Review of physical fitness, physiological demands and performance characteristics of jockeys
Authors: Legg K.A. , Cochrane D.J. , Gee E.K. , Rogers C.W.
Published: April 2021

This narrative review collates data from different equestrian disciplines, both amateur and professional, to describe the physiological demands, muscle activity and synchronicity of movement involved in jockeys riding in a race and to identify limitations within our current knowledge. A literature search was conducted in Web of Science, Google Scholar, PubMed and Scopus using search terms related to jockeys, equestrian riders and their physiological demands, muscle use, movement dynamics and experience. Abstracts, theses and non-peer reviewed articles were excluded from the analysis. Jockeys work at close to their physiological capacity during a race. The quasi-isometric maintenance of the jockey position requires muscular strength and endurance, specifically from the legs and the core, both to maintain their position and adapt to the movement of the horse. Synchronous movement between horse and rider requires a coordinated activation pattern of the rider’s core muscles, resulting in less work done by the horse to carry the rider, possibly leading to a competitive advantage in race riding. Reports of chronic fatigue in jockeys demonstrate poor quantification of workload and recovery. The lack of quantitative workload metrics for jockeys’ limits calculation of a threshold required to reach race riding competency and development of sport-specific training programmes. Until the sport-specific demands of race riding are quantified, the development of evidence-based sport specific and potentially performance enhancing jockey strength and conditioning programmes cannot be realised.
Consideration of Legislative Mandatory Continuing Education Proposals
Authors: Anonymous
Published: April 2021

The American Hospital Association firmly supports the policy of voluntary continuing education for health care professionals. In recent years, a growing number of states have enacted legislation that makes continuing education mandatory for licensure renewal of selected professionals. Because no evidence exists that continuing education ensures continued competence and because the Association believes that it is the responsibility of the individual professional to maintain his/her competence and of the institution to ensure the competence of those who provide services, the Association's Council on Human Resources in 1977 appointed a Special Committee on Continued Competence of Health Care Professionals to develop appropriate guidelines. These guidelines were approved by the AHA Board of Trustees in September 1978. The objective of this document is to help state legislators, professional groups, and others evaluate requests for the passage or implementation of mandatory continuing education legislation. After a thorough examination of the issues raised in these guidelines, these individuals and groups should be able to determine whether such requests are feasible and desirable.
SALMONELLA VERTEBRAL OSTEOMYELITIS: A COMPLICATION OF SALMONELLA AORTITIS
Authors: Baird Robert A , Anderson Nolan J , Bloch Jack H
Published: April 2021

ABSTRACT: Salmonella vertebral osteomyelitis of the lumbar spine is encountered as a complication of Salmonella arteritis. Salmonella organisms, especially those of the choleraesuis and typhimurium species, invade the lamina intima of a diseased or atherosclerotic abdominal aorta, penetrate its wall, and cause the formation of a mycotic aneurysm. Further spread of thé infectious process through the aneurysmal aortic wall leads to infection of the retroperitoneum, psoas abscess formation, and osteomyelitis of the adjacent lumbar vertebrae. A review of the literature reveals a 77% mortality rate. Successful treatment of this association requires resection of the abdominal aneurysm and debridement of the retroperitoneum, extra-anatomic bypass grafting, and appropriate antimicrobial therapy.

Key Indexing Terms: Salmonella Vertebral Osteomyelitis; Salmonella Aortitis; Mycotic Aortic Aneurysm.
LONG-TERM CLINICAL AND HISTOLOGICAL EVALUATION OF BIOCERAMIC TOTAL HIP ENDOPROSTHESES
Authors: Salzer Martin , Knahr Karl , Plenk H
Published: April 2021

ABSTRACT: Implantations of aluminum oxide prostheses were started in 1972 for two reasons: firstly, because ceramic is completely bioinert and secondly, because when paired with ceramic it exhibits excellent friction properties. The following paper discusses the advantages and disadvantages of ceramic endoprostheses.
COMPUTERIZED TOMOGRAPHY IN THE MEASUREMENT OF FEMORAL ANTEVERSION IN LEGG-CALVE PERTHES DISEASE
Authors: Garske Jeff , Weiner Dennis S , Cook Albert
Published: April 2021

ABSTRACT: This article reviews the method by which computerized axial tomography is utilized in the management of femoral anteversion, and the use of this method in Legg Perthes disease.
SURGICAL MANAGEMENT OF DELAYED UNION AND NONUNION OF THE TIBIA
Authors: Brodersen Mark P , Sim Franklin H
Published: April 2021

ABSTRACT: A review of 163 patients seen between 1963 and 1975 with tibial nonunion revealed that operative treatment of the fracture, soft tissue injury, infection, and comminution appeared to have a role in the nonunion. The patients usually were seen between five and 12 months after injury. Multiple methods, involving both soft tissue and bone, were used to treat the nonunion. Phemister grafting was both the most frequent (21%) and the most successful (83%) procedure. Plate with graft and external compression with graft were both used with success (73% and 83%, respectively) in smaller patient populations. Infection tended to decrease the rate of successful union. The need to individualize treatment is important.
RESULTS OF SURGICAL TREATMENT OF KNEE INSTABILITIES
Authors: Kiss Imre , Gáspár Levente , Szepesi Kálmán
Published: April 2021

ABSTRACT

Between January 1, 1981 and January 5, 1987, 146 reconstructive operations for acute (39) and chronic (107) knee instabilities were performed. The majority of the acute cases were anteromedial (24), and of tbe chronic instabilities, 33 were anteromedial, 14 anterolateral, and 53 combined anteromedialanterolateral. In terms of suture, replacement, and reinforcement of the damaged structures of the acute cases, 32 were good, 6 fair, and 1 poor, while the reconstruction, according to Müller, for chronic instabilities produced good results in 34, fair in 59, and poor in 14. It is essential that such operations be performed by a trained surgical team. For success, precise knowledge of anatomy, exact examination, accurate diagnosis, adequate surgical techniques, and careful postoperative treatment are essential.
SURGICAL TREATMENT OF PATHOLOGIC FRACTURES FROM METASTATIC TUMORS OF LONG BONES
Authors: Mándi András , Szepesi Kálmán , Mórocz István
Published: April 2021

ABSTRACT

Surgical treatment of 74 cases of impending and established metastatic pathologic fractures were analyzed. On the basis of various reports, the incidence of bone lesions, boneseeking primary tumors, lesion sites, diagnostic techniques and possibilities, as well as indications for and methods of surgical treatment, are surveyed. Surgical intervention is only one aspect of the different components of general treatment in bone metastases. An aggressive surgical procedure yields very satisfactory results in most cases, compared with those of conservative treatment.
THE EFFECT OF EARLY ANTERIOR APPROACH OPEN REDUCTION WITH FUNCTIONAL POSTOPERATIVE TREATMENT ON THE EARLY DEVELOPMENT OF THE ACETABULUM IN CDH
Authors: Szepesi Kálmán , Biró Béla , Fazekas Katalin , Szüc Gabriella
Published: April 2021

ABSTRACT

Between 1980 and 1983, 30 anterior approach open reductions were performed on congenitally dislocated hips of 29 patients after unsuccessful conservative treatment; patients were between 6 and 18 months old. After the removal of the obstruction from the acetabulum, the reduction was performed with preservation of the limbus. Some part of the capsule was removed to constrict and tighten it and to prevent redislocation. This capsuloplasty demonstrates the success of a Pavlik harness and abduction splint postoperatively, without plaster fixation. The accelerated development of the acetabulum could be observed on radiograph by this functional treatment, compared to the control group treated with the usual hip spica postoperatively. The development of the acetabulum on the operated side almost equals the sound side within a year. If the operation was performed earlier, joint development would be quicker.
PERCUTANEOUS NUCLEOTOMY: TECHNIQUE WITH DISCOSCOPY
Authors: Schreiber A , Leu Hj
Published: April 2021

ABSTRACT

In its first decade of use, percutaneous nucleotomy has proven its value in decompressive indications for lumbar disc disease. Indications include contained disc herniations as isolated pathology, or in combination with other lumbar pathology at risk for decompensation after open hemüaininotomy, eg, spondylolysis/olisthesis or former open operative procedures. The precise indications underline the need for conclusive preoperative screening, such as disco-scan and contrastdiscomanometry. Overall results are 85% favorable. Percutaneous intervertebral fusion is also presented.
GIRDLESTONE'S MODIFIED RESECTION ARTHROPLASTY
Authors: Böhler M , Salzer M
Published: April 2021

ABSTRACT

Thirty-three patients were operated for septic (n=20) and aseptic (n = 13) loosening of their hip prostheses using Girdlestone's operation over 10 years. An average of 46.6 months later, 22 of these patients were given a follow-up examination. Clinical evaluation according to Harris showed an improvement in mean values from 25 to 53 points, which can be attributed mainly to a marked reduction in pain, as function remained poor and the patients still depended on walking aids. The infection ceased in 92% of the patients with septic prosthesis loosening.
ANATOMIC VARIATIONS OF THE BLOOD SUPPLY OF THE SOLEUS MUSCLE
Authors: Sadasivan Kalia K , Ogden John T , Albright James A
Published: April 2021

ABSTRACT

A total of 36 cadaver and fresh amputation specimens were studied by dissection. Two vascular patterns were identified - a segmental posterior tibial artery (Type 1) and a proximally dominant posterior tibial artery (Type 2). Type 1 was seen in 77.8% of cases, and Type 2 in 22.2%. Injection studies in five fresh specimens demonstrated numerous crossconnections between the two halves of the muscle. A distally based hemisoleus flap should not be performed when a Type 2 vascular pattern is encountered. Also, vascular cross-connections between the two halves of the soleus muscle should be preserved, when possible.
DISPLACED FRACTURES OF THE HEAD AND NECK OF THE RADIUS IN CHILDREN: OPEN REDUCTION AND TEMPORARY TRANSARTICULAR INTERNAL FIXATION
Authors: Merchan E Carlos Rodriguez
Published: April 2021

ABSTRACT

This report reviews the results of 36 children surgically treated for fractures of the head and neck of the radius. Indications for operation were: displacement over 2 mm and/or angulation over 45e. Treatment included open reduction and temporary internal fixation with a K-wire transfixing the joint. Eighteen children had a good result, 8 had a fair result, and 10 had a poor result. It appears that when radial head fractures are associated with severe displacement, a high rate of fair and poor results can be expected, despite treatment by open reduction and temporary internal fixation.
L PLATE FIXATION FOR OSTEOTOMIES
Authors: Stevens Peter M
Published: April 2021

ABSTRACT

It is generally acknowledged that stable fixation of osteotomies offers certain benefits, including maintenance of predictable alignment, while permitting rapid mobilization and rehabilitation. A variety of implants are available which require technical proficiency and familiarity by the surgeon for successful implantation. The ability to customize implants before or during surgery allows the surgeon critical control in a variety of situations. An L plate, which is a pre-bent dynamic compression plate (DCP), applied as a tension band with interfragmentary screws serves this purpose well.
PROXIMAL FEMORAL FOCAL DEFICIENCY: EVALUATION AND MANAGEMENT
Authors: Bryant D'Orsay D , Epps Charles H
Published: April 2021

ABSTRACT

Proximal femoral focal deficiency is a rare congenital anomaly characterized by limb malrotation, deficiency of the iliofemoral articulation, and limb length discrepancy. Advances in radiology, such as computed tomography and magnetic resonance imaging, have enhanced the assessment of pelvicfemoral instability prior to ossification of the femoral capital epiphysis. The histopathology of the fetal proximal femoral growth plate has been described, which has increased our knowledge about the etiology of the proximal femoral malformation. Data are now available regarding the long-term functional status of patients with severe acetabular dysplasia (Aitken Class C or Class D deformity) following nonoperative management of the hip. A review of the current knowledge regarding proximal femoral focal deficiency is presented to assist the orthopedic surgeon in evaluation and management.
PREVENTING DVT FOLLOWING TOTAL KNEE REPLACEMENT: A REVIEW OF RECENT CLINICAL TRIALS
Authors: Fitzgerald Robert H
Published: April 2021

ABSTRACT

Deep vein thrombosis (DVT) following total hip or knee arthroplasty is a frequent complication which can cause fatal pulmonary embolism (PE). Although many different approaches to its prevention have been attempted, low-dose warfarin has become the standard treatment for the prevention of thromboembolic disease following total hip and knee arthroplasty. Although subcutaneous heparin can reduce the incidence of thromboembolic disease, it has been associated with excessive bleeding complications. The introduction of low molecular weight heparins promises fewer bleeding complications with efficacy equal to that of warfarin. We wish to report the results of a randomized, prospective study comparing a low molecular weight heparin with low dose warfarin in the prevention of thromboembolic disease following total knee arthroplasty (TKA).
A Modular Endoprosthetic System for Tumor and Non-Tumor Reconstruction: Preliminary Experience
Authors: Freedman Eric L , Eckardt Jeffrey J
Published: April 2021

ABSTRACT

Though originally designed to facilitate the management of primary malignant bone tumors, the indications for the Howmedica Oncology modular endoprostheses have expanded to include the reconstruction of metastatic lesions, failed internal fixation of difficult trauma problems, and failed conventional and custom tumor endoprostheses. Between July 1989 and August 1992, 24 patients underwent 25 procedures, either proximal humeral replacement (7), proximal femoral replacement (5), distal femoral replacement (9), or total femoral replacement (4). Diagnoses included primary bone tumor (6), metastases (5), and failed previous orthopedic intervention (14). Two early and four late complications in five patients were all treated successfully with surgical or nonoperative treatment. Preliminary functional results indicate very satisfactory results. Modular endoprostheses appear to be effective in the treatment of a wide range of diagnoses, not limited to the reconstruction following primary malignant bone tumor resections.
Radiation-Induced Physical Changes in UHMWPE Implant Components
Authors: Naidu Sanjiv H , Bixler Brian L , Moulton Mark J R
Published: April 2021

ABSTRACT

Post-irradiation aging of ultra-high molecular weight polyethylene (UHMWPE) is not well understood. Retrieval studies and in vitro aged specimens have shown oxidative changes along with increases in crystallinity. Critical analysis and review of the polymer science and polymer physics literature shows that while oxidation may be important during the first year post-irradiation, subsequent aging occurs because of initial γ radiation-induced chain scission leading to eventual isothermal crystallization of polymer chains in the amorphous regions of the UHMWPE bulk. Mechanical properties of aged UHMWPE are not as yet clear and, until such data become available, γ irradiation sterilization must be used with caution.
The Use of the Ilizarov Technique in the Correction of Lower Extremity Deformities in Children
Authors: Bassett George S , Morris John R
Published: April 2021

ABSTRACT

The first time the Ilizarov technique was used at Children's Hospital of Los Angeles, 25 limb segments were treated in 15 patients. Thirteen segments (52%) required angular correction, 6 (24%) required lengthening, and 6 (24%) required both angular correction and lengthening. Average angular correction was 21° (8° to 41°); average length gained was 44 mm (25 to 85 mm). All patients except two achieved preoperative goals.

A total of 17 minor (.68/limb) and four major (.16/limb) complications occurred in the 25 limb segments in the study. The total complication rate was .84 complications per limb segment. The most common complication was pin tract infection (1 1 patients). This comprised 52% of complications and occurred in 44% of limb segments.
Cervical Disk Disease and the Keyhole Foraminotomy: Proven Efficacy at Extended Long-Term Follow up
Authors: Silveri Christopher P , Simpson J Michael , Simeone Frederick A , Balderston Richard A
Published: April 2021

ABSTRACT

Eighty-four consecutive patients with posterolateral cervical disk herniation treated by keyhole foraminotomy between 1980 and 1987 were reviewed. Radicular pain was the most common presenting complaint Weakness was present in 59 patients.

Sixty patients were available for long-term follow up, averaging 6.1 years. Fifty-six patients' results were graded as excellent. Three patients had good results and one fair result was noted. There were no poor results. Preoperative pain symptoms were relieved in all patients. There were no significant complications.

The posterolateral keyhole foraminotomy is an efficient means of decompressing lateral soft disk herniations, without the risk of an anterior approach or iliac crest bone harvest. Careful patient selection and use of an operative microscope are essential in obtaining consistent, excellent results.
All-Poly Cemented Sockets: The Resurrection?
Authors: Ranawat Chitranjan S
Published: April 2021

Acetabular Fixation Options in the 1990s
Acetabular Revision Options
Authors: Christie Michael J , DeBoer David K
Published: April 2021

Management of the Bone Deficient Hip
Thinking About Deformity and Alignment in TKA
Authors: Krackow Kenneth A , Miller C D , Mihalko W M , Serpe L J , Thering M B , Phillips M J
Published: April 2021

Knee Arthroplasty: Technique & Management Issues
A Global Approach to the Management of DVT in Total Hip and Knee Arthroplasty
Authors: Sculco Thomas P
Published: April 2021

Knee Arthroplasty: Technique & Management Issues
Wound Complications in Total Knee Arthroplasty
Authors: Dennis Douglas A
Published: April 2021

Knee Arthroplasty: Technique & Management Issues
Sins of Omission: What the Brochures Don't Tell You
Authors: Scott Richard D
Published: April 2021

Knee Arthroplasty: The Devil Is in the Detail
Skin Impedance Comparisons of Electrodes for Electro-Oculography
Authors: Lee Jong Bok , Reinecke Robert D
Published: April 2021

ABSTRACT

In an effort to define the most comfortable electrode needing the simplest skin preparation with low and stable skin impedance, we compared the impedance between skin electrodes and Stat-Trace Il SM 02 EKG electrodes (Niko Med USA, New Brunswick, NJ) - the latter being renamed "dry electrodes" because they are used without electrolyte paste - on 12 normal subjects with two different skin preparations, with and without alcohol. The dry electrodes were found to have lower impedance than the skin electrodes. With each skin preparation the alcohol scored better, 7.2 kOhm vs 16.5 kOhm, respectively, and "no preparation" worse, 13.8 kOhm vs 22.7 kOhm, respectively, (but still acceptable when the dry electrode was used). The dry electrode's impedance was quite stable from the moment of application while the skin electrode's impedance drifted dramatically for 30 minutes. If the dry electrode was halved in area of skin contact, as often is necessary with the nasal electrode in children, the impedance rose proportionally but remained acceptable. We conclude that the new dry electrodes give us improved electro-oculography records and suggest their use, particularly for infants and young children where ease of application and simple skin preparation are particularly important.
Persistent Pupillary Membranes
Authors: Jacobs Mark , Jaouni Ziad , Crompton John , Kriss Anthony , Taylor David
Published: April 2021

ABSTRACT

Extensive persistent pupillary membranes which occlude the pupil may occur in isolation or in association with other ocular anomalies. Amblyopia may result if the membranes are extensive. We favor nonsurgical intervention except if unusual circumstances are present as demonstrated in one of our two cases.
Monocular Congenital Cataracts: Psychological Effects of Treatment
Authors: Smith Kyle H , Baker David B , Keech Ronald V , Adams Louis W , Rosa Robert H , Austin Christopher J , Austin Karla M
Published: April 2021

ABSTRACT

Visual success in the treatment of monocular congenital cataracts requires early surgery, and aggressive, long-term amblyopia management and optical correction. These children will have their only normally seeing eye patched for a significant percentage of their early childhood years. We have been concerned about the possibility of an adverse psychological impact of this form of treatment. This study utilized two standardized testing instruments to evaluate the incidence of developmental delay and behavioral problems in children treated for monocular congenital cataracts. A total of 22 children were evaluated with one or both of these instruments and compared to a control group of 18 normal siblings. There was no statistically significant evidence of developmental delay or increased behavioral problems in the treatment group.
Cosmetic Surgery for a Fatally Ill Infant
Authors: Frankel Carl A , Juengst Eric T
Published: April 2021

ABSTRACT

The ethical and clinical dimensions of strabismus surgery in a case of an infant with mucolipidosis type Il are discussed. Three sets of considerations are relevant to the decision of performing such surgery: professional obligations to protect patients from futile or contraindicated treatment; parental authority to assess the risks and benefits for elective pediatric care; and the role of the family as patient. We argue that, when weighed together in the context of this case, these considerations can support a decision to perform the surgery upon parental request, despite the patient's poor prognosis.
Borderline Melanocytic Tumor of the Conjunctiva: Diagnostic and Therapeutic Considerations
Authors: Margo Curtis E , Roper Daniel L , Hidayat Ahmed A
Published: April 2021

ABSTRACT

A clinically benign appearing nevus was surgically excised from the conjunctiva of a 13-year-old girl because of complaints that it had recently enlarged. Histologically, the melanocytic lesion displayed considerable cytologic atypia and showed signs that were consistent with malignant transformation. Because of the rarity of conjunctival melanomas in children, the case was reviewed by several experienced pathologists and dermatopathologists whose diagnoses ranged from benign nevus with atypia to malignant melanoma. When the biologic potential of certain melanocytic lesions cannot be accurately predicted histologically, treatment and follow up must be individualized. Physicians must weigh the perceived risks and disadvantages of treating a histologically indeterminate tumor against the consequences of "under" treatment if the lesion is, in fact, biologically malignant.
Visual Loss in Patients With Craniofacial Synostosis
Authors: Hertle Richard W , Quinn Graham E , Minguini Nilza , Katowitz James A
Published: April 2021

ABSTRACT

We reviewed the ocular findings in patients with cranial stenosis, who were seen in the Craniofacial Clinic at The Children's Hospital of Philadelphia, to determine the prevalence, pattern, and etiology of visual loss. There were 15 patients with Apert syndrome, 25 patients with Crouzon syndrome, and 18 patients with other forms of Craniofacial synostoses. Visual loss occurred in 17 eyes of 11 patients with Apert syndrome, 14 eyes of 11 patients with Crouzon syndrome, and 12 eyes of 8 patients with other Craniofacial synostosis syndromes. Refractive errors and strabismus were present in the majority of these patients. Amblyopia due to strabismus, ametropia, or ptosis was the major reason for visual loss in all three groups of patients. Structural abnormalities contributed to loss of vision in six eyes.
Incidence and Survival Characteristics of Retinoblastoma in Singapore From 1968-1995
Authors: Saw Seang-Mei , Tan Nikolle , Lee Sao-Bing , Eong Kah-Guan Au , Chia Kee-Seng
Published: April 2021

ABSTRACT

Purpose: To describe the incidence and survival of 69 Singapore residents with retinoblastoma in all Singapore hospitals from 1968-1995.

Methods: Data of all Singapore residents diagnosed with retinoblastoma from 1968-1995 were collected by the Singapore Cancer Registry based on notifications from physicians, pathology records, hospital discharge records, and death certificates. The medical records of 46 patients were traced, and information on laterality of tumor, spread of tumor, mode of treatment, and family history of retinoblastoma was obtained. Time trends and survival characteristics of the cohort were described.

Results: The incidence rate of retinoblastoma was 2.4 per 1 million for children <9 years and 11.1 per 1 million for children <5 years. The incidence of retinoblastoma has been almost uniform over time from 1 968-1 995, except for an apparent increase in 1988-1992. The 3-year survival rate for retinoblastoma was 83%. Survival rates were higher in children <2 years because children who present at a younger age may have tumors diagnosed at earlier stages of the disease. There was no difference in survival rates for sex, race, laterality, family history of retinoblastoma, treatment, or year of diagnosis.

Conclusion: Retinoblastoma is the most common eye cancer in children that may cause blindness or death. The incidence rates of retinoblastoma in Singapore have remained fairly stable over 28 years, and the survival rate is higher in younger children. This study will be helpful in monitoring future disease patterns in Asian populations.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:87-93.
e-Consults
Authors: Ruttum Mark , Alcorn Deborah
Published: April 2021

Our Column Editors prepared a patient case for virtual consultation - the patient's history, physical examination, and pertinent photos are e-mailed to colleagues for a discussion of their individual treatment choices.

In this column, Mark Ruttum presents a case of a 10-year-old boy with Duane syndrome OS. Emilio C. Campos, MD; R. Scott Foster, MD; and Lionel Kowal, MD, served as "consultants" and share their diagnosis and treatment options.
Sensory Deviations Subsequent to Senile Cataract
Authors: Chaudhuri Zia , Pandey P K
Published: April 2021

ABSTRACT

Purpose: To evaluate the effect of extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation in patients with sensory deviations subsequent to senile cataract.

Methods: Twenty patients with dense cataract and associated sensory deviations underwent followup between April 1 996 and April 1 998 after extracapsular cataract extraction with posterior chamber IOL implantation in the deviating eye. All patients underwent follow-up for a minimum period of 6 months.

Results: Preoperatively, all patients had a visual acuity of PL positive (perception of light present) and PR (projection of rays) accurate in the deviating eye. Two patients had an esodeviation, and 1 8 patients had an exodeviation. Postoperatively, all patients had a corrected visual acuity of 20/40 or better in the operated eye at 12 weeks. Nineteen patients had ocular alignment within ±8 prism diopters of orthophoria at 12 weeks.

Conclusion: Sensory deviations subsequent to senile cataract usually resolve spontaneously after cataract surgery if visual gains are 20/40 or better. The prognosis for binocular vision is good.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:159-162.
Tolerance of Patients and Postoperative Results: Topical Anesthesia for Strabismus Surgery
Authors: Kim Sangduck , Yang Yunsik , Kim Jaeduck
Published: April 2021

ABSTRACT

Purpose: To assess patient tolerance and the postoperative results of intraoperative adjustment of strabismus surgery under topical anesthesia.

Methods: Twenty-four patients with strabismus underwent rectus muscle recession under topical anesthesia without the use of additional systemic analgesics and sedatives. Ritieni tolerance was estimated according to the sites of procedure. In addition, the angle of strabismus was measured 1 day, 6 weeks, and 1 year postoperatively.

Results: Of the 24 patients Identified (1 1 men and 1 3 women; mean age: 24 years), 1 6 had exotropia, 7 were esotropie, and 1 was hypertroplc. During the operation, 17 patients never expressed any pain, and 7 patients complained of discomfort on muscle manipulation. Postoperatively, the success rate was 95.8% (23 patients) the first day after surgery, 79.2% (19 patients) after 6 weeks, and 70.8% (1 7 patients) after 1 year.

Conclusion: Intraoperative adjustment performed with the patient under topical anesthesia is recommended in all cooperative cases of strabismus surgery and is comfortable for patients.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:344-348.
Carbamazepine Treatment of Psychosis
Authors: Norris Anne E , Dilsaver Steven C , Del Medico Valerie J
Published: April 2021

Implications for Patient Welfare and Nursing Practice
What Every NURSE Needs to Know about...JUVENILE FIRESETTERS
Authors: Slavkin Michael L
Published: April 2021

ABSTRACT

With the number of juvenile firesetters growing each year and the amount of psychological and financial damage they create, it is essential that clinical professionals are aware of the characteristics surrounding juveniles who set fires. This study had two primary purposes: to educate nurses and mental health practitioners about the etiology and treatment of juvenile firesetters and to discuss a number of exploratory predictors, including age, gender, aggression, internalizing behaviors, level of deviancy, family dynamics, and sociability. Certain individual and environmental characteristics relate to varying levels of damage caused by the fire and the presence or absence of recidivistic behaviors. Firesetters are a group widely seen in the general population but not often identified or studied by clinical professionals. Therefore, this article has implications for the clinical practice of nurse practitioners and others who come into contact with this clinical population.
LUNACY REVISITED
Authors: Barr Wally
Published: April 2021

ABSTRACT

The idea that the stars and planets may influence human health and behavior can be traced to at least Roman times, and research suggests a high proportion of health professionals continue to hold this belief. Nevertheless, evidence for the supposed influence of the moon on human behavior has proved particularly elusive, and research has tended to suffer from weaknesses in methodology and data analysis.

This article reports findings drawn from a re-analysis of data from a research study into the functioning of a sample of mentally ill people living in the community. The mental health and quality of life of a sample of 100 people were assessed on four occasions during a 30-month period. Data were aggregated to represent the span of one lunar month, with scores being allocated to the relevant week of the lunar cycle during which each assessment was made. Comparison of mean values across the weeks of the lunar cycle was preformed using the ANOVA. Results showed significant change at the time of the full moon only in subjects with a diagnosis of schizophrenia (n = 56), where deterioration was observed in three areas of psychopathology and one area of quality of life. Some implications for nursing practice are discussed, and it is suggested that future research into the possibility of a lunar effect on human life should focus on the direct measurement of functioning in people with schizophrenia.
Logs as Adjuncts to Therapy for Adolescents in a Residential Psychiatric Program
Authors: Yonge Olive
Published: April 2021

ABSTRACT

As part of a 3-year ethnography of an adolescent residential psychiatric program, staff, patients, and occasionally family members were observed communicating using written logs. Using participant observation and opportunistic interviewing, and reading the logs, the researcher was able to determine the advantages, disadvantages, and direct value of the logs to patients and staff. Logs, when used judiciously after patient assessment, demonstrated patient responsiveness to treatment and promoted patient-centered care. Writing in logs increased patients' identification of thoughts and feelings, mirrored their developmental state, and demonstrated staff members' skills in communication. They are an invaluable adjunct to therapy for certain adolescent patients.
The Antidepressant Nefazodone: A Review of its Pharmacology, Clinical Efficacy, Adverse Effects, Dosage, and Administation
Authors: Khouzam Hani Raoul
Published: April 2021

ABSTRACT

Nefazodone is an antidepressant medication which received approval from the Food and Drug Administration for treatment of major depressive disorder in 1994. This article summarizes the pharmacodynamics, pharmacokinetics, adverse effects, and drug interactions of nefazodone as well as its administration and dosing schedule. The potential efficacy of nefazodone in treating anxiety, premenstrual syndrome, chronic pain conditions, and sleep disturbances also is summarized. Nefazodone has a favorable side effects profile which makes it an attractive alternative option for patients who withdraw from treatment when they develop adverse effects to other available antidepressants.
Diffractive Smoothing of Excimer Laser Ablation Using a Defocused Beam
Authors: Krueger Ronald R , Wang Xun Wei , Rudisill Michael , Trokel Stephen L , McDonnell Peter J
Published: April 2021

ABSTRACT

OBJECTIVE: To determine if excimer laser myopic ablation with a defocused laser image produces a smoother ablation profile than does focused laser light.

METHODS: An ArF excimer laser was used to ablate a 5.00-diopter myopic correction in test blocks using both a contracting and expanding iris aperture. Defocused ablation was performed using a contracting iris aperture by translating the target away from the laser source. A confocal laser scanning microscope was used to analyze the surface smoothness at 55 × and 275 × magnifications.

RESULTS: The confocal laser scanning micrographs revealed a series of sharply demarcated concentric ridges in the focused ablation, and less prominent, slightly wavy lines in the defocused ablation performed with a contracting aperture. The focused ablation with an expanding aperture also created concentric ridges toward the periphery, but with slightly smoother edges.

CONCLUSION: Micrographic analysis of the surface profile of excimer laser myopic ablation using a variable iris aperture revealed the presence of concentric ridges following focused ablation and smooth curvilinear lines when ablation was performed with a defocused image. [Refract Corneal Surg. 1994;10:20-26.)

RÉSUMÉ

INTRODUCTION: Afin de déterminer si le laser excimer permet de réaliser une ablation plus lisse avec le faisceau flou, nous avons procédé à des corrections de 5 dioptries en blocs d'essai en utilisant une ouverture variable.

MÉTHODES: L'ablation floue fut réalisée en inclinant la cible par rapport à l'ouverture en phase de rétrécissement. L'aspect de la surface fut analysé au microscope scanographique du laser confocal avec un grossissement de 55× puis 275× .

RÉSULTATS: Les micrographes ont montré une série d'arêtes nettement démarquées dans l'ablation mise au point et des lignes onduleuses et moins proéminentes dans l'ablation floue réalisée avec une ouverture qui va en se rétrécissement. L'ablation mise au point réalisée avec une ouverture qui va en augmentant entraînait des arêtes concentriques, mais les bords étaient un peu plus lisses.

CONCLUSION: L'analyse micrographique du profil de la surface après l'ablation myopique au laser excimer montrait des arêtes concentriques après l'ablation mise au point et des lignes lisses et curvilignes après l'ablation à l'image floue. (Translated by Rob Mack, MD, Iowa City, la.)

SOMMARIO

PREMESSA: Scopo del lavoro è stato il determinare se l'ablazione miopica con laser ad eccimeri con raggio defocalizzato determina una superficie di ablazione più regolare di quella prodotta dal raggio focalizzato.
Severe Ocular Trauma Without Corneal Rupture After Radial Keratotomy: Case Reports
Authors: Casebeer J Charles , Shapiro David R , Phillips Steven
Published: April 2021

ABSTRACT

The vulnerability of the ocular coat to trauma following radial keratotomy is an issue of concern to both patients and physicians. Herein, we report two cases of eyes which were exposed to severe trauma after previously undergoing radial keratotomy procedures. In the first case, a woman sustained multiple facial bone fractures in a fatal airplane crash. In the second case, a man was involved in a case of blunt ocular trauma involving a high velocity racquetball. Rupture of the ocular coat did not occur in either case. [Refract Corneal Surg. 1994;10:31-33.)
Corneal Power Correction Factor for Photorefractive Keratectomy
Authors: Mandell Robert B
Published: April 2021

ABSTRACT

BACKGROUND: Studies of corneal power changes resulting from photorefractive keratectomy generally rely on keratometer or videokeratograph measurements. These instruments convert corneal radius of curvatures values to optical powers by means of the single refracting surface formula, which incorporates an index of refraction value of 1.3375. This index approximates that of the tears but not the 1.376 index of the corneal epithelium or stroma. A hypothetical optical model was used to determine the most appropriate index to be chosen with respect to corneal power calculations relative to photorefractive keratectomy.

METHODS: The contribution of each refractive element in the tear lens-corneal surface to the total power of the eye was calculated in order to identify which index of refraction was most appropriate for the corneal power calculation.

RESULTS: The outer tear surface has significant optical power but the tear layer as a whole has nearly zero power due to the offsetting negative power of the posterior tear surface. There is no significant difference in the effective power of light leaving the corneal anterior surface when considered with or without the tear layer. Photorefractive keratectomy changes the epithelium and anterior surface of the corneal stroma, but does not affect the posterior stroma or other ocular media. Hence the refractive index for the corneal epithelium or stroma of 1.376 should be used in converting radius to optical power values. The error in assuming a corneal index of 1.3375 is a constant proportion equal to 11.4% of the corneal power reading.

CONCLUSIONS: Photorefractive keratectomy presents a situation in which the actual corneal refractive index of 1.376 should be used for correct corneal radius to power conversions. This may be accomplished by changing the index value in the instrument algorithm for keratometry and videokeratography to 1.376 or by adding a correction factor of either 11.4% of the regular reading to its value or multiplying by the factor 1.114. In other applications of keratometry or videokeratography, the index 1.3375 may be more appropriate. [J Refract Corneal Surg. 1994;10:125-128.]
Photorefractive Keratectomy for Myopia of More Than -10 Diopters
Authors: Rogers Ohristopher M , Lawless Michael A , Cohen Peter R
Published: April 2021

ABSTRACT

Twenty-seven consecutive eyes of 18 patients with myopia of more than -10.00 diopters (D) were treated by photorefractive keratectomy (PRK) using the ExciMed UV200LA excimer laser and a double ablation technique in an attempt to achieve a refraction of piano. The preoperative mean spherical equivalent refraction was -13.32 D (standard deviation 2.54, range -10.25 to -20.50). Preoperative spectacle corrected visual acuity ranged from 6/6 to 6/60 and one eye had had two previous refractive keratotomies. Follow up ranged from 3 to 15 months (mean 8.9).

At 6 months after surgery, the mean change in refraction was 11.03 D, from a preoperative mean of -13.32 D to a postoperative mean of -2.29 D. The mean keratometric flattening was 5.83 D, from a preoperative mean of 42.92 D to a postoperative mean of 39.09 D. The reason for this large difference is uncertain.

At three months the mean spherical equivalent refraction was +0.07 D (SD 2.94, range -10.50 to + 3.25). The 14 eyes that had achieved 12 months follow up had a mean spherical equivalent of -1.91 D (SD 3.87, range -11.00 to +2.50). Seven of these 14 eyes have been reablated for manifest scars in association with regression. All 14 eyes had best spectacle corrected visual acuity at or better than their preoperative level. [J Refract Corneal Surg (suppl.) 1994;10:S171-S173.]