bluuebunny/crossref_metadata_2025 huggingface dataset:
Wound Complications in Thyroxine-Supplemented Patients Following Foot and Ankle Surgery
Authors: Grunfeld Robert , Kunselman Allen , Bustillo Jorge , Juliano Paul J.
Published: February 2011

Background: Our hypothesis was that thyroxine supplementation in patients undergoing foot and ankle surgery would be associated with increased postoperative wound complications and wound dehiscence compared to patients without thyroxine supplementation. Materials and Methods: A retrospective review of 48 patients supplemented with thyroxine that underwent foot and ankle surgery was conducted and analyzed for wound complications. All patients were non-diabetic. A total of 94 historical controls were used to compare the incidence of wound complications to the thyroxine sample. Patient demographics, medical comorbidities, principal diagnosis and procedure performed were recorded. The presence or absence of wound dehiscence, infection or other wound complications was recorded for all patients based on the followup clinical notes in the electronic record. Results: In the thyroxine group, the most common diagnosis was degenerative arthritis (31%, n = 15), which also occurred in 28.7% of control patients ( n = 27). Wound dehiscence was reported in 36.2% ( n = 17) of thyroxine-supplemented patients compared to 10.8% of control patients ( n = 10). After adjusting for age, gender, hypertension diagnosis, and vascular disease diagnosis, the odds for wound dehiscence remained significantly greater for the thyroxine group compared to control patients (adjusted OR = 3.7; 95% CI: (1.3, 11.4); p = 0.01). Conclusion: Overall, our results suggest increased wound dehiscence complications in the postoperative period for thyroxine-supplemented patients compared to control patients. This finding remained even after adjusting for the associated cardiovascular comorbidities seen in thyroxine-supplemented patients.

Level of Evidence: IV, Retrospective Case Series
Percutaneous Lateral Ankle Stabilization: An Anatomical Investigation
Authors: Klammer Georg , Schlewitz Gudrun , Stauffer Christiane , Vich Magdalena , Espinosa Norman
Published: February 2011

Background: The current study investigated the topographic anatomy of the percutaneous anatomical lateral ankle stabilization in relation to the neurovascular hindfoot structures. The study should serve as an aid for performance of this new minimally invasive technique. Materials and Methods: Eleven cadaver specimens were dissected exposing the nerves, vessels, ligaments and tendons. The portals and transosseous tunnels were performed with Kirschner wires. All distances of the Kirschner wires and the neurovascular structures were measured with reference to clearly identifiable bony landmarks. Results: On the medial side the average distance of the Kirschner wire to the medial calcaneal branch of the tibial nerve was found to be 7 mm (SD ± 4). The medial calcaneal branch was hit twice by the transosseous Kirschner wire. On the lateral side the mean distance of the fibular exit point of the Kirschner wire to the sural nerve was 13 mm (SD ± 4). The closest distance of the superficial peroneal nerve to the footprint of the ATFL averaged 11.5 mm (SD ± 3) and its anterior location in relation to the tip of the fibula was 28 mm (SD ± 8). The posterior tibial artery was found at a mean distance of 41 mm from the perforating Kirschner wire (SD ± 6). Conclusion: The current study introduced a novel percutaneous approach to treat chronic ankle instability that had minimal risk to neurovascular structures in a cadaver model. Clinical Relevance: Further clinical studies must be undertaken to identify whether this technique would also be superior when compared with open surgery.
Effect of Impeded Medial Longitudinal Arch Drop on Vertical Ground Reaction Force and Center of Pressure During Static Loading
Authors: Chen Shing-Jye , Gielo-Perczak Krystyna
Published: February 2011

Background: Arch supports commonly used to alleviate foot pain can impede the normal drop of medial longitudinal arch (MLA) thereby altering its function. The purpose of the study was to examine the effect of using arch supports on vertical ground reaction force (GRF) and center of pressure (COP) during simulated midstance while the foot was statically loaded. Materials and Method: Ten healthy young subjects were recruited. Two dimensional (2D) analysis of the MLA was captured for both barefoot (BF) and arch support conditions before and after loading via a custom made weight loading apparatus. The foot was loaded and positioned to simulate the midstance phase of walking. Two-dimensional reflective markers demarcated the MLA and captured with the loaded foot on a force platform. The impeded MLA drop was compared between the unloaded BF, loaded BF and loaded arch support conditions. The vertical GRF, the anterior-posterior and the medial-lateral COP displacements were also measured in response to the impeded MLA by the arch supports. Results: The arch supports impeded the MLA drop ( p < 0.05) and shifted the COP toward the medial side ( p < 0.05), specifically for the rearfoot (calcaneal segment region), but no changes were determined for the vertical GRF ( p > 0.05). Conclusion: The impedance of MLA drop by the arch support altered the pattern of the ML COP shift in the rearfoot region. Clinical Relevance: The use of arch supports may not relieve painful foot conditions that are associated with excessive calcaneal eversion indicated by altering COP shifts in localized foot regions.
Reverse Distal Chevron Osteotomy to Treat Iatrogenic Hallux Varus After Overcorrection of the Intermetatarsal 1–2 Angle: Technique Tip
Authors: Lee Kyung Tai , Park Young Uk , Young Ki Won , Kim Jin Su , Kim Ki Chun , Kim Jun Beom
Published: February 2011

Level of Evidence: V, Expert Opinion
Cincinnati Incision Approach for Posterior Ankle and Calcaneal Pathology: Technique Tip
Authors: Feldbrin Zeev , Alexander Lipkin
Published: February 2011

Level of Evidence: V, Expert Opinion
Preservation of Lesser Metatarsophalangeal Joints in Rheumatoid Forefoot Reconstruction
Authors: Krause Fabian G. , Fehlbaum Olivia , Huebschle Lars M. , Weber Martin
Published: February 2011

Background: A standard rheumatoid forefoot reconstruction consists of arthrodesis of the first metatarsophalangeal (MTP) joint and resection arthroplasty of the lesser metatarsal heads. However, preservation of the metatarsal heads has gained renewed interest since the medical treatment of rheumatoid arthritis has improved dramatically. Material and Methods: Nineteen consecutive patients with severe rheumatoid forefoot deformities underwent 24 forefoot reconstructions including first MTP arthrodesis with lesser MTP resection arthroplasty (resection arthroplasty group, ten feet), arthrolysis (arthrolysis group, six feet), or a combination of both (combined group, eight feet). Subjective, functional, and radiographic results were evaluated at 28 and 133 months (mean) followup. Results: The overall AOFAS Forefoot Score at short- and long-term followup improved significantly (all p < 0.0001). There were no substantial differences between groups with regard to subjective rating, function, use of orthopaedic aids or shoewear, and walking capacity. Radiographic evaluation revealed a significant increase in axial malalignment of the lesser toes at long-term followup in all groups (all p < 0.018). Sagittal malalignment increased substantially in the resection arthroplasty group only. Reoperation rate was comparable among all groups, and a single third MTP arthrolysis (3%, 1/40) was converted to resection arthroplasty. Conclusion: In combination with first MTP arthrodesis, arthrolysis with preservation of all or only the lateral lesser MTP joints in rheumatoid forefoot reconstruction was a viable and durable alternative to resection arthroplasty when the joint destruction was mild to moderate.

Level of Evidence: III, Retrospective Comparative Series
Hemiarthroplasty and Distal Oblique First Metatarsal Osteotomy for Hallux Rigidus
Authors: Ronconi Paolo , Martinelli Nicolò , Cancilleri Francesco , Marinozzi Andrea , Marineo Gianluca , Denaro Vincenzo
Published: February 2011

Background: In a retrospective study, we evaluated the effect of the addition of a decompressive osteotomy to hemiarthroplasty of the great toe in terms of clinical and radiographic outcomes. Material and Methods: Twenty-one consecutive patients affected by Grade III hallux rigidus underwent distal oblique osteotomy of the first metatarsal and hemiarthroplasty of the hallux metatarsophalageal joint. Clinical evaluation included the American Orthopaedic Foot and Ankle Society scoring system (AOFAS) and the Short Form 36 questionnaire (SF-36), preoperatively and at followup visits. Standard weightbearing radiographs were performed to assess implant alignment, loosening, and bone loss. The mean followup was (range, 16 to 29) months. Results: The mean AOFAS score improved from 47.5 ± 11.5 preoperatively to 76.0 ± postoperatively ( p < 0.01). At the last followup the SF-36 subscales Physical functioning, Bodily pain and Emotional role scores were increased from baseline. At the last followup, six patients (28.5%) were very satisfied with the outcome, ten patients (47.6%) were satisfied and five patients (23.8%) were dissatisfied. In the dissatisfied group, two patients had persistent joint pain with stiffness and subluxation of the prosthesis. Dorsal subsidence of the implant was present in ten patients at the last radiographic followup. Conclusion: Hemiarthroplasty of the proximal phalanx and distal oblique metatarsal osteotomy for Grade III hallux rigidus at 2-years followup yielded mixed patient satisfaction and unsatisfactory radiographic outcome.

Level of Evidence: IV, Case Series
Long-Term Results after Modified Brostrom Procedure without Calcaneo-fibular Ligament Reconstruction
Authors: Lee Kyung Tai , Park Young Uk , Kim Jin Su , Kim Jun Beom , Kim Ki Chun , Kang Seung Kyun
Published: February 2011

Background: The short-term results of modified Brostrom procedures (MBP) have been satisfactory. However, the long-term results of anatomical reconstruction have been less frequently reported. We report on our long-term results in our patient group. Materials and Methods: Thirty patients with chronic ankle instability who were treated using the MBP without CFL reconstruction from March 1997 to June 1999 were evaluated retrospectively. This consecutive series of patients was comprised of 26 males and four females. The mean age of the patients at the time of operation was 23 years. The mean followup period was 10.6 years. Twenty-four of the 30 were high-level amateur or professional athletes. The operation procedure involved only ATFL imbrication with inferior extensor retinaculum (IER) reinforcement. Clinical outcomes were evaluated by reviewing clinical charts, retrospectively. Functional outcome scores were obtained using the Hamilton scale, a VAS, and AOFAS score at final followup visit, when each patient underwent a physical examination and stress radiography. Results: Mean AOFAS score was 91 and the mean VAS at final followup was 87. According to the Hamilton classification, 12 achieved an excellent result, 16 a good result, and two a fair result. Mean anterior translation values at final followup were 6.9 and 6.1 mm on ipsilateral and contralateral sides. Furthermore, mean talar tilt angles were 3.0 and 2.5 degrees for ipsilateral and contralateral sides. Twenty-eight of the 30 patients

Level of Evidence: IV, Retrospective Case Series
High Rate of Osteolytic Lesions in Medium-Term Followup after the AES Total Ankle Replacement
Authors: Kokkonen Ari , Ikavalko Mikko , Tiihonen Raine , Kautiainen Hannu , Belt Eero A.
Published: February 2011

Background: Some previous studies have shown a high percentage of early-onset and rapidly progressing osteolysis associated with total ankle arthroplasty (TAA) by the Ankle Evolutive System (AES). The purpose of our study was to analyze medium-term results at our institution. Materials and Methods: Altogether 38 TAAs using AES prostheses were carried out between 2003 and 2007. Diagnoses were rheumatoid arthritis (71%), post-traumatic and idiopathic osteoarthritis (29%). The mean age was 54 years, followup 28 months. Tibial and talar components had hydroxyapatite coating on metal (Co-Cr) components (HA-coated). Since 2005 the design was changed and components were porous coated with titanium and hydroxyapatite (dual-coated). Results: Two-year survival was 79% (95% CI: 56 to 98). At followup 34 (89%) primary tibial and talar components were preserved. In 19 (50%) TAAs osteolysis (more than or equal to 2 mm) occurred in the periprosthetic bone area and in nine (24%) comprised large “cyst-like osteolysis”. In HA-coated prostheses radiolucent lines (less than or equal to 2 mm) or osteolysis (more than or equal to 2 mm) were detected in 11 (100%) cases and in dual-coated prostheses in 19 (74%) ( p= 0. 08). On the other hand there was more large “cyst-like osteolysis” around the dual-coated prosthesis and lesions were larger ( p= 0. 017). In rheumatoid arthritis osteolysis was detected in 14 (52%) and large “cyst-like osteolysis” in seven (26%) prostheses and in the group of traumatic and idiopathic osteoarthritis in six (55%) and two (18%), respectively. Conclusion: This study showed a high frequency of osteolysis in medium-term followup after the AES ankle replacement. The outcome was not sufficiently beneficial and we have discontinued use of this prosthesis.

Level of Evidence: IV, Retrospective Case Series
Ankle and Foot Contributions to Extreme Plantar- and Dorsiflexion in Female Ballet Dancers
Authors: Russell Jeffrey A. , Shave Ruth M. , Kruse David W. , Koutedakis Yiannis , Wyon Matthew A.
Published: February 2011

Background: Female ballet dancers require extreme ankle motion. The objective of this study was to quantify the relative contributions of the ankle and various foot joints to extreme plantarflexion (PF) and dorsiflexion (DF) in female ballet dancers using an X-ray superimposition technique and digital graphics software. Materials and Methods: One asymptomatic ankle was studied in each of seven experienced female ballet dancers. Three lateral weightbearing X-rays were taken of each ballet dancer's ankle: en pointe (maximum PF), in neutral position, and in demi-plié (maximum DF). Using graphics software, a subject's three X-ray images were superimposed and the tall were aligned. On each image the tibia, navicular, intermediate cuneiform, and first metatarsal were marked. Positional differences of a bone's line among the three images demonstrated angular movement of the bone in degrees. The neutral position was the reference from which PF and DF of the bones were calculated. Results: The talocrural joint contributed the most motion of any pair of bones evaluated for both PF and DF, with mean movements of 57.6 ± 5.2 degrees en pointe and 24.6 ± 9.6 degrees in demi-plié. Approximately 70% of total PF and DF were attributable to the talocrural joint, with the remaining 30% coming from motion between adjacent pairs of the studied foot bones. Conclusion: Superimposed X-rays for assessing ankle and foot contributions to the extreme positions required of female ballet dancers offer insight into how these positions are attained that is not available via goniometry. Clinical Relevance: Functional information gained from this study may assist clinicians in assessing ankle and foot pain in these individuals.
Validity of the Posterior Tibial Edema Sign in Posterior Tibial Tendon Dysfunction
Authors: DeOrio James K. , Shapiro Shane A. , McNeil Rebecca B. , Stansel Jonathan
Published: February 2011

Background: Posterior tibial tendon dysfunction (PTTD) is a common malady leading to acquired flatfoot, which frequently causes foot and ankle pain and swelling. We hypothesized that patients with PTTD and pitting edema along the course of the posterior tibial tendon (PTT) would have evidence of fluid within the tendon sheath on MRI. We introduce and validate a novel, yet simple physical examination finding, the posterior tibial edema (PTE) sign, to help distinguish PTTD from other causes of foot and ankle pain and swelling. Patients and Methods: To determine an association between the PTE sign and changes to the PTT evident on MRI, we reviewed the medical records of patients with PTTD who underwent magnetic resonance imaging (MRI). Results: Of 186 patients identified with PTTD, 49 underwent MRI, and 42 (86%) demonstrated imaging characteristics consistent with tendonitis, tendinosis, or tenosynovitis. Presence or absence of increased posterior malleolar pitting edema agreed with presence or absence of these MRI findings in 43 patients (88%), making the clinical examination finding significantly predictive of MRI results ( p = 0.01). The sensitivity of the test for PTE was 86%, with specificity of 100%. Conclusion: The PTE sign refers to pitting edema along the course of the PTT, not associated with acute trauma and not accompanied by other areas of edema. Physical examination signs that are highly sensitive and specific to the condition may help lower the cost of diagnosis by eliminating the need for expensive tests that are not always necessary.
Balloon Reduction of Displaced Calcaneus Fractures: Surgical Technique and Case Series
Authors: Gupta Anil K. , Gluck George S. , Parekh Selene G.
Published: February 2011

Level of Evidence: V, Expert Opinion
Technique Tip: Interposition of Extensor Digitorum Longus after Resection Arthroplasty of Lesser Metatarsophalangeal Joints for Rheumatoid Forefoot Deformity
Authors: Miyamoto Wataru , Takao Masato , Innami Ken , Yasui Youichi , Matsushita Takashi
Published: February 2011

Level of Evidence: V, Expert Opinion
Casting Technique Tip: The Cure for Curled Edges
Authors: White Lydia A. , Amis James A.
Published: February 2011

Level of Evidence: V, Expert Opinion
Political Demonstrations and Spectacles during the Rebellion Losses Controversy in Upper Canada
Authors: Radforth Ian
Published: February 2011

Abstract:

In response to the rebellion losses bill controversy of 1849, Upper Canadians mounted a series of political demonstrations and spectacles. Opponents of the bill (and of the governor who gave it royal assent) took to the streets in displays of ‘muscular conservatism' where sheer numbers and undertones of violence associated with effigy burnings and rioting gave weight to their opposition. In response, Reform government supporters joined the fray, engaging in emotional and physical outbursts that strayed from the etiquette of deliberative democracy. Government supporters also staged welcome ceremonies – vice-regal displays – when Governor Elgin toured the province to reveal popular support for his actions and the principle of responsible government. The article examines the wide range of performative strategies deployed across the province as Upper Canadians grappled with a divisive issue. It argues that deliberative democracy built a public, but so too did muscular conservatism and monarchical display.
Off the Streets and into the Fortress: Experiments in Hip Separatism at Toronto's Rochdale College, 1968–1975
Authors: Henderson Stuart
Published: February 2011

Abstract:

Toronto's Rochdale College (1968–1975) represented something much more than simply a new venue for countercultural experimentation and identity in the centre of English Canada's biggest city. It served as a bridge between the hip emphasis on public performativity that characterized the Yorkville scene of the mid-1960s and the more private hip separatism of the early 1970s. The symbolic association between Rochdale and impenetrability was central to both Rochdalians' self-identification and its perception by outsiders; there also were connections between Rochdale and the broader trend toward hip separatism in the years after 1968.
Deep brain stimulation for the treatment of drug-refractory epilepsy in a patient with a hypothalamic hamartoma
Authors: Marras Carlo Efisio , Rizzi Michele , Villani Flavio , Messina Giuseppe , Deleo Francesco , Cordella Roberto , Franzini Angelo
Published: February 2011

Hypothalamic hamartomas (HHs) are developmental malformations associated with a range of neurological problems, including intractable seizures. There is increasing evidence of the epileptogenicity of the hamartoma and of the inhomogeneous distribution of the epileptic abnormalities within the malformation. The management strategy for treatment and results differ according to the insertion plane and the extension of the malformation into the hypothalamus. Cases characterized by extensive involvement of the hypothalamus are particularly challenging.

The authors describe the case of a patient with drug-resistant epilepsy and a large hypothalamic hamartoma with an extensive area of attachment. The patient underwent implantation of 2 deep brain electrodes. The intraoperative recording showed a synchronous interictal epileptic discharge in the left temporal lobe and on the left side of the lesion. The patient was treated with chronic high-frequency stimulation. No side effects due to the stimulation were reported. At 18 months' follow-up, a reduction in complex partial seizure frequency was reported, but no significant reduction in overall seizure frequency was noticed (p = 0.14, t-test).

The authors report on neurophysiological studies of the relationship between HH and epilepsy, and also discuss the literature on chronic high-frequency stimulation, including its rationale and the results of chronic stimulation of various targets for the treatment of drug-resistant epilepsy due to HH.
The evolution of treatment for hypothalamic hamartoma: a personal odyssey
Authors: Rosenfeld Jeffrey V.
Published: February 2011

The prognosis for patients with hypothalamic hamartoma has improved dramatically over the last 20 years, for 3 main reasons. First, because of improved understanding of the anatomy and pathophysiology of these varied lesions. Second, due to advances in brain imaging and refinements in microsurgery, including the anterior transcallosal interforniceal approach, endoscopic, and skull-base approaches. And third, because of increasing experience with stereotactic radiosurgery, interstitial radiotherapy, and radiofrequency lesioning. Patients with hypothalamic hamartoma should be managed in comprehensive epilepsy centers where the treatments are individualized and concentrated in the hands of surgeons who can perform the full range of surgery, including approaches to the third ventricle. Total seizure-freedom rates of 52% to 66% have been achieved with surgery.
Preoperative and postoperative developmental attainment in patients with sagittal synostosis: 5-year follow-up
Authors: Bellew Maggie , Liddington Mark , Chumas Paul , Russell John
Published: February 2011

Object

The object of this study was to clarify whether improved developmental attainment following surgical correction of sagittal synostosis (SS), previously identified at initial postoperative assessment, is maintained at longer-term follow-up at 5 years of age.

Methods

The study involved 32 children with SS who underwent corrective surgery at a mean (± SD) age of 8.5 ± 7.25 months (range 2.8–39.9 months). All the children were assessed preoperatively, at 7 months postoperatively, and at 5 years of age, using the Griffiths Mental Development Scales. A control group consisted of 23 children with SS who had received developmental assessment on 2 or more occasions without surgical intervention (8 of these children had had follow-up at 5 years of age).

Results

The data indicated that, prior to surgical correction, children with SS had poorer Gross Locomotor function than other areas of development and that, following surgical intervention, the deficit resolved (even where there was severe developmental delay). The results further showed that improvement in Gross Locomotor function observed at 7 months postoperatively was further improved upon by 5 years of age. The same was true for their overall General Quotient, even in those children exhibiting severe developmental delay. Lesser improvements across time were shown for other skill areas. The children with SS who did not undergo surgery did not show any improvement in development, and in fact a deterioration in fine locomotor control was identified in these patients.

Conclusions

The results of this study suggest that corrective surgery for SS has a positive early impact on development, which is maintained and improved upon by 5 years of age, and that this surgery therefore offers more than simply a cosmetic improvement. Furthermore, the results suggest that not operating on children with SS means not only that this opportunity for developmental gain is missed, but that it may also cause an actual deterioration in developmental attainment.
Giant glioependymal cyst in an infant
Authors: Morigaki Ryoma , Shinno Kiyohito , Pooh Kyong-Hon , Nakagawa Yoshinobu
Published: February 2011

The authors report the case of an infant with a giant glioependymal cyst. Although it has been suggested that these cysts originate from the tela choroidea, their origin remains controversial. This 35-month-old girl with truncal ataxia was referred to the authors' hospital. Magnetic resonance imaging revealed a giant cystic mass extending from the anterior to the posterior cranial fossa. Hydrocephalus was caused by obstruction of the sylvian aqueduct. Endoscopic fenestration of the cyst wall was performed. Histochemical and immunohistochemical staining identified the lesion as a glioependymal cyst. Magnetic resonance imaging performed 8 months later suggested that the cyst originated from the tela choroidea. At 5-year follow-up, there was no tumor recurrence and she had fully recovered. The origin of glioependymal cysts is discussed, and the authors suggest that their origin is the tela choroidea.
Endoscopic fenestration of a cerebellopontine angle arachnoid cyst resulting in complete recovery from sensorineural hearing loss and facial nerve palsy
Authors: Olaya Joffre E. , Ghostine Michelle , Rowe Mark , Zouros Alexander
Published: February 2011

Cerebellopontine angle arachnoid cysts are usually asymptomatic, but are frequently found incidentally because of increased use of neuroimaging. Nevertheless, as these cysts enlarge, they may compress surrounding structures and cause neurological symptoms. Patients may present with vague, nonspecific symptoms such as headache, nausea, vomiting, and vertigo. Cranial nerve palsies, including sensorineural hearing loss and facial weakness, although rare, have also been reported in association with posterior fossa arachnoid cysts. Although surgery for these entities is controversial, arachnoid cysts can be treated surgically with open craniotomy for cyst removal, fenestration into adjacent arachnoid spaces, shunting of cyst contents, or endoscopic fenestration. Reversal of sensorineural hearing loss following open craniotomy treatment has been described in the literature in only 1 adult and 1 pediatric case. Improvement in facial weakness has also been reported after open craniotomy and arachnoid cyst fenestration. The authors report the first case of complete recovery from sensorineural hearing loss and facial weakness following endoscopic fenestration in a patient with a cerebellopontine angle arachnoid cyst.
Delayed development of os odontoideum after traumatic cervical injury: support for a vascular etiology
Authors: Zygourakis Corinna C. , Cahill Kevin S. , Proctor Mark R.
Published: February 2011

A previously healthy 2-year-old girl sustained a C1–2 ligamentous injury after a motor vehicle accident and underwent successful halo immobilization, with postimmobilization images showing good cervical alignment. At the time, plain radiography, CT scanning, and MR imaging showed a normal odontoid. Four years later, however, the patient was found to have an os odontoideum, evident on plain radiography and CT imaging. At the 10-year follow-up, the os odontoideum had not been surgically repaired, and the child had mild hypermobility.

This is the first documented case in the modern imaging era of delayed os odontoideum formation after definitive CT scanning showed no fracture. As such, this suggests that os odontoideum may result from traumatic vascular interruption in the developing spine, with resulting osseous remodeling leading to an os odontoideum. This case argues against the congenital etiology of os odontoideum, as well as the strict posttraumatic theory whereby a trauma-induced odontoid fracture leads to osseous remodeling and subsequent development of an os odontoideum.
Corpus callosotomy in multistage epilepsy surgery in the pediatric population
Authors: Lin Jessica S. , Lew Sean M. , Marcuccilli Charles J. , Mueller Wade M. , Matthews Anne E. , Koop Jennifer I. , Zupanc Mary L.
Published: February 2011

Object

The object of this study was to evaluate surgical outcome in a select group of patients with medically refractory epilepsy who had undergone corpus callosotomy combined with bilateral subdural electroencephalography (EEG) electrode placement as the initial step in multistage epilepsy surgery.

Methods

A retrospective chart review of 18 children (ages 3.5–18 years) with medically refractory symptomatic generalized or localization-related epilepsy was undertaken. A corpus callosotomy with subdural bihemispheric EEG electrode placement was performed as the initial step in multistage epilepsy surgery. All of the patients had tonic and atonic seizures; 6 patients also experienced complex partial seizures. All of the patients had frequent generalized epileptiform discharges as well as multifocal independent epileptiform discharges on surface EEG monitoring. Most of the patients (94%) had either normal (44%) MR imaging studies of the brain or bihemispheric abnormalities (50%). One patient had a suspected unilateral lesion (prominent sylvian fissure).

Results

Of the 18 patients who underwent corpus callosotomy and placement of subdural strips and grids, 12 progressed to further resection based on localizing data obtained during invasive EEG monitoring. The mean patient age was 10.9 years. The duration of invasive monitoring ranged from 3 to 14 days, and the follow-up ranged from 6 to 70 months (mean 35 months). Six (50%) of the 12 patients who had undergone resection had an excellent outcome (Engel Class I or II). There were no permanent neurological deficits or deaths.

Conclusions

The addition of invasive monitoring for patients undergoing corpus callosotomy for medically refractory epilepsy may lead to the localization of surgically amenable seizure foci, targeted resections, and improved seizure outcomes in a select group of patients typically believed to be candidates for palliative surgery alone.
Factors affecting survival of infants with myelomeningocele in southeastern Uganda
Authors: Warf Benjamin C. , Wright Ernest J. , Kulkarni Abhaya V.
Published: February 2011

Object

The survival of infants treated for myelomeningocele (MM) and hydrocephalus in Uganda is unknown. This study investigated 5-year survival and the factors that influenced death in these patients.

Methods

All 140 children from 16 contiguous districts in southeastern Uganda presenting to CURE Children's Hospital of Uganda for repair of MM prior to 6 months of age between December 2000 and December 2004 comprised the study cohort. Nine patients died within 1 month (6.4% operative mortality) and were excluded from further analysis. Sixty-seven (51%) required treatment for hydrocephalus. Survival status could not be determined for 3 patients (2%). Circumstances of death were ascertained by hospital record or interview. The Kaplan-Meier method was used for survival analysis. Association between survival and district of origin, age at MM closure, MM lesion level, presence of hydrocephalus, and method of hydrocephalus treatment were investigated.

Results

The median follow-up was 86 months. Seventy-three children (56%) were alive at the time of the study, and 81 (63%) had survived more than 5 years. The under-5 mortality rate was 37% (2.5 times greater than the general population). Only 4 deaths appeared directly related to hydrocephalus or MM. There was no significant association between survival and age at MM closure, MM lesion level, presence of hydrocephalus, or its method of treatment. Mortality was lower, approaching that for their unaffected peers, in districts with community-based rehabilitation programs (p = 0.001).

Conclusions

Community-based support following surgical interventions for MM and hydrocephalus appears essential to the continued survival of these children in Africa.
Posttraumatic subgaleal and orbital hematoma due to factor XIII deficiency
Authors: Natarajan Manikandan S. , Prabhu Krishna , Braganza Andrew , Chacko Ari G.
Published: February 2011

The authors report on a 6-year-old boy who presented with a tense subgaleal hematoma and proptosis 2 weeks after a minor head injury that were successfully managed by continuous closed-system drainage and blood transfusion. At evaluation he was found to have a transient mild factor XIII deficiency.
Fourth ventriculostomy: an alternative treatment for hydrocephalus due to atresia of the Magendie and Luschka foramina
Authors: Giannetti Alexandre Varella , Malheiros Jose Augusto , Silva Marcia Cristina da
Published: February 2011

Atresia of the foramina of Magendie and Luschka is a rare cause of obstructive hydrocephalus. Although this condition has been classically treated by CSF shunting, recent treatments have also included endoscopic third ventriculostomy. In the present study, the authors present the case of a patient with hydrocephalus in whom an alternative method was used following a CSF shunt malfunction.

A young female patient in whom a shunt was placed during the patient's 1st year of life was faring well until she was 8 years old. She was admitted to the emergency department 5 times with signs of CSF shunt malfunction. Each time, the CT scan showed a slight dilation of the lateral and third ventricles and a large increase in the size of the fourth ventricle. In comparison, ventricles were smaller in a previous imaging study obtained when the patient was asymptomatic. Magnetic resonance imaging showed the same slight dilation of all the ventricles and a significant increase in the fourth ventricle. There was no aqueductal stenosis. An important enlargement of both lateral recesses of the fourth ventricle suggested the possibility of an atresia of the foramina. The foramen of Monro and the width of the third ventricle would not allow the passage of an endoscope. The decision was made to open those foramina endoscopically through the fourth ventricle. After induction of general anesthesia, with the patient in the prone position, a bur hole was made in the left paramedian and suboccipital region. The endoscope was introduced underneath the cerebellar hemisphere. The authors were then able to distinguish the floor of the fourth ventricle and other anatomical landmarks. Navigation through the lateral recesses allowed them to see the fine membranes closing the foramina. These membranes were opened with a monopolar cautery as a blunt instrument. The orifice was then enlarged with a 3 Fr Fogarty catheter. The authors also opened a bulging thin membrane located at the foramen of Magendie. During the postoperative period, the authors observed a marked improvement in the state of the patient's alertness as well as a disappearance of her headaches and cessation of vomiting. In addition, the patient's gait ataxia improved slowly. Six-month postoperative MR imaging demonstrated an unequivocal reduction in the size of the fourth ventricle. The patient was still doing well 36 months after the surgery.

Endoscopic fourth ventriculostomy, the opening of the 3 foramina of the fourth ventricle, may be an alternative treatment in cases in which these structures are congenitally closed.
Syndrome of alternating hypernatremia and hyponatremia after hypothalamic hamartoma surgery
Authors: Abla Adib A. , Wait Scott D. , Forbes Jonathan A. , Pati Sandipan , Johnsonbaugh Roger E. , Kerrigan John F. , Ng Yu-Tze
Published: February 2011

Object

In this paper, the authors' goal was to describe the occurrence of alternating hypernatremia and hyponatremia in pediatric patients who underwent resection of hypothalamic hamartomas (HHs) for epilepsy. Hypernatremia in patients after pituitary or hypothalamic surgery can be caused by diabetes insipidus (DI), whereas hyponatremia can occur due to a syndrome of inappropriate antidiuretic hormone, cerebral salt wasting, or excessive administration of desmopressin (DDAVP). The triphasic response after surgery in the pituitary region can also explain variations in sodium parameters in such cases.

Methods

One hundred fifty-three patients with HH who underwent surgery were enrolled in a prospective study to monitor outcomes. Of these, 4 patients (2.6%) were noted to experience dramatic alterations in serum sodium values. The medical records of these patients were identified and evaluated.

Results

Patients' ages at surgery ranged from 1.2 to 6.0 years. All patients were girls. Two patients had Delalande Type IV lesions (of 16 total Type IV lesions surgically treated) and 2 had Type III lesions (of 39 total Type III lesions). All patients had a history of gelastic seizures refractory to medication. Seizure frequency ranged from 3 to 300 per day. After surgery, all patients experienced hypernatremia and hyponatremia. The largest fluctuation in serum sodium concentration during hospitalization in a single patient was 53 mEq/L (range 123–176 mEq/L). The mean absolute difference in maximum and minimum sodium values was 38.2 mEq/L.

All patients exhibited an initial period of immediate DI (independent of treatment) after surgery followed by a period of hyponatremia (independent of treatment), with a minimum value occurring between postoperative Days 5 and 8. All patients then returned to a hypernatremic state of DI, and 3 patients still require DDAVP for DI management. A second occurrence of hyponatremia lasting several days without DDAVP administration occurred in 2 patients during their hospitalization between periods of hypernatremia. One patient stabilized in the normal range of sodium values prior to discharge from rehabilitation without the need for further intervention. At last follow-up, 3 patients are seizure-free.

Conclusions

Severe instability of sodium homeostasis with hypernatremia and hyponatremia is seen in up to 2.6% of children undergoing open resection of HH. This risk appears to be related to HH type, with a higher risk for Types III (2 [5.1%] of 39) and IV (2 [12.5%] of 16) lesions. Here, the authors describe alternating episodes of hypernatremia and hyponatremia in the postoperative period following HH surgery. Management of this entity requires careful serial assessment of volume status and urine concentration and will often require alternating salt replacement therapy with DDAVP administration.
Long-term outcome after emergency resection of hypothalamic hamartomas for status gelasticus
Authors: Pati Sandipan , Rastogi Reena G , Abla Adib A. , Rekate Harold L. , Ng Yu-Tze
Published: February 2011

Object

Gelastic seizures are epileptic events characterized by bouts of laughter. They are rare and mostly associated with hypothalamic hamartomas (HHs). Status gelasticus, a rare form of status epilepticus, is defined as a prolonged cluster of gelastic seizures (> 20–30 minutes) without necessarily involving loss of awareness between seizures. Emergency resection of the hamartoma is highly effective in these situations and should be considered as early as possible. The authors retrospectively reviewed their surgical cases to document the success, complications, and long-term follow-up after emergency resection of HHs for status gelasticus.

Methods

The authors report on a retrospective case series from a single tertiary care center. Three patients who presented with status gelasticus underwent emergency resection of HHs. Demographic details, seizure history, medical treatment, and postoperative follow-up data were evaluated. Long-term follow-up (minimum 2 years) data were obtained either from the last clinic visit notes or via telephone and e-mail contacts. The institutional review board at St. Joseph's Hospital approved this study.

Results

In the last 7 years, of 157 patients who underwent HH resection, the resection was performed on an emergency basis for status gelasticus in 3 cases. At emergency surgery, these 3 patients ranged in age from 9 months to 3.5 years. All of the patients were boys. Delalande and Fohlen Type II, III, and IV lesions were present in the 3 patients. Surgical approaches for resection of HH included an orbitozygomatic, transcallosal anterior interforniceal approach and endoscopic resection. Status gelasticus was terminated following emergency surgery in all cases, and 1 patient was seizure free. Postsurgical complications included, in 1 case, a small right thalamic infarct with mild transient left hemiparesis, which completely resolved within 2 days. Within 2 years of their original surgery, 2 patients underwent further elective surgeries (endoscopic resection and radiosurgery for persistent symptomatic seizures). Follow-up since their most recent surgery ranged from 8 months to 2 years. Two patients were seizure free and 1 patient had greater than 50% reduction in seizures.

Conclusions

Status gelasticus associated with HHs can be successfully terminated by emergency resection of the HH. Long-term follow-up in the present series suggests good seizure freedom results or at least greater than 50% reduction in seizures, although repeat operations were necessary.
Nerve Growth Factor in Cancer Cell Death and Survival
Authors: Molloy Niamh , Read Danielle , Gorman Adrienne
Published: February 2011

One of the major challenges for cancer therapeutics is the resistance of many tumor cells to induction of cell death due to pro-survival signaling in the cancer cells. Here we review the growing literature which shows that neurotrophins contribute to pro-survival signaling in many different types of cancer. In particular, nerve growth factor, the archetypal neurotrophin, has been shown to play a role in tumorigenesis over the past decade. Nerve growth factor mediates its effects through its two cognate receptors, TrkA, a receptor tyrosine kinase and p75NTR, a member of the death receptor superfamily. Depending on the tumor origin, pro-survival signaling can be mediated by TrkA receptors or by p75NTR. For example, in breast cancer the aberrant expression of nerve growth factor stimulates proliferative signaling through TrkA and pro-survival signaling through p75NTR. This latter signaling through p75NTR promotes increased resistance to the induction of cell death by chemotherapeutic treatments. In contrast, in prostate cells the p75NTR mediates cell death and prevents metastasis. In prostate cancer, expression of this receptor is lost, which contributes to tumor progression by allowing cells to survive, proliferate and metastasize. This review focuses on our current knowledge of neurotrophin signaling in cancer, with a particular emphasis on nerve growth factor regulation of cell death and survival in cancer.
Sustainable Forest Management and Carbon in Tropical Latin America: The Case for REDD+
Authors: Nasi Robert , Putz Francis E. , Pacheco Pablo , Wunder Sven , Anta Salvador
Published: February 2011

In this review paper, we assess the economical, governance, and technical conditions that shape forest management in tropical Latin America with particular regard to efforts to reduce forest-based carbon emissions. We provide a framework for discussions about ways to improve forest management that achieve environmental objectives while promoting local and national development and contributing to local livelihoods. We argue that many management practices that lead towards sustainability are only likely to be adopted where there is good governance backed by financial incentives for effective enforcement of management regulations. We propose some policy interventions designed to lower net greenhouse gas emissions by decreasing rates of forest degradation and increasing carbon stock recovery in logged-over or otherwise degraded forests. Implementation of REDD+ could provide critical compensation to forest users for improved management practices in the absence of, or in combination with other economic incentives.
A Distributed Public Key Infrastructure Based on Threshold Cryptography for the HiiMap Next Generation Internet Architecture
Authors: Hanka Oliver , Eichhorn Michael , Pfannenstein Martin , Eberspächer Jörg , Steinbach Eckehard
Published: February 2011

In this article, a security extension for the HiiMap Next Generation Internet Architecture is presented. We regard a public key infrastructure which is integrated into the mapping infrastructure of the locator/identifier-split addressing scheme. The security approach is based on Threshold Cryptography which enables a sharing of keys among the mapping servers. Hence, a more trustworthy and fair approach for a Next Generation Internet Architecture as compared to the state of the art approach is fostered. Additionally, we give an evaluation based on IETF AAA recommendations for security-related systems.
A Model-Based Prioritisation Exercise for the European Water Framework Directive
Authors: Daginnus Klaus , Gottardo Stefania , Payá-Pérez Ana , Whitehouse Paul , Wilkinson Helen , Zaldívar José-Manuel
Published: February 2011

A model-based prioritisation exercise has been carried out for the Water Framework Directive (WFD) implementation. The approach considers two aspects: the hazard of a certain chemical and its exposure levels, and focuses on aquatic ecosystems, but also takes into account hazards due to secondary poisoning, bioaccumulation through the food chain and potential human health effects. A list provided by EU Member States, Stakeholders and Non-Governmental Organizations comprising 2,034 substances was evaluated according to hazard and exposure criteria. Then 78 substances classified as “of high concern” where analysed and ranked in terms of risk ratio (Predicted Environmental Concentration/Predicted No-Effect Concentration). This exercise has been complemented by a monitoring-based prioritization exercise using data provided by Member States. The proposed approach constitutes the first step in setting the basis for an open modular screening tool that could be used for the next prioritization exercises foreseen by the WFD.
Role of Intestinal Hydrolase in the Absorption of Prenylated Flavonoids Present in Yinyanghuo
Authors: Chen Yan , Wang Jinyan , Jia Xiaobin , Tan Xiaobin , Hu Ming
Published: February 2011

Purpose: Yinyanghuo (Herba Epimdii) is a traditional Chinese herb containing prenylated flavonoids as its active constituents. The aim of this study was to examine the significance of the intestinal hydrolysis of prenylated flavonoids by lactase phlorizin hydrolase (LPH), an enzyme at the brush border membrane of intestinal cells. Methods: A four-site perfused rat intestinal model was used. The concentration of the flavonoids of interest and their metabolites in different intestinal segements were analyzed by HPLC, and the apparent permeabilities were calculated. A lactase phlorizin hydrolase inhibitor (gluconolactone) was employed to investigate the mechanism of the intestinal absorption, and the metabolites of the four flavonoids were identified using LC/MS/MS. Results: Diglycosides (icariin) or triglycosides (epimedin A, epimedin B, and epimedin C) were hydrolyzed rapidly in duodenum and jejunum producing one or two metabolites, while a monoglycoside (baohuoside I) was absorbed directly. When co-perfused with glucono-lactone, both the hydrolysis of diglycosides and triglycosides were significantly inhibited, with inhibition rates for icariin (62%, 50%, 40%, 46%), epimedin A, (55%, 26%, 21%, 14%); epimedin B (42%, 40%, 74%, 22%), and epimedin C (42%, 40%, 52%, 35%) in duodenum, jejunum, ileum, and colon, respectively. Also the metabolites of icariin, epimedin A, epimedin B, and epimedin C were identified as baohuoside I (one of two), sagittatoside A, sagittatoside B, and 2"-O-rhamnosylicariside II, respectively. Conclusions: The results showed that lactase phlorizin hydrolase was a major determinant of the intestinal absorption of prenylated flavonoids present in Yinyanghuo.