bluuebunny/crossref_metadata_2025 huggingface dataset:
Apomorphine for Motor Fluctuations and Freezing in Parkinson's Disease
Authors: Corboy Dannielle L. , Wagner Mary L. , Sage Jacob I.
Published: January 2017

Objective:

To review the pharmacokinetics and use of apomorphine in patients with Parkinson's disease; to report a case of beneficial outcome with apomorphine in a patient with Parkinson's disease with severe levodopa “on-off” fluctuations and freezing; and to outline the types of patients or situations where apomorphine may be useful.

Data Sources:

Case reports, review articles, and relevant clinical studies identified by a MEDLINE search of the English-language literature published between 1975 and October 1994.

Study Selection:

Because all but 2 reports were of open-label design with small sample sizes, all studies identified were evaluated.

Data Extraction:

The following data were extracted from each study: apomorphine treatment duration, dosing, onset, duration, and adverse effects. The following efficacy variables were extracted: percent decrease in off periods, improvement in parkinsonian symptoms, and percent decrease in levodopa dosage.

Data Synthesis:

Efficacy of apomorphine following subcutaneous, rectal, sublingual, and intranasal dosage forms are evaluated. We also describe the use of apomorphine in a patient with Parkinson's disease who experienced on-off fluctuations and freezing. Based on these reports, recommendations for patient selection, product selection, and apomorphine dosing guidelines are presented.

Conclusions:

Apomorphine decreases off time, freezing, and levodopa requirements in patients with Parkinson's disease. It can be administered via a number of different nonoral routes; however, subcutaneous apomorphine is the most extensively studied. Rectal, sublingual, and intranasal routes also have been shown to provide benefit in motor fluctuations, but differ from the subcutaneous route in onset of action, duration of effect, and adverse effect profile.
Comparison of Tobramycin Pharmacokinetics After Administration by Cris and a Traditional Intravenous Piggyback Infusion
Authors: Mauro Vincent F , Jacobs Lori R , Mauro Laurie S , MacArthur Rodger D , White Donald B
Published: January 2017

Objective:

To compare the administration pharmacokinetics of a 30-minute intravenous piggyback (ivpb) infusion of tobramycin with those of controlled-release infusion system (CRIS) using a 20-mL vial at rates of 60 and 120 mL/h.

Design:

Randomized, controlled, crossover, prospective, open-label trial.

Setting:

Medical college-affiliated hospital.

Participants:

Eight healthy volunteer men between the ages of 22 and 24 years weighing between 60 and 90 kg.

Interventions:

Volunteers received, in random order, tobramycin sulfate 2 mg/kg iv on 3 occasions separated by 1 week. The drug was administered using a 50-mL ivpb infusion at 100 mL/h for 30 minutes, and with the CRIS using a 20-mL vial with flow rates of 60 mL/h for 1 hour (slow) and 120 mL/h for 1 hour (fast).

Main Outcome Measures:

Primary endpoints were area under the time–concentration curve (AUC), time to reach maximum concentration (tmax), and maximum concentration (Cmax). Secondary endpoints were elimination rate constant (ke), clearance (Cl), and half-life (t1/2).

Results:

Six volunteers successfully completed the trial. The tmax values observed following fast CRIS and ivpb were 28 ± 8 and 32 ± 4 minutes, respectively, and not significantly different from each other. Both occurred significantly earlier than the tmax associated with slow CRIS (44 ± 7 min). The Cmax values observed following ivpb (11.2 ± 1.5 mg/L) and slow CRIS (10.9 ± 0.9 mg/L) administration were not significantly different from each other, but both were significantly lower than that of fast CRIS (13.4 ± 1.5 mg/L). The AUCs of slow and fast CRIS were 29.8 ± 4.8 and 31.2 ± 3.8 mg/L•h, respectively, and were not significantly different from each other. The AUC of fast CRIS was significantly greater than that observed with ivpb (27.4 ± 4.3 mg/L•h). No significant difference in ke (fast CRIS 0.32 ± 0.03 h-1; slow CRIS 0.33 ± 0.04 h-1; ivpb 0.34 ± 0.0 h-1) was observed among any of the methods.

Conclusions:

CRIS administration of tobramycin resulted in higher AUCs than did ivpb administration. Compared with ivpb, fast CRIS resulted in a higher Cmax, but the tmax values of fast CRIS and ivpb administration were not statistically different. Compared with ivpb, slow CRIS resulted in a more delayed tmax, but the Cmax values of slow CRIS and ivpb were not statistically different.
Gaucher's Disease: A Review
Authors: Morales Laura E
Published: January 2017

OBJECTIVE:

To review the epidemiology, pathophysiology, clinical features, diagnosis, and treatment of Gaucher's disease, focusing on the role of enzyme replacement therapy.

DATA SOURCES:

a MEDLINE search (from 1984 to July 1995) of English-language literature pertaining to the treatment of Gaucher's disease was performed. Additional references were obtained by reviewing the references of pertinent articles identified through the search. Tertiary sources were also used.

STUDY SELECTION AND DATA EXTRACTION:

Articles with information on enzyme treatment were selected for review. Articles containing other interesting aspects of the disease or its treatment were also included.

DATA SYNTHESIS:

Gaucher's disease is the most common lipid storage disorder known and results from a genetic deficiency of the enzyme glucocerebrosidase (glucosylceramidase). Enzyme deficiency results in accumulation of glucocerebroside within the reticuloendothelial system. If may present with hepatosplenomegaly, bone marrow suppression, and bone lesions. The most common of the three subtypes, type 1, is non-neuronopathic. In the rare neuronopathic subtypes, type 2 or 3, there may also be nerve cell destruction within the central nervous system with acute brainstem dysfunction or progressive neurologic deterioration, respectively. In 1991, enzyme treatment became available with the marketing of alglucerase, a placentally derived modified form of glucocerebrosidase. In 1994, a recombinant DNA modified form of glucocerebrosidase, known as imiglucerase, was developed to replace alglucerase. Most published data on enzyme therapy are with alglucerase in patients with type 1 disease. A dosage regimen of 60 units/kg every 2 weeks for moderately to severely ill patients has been effective in reducing hepatosplenomegaly, improving anemia and thrombocytopenia, as well as improving weight gain and growth in children and increasing vigor and self-esteem in adults. Bone involvement is often slow to respond to therapy although pain is frequently improved. Controversy exists as to whether lower dosage regimens are as effective. The role of enzyme therapy in the rarer neuronopathic subtypes remains to be determined, but initial reports have been disappointing.

CONCLUSIONS:

Enzyme replacement therapy is available for the treatment of type 1 Gaucher's disease, resulting in clinical improvement with enhanced quality of life within the first year of treatment, although improvement in bone disease can take longer. Doses of 60 units/kg every 2 weeks are of clinical benefit to patients with moderate to severe disease. A number of lower dosage regimens have been evaluated in small groups of patients, with satisfactory clinical responses occurring in some of these patients.
Rhabdomyolysis Induced by Epsilon-Aminocaproic Acid
Authors: Seymour Beverly D , Rubinger Morel
Published: January 2017

OBJECTIVE:

To report a case of rhabdomyolysis associated with epsilon-aminocaproic acid (epsilon-ACA).

CASE SUMMARY:

A 33-year-old female patient with chronic granulocytic leukemia was treated with epsilon-ACA for approximately 3.5 months for thrombocytopenic bleeding. The initial dosage was 4 g po q6h. One month after an increase in dosage to 5 g po q4h the patient developed severe lower extremity myalgia and marked weakness. Laboratory investigations revealed an elevated creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and myoglobinemia. Epsilon-ACA was thought to be the causative agent and was discontinued. The patient received intravenous fluids to minimize renal damage due to myoglobin. Serum enzyme concentrations did not return to normal. The patient died of a central nervous system hemorrhage 1 week after the epsilon-ACA was discontinued.

DISCUSSION:

There were 31 cases of epsilon-ACA-induced myopathies published in the literature (MEDLINE) from 1972 to June 1995. Of these, 10 cases were reviewed. In all cases, patients received epsilon-ACA in doses ranging from 16 to 36 g/d for more than 28 days. Clinical findings varied from extreme muscle weakness to myopathic changes in electromyelograms. All patients recovered following discontinuation of epsilon-ACA.

CONCLUSIONS:

Long-term therapy with high-dose epsilon-ACA may produce muscle weakness or rhabdomyolysis. Patients who require long-term, high-dose epsilon-ACA therapy should be monitored for myoglobinuria and changes in serum CK, LDH, and AST, for myoglobinemia, for decreases in muscle strength, and/or for myalgia. Significant changes in these parameters compared with baseline values should suggest a need to discontinue epsilon-ACA therapy.
Painful Idiopathic Rigid Flatfoot in Children and Adolescents
Authors: Luhmann Scott J. , Rich Margaret M. , Schoenecker Perry L.
Published: January 2017

Nine patients (13 feet) were identified whose primary complaints were of atraumatic-onset, chronic pain in the hindfoot exacerbated with increased activity and who had the diagnosis of idiopathic rigid flatfeet. Eight of 11 were greater than the 95th percentile in weight for their age. Exam under anesthesia showed moderate to significant improvement in hindfoot motion in 9 feet; 4 feet required fractional peroneal lengthenings. Only 5 of 11 patients have had sustained relief of pain and report unlimited activity level.

Children and adolescents with painful idiopathic rigid flatfeet without known causation can have significant, persistent, disability and do not uniformly respond well to traditionally-described nonoperative interventions.
Correction of Ankle and Hindfoot Deformities by Supramalleolar Osteotomy
Authors: Sen Cengiz , Kocaoglu Mehmet , Eralp Levent , Cinar Murat
Published: January 2017

Ankle and hindfoot deformities in 11 patients with a mean age of 15 (range, four to 35) have been gradually corrected by an Ilizarov external fixator. In all patients, supramalleolar osteotomy was utilized by percutaneous drilling and osteotomy technique. The patients were evaluated clinically by the AOFAS scoring system and radiologically by malorientation and malalignment tests described by Paley. The purpose of the current study is to evaluate the efficacy of supramalleolar osteotomy and correction by an Ilizarov device in treating hindfoot and ankle deformities.

The mean external fixation period was five (2.5 to eight) months. The mean interval between the operation and last follow-up examination was 19 (13 to 26) months. The patients improved an average of 30 points after the operation regarding to AOFAS score. A plantigrade foot was achieved in the whole group. Radiologically, no malalignment or malorientation was measured. Equal leg lengths were achieved in all nine patients with one exception. Complications were graded after Paley as minor problems in 11 patients and as obstacles requiring surgical interventions in four patients. Sequelae remained in only one patient.

Ankle and hindfoot deformities caused by various etiologies are complicated by poor soft tissue condition and a short foot. A supramalleolar osteotomy and Ilizarov external fixator can safely and effectively correct these deformities.
Flexor Hallucis Longus Transfer for Repair of Chronic Achilles Tendinopathy
Authors: Tashjian Robert Z. , Hur John , Sullivan Raymond J. , Campbell John T. , DiGiovanni Christopher W.
Published: January 2017

Background:

The flexor hallucis longus (FHL) tendon has been used to augment the repairs for chronic Achilles tendinopathy. Two common methods of FHL harvesting include a single incision (posterior) technique and a double incision (posterior and medial utility) technique. This cadaver study was designed to measure and compare the lengths of FHL tendon obtainable for reconstruction with each technique.

Methods:

Fourteen fresh-frozen cadaver lower limbs were utilized for FHL harvest. The tendon was first exposed through the single posterior-medial incision approach adjacent to the Achilles. A second medial utility midfoot incision was then made and the FHL was marked at the level of Henry's knot with a suture, to approximate the level of potential harvest via a two-incision technique. The FHL was then harvested and delivered into the posterior wound. Single incision technique graft length was then measured from the tip of the calcaneal tuber to the level of transection. The remaining in situ tendon was then also measured between its level of transection and the more distal suture placed at Henry's knot. These two lengths were then combined to determine the total potential tendon graft length obtainable using a double incision technique.

Results:

The average length of the FHL tendon harvested through the single posterior incision technique measured 5.16 cm (range, 3.4–6.9 cm, SD = 1.29). The average total tendon graft length available using the double incision technique measured 8.09 cm (range, 5.1–11.1 cm, SD = 1.63). The difference between the lengths obtained from these two techniques was significant ( p < .001).

Conclusions:

These results demonstrate approximate FHL graft lengths obtainable by using either a single or double incision harvest technique and show that a significantly longer graft can be obtained using a double incision technique. Further data need to be obtained, however, to support whether the extra surgery and graft length obtained from a double incision technique are of any benefit in improving the ultimate functional outcome of these repairs.
A Feasibility Trial of a Prefabricated Immediate Postoperative Prosthetic Limb System
Authors: Pinzur Michael S. , Angelico John
Published: January 2017

In this feasibility trial, 32 consecutive patients undergoing transtibial or knee disarticulation amputation had application of a prefabricated immediate postoperative prosthesis in the operating room following lower extremity amputation. Partial weightbearing was initiated on the first postoperative day. Twenty-nine underwent primary amputation as a consequence of nonsalvageable gangrene or diabetic foot infection. Others were performed at the time of wound closure following traumatic amputation for a crushed extremity and one was performed for an infected nonunion of the tibia and fibula. Seventeen of the 29 patients with diabetes were insulin dependent. Nine patients required renal dialysis and were diagnosed with concurrent malnutrition. Twenty were male and 12 were female, with an average age of 61.6 (range, 42–90) years. The average time to custom prosthetic limb fitting was 8.1 (range, 4–16) weeks. This preliminary experience with a commercially available pneumatic immediate postoperative prosthetic limb system supports its role in the early rehabilitation of lower extremity amputees.
Giant Cell Tumor of the Tendon Sheath of the Toe Imitating Macrodactyly: Case Report
Authors: Skaliczki Gábor , Mády Ferenc
Published: January 2017

The authors present a case of giant cell tumor of the tendon sheath (GCTTS) imitating macrodactyly macroscopically. They give an overview of the differential diagnosis of macrodactyly, the behavior of GCTTS, its most frequent localizations, the scope of surgical procedures available in cases of the disproportionate enlargement of a digit, and also of earlier GCTTS cases recorded in the files of the Orthopedic Clinic of the Semmelweis University.
Kinematic Changes After Fusion and Total Replacement of the Ankle Part 2: Movement Transfer
Authors: Valderrabano Victor , Hintermann Beat , Nigg Benno M. , Stefanyshyn Darren , Stergiou Pro
Published: January 2017

Introduction: The purpose of this in vitro study was to determine the biomechanical characteristics of the ankle based on the movement transfer between foot and leg before and after ankle arthrodesis, and after implantation of three currently used total ankle prostheses. Methods: A 6-df device with an axial load of 200 N and a four-camera high-speed video system were used for the measurement of the range of motion in six fresh-frozen cadaveric leg specimens. While the foot was moved through the range of dorsiflexion/plantarflexion, the resulting foot eversion/inversion and tibial rotation were recorded. Analogously, the resulting foot eversion/inversion from tibial rotation and, vice versa, the resulting tibial rotation from foot eversion/inversion were determined. The same measurements were performed for the normal ankle, the fused ankle, and after total ankle replacement by the AGILITY, HINTEGRA, and S.T.A.R. prostheses. Results: While in dorsiflexion/plantarflexion of the foot, ankle joint fusion increased the movement transfer to tibial rotation by a 2.4 factor and to eversion/inversion by a 18.5 factor, whereas, this movement transfer did not change for all prostheses conditions. The movement transfer between foot eversion and tibial rotation was found to decrease for all ankle prostheses, but more in the AGILITY and S.T.A.R. prosthesis than in the HINTEGRA. Conclusions: The three tested ankle joint prostheses changed the movement transferred within the ankle joint complex less than ankle fusion did, especially for dorsiflexion/plantarflexion movement of the foot. The closer the design was to the normal anatomy of the ankle, the closer the transfer of movement was shown to be replicated with respect to normal joint. It is suggested that success of total ankle arthroplasty depends on how successfully designs can mimic the movement transfer of the normal ankle, while dissipating the rotational forces and maintaining the stability of the joint.
The Effects of Total Contact Casting Materials on Plantar Pressures
Authors: Hartsell Heather D. , Brand Richard A. , Frantz Rita A. , Charles L. Saltzman
Published: January 2017

The plaster-based total contact cast (TCC) is effective at reducing high plantar pressures associated with foot ulceration in the patient with diabetes. However, the weight and the lengthy drying time which require nonweightbearing create an inconvenience for the patient. Fiberglass has been commonly used as a substitute for plaster due to the quicker drying time, although little is known about the effects of fiberglass on plantar pressures. The purpose of the study was to compare a plaster-based TCC (PB-TCC) and an all-fiberglass TCC (AF-TCC) using selected plantar pressure parameters for commonly ulcerated regions of the foot. Using a repeated measures design, 10 healthy subjects consented to walk, for four consecutive trials, along a 25-m corridor while wearing a running shoe, PB-TCC, and AF-TCC. For each of the footwear conditions, parameters of peak pressure, pressure–time integral, and contact time for the forefoot, lateral midfoot, and heel regions were recorded using the Pedar™ system of plantar pressure measurement. Both the PB-TCC and AF-TCC produced similar peak plantar pressures that were significantly lower ( p = .001) than the running shoe. Pressure–time integrals were similar for all footwear conditions and contact time was not altered with footwear type. In summary, the AF-TCC appears to be an effective alternative to the PB-TCC for plantar pressure reduction in the management of neuropathic foot ulceration.
Preliminary Gait Analysis Results After Posterior Tibial Tendon Reconstruction: A Prospective Study
Authors: Brodsky James W. , Zubak Joseph J. , Pollo Fabian E. , Baum Brian S.
Published: January 2017

The purpose of this study was to investigate the effect on gait in patients who underwent reconstruction for stage II posterior tibial tendon (PTT) dysfunction. Twelve patients with stage II PTT dysfunction underwent surgical reconstruction consisting of debridement of the posterior tibial tendon, flexor digitorum longus tendon transfer to the navicular tuberosity, medial displacement calcaneal osteotomy, and spring ligament reconstruction. Midfoot arthrodesis was performed in six patients and gastrocnemius recession in three. Gait analysis was performed 2 weeks prior to surgery and 1 year postoperatively. Preoperative and postoperative data were compared to determine differences in temporal-spatial parameters, lower limb kinematics, and ankle push-off power. Step length for the operated side increased from 52.6 ± 9.6 cm before the surgery to 57.5 ± 7.1 cm after the surgery ( p = .048). Cadence improved from 100.2 ± 10.7 steps/min to 109.1 ± 8.5 steps/min ( p = .05), thus increasing velocity from 87.6 ± 22.6 cm/s to 103.4 ± 15.9 cm/s ( p = .042). Single support percentage was unchanged. Maximum sagittal ankle joint power at push-off increased from 0.79 ± 0.35 W before surgery to 1.2 ± 0.5 W after surgery ( p = .042). There were statistically significant improvements in all radiographic parameters studied. This is the first prospective study to evaluate the in vivo effects on gait in patients undergoing this common surgical procedure. Analysis demonstrated statistically significant improvement in kinetic and kinematic parameters of gait function.
Health Related Quality of Life, Cognitive Function, and Depression in Diabetic Patients With Foot Ulcer or Amputation. A Preliminary Study
Authors: Willrich Amanda , Pinzur Michael , McNeil Misty , Juknelis Danaius , Lavery Lawrence
Published: January 2017

Background: Diabetic foot ulcers, foot infection, Charcot foot arthropathy, and lower extremity amputation have a severe negative effect on the health-related quality of life in individuals with diabetes. The purpose of this study was to determine if there is a relationship between these negative effects and cognitive impairment or clinical depression. Methods: Sixty adults with diabetes completed the Short Form 36 (SF-36) Health Survey questionnaire, two screening examinations for cognitive function (Mini Mental Exam and Clock-Drawing Test), and a screening examination for depression (Zung Self-Rating Depression Scale). The two focus groups were composed of 20 subjects each who were undergoing treatment for (1) diabetic foot ulcers or active Charcot foot arthropathy or (2) lower extremity amputation. Twenty diabetic individuals without foot-related morbidity but with evidence of peripheral neuropathy as measured by insensitivity to the Semmes-Weinstein 5.07 (10 gm) monofilament comprised the control group. Results: The SF-36 Health Survey score was significantly impaired in both the diabetic foot ulcer and Charcot arthropathy group ( p < 0.001) and amputee ( p < 0.000) group. There was no evidence of cognitive impairment or depression in either group. The negative impact on health-related quality of life was similar in both focus groups ( p < 0.314). Conclusion: The results of this preliminary study suggest that the negative impact on health-related quality of life in diabetic patients with foot ulcers or Charcot foot arthropathy may be as severe as in similar patients with lower extremity amputation. The negative effect did not seem to cause cognitive impairment or clinical depression in either focus group.
Ankle Arthropathy of Hemochromatosis: A Case Series and Review of the Literature
Authors: Davies Mark B. , Saxby Terry
Published: January 2017

Background:

Genetic hemochromatosis is a relatively common disease that may present as an arthropathy. In particular, arthropathy of the ankle is invariably bilateral and occurs in young men. However, the orthopaedic management of this condition has been poorly documented.

Methods:

Four patients with hemochromatic ankle arthropathy were treated with unilateral mobile bearing total ankle arthroplasty.

Results:

All four patients had good relief of symptoms after arthroplasty.

Conclusions:

Hemochromatosis should be considered when symmetrical ankle arthropathy occurs in a young man. Early diagnosis is necessary to prevent extra-articular progression of the disease and inappropriate management.
Postoperative Second Metatarsal Fractures Associated With Suture-Button Implant in Hallux Valgus Surgery
Authors: Weatherall Justin M. , Chapman Cary B. , Shapiro Steven L.
Published: January 2017

Background:

The purpose of this study was to perform a retrospective review of a nonosteotomy technique for the reduction of the intermetatarsal (IM) angle in hallux valgus (HV) surgery using a modified nonabsorbable suture-button implant previously described for ankle syndesmotic injuries and to report on the outcomes and complications associated with this technique.

Methods:

A retrospective review was performed of consecutive patients with a minimum follow-up of 1 year. Twenty-five patients, a total of 25 feet, were identified with a mean follow-up of 22.5 months. The mean age was 60 years. The pre- and postoperative HV and IM angles were compared. Each postoperative radiograph was assessed for loss of correction, implant failure, and second metatarsal (MT) stress fracture. The postoperative hallux American Orthopaedic Foot & Ankle Society (AOFAS) scores were obtained at the patient’s final follow-up visit. Statistics were performed using the paired Student t test with the P value set at .05 to determine statistical differences.

Results:

The preoperative mean IM and HV angles were 15.1 and 30.5 degrees, respectively. The postoperative mean IM and HV angles were 8.2 and 10.2 degrees, respectively. The reductions in the IM and HV angles were statistically significant ( P < .05). The average postoperative AOFAS hallux score was 85. Two patients developed hallux varus (8%). Eight patients (32%) developed second metatarsal stress fractures. One patient (4%) with a second metatarsal stress fracture had a failure of the implant that required implant removal. The remaining stress fractures healed uneventfully.

Conclusion:

Suture-button fixation in hallux valgus achieved a satisfactory reduction in the first–second intermetatarsal angle compared with first metatarsal osteotomies but was associated with a high rate of second metatarsal stress fractures.

Level of Evidence:

Level IV, retrospective case series.
Operative Treatment of Freiberg Disease Using Extra-articular Dorsal Closing-Wedge Osteotomy
Authors: Lee Hyun-Joo , Kim Jeong-Woo , Min Woo-Kie
Published: January 2017

Background:

Extra-articular dorsal closing wedge osteotomy has been used with successful results for Freiberg disease; however, there has been concern regarding the technical difficulty. The purpose of this study was to address technical tips and report on the clinical and radiographic outcome using Kirchner wire–assisted dorsal closing wedge osteotomy.

Methods:

A retrospective review of 13 patients with a mean age of 29.1 years was conducted. Extra-articular dorsal wedge osteotomy was performed after debridement of the joint. Two Kirschner wires were inserted and used as a joystick to manipulate the osteotomized bone. The osteotomy site was fixed with crossed pins. Clinical outcome was assessed according to American Orthopaedic Foot and Ankle Society score, range of motion of the metatarsophalangeal joint, and visual analogue scale. Head necrosis was classified according to Smillie stage; time to bone union and metatarsal shortening were reviewed. Patients were followed for a mean period of 44.2 months.

Results:

Mean American Orthopaedic Foot and Ankle Society score at the latest follow-up was 92.2 (range, 92-100). The range of motion of the metatarsophalangeal joint showed a mean increase of 6.2 degrees (range, –10 to 25) at the latest follow-up. The mean visual analogue scale score decreased from 7.5 (range, 5-10) preoperatively to 1 (range, 0-4) at the latest follow-up ( P < .01). All osteotomies healed on average after 7.0 weeks (range, 4-13.6) without nonunion. The average metatarsal shortening was 0.5 mm (range, –3.1 to 3.5). None of the patients showed progression of osteonecrosis or joint space narrowing.

Conclusion:

Extra-articular closing dorsal wedge osteotomy can yield good articular congruity with bone remodeling, with easy performance of the procedure with temporary Kirschner wires without complication.

Level of Evidence:

Level IV, retrospective case series.
New Manager Orientation: Is it Important? Should We Find Time to Do This?
Authors: Niewenhous Susan S.
Published: January 2017

Turnover in home care takes place among the management staff as well as among direct providers of care. It is important that orientation of new managers be as thorough as that of the field staff. This article discusses the components of an orientation program designed for new management staff. The program solicits participation from key leaders in the organization so that the functions of the new manager are linked to the operations of the entire agency.
The Relationship between Size and Performance of Primary Care Organisations in England
Authors: Wilkin David , Bojke Chris , Coleman Anna , Gravelle Hugh
Published: January 2017

Objectives:

To examine the relationship between the size and performance of primary care organisations, the effect of and the reasons for mergers.

Methods:

Data on size, proxy measures of performance and merger intentions for 71 organisations were extracted from telephone and mail surveys of primary care groups and trusts (PCG/Ts).

Results:

Of the 22 performance measures examined, only two were significantly associated with size, and over half were not associated with any of the potential explanatory variables. Most organisations (70%) were planning mergers. If all planned mergers take place, the mean size of primary care organisations will double to nearly 200 000. The main reasons for mergers were to make better use of resources and for PCGs to become PCTs.

Conclusions:

There is little evidence that the performance or efficiency of a primary care organisation is associated with its size. Optimal size may differ for different functions. Mergers are seen as a way of increasing management capacity and may reflect the desire of managers to manage large organisations. There is a risk that larger primary care organisations will recreate hierarchies and lose local ownership and participation.
Treatment of Rectal Mucosal Prolapse with Radiofrequency Coagulation and Plication — A New Surgical Technique
Authors: Gupta P. J.
Published: January 2017

Background:

This study was designed to assess the outcome of using a new technique of mucosal ablation using a radiofrequency device followed by its plication for rectal mucosal prolapse and to compare the results with those under the conventional ligature and excision procedure.

Materials and Methods:

The procedure of radiofrequency ablation and mucosal plication (RAMP) is described. A Ellman radiofrequency generator was used for the procedure. Out of the 46 patients with rectal mucosal prolapse, 24 patients were randomized to undergo ligature and excision procedure (LEP) and 22 were operated with RAMP. The operating time, amount of pain (VAS scale)[Primary end points], postoperative analgesic requirement, time to return to work, wound healing period and postoperative complications were documented.

Results:

Radiofrequency ablation and mucosal plication procedure on an average resulted in shorter operation time (9 vs. 32 minutes, p < 0.0001), shorter hospitalization (16 vs. 42 hours, p < 0.0001) significantly lesser postoperative pain, fewer cumulative requests for analgesia by the patients (21 vs. 54 tablets, p < 0.0001), earlier return to work (7 vs. 18 days, p < 0.0001) and faster wound healing time (14 vs. 35 days, p < 0.0001). The complication rate was 9 %with RAMP group and 29 %with LEP group.

Conclusion:

The procedure of radiofrequency ablation and plication of mucosa shows promising results in patients with rectal mucosal prolapse. Being safe, effective, and a swift technique, it can be proposed as an improved alternative to conventional surgical procedure.
Traumatic Injuries Associated with Horseback Riding
Authors: Carrillo E. H. , Varnagy D. , Bragg S. M. , Levy J. , Riordan K.
Published: January 2017

Background:

According to the Center for Disease Control and Prevention (CDC), an estimated 30 million people ride horses each year in the United States. Horseback riding related injuries are common, with an estimated 50,000 emergency room visits annually. The popularity of recreational horseback riding has increased in South Florida and the incidence of associated traumatic injuries is a reflection of this.

Material and Methods:

Retrospective review of patients admitted to a state designated Level I trauma center that sustained horseback riding associated injuries between January 2000 and December 2003. Information extracted from the Trauma Center's data base included demographics, mechanism of injury and toxicology screening.

Results:

During the review period, twenty-seven patients were identified. There were 12 men and 15 women. The average age was 36 years. The injuries occurred during pleasure riding in 23 patients and thoroughbred related activities in 4 patients. Multiple severe injuries were common and documented in 24 patients. All patients required hos-pitalization with an average stay of 5 days. Five patients had a positive toxicology screen on admission. No deaths were documented in this review.

Conclusion:

Horseback riding related injuries tends to be serious. Alcohol and recreational drugs may contribute to exacerbate the extent of these injuries. The use of proper protective equipment, instructions for safe riding, and discouraging drug and alcohol use during riding activities should be emphasized.
Management of Brachial Plexus Injury in Adults
Authors: Songcharoen P.
Published: January 2017

Brachial plexus injury in adults is commonly caused by motorcycle accidents. Surgical management consists of nerve repair and nerve grafting for extraforaminal nerve root or trunk injury, and of neurotization or nerve transfer for nerve roots avulsion. In general, the results regarding restoration of shoulder and elbow function are good but reinnervation of the forearm muscles is less than safisfactory in respect to restoration of hand function. Functioning free muscle transfer in combination with selective nerve transfer is a reasonable alternative surgical procedure.
Enhanced Recoveryafter Colorectal Surgery. Results from Aprospective Observational Two-Centre Study
Authors: Miohn A. C. , Bernardshaw S. V. , Ristesund S.-M. , Hansen P. E. Hovde , Rœkke O.
Published: January 2017

Background and Aims:

Enhanced recovery after surgery (ERAS) has reduced the median hospital stay from 8–10 days with traditional peri-operative routines to four days. The aim of the present study was to introduce the principles of ERAS in our hospital and measure the effect on hospital stay, complications and quality of life after discharge from hospital.

Material and Methods:

94 consecutive patients, 40 males, 54 females, median age 66 years, were included in a prospective non-randomised observational study at Haukeland University Hospital and Haugesund Hospital from October 2000 until February 2003. After a three-month preparation period, the principles of ERAS were implemented. The results were evaluated with questionnaires and by follow-ups 8–10 and 30 days after surgery. The results were compared to the results of colorectal surgery before introduction of accelerated recovery.

Results:

45 (48%) and 73 (78%) patients were discharged within three and five days after surgery with ERAS, compared to zero and seven (5%) patients with traditional recovery. The complication rate with ERAS was 31%, and the readmission rate was 15%. After one week, 57% had resumed their daily activities at home. After 30 days, 65% of the patients had resumed their normal and leisure activities.

Conclusion:

After a proper preparation period, ERAS principles may be implemented in surgical department, and is followed by a reduced median hospital stay and rapid return to normal daily activities for most patients after colorectal surgery.
Management of Hypertension in Solid-Organ Transplantation
Authors: Park Jeong M. , Luan Fu L.
Published: January 2017

Posttransplant hypertension is a major risk factor for cardiovascular disease and chronic renal allograft dysfunction. A significant number of transplant recipients suffer from posttransplant hypertension in part because of corticosteroid and calcineurin inhibitor use. Although the optimal blood pressure range and the antihypertensive agents of choice in the transplant population have not been determined, the guidelines for blood pressure control in the general population can be extrapolated to the transplant population. The choice of an antihypertensive regimen should be tailored on the basis of the individual patient's risk factors and comorbidities.
Stress among the Family Caregivers of Liver Transplant Recipients
Authors: Cohen Miri , Katz Dafna , Baruch Yaacov
Published: January 2017

Context

Family members of liver transplant patients continue caregiving activities for a lengthy period after transplantation.

Objectives

To assess the effect of stress-related factors on psychological distress and perceived health of family caregivers of liver transplant recipients.

Setting and Participants

Twenty-four caregivers of liver transplant recipients treated at a liver unit serving the northern part of Israel.

Main Outcome Measures

Pearlin's caregiving stress questionnaire was administered to assess the subscales of patients' symptoms as perceived by caregivers, caregiving activities, perceived overload, relational deprivation, personal gain, and social support; also, a depression questionnaire and a perceived caregivers' health questionnaire were administered to participants.

Results

Caregivers experienced considerable caregiving overload. Women reported performing more caregiving activities, higher perceived overload, and higher level of depression than men. Increasing passage of time since transplantation, higher perceived overload, higher sense of relational deprivation, and lower sense of personal gain were significantly associated with higher level of depression and worse perceived health. Perceived support and level of depression were not significantly associated with perceived health.

Conclusions

Caregiving stress endures after transplantation. Professional intervention is needed to improve caregivers' quality of life and, consequently, that of transplant recipients as well.
An Occupational Perspective of the Weil-Being of Maya Women in Southern Belize
Authors: Ekelman Beth A. , Bazyk Susan S. , Bello-Haas Vanina Dal
Published: January 2017

A study was designed to explore the relationship between occupation and the well-being of indigenous Maya women living in a rural village in the Toledo District of southern Belize. Using a qualitative multiple methods approach, data were collected through participant observation, interviews, a focus group, and document review. Subjects were Maya women, 18 years or older, living in a rural village in southern Belize. The women demonstrated similarities in daily physical and social routines at the river and in their homes, reflecting occupational patterns and routines that are deeply imbedded in their culture and play a critical role in the formation of self-identity. Several themes emerged describing the women's definitions of health and well-being. Each woman interpreted her life in relation to her occupations and well-being differently. This seemed to vary depending on individual life experiences, routines, and contexts.
Segmental Identity and Vulnerability in Cerebral Arteries
Authors: Lasjaunias P.L.
Published: January 2017

Clinical experience shows that certain diseases involve specific areas of the vascular tree and remarkably spare others. Topographic differences in the vascular environment already suggest a regional specificity of the vascular anatomy. The biological grounds of such regional differences, although unknown, can account for the specificity of biological responses to stimuli. Such segmental specificities are beyond morphological analysis. They create an invisible discontinuity in an apparently homogenous anatomical, histological and haemodynamic system. We call this property segmental identity and thus vulnerability. Most of this identity is established during development and is preserved throughout life; its expression, however, may vary over time according to various stresses and create various clinical phenotypes.

The memory of the evolutionary steps and their chronology is imprinted on the arterial anatomy and thus potentially readable. One can postulate that since the age of each arterial segment is different, its resistance to time and stimuli is most likely variable. The vulnerability of these segments cannot be permanent both in a qualitative and quantitative way. Some genetic functions only seem to be active during a short period of time: during vasculogenesis for example. Therefore either the trigger is always active and the target vulnerability window of the cells time-limited, or the target is permanently exposed and the trigger agent can either be exogenous and rare, or most of the time inactive or inactivated.
Early Clinical Experience with a Dedicated Portable Computed Tomography Scanner in a Biplane Neuroangiography Suite: Assessment of Feasibility and Utility in Neurointerventional Practice
Authors: Mangla S. , Chaloopka J.C. , Huddle D.C.
Published: January 2017

The ability to have on-site access to cross-sectional imaging in a biplane neuroangiography suite has tremendous potential for enhancing current neurointerventional practice. Although a few prototypical multimodality suites have been created, several problems/limitations have prevented widespread implementation. Recently, a portable CT scanner has been developed, which may overcome previous shortcomings. We review our recent clinical experience with this new modality, exploring numerous adjunctive diagnostic and therapeutic applications. Forty-one patients underwent periprocedural CT using the Tomoscan M/EG portable CT (Philips). The portable CT scanner is kept at the “head-end” of the biplane neuroangiography suite, being moved into position as needed before, after, or during a procedure. A pivoting angiographic table permits excellent z-plane mobility for rapid gantry to fluoroscopy positioning. Five mm slices at five mm increments were obtained.

High quality images were obtained in all cases. The portable CT scanner could be quickly positioned and activated within five min. Total scanning time for a typical case, including initial positioning and set-up was 10–12 min. Twelve of 41 cases were performed adjunctively during diagnostic angiography; 29/41 were performed in an interventional setting. Twenty of 29 scan evaluated baseline or post-therapeutic status of the brain (e.g., Guglielmi detachable coil aneurysm obliteration, arteriovenous malformation (AVM) embolisation, local thrombolysis); 9/29 provided cross-sectional guidance to various interventions (direct puncture embolisation, percutaneous vertebroplasty, spinal biopsy, discography).

Use of the portable CT scanner permitted rapidly accessible high quality cross sectional imaging within the biplane neuroangiography suite, which augmented diagnostic and therapeutic decision-making, and therapeutic intervention.
Follow-up of a Patient Treated by the Mechanical Detachable System (MDS) of Tungsten Spirals
Authors: Kolasa P. , Kaurzel Z.
Published: January 2017

A case is presented of basilar artery aneurysm, to which endovascular treatment was applied, employing the mechanical detachable system (MDS) of tungsten spirals. The aim of the study was to demonstrate spiral disappearance in embolised aneurysm without recanalisation, following a long-term follow-up period — up to 42 months. During the years 1994 to 1999, about 100 intracranial aneurysms and carotid-cavernous fistulas were embolised by the use of MDS spirals. In one case, spiral disappearance was noted, that event not, however, affecting the patient's state in any way and confirmed by clinical and radiological evaluations.
Two Cases of Hemorrhage in Benign Brain Tumors during Systemic Heparinization
Authors: Nakagawa T. , Onozuka S. , Mayanagi K.
Published: January 2017

Anticoagulant therapy is usually used after endovascular operations like coil embolization of aneurysms, or for thromboembolic diseases such as myocardial infarction. Few data exist regarding hemorrhage from benign brain tumors during systemic heparinization with the exception of pituitary adenomas1,2. We experienced two cases of hemorrhage from benign brain tumors during systemic heparinization. The first patient had an unruptured aneurysm in her suprasellar tumor. She underwent coil embolization to prevent hemorrhage during the subsequent tumorectomy. During and after the endovascular operation, she was heparinized and she suffered a hemorrhage from the tumor on the first postoperative day. The second patient had a suprasellar tumor and was heparinized prophylactically for myocardial infarction. He had an intratumoral hemorrhage on the fifth day after the start of the heparinization. This small series suggests that systemic heparinization with brain tumors, even when they are benign, is very dangerous, and further studies with a larger patient base are warranted.
Intradural Aneurysm Caused by Arterial Injury during Surgery
Authors: Oran I. , Parildar M. , Dalbasti T. , Memis A. , Ozdamar N.
Published: January 2017

We described a patient with subarachnoid hemorrhage due to a ruptured intradural aneurysm caused by arterial injury during surgery and severe symptomatic vasospasm. The iatrogenic posttraumatic aneurysm was occluded by using GDC with preservation of parent artery followed by intraarterial infusion of papaverine to treat vasospasm as an one-stage procedure.

This resulted in significant angiographic resolution of the vasospasm and the patient's clinical outcome was excellent. Endovascular approach to posttraumatic intracranial aneurysms and endosaccular GDC embolization of aneurysm with concomitant intraarterial papaverine infusion to treat vasospasm are discussed.