bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Imaging as a Predictor of Response to Somatostatin Analogs in Acromegaly after Surgical Failure
Authors: Puig-Domingo Manel , Resmini Eugenia , Gomez-Anson Beatriz , Nicolau Joana , Mora Mireia , Palomera Elisabet , Martí Camelia , Halperin Irene , Webb Susan M.
Published: August 2010

Context: Transsphenoidal surgery is considered first-line therapy for acromegaly; however, there is often a need for adjunctive therapy. Somatostatin analogs (SSA) have greatly improved the effectiveness of medical treatment, but one third of patients are resistant.

Objective: The aim was to evaluate whether magnetic resonance imaging (MRI) signal could predict long-term response to SSA in patients with active acromegaly after neurosurgery.

Patients and Methods: Sixty-two patients who were active acromegalic after surgery were included in this retrospective study. Remaining pituitary tumor was classified as hyper-, iso-, or hypointense by evaluating T2-weighted MRI signal. Treatment with SSA at maximal effective doses was prescribed and evaluated at 6 and 12 months by monitoring IGF-I, GH, and T2 MRI.

Results: Complete response to SSA treatment (defined as normal IGF-I) at 6 months was observed in 30%, partial response (defined as IGF-I between 2 and 3 sd score) in 15%, and no response in 55% of patients. At 12 months, 28, 20, and 52% were observed, respectively. MRI signal was hypointense in 40%, hyperintense in 48%, and isointense in 12%. At 6 months, complete response to SSA was observed in 71% of cases having hypointense MRI signal and in 20% of hyperintense (P = 0.04). At 12 months, 62% of hypointense remained well controlled, whereas in the hyperintense group, good, partial, or no response results did not change from that observed at 6 months (P = 0.04).

Conclusion: In active acromegalic patients after surgery, a hypointense T2-weighted MRI signal is associated with a better response to SSA treatment at 6 and 12 months.
Radiating Nests: Metalingual Tropes in Poetry of Exile
Authors: ZORIĆ VLADIMIR
Published: August 2010

This article examines interlingual poetry of exile in the context of different theories of language in poetry and focuses on Miloš Crnjanski's (1893–1977) poem “Lament nad Beogradom” (“Lament over Belgrade”). The article claims that interlingual poetry of exile has been a blind spot in most theories of poetry, because it undermines the pervasive idea of a monolingual idiom independent from social developments, but that Roman Jakobson's theory of equational relations may be valuable if applied with substantial readjustments to account for the fact that different languages are not connected by any prior paradigmatic framework. In the absence of such an overarching arrangement, code switches in interlingual poetry do not reflect but creatively project paradigmatic relations—in the form of metaphors that constitute a poetic metalanguage. The article focuses on the interlingual poetry of exile and asks how this metaphoric projection of paradigmatic relations between languages is influenced by this severe form of displacement. Crnjanski's “Lament over Belgrade” features dramatic code switches that cluster around various exotopic images indicating some form of spatial outsideness. The article compares these images to metaphors of interlinguality used by other poets in exile such as Ovid, Marina Tsvetaeva, Joseph Brodsky, and Eva Hoffman. Four images are singled out: the capsule, the mountaintop, the nest, and the abyss. In the case of the capsule, externality is a place of isolation and concentration; in the metaphor of the mountaintop, it is a commanding position in which different codes unlock different aspects of the world; in the metaphor of the nest, it is a place with a harmonious synthetic view; in the metaphor of the abyss, it is a place defined by conflict and the risk of annihilation. The article concludes by considering how the imagery of “Lament over Belgrade” converges towards some of these four tropes of interlinguality in creating the poem's metalanguage. After exposure to the abysmal visions of the odd-numbered stanzas in his poem, in every even-numbered stanza Crnjanski retreats to the capsular space of his mother tongue for protection and the gestation of a monolithic poetic idiom, a movement that reflects Crnjanski's incomplete integration of the English language in his own verbal creativity. Crnjanski thus represents interlinguality in terms of an enclosed space whereby the exiled poet is left to his own devices rather than as a vantage point from which new insights can be gained. Finally, the apparent rhythmic and syntactic disparity of poems such as “Lament over Belgrade” is countervailed by a set of metaphors of outsideness which, on the one hand, construct the idea of an imagined metalanguage and, on the other hand, reflect the human trauma of exile.
Historicizing the Stones: Ruskin'sThe Stones of Veniceand Italian Nationalism
Authors: BARNES DAVID
Published: August 2010

This essay performs a new reading of John Ruskin's The Stones of Venice, placing the work in the context of nineteenth-century Italian nationalist debates on the character and history of Venice. Using letters, diaries, and other sources, the essay discusses the ways in which the production of Ruskin's architectural treatise was informed by a number of contemporary contexts. These include Ruskin's own frustration with the effects of the Austrian occupation on Venice and his awareness of the conflict between pro- and anti-Austrian parties in the city in the aftermath of the 1848 revolution. Ruskin's awareness of and conflict with the leggenda nera (black legend) debate—the political myth of a despotic Venice first propagated by apologists for Napoleon's annexation of the city—is discussed in depth. Ruskin's work is further compared with two contemporary American treatments of Italy, Nathaniel Hawthorne's “romance” The Marble Faun and William Dean Howells's Venetian Life, an account of his time as U.S. consul in Venice. This comparison highlights the variety of ways in which Anglo-American literary figures engaged with contemporary Italian politics in their visions of Italy—from the anxious negation of the political present performed by Hawthorne in his descriptions of Rome in The Marble Faun to the journalistic record of a tense, divided Venice in Howells's book—challenging the popular Anglo-American notion of an “apolitical,” fantastic Italy. In its conclusion, the essay shows how Ruskin's appropriation of Venetian history may be read in parallel with the rhetoric of Italian nationalism as both aimed to recover a lost, proud, ancient Venice.
“A Fragment from Another Context”: Modernist Classicism and the Urban Uncanny in Rainer Maria Rilke
Authors: JUNYK IHOR
Published: August 2010

This essay considers Rainer Maria Rilke's use of classicism as a response to the uncanny and fragmenting industrial city. While the twentieth-century revival of classicism has typically been seen as part of the reactionary “call to order,” I argue that Rilke's work represents a radically different modernist classicism – one that celebrates the fluidity and contingency of urban life. While his early work evinces a flight from the chaos of the modern city to a lost antique wholeness, after his engagement with Rodin's disarticulated sculpture, Rilke radically reimagines classicism as the ideal form for a Baudelairean modernity defined by “the ephemeral, the fugitive, the contingent.”
Messenger Writers: Anna Seghers and Alejo Carpentier in the Cold War
Authors: JANZEN MARIKE
Published: August 2010

In the early 1960s, the East German Anna Seghers and the Cuban Alejo Carpentier published historical narratives of the slave uprisings that had rocked French and British colonies in the Caribbean during the late eighteenth and early nineteenth centuries. In both Seghers's “Das Licht auf dem Galgen” (“Light on the Gallows”) and Carpentier's El siglo de las luces (Explosion in a Cathedral), revolutionary agents of the French government face the question of whether to prioritize official policy or solidarity with the oppressed in their work to advance emancipatory ideas. In light of the historical situation of Seghers and Carpentier as authors aligned with new, revolutionary states in the middle of the twentieth century, these stories about revolutionary messengers can be understood as contemporaneous, critical reflections on the particular author position of being a “messenger writer.” In contrast with prior studies that evaluate the historical realism of these works, I draw on Walter Benjamin's notions of revolutionary historiography in order to show how both the content and circumstances of publication of Seghers's and Carpentier's fiction illuminate their struggles with the role of messenger writer. This in turn contributes to a more thorough historicization of the texts and the concerns of iconic leftist writers in the Cold War.
Report on the International ICF Consensus Conference on the ICF Core Sets for Hand Conditions
Authors: Rudolf Klaus-Dieter , Kus Sandra , Coenen Michaela , Dereskewitz Caroline , van de Ven-Stevens Lucelle A W , Cieza Alarcos
Published: August 2010

Objective

The aim of the conference was to derive the Brief and the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Hand Conditions from the subset of ICF categories selected on the basis of the preparatory phase research.

Methods

Following a multistage decision process, the experts agreed on the ICF categories to be included in the ICF Core Sets for Hand Conditions. The development of the ICF Core Sets for Hand Conditions involved a formal decision-making and consensus process, integrating evidence gathered from preparatory studies including a qualitative study, a systematic literature review, an expert survey and an empirical multicentre study.

Results

Twenty-three experts selected a total of 117 categories for the Comprehensive Core Set and 23 categories for the Brief Core Set. The largest number of categories was selected from the ICF component ‘Activities and Participation’.

Conclusion

The ICF Core Sets for Hand Conditions serve a clinical framework to comprehensively assess patients in acute care hospitals and early postacute rehabilitation facilities. The first versions of the ICF Core Sets will be further tested and validated through empirical studies.
A qualitative investigation into the rehabilitation experience of patients following wrist fracture
Authors: Bamford Rachael , Walker Dawn-Marie
Published: August 2010

Introduction

Fractures of the wrist are often highly traumatic, leading to significant pain and reduction in an individual's home, work and leisure roles for a considerable time. Among the studies on wrist fracture, there is limited evidence which qualitatively explores the patient's rehabilitation experiences of this condition, and the impact they feel it has on their daily lives. The aim of this study was therefore to explore the experiences of working age people with dominant side wrist fracture in terms of the impact on their lives from the resulting loss of hand function, and the role that hand therapy plays in the rehabilitation process.

Method

Using a qualitative approach, semistructured interviews were carried out with six participants who were current or previous patients of an outpatient occupational therapy department and who had sustained wrist fracture. Three key themes equated to the impact the fracture had on their lives: ‘functional ability’, ‘attitudes and expectations of self and others’ and ‘assessment and treatment in occupational therapy’.

Results

The main findings showed that the impact of reduced ability evoked negative reactions and dependence on others. Lack of information on application and removal of plaster cast contributed towards early anxieties about the appearance and function of the hand. Patients' attitudes generally reflected taking some responsibility for their own progress. Occupational therapy input increased motivation, and particularly for those who attended rehabilitation sessions in the department, the therapy was valued.

Discussion

The recommendations from this study are that early and continued patient education is provided by the therapist, engaging relatives where appropriate, to alleviate patient and family anxieties and to help determine realistic expectations of recovery. While patients generally engage with objective measurements, making assessment and treatment relevant to their activities of daily living is essential to ensure they are motivated for therapy.
Validity, responsiveness and reliability of the Patient-Rated Tennis Elbow Evaluation
Authors: Chung Bryan , Wiley J Preston
Published: August 2010

Introduction

Lateral epicondylitis (LE) is a common, often chronic injury that affects a person's ability to grip and perform manual tasks including activities of daily living and leisure. Treatment of LE is controversial; however, there have been no standardized tools with which to measure outcomes in trials investigating new or existing therapies for LE. The Patient-Rated Tennis Elbow Evaluation (PRTEE) was designed to fill this gap, but has not yet been validated to the same standard as other, similarly developed tools.

Methods

Sixty subjects with LE who participated in a double-blind randomized controlled trial were measured with respect to the PRTEE, ‘overall pain’, ‘resting pain’, ‘pain during sleep’, ‘pain at its worst’ and ‘pain at its least’, and quality of life. All tools were administered at baseline, four and eight weeks.

Results

The PRTEE showed poor item-specific validity with measures of similar constructs. The intraclass correlation coefficient for test–retest reliability over four weeks was 0.76. The mean PRTEE differences between the group that experienced clinical significant change and the group that experienced virtually no change were significantly different from one another ( t = −2.96, df = 30, P = 0.006).

Discussion

The PRTEE shows questionable discriminant ability due to its moderate test–retest reliability and possibly due to low convergent validity with other measures of similar constructs. The PRTEE appears to be sensitive to change, but the margin of difference between a clinically relevant change and ‘no change’ is very small.
Finger circumference measurements: inter- and intra-rater reliability
Authors: Lewis Erika S
Published: August 2010

Background

Finger oedema can occur for a variety of reasons, including traumatic injuries to the fingers and as a consequence of stroke or diabetes. The purpose of this study was to determine the intra- and inter-rater reliability for finger circumference measurements.

Methods

Eight hand therapists assessed the middle finger circumference of 11 healthy adults using the Richardson Products finger circumference device for three trials over two testing days. Intraclass reliability analysis and analysis of variance were used to assess the consistency and stability of measures. Level of significance was set at P ≤ 0.05.

Results

Significant differences ( P < 0.001) were found between raters for circumference measurements with a range difference of 0.5 cm. Intrarater reliability was 0.98–0.99 (single measure intraclass coefficient). Inter-rater reliability coefficients ranged from 0.94 to 0.95.

Conclusions

These results provide clinicians with evidence for using a specific finger circumference device and issues associated with various therapists assessing finger circumference. A device with a way of assessing tension at the end of the tape measure or cloth pulled around the finger is warranted.
New Models of Self-Management Education for Minority Ethnic Groups: Pilot Randomized Trial of a Story-Sharing Intervention
Authors: Greenhalgh Trisha , Campbell-Richards Desirée , Vijayaraghavan Shanti , Collard Anna , Malik Farida , Griffin Mark , Morris Joanne , Claydon Anne , Macfarlane Fraser
Published: August 2010

Objective

No model of self-management education or peer support has yet achieved widespread reach and acceptability with minority ethnic groups. We sought to refine and test a new complex intervention in diabetes education: informal story-sharing groups facilitated by bilingual health advocates.

Methods

Pilot randomized trial with in-depth process evaluation in a socioeconomically deprived area. 157 people referred for diabetes education were randomized by concealed allocation to an intervention (storysharing group in their own language) or control (‘usual care’ self-management education, through an interpreter if necessary) arm. Story-sharing groups were held in five ethnic languages and English (for African Caribbeans), and ran fortnightly for six months. Primary outcome was UKPDS (UK Prospective Diabetes Study) risk score. Secondary outcomes included attendance, HbA1c, well-being and enablement. Process measures included ethnographic observation, and qualitative interviews with staff and patients.

Results

Some follow-up data were obtained on 87% of participants. There was no significant difference between intervention and control arms in biomedical outcomes. Attendance was 79% in the story-sharing arm and 35% in the control arm (p < 0.0001), and patient enablement scores were significantly higher (8.3 compared to 5.9, p < 0.005). The model was very popular with clinicians, managers and patients, which helped overcome numerous challenges to its successful embedding in a busy public sector diabetes service.

Conclusion

People from minority ethnic groups in a socioeconomically deprived area were keen to attend informal story-sharing groups and felt empowered by them, but clinical outcomes were no better than with conventional education. Further research is needed to maximize the potential and evaluate the place of this appealing service model before it is introduced as a part of mainstream diabetes services.
The portrait of Dr Edward Harrison MD (1766–1838)
Authors: Bovine D C Gary
Published: August 2010

The portrait of the London and Horncastle Physician Edward Harrison, painted and displayed in 1823, was editorially criticized by one of the medical journals of the time. After Harrison died the portrait remained in the family estate until 1938, after which it was presented to the National Gallery of Ireland. The image of Dr Harrison had never been displayed in any of his medical writings, nor in any other medical historical works, until 2008. This paper provides some history of the criticism of the portrait, similar to the historical vignette of the portraiture of William Harvey and outlines the detective work to track down the location of the portrait.
William Roentgen's (1845–1923) influence: contrasts and comparisons
Authors: Shreeve David R
Published: August 2010

William Roentgen's discovery of X-rays in 1895 influenced two students from Manchester who first met in 1899. They developed an interest in radiology of the gastrointestinal tract through which they maintained a long association. Sir Arthur Hurst, after qualifying in Oxford in 1904, became a renowned physician at Guy's Hospital, London, and founder of what was to become the British Society of Gastroenterology. Dr Alfred Barclay qualified in Cambridge in 1904 and subsequently became the first Consultant Radiologist in Manchester and doyen of gastrointestinal radiology. He moved to Cambridge in 1928 to sustain the DMRE course. In 1937 he was invited to join the Nuffield Institute of Medical Research in Oxford at an age when many would have considered retiring. In 1939 Hurst also returned to Oxford where he taught at the medical school and consulted at the Radcliffe Infirmary, bringing his path and Barclay's together once more.
The curious death of Constantine Samuel Rafinesque (1783–1840): the case for the maidenhair fern
Authors: Ambrose Charles T
Published: August 2010

Constantine Rafinesque, a French émigré to America in the early 19th century, was a forerunner of Charles Darwin and a zealous field naturalist who identified thousands of new species of plants and animals. His career was controversial in part because of his unfocused ambition to gain scientific recognition. In his later years he published in many areas apart from biology. His polymathic life ended in 1840 with his death (aged 57) from stomach cancer. In 1826 he had developed an illness he thought was consumption and which he believed was cured by a herbal mixture he devised. It may have contained one or more species of ferns related to one now known to induce human gastric carcinoma. Rafinesque's self-medication may have led to his death years later.
A scenario guideline for designing new teletreatments: a multidisciplinary approach
Authors: Huis in 't Veld Rianne MHA , Widya Ing A , Bults Richard GA , Sandsjö Leif , Hermens Hermie J , Vollenbroek-Hutten Miriam MR
Published: August 2010

Lack of user acceptance of telemedicine services is an important barrier to deployment and stresses the need for involving users, i.e. medical professionals. However, the involvement of users in the service development process of telemedicine services is difficult because of (a) the knowledge gap between the expertise of medical and technical experts; (b) the language gap, i.e. the use of different terminologies between the medical and the technical professions; and (c) the methodological gap in applying requirement methods to multidisciplinary scientific matters. We have developed a guideline in which the medical and technical domains meet. The guideline can be used to develop a scenario from which requirements can be elicited. In a retrospective analysis of a myofeedback-based teletreatment service, the technically-oriented People-Activities-Context-Technology (PACT) framework and medically-oriented principles of evidence-based medicine were incorporated into a guideline. The guideline was developed to construct the content of a scenario which describes the new teletreatment service. This allows the different stakeholders to come together and develop the service. Our approach provides an arena for different stakeholders to take part in the early stages of the design process. This should increase the chance of user acceptance and thus adoption of the service being developed.
The myofeedback-based teletreatment system and its evaluation
Authors: Bults Richard GA , Knoppel Daniël F , Widya Ing A , Schaake Leendert , Hermens Hermie J
Published: August 2010

The myofeedback-based teletreatment system allows patients to receive tactile and/or visual feedback on muscle activity and muscle relaxation times. Health-care professionals can analyse muscle activity and muscle relaxation times and provide guidance to the patient on the course of treatment. The system was evaluated in a small clinical trial. Qualitative data were obtained by interviews and visual inspection of graphical patient data during the trial. Quantitative data were based on post-trial data analysis. We used a revised version of the information systems success model to evaluate the teletreatment system, and focused on the success categories of system use and user satisfaction. The evaluation found good input data quality, system quality and information quality. Both system use and user satisfaction were good. Thus the teletreatment system appears suitable for small scale clinical deployment. However, the sensory components suffered from heavy use and embedded software problems which made them unreliable. Large scale deployment requires improvement in terms of durability and reliability of the system's sensors.
Clinical evaluation of a myofeedback-based teletreatment service applied in the workplace: a randomized controlled trial
Authors: Sandsjö Leif , Larsman Pernilla , Huis in 't Veld Rianne MHA , Vollenbroek-Hutten Miriam MR
Published: August 2010

We evaluated the clinical effects of a myofeedback-based teletreatment service in terms of pain, pain-related disability and work ability. We also investigated the time investment/savings of this treatment with respect to conventional care. Sixty-five women with neck and shoulder pain at work participated in the study. Thirty-three took part in the teletreatment and 32 participated in a control group which continued with conventional care. Questionnaires were completed before the start of the intervention (baseline) and at initial follow-up (T0) and 3 months (T3) after the intervention ended. A general linear model analysis for repeated measurements showed an improvement in terms of pain and work ability for both groups taken together, with no differences between them. Non-parametric tests showed an intervention effect in pain-related disability for both groups together and no differences between them when tested at baseline, T0 and T3. The time saved in relation to conventional care was mainly from reduced travel time, which was 41 min per teleconsultation. The teletreatment service allowed employees to take part in muscle relaxation training while performing their regular work. The clinical evaluation showed that the treatment was on par with conventional care, but without the effort and time loss associated with regular visits to the clinic. We conclude that the myofeedback-based teletreatment service has potential for addressing neck and shoulder symptoms at the workplace.
Prognostic factors for the effect of a myofeedback-based teletreatment service
Authors: Larsman Pernilla , Hasenbring Monika , Sandsjö Leif , Huis in 't Veld Rianne MHA , Witvrouw Erik , Kosterink Stephanie M , Kadefors Roland , Vollenbroek-Hutten Miriam MR
Published: August 2010

We investigated the potential prognostic factors for clinically relevant improvements in pain intensity and pain-related disability after myofeedback-based teletreatment. Sixty-five female computer users, 56 female patients with whiplash-associated disorders and 18 female patients with non-specific neck and shoulder pain participated in the study. They received myofeedback-based teletreatment or usual treatment. Questionnaires concerning prognostic factors, pain and disability were completed before the start of the intervention (baseline) and at follow-ups at the end of the intervention, and after 3 and 6 months. Logistic regression analyses were performed in order to investigate prognostic factors for clinically relevant improvement. In the intervention group, improvement in pain intensity was predicted by baseline pain intensity. Baseline pain intensity and disability, and fear-avoidance and endurance related pain coping responses were prognostic factors for outcome in pain-related disability in this group. There were few differences between the intervention groups; fear-avoidance coping responses influenced the outcome after teletreatment only. Myofeedback-based teletreatment appears to be an useful telemedicine intervention, especially for participants with moderate to high levels of pain and disability, high perceived help/hopelessness, and those who tend to deal with their pain by avoiding social and physical activities.
Functional elucidation of a key contact between tRNA and the large ribosomal subunit rRNA during decoding
Authors: Ortiz-Meoz Rodrigo F. , Green Rachel
Published: August 2010

The selection of cognate tRNAs during translation is specified by a kinetic discrimination mechanism driven by distinct structural states of the ribosome. While the biochemical steps that drive the tRNA selection process have been carefully documented, it remains unclear how recognition of matched codon:anticodon helices in the small subunit facilitate global rearrangements in the ribosome complex that efficiently promote tRNA decoding. Here we use an in vitro selection approach to isolate tRNATrp miscoding variants that exhibit a globally perturbed tRNA tertiary structure. Interestingly, the most substantial distortions are positioned in the elbow region of the tRNA that closely approaches helix 69 (H69) of the large ribosomal subunit. The importance of these specific interactions to tRNA selection is underscored by our kinetic analysis of both tRNA and rRNA variants that perturb the integrity of this interaction.
How will surgical site infection be measured to ensure “high quality care for all”?
Authors: Ashby E. , Haddad F. S. , O’Donnell E. , Wilson A. P. R.
Published: August 2010

As of April 2010 all NHS institutions in the United Kingdom are required to publish data on surgical site infection, but the method for collecting this has not been decided. We examined 7448 trauma and orthopaedic surgical wounds made in patients staying for at least two nights between 2000 and 2008 at our institution and calculated the rate of surgical site infection using three definitions: the US Centers for Disease Control, the United Kingdom Nosocomial Infection National Surveillance Scheme and the ASEPSIS system. On the same series of wounds, the infection rate with outpatient follow-up according to Centre for Disease Control was 15.45%, according to the UK Nosocomial infection surveillance was 11.32%, and according to ASEPSIS was 8.79%. These figures highlight the necessity for all institutions to use the same method for diagnosing surgical site infection.

If different methods are used, direct comparisons will be invalid and published rates of infection will be misleading.
Internal rotational error of the tibial component is a major cause of pain after total knee replacement
Authors: Nicoll D. , Rowley D. I.
Published: August 2010

This study used CT analysis to determine the rotational alignment of 39 painful and 26 painless fixed-bearing total knee replacements (TKRs) from a cohort of 740 NexGen Legacy posterior-stabilised and cruciate-retaining prostheses implanted between May 1996 and August 2003.

The mean rotation of the tibial component was 4.3° of internal rotation (25.4° internal to 13.9° external rotation) in the painful group and 2.2° of external rotation (8.5° internal to 18.2° external rotation) in the painfree group (p = 0.024). In the painful group 17 tibial components were internally rotated more than 9° compared with none in the painfree group (p < 0.001). Additionally, six femoral components in the painful group were internally rotated more than 6° compared with none in the painfree group (p = 0.017). External rotational errors were not found to be associated with pain.

Overall, 22 (56.4%) of the painful TKRs had internal rotational errors involving the femoral, the tibial or both components. It is estimated that at least 4.6% of all our TKRs have been implanted with significant internal rotational errors.
Extensor hallucis longus transfer as an alternative to split transfer of the tibialis anterior tendon to correct equinovarus foot in hemiplegic patients without overactivity of tibialis anterior
Authors: Carda S. , Molteni F. , Bertoni M. , Zerbinati P. , Invernizzi M. , Cisari C.
Published: August 2010

This study assessed if transfer of the extensor hallucis longus is a valid alternative treatment to split transfer of the tibialis anterior tendon in adult hemiplegic patients without overactivity of the tibialis anterior.

One group of 15 patients had overactivity of tibialis anterior in the swing phase, and underwent the split transfer. A further group of 14 patients had no overactivity of tibialis anterior, and underwent transfer of extensor hallucis longus. All patients had lengthening of the tendo Achillis and tenotomies of the toe flexors. All were evaluated clinically and by three-dimensional gait analysis pre- and at one year after surgery. At this time both groups showed significant reduction of disability in walking. Gait speed, stride length and paretic propulsion had improved significantly in both groups. Dorsiflexion in the swing phase, the step length of the healthy limb and the step width improved in both groups, but only reached statistical significance in the patients with transfer of the extensor hallucis longus. There were no differences between the groups at one year after operation.

When combined with lengthening of the tendo Achillis, transfer of the extensor hallucis longus can be a valid alternative to split transfer of the tibialis anterior tendon to correct equinovarus foot deformity in patients without overactivity of tibialis anterior.
A prospective comparative study of kyphoplasty using the Jack vertebral dilator and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures
Authors: Shen G. W. , Wu N. Q. , Zhang N. , Jin Z. S. , Xu J. , Yin G. Y.
Published: August 2010

This study prospectively compared the efficacy of kyphoplasty using a Jack vertebral dilator and balloon kyphoplasty to treat osteoporotic compression fractures between T10 and L5. Between 2004 and 2009, two groups of 55 patients each underwent vertebral dilator kyphoplasty and balloon kyphoplasty, respectively. Pain, function, the Cobb angle, and the anterior and middle height of the vertebral body were assessed before and after operation. Leakage of bone cement was recorded. The post-operative change in the Cobb angle was significantly greater in the dilator kyphoplasty group than in the balloon kyphoplasty group (−9.51° (sd 2.56) vs −7.78° (sd 1.19), p < 0.001)). Leakage of cement was less in the dilator kyphoplasty group. No other significant differences were found in the two groups after operation, and both procedures gave equally satisfactory results in terms of all other variables assessed. No serious complications occurred in either group.

These findings suggest that vertebral dilator kyphoplasty can facilitate better correction of kyphotic deformity and may ultimately be a safer procedure in reducing leakage of bone cement.
Anatomy of piriformis, obturator internus and obturator externus
Authors: Solomon L. B. , Lee Y. C. , Callary S. A. , Beck M. , Howie D. W.
Published: August 2010

We dissected 20 cadaver hips in order to investigate the anatomy and excursion of the trochanteric muscles in relation to the posterior approach for total hip replacement. String models of each muscle were created and their excursion measured while the femur was moved between its anatomical position and the dislocated position. The position of the hip was determined by computer navigation.

In contrast to previous studies which showed a separate insertion of piriformis and obturator internus, our findings indicated that piriformis inserted onto the superior and anterior margins of the greater trochanter through a conjoint tendon with obturator internus, and had connections to gluteus medius posteriorly. Division of these connections allowed lateral mobilisation of gluteus medius with minimal retraction. Analysis of the excursion of these muscles revealed that positioning the thigh for preparation of the femur through this approach elongated piriformis to a maximum of 182%, obturator internus to 185% and obturator externus to 220% of their resting lengths, which are above the thresholds for rupture of these muscles.

Our findings suggested that gluteus medius may be protected from overstretching by release of its connection with the conjoint tendon. In addition, failure to detach piriformis or the obturators during a posterior approach for total hip replacement could potentially produce damage to these muscles because of over-stretching, obturator externus being the most vulnerable.
Revision interposition arthroplasty of the elbow
Authors: Larson A. N. , Adams R. A. , Morrey B. F.
Published: August 2010

Between 1996 and 2008, nine patients with severe post-traumatic arthritis underwent revision of a failed interposition arthroplasty of the elbow with a further interposition procedure using an allograft of tendo Achillis at a mean of 5.6 years (0.7 to 13.1) after the initial procedure. There were eight men and one woman with a mean age of 47 years (36 to 56).

The mean follow-up was 4.7 years (2 to 8). The mean Mayo Elbow Performance score improved from 49 (15 to 65) pre-operatively to 73 (55 to 95) (p = 0.04). The mean Disability of the Arm, Shoulder and Hand score was 26 (7 to 42). One patient was unavailable for clinical follow-up and one underwent total elbow replacement three months post-operatively. Of the remaining patients, one had an excellent, two had good, three fair and one a poor result. Subjectively, five of the nine patients were satisfied. Four continued manual labour.

Revision interposition arthroplasty is an option for young, active patients with severe post-traumatic arthritis who require both mobility and durability of the elbow.
Septic arthritis or transient synovitis of the hip in children
Authors: Sultan J. , Hughes P. J.
Published: August 2010

The crucial differentiation between septic arthritis and transient synovitis of the hip in children can be difficult. In 1999, Kocher et al introduced four clinical predictors which were highly predictive (99.6%) of septic arthritis. These included fever (temperature ≥ 38.5°C), inability to bear weight, white blood-cell count > 12.0 × 109 cells/L and ESR ≥ 40 mm/hr; CRP ≥ 20 mg/L was later added as a fifth predictor. We retrospectively evaluated these predictors to differentiate septic arthritis from transient synovitis of the hip in children over a four-year period in a primary referral general hospital. When all five were positive, the predicted probability of septic arthritis in this study was only 59.9%, with fever being the best predictor. When applied to low-prevalence diseases, even highly specific tests yield a high number of false positives and the predictive value is thereby diminished.

Clinical predictors should be applied with caution when assessing a child with an irritable hip, and a high index of suspicion, and close observation of patients at risk should be maintained.
Predicting dissatisfaction following total knee replacement
Authors: Scott C. E. H. , Howie C. R. , MacDonald D. , Biant L. C.
Published: August 2010

Up to 20% of patients are not satisfied with the outcome following total knee replacement (TKR). This study investigated the pre- and post-operative predictors of dissatisfaction in a large cohort of patients undergoing TKR. We assessed 1217 consecutive patients between 2006 and 2008 both before operation and six months after, using the Short-form (SF)-12 health questionnaire and the Oxford Knee Score. Detailed information concerning comorbidity was also gathered. Satisfaction was measured at one year when 18.6% (226 of 1217) of patients were unsure or dissatisfied with their replacement and 81.4% (911 of 1217) were satisfied or very satisfied. Multivariate regression analysis was performed to identify independent predictors of dissatisfaction. Significant (p < 0.001) predictors at one year included the pre-operative SF-12 mental component score, depression and pain in other joints, the six-month SF-12 score and poorer improvement in the pain element of the Oxford Knee Score.

Patient expectations were highly correlated with satisfaction. Satisfaction following TKR is multifactorial. Managing the expectations and mental health of the patients may reduce dissatisfaction. However, the most significant predictor of dissatisfaction is a painful total knee replacement.
Electrocautery of the patellar rim in primary total knee replacement: beneficial or unnecessary?
Authors: Gupta S. , Augustine A. , Horey L. , Meek R. M. D. , Hullin M. G. , Mohammed A.
Published: August 2010

The management of the patella during total knee replacement is controversial. In some studies the absence of patellar resurfacing results in residual anterior knee pain in over 10% of patients. One form of treatment which may be used in an endeavour to reduce this is circumferential patellar rim electrocautery. This is believed to partially denervate the patella. However, there is no evidence of the efficacy of this procedure, nor do we know if it results in harm.

A retrospective comparative cohort study was performed of 192 patients who had undergone a primary total knee replacement with the porous coated Low Contact Stress rotating platform prosthesis without patellar resurfacing between 2003 and 2007. In 98 patients circumferential electrocautery of the patellar rim was performed and in 94 patients it was not. The two groups were matched for gender and age. The general Oxford Knee Score and the more specific patellar score for anterior knee pain were used to assess patient outcomes a minimum of two years post-operatively.

No statistically significant differences were noted between the groups for either scoring system (p = 0.41 and p = 0.87, respectively). Electrocautery of the patella rim did not improve the outcome scores after primary total knee replacement in our patients.
Mid-term results of a custom-made short proximal loading femoral component
Authors: Santori F. S. , Santori N.
Published: August 2010

Bone preservation and physiological distribution of forces on the proximal femur are key elements in introducing a successful uncemented total hip replacement. In order to achieve this, in the mid 1990s, we developed an ultra short proximal loading custom-made component with a lateral flare, a high femoral neck osteotomy and without a diaphyseal stem.

We report the outcome of 129 custom-made hydroxyapatite-coated uncemented short femoral components inserted into 109 patients between June 1995 and May 2004. The mean age of the patients was 51 years (21 to 71) and the mean follow-up was eight years (4.9 to 14.1). Bone behaviour around the implant was studied on the post-operative radiographs. The mean Harris hip score improved from 44 (8 to 66) pre-operatively to 95 (76 to 100) at final follow-up. The Western Ontario MacMaster University Osteoarthritis index was 93 of 100 at final review. None of the patients reported thigh pain. A total of five hips were revised, three for polyethylene liner exchange and two for complete revision of the acetabular component. No femoral components were revised. The radiological changes in the proximal femur were generally good, as evidenced by spot welds both on the medial and lateral aspects of the femur. No component migrated. The presence of a lateral flare and use of a high osteotomy of the femoral neck provided good clinical and radiological results. The absence of a diaphyseal portion of the stem did not impair stability.
A review of the use of common antiplatelet agents in orthopaedic practice
Authors: Dineen P. F. , Curtin R. J. , Harty J. A.
Published: August 2010

Antiplatelet agents are widely prescribed for the primary and secondary prevention of cardiovascular events. A common clinical problem facing orthopaedic and trauma surgeons is how to manage patients receiving these agents who require surgery, either electively or following trauma. The dilemma is to balance the risk of increased blood loss if the antiplatelet agents are continued peri-operatively against the risk of coronary artery/stent thrombosis and/or other vascular event if the drugs are stopped. The traditional approach of stopping these medications up to two weeks before surgery appears to pose significant danger to patients and may require review.

This paper covers the important aspects regarding the two most commonly prescribed antiplatelet agents, aspirin and clopidogrel.
Statistical power in testing a hypothesis
Authors: Petrie A.
Published: August 2010

In comparing or assessing methods of treatment it is vital that the appropriate number of patients is selected in order to ensure that the conclusions drawn are statistically viable. This annotation describes the relevance of a statistical power analysis in the context of hypothesis testing to the determination of the optimal sample size of a study. The power of the test indicates how likely it is that the test will correctly produce a statistically significant result.
Recognising anaemia and malnutrition in vascular patients with critical limb ischaemia
Authors: Shah M , Martin A , Myers B , MacSweeney S , Richards T
Published: August 2010

INTRODUCTION

Anaemia is a common problem in surgical patients. Patients with critical limb ischaemia (CLI) suffer chronic inflammation, repeated infection, require intervention, and can have a protracted hospital stay. The aims of this study were to assess anaemia and nutritional status in patients presenting with CLI.

PATIENTS AND METHODS

Two observational studies were undertaken, initially a retrospective series of 27 patients with CLI. Patient demographics, clinical details, transfusion status and in-patient laboratory haemoglobin values (Hb) were recorded. In a prospective series of 32 patients, laboratory markers to identify the cause for anaemia were assessed. Further nutritional status was assessed by records of height, weight, body mass index and a validated scoring system.

RESULTS

In the retrospective series, 15 patients (56%) were anaemic. Ten (37%) were transfused a median of 2 units (range, 2–13), a total of 35 units. Patients who were transfused had lower Hb on admission (P = 0.0019), most were anaemic on admission (90%). At discharge, most patients were anaemic (n = 23; 83%). In the prospective series of 32 patients, 20 (63%) were anaemic. Nutritional assessment was performed on 18, only seven patients were scored undernourished. This was increased to 23 by an independent assessor. Anaemia was associated with malnutrition (n = 17; P = 0.049) and an increased hospital stay (mean 25 days [SD 16] vs mean 12 days [SD 8], P = 0.0125; total 513 vs 144 bed days).

CONCLUSIONS

Anaemia and poor nutrition are common and not recognised in vascular patients presenting with critical limb ischaemia. Anaemia is associated with and increased length of hospital stay.
Internal or external wall diameter for abdominal aortic aneurysm screening?
Authors: Thapar A , Cheal D , Hopkins T , Ward S , Shaloub J , Yusuf SW
Published: August 2010

INTRODUCTION

The national abdominal aortic aneurysm (AAA) screening programme measures internal wall diameter; however, UK intervention criteria use external wall diameter. Our aim was to determine the clinical significance of the difference between these two measurements.

PATIENTS AND METHODS

Fifty patients on an aneurysm surveillance programme were ultrasound scanned by two experienced vascular scientists, blinded to the other's results. Maximum anteroposterior internal wall and maximum anteroposterior external wall diameters were measured.

RESULTS

The median difference between internal and external diameter was 6 mm (IQR 6–7) for scientist 1 and 7 mm (IQR 5–8) for scientist 2. This was statistically significant (P < 0.0002). External wall diameter displayed less interobserver variability m vs 6 mm).

CONCLUSIONS

Screening measurements underestimate aneurysm size by 6 mm and display greater variability in comparison external wall measurements. These findings should be understood to prevent a delay in the detection and treatment of AAAs.
Nicorandil ulcer: moves beyond the mucosa
Authors: Patel Girish K , Harding Keith G
Published: August 2010

The management of wounds is a specialty in its infancy. Success requires more than the use of dressings. All wounds require a diagnosis, a point well illustrated by the management of these cases which depended solely on stopping nicorandil.
Healthcare associated infection: novel strategies and antimicrobial implants to prevent surgical site infection
Authors: Leaper David , McBain Andrew J , Kramer Axel , Assadian Ojan , Sanchez Jose Luis Alfonso , Lumio Jukka , Kiernan Martin
Published: August 2010

This report is based on a Hygienist Panel Meeting held at St Anne's Manor, Wokingham on 24–25 June 2009. The panel agreed that greater use should be made of antiseptics to reduce reliance on antibiotics with their associated risk of antibiotic resistance. When choosing an antiseptic for clinical use, the Biocompatibility Index, which considers both the microbiocidal activity and any cytotoxic effects of an antiseptic agent, was considered to be a useful tool. The need for longer and more proactive post-discharge surveillance of surgical patients was also agreed to be a priority, especially given the current growth of day-case surgery. The introduction of surgical safety checklists, such as the World Health Organization's Safe Surgery Saves Lives initiative, is a useful contribution to improving safety and prevention of SSIs and should be used universally. Considering sutures as ‘implants’, with a hard or non-shedding surface to which micro-organisms can form biofilm and cause surgical site infections, was felt to be a useful concept.