bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiographic Predisposing Factors for Degenerative Spondylolisthesis
Authors: Smorgick Yossi , Mirovsky Yigal , Fischgrund Jeffrey S. , Baker Kevin C. , Gelfer Yael , Anekstein Yoram
Published: August 2014

This study was a retrospective radiographic study involving analysis of computed tomography scans obtained for patients with degenerative spondylolisthesis of the L4–L5 segment and a control group. The purpose of the study was to identify radiological predisposing factors for degenerative spondylolisthesis of the L4–L5 segment. The authors reviewed all computed tomography scans (N=3370) performed at their institution between January 2005 and December 2008. Eighty-four patients with degenerative spondylolisthesis were identified and compared with a control group regarding facet joint orientation, the presence of sacralization of the L5 vertebra, the presence of major degenerative changes in the L5-S1 disk space, and the location of the intercrestal line. There was a statistically significant difference between the 2 groups regarding facet joint orientation, with more sagittal facet joints in the degenerative spondylolisthesis group (56° and 54° in the right and left facets, respectively, in the study group, and 46° and 42° in the right and left facets, respectively, in the control group) (
P
<.001). There was no statistically significant difference between the 2 groups regarding the presence of sacralization of the L5 vertebra, the presence of major degenerative changes in the L5-S1 disk space, and the location of the intercrestal line relative to the lumbar spine. There is an association between sagittal orientation of the facet joints at the L4–L5 segment and degenerative spondylolisthesis at the same level.
Arthroscopic Findings of Coexisting Lesions With Greater Tuberosity Fractures
Authors: Maman Eran , Dolkart Oleg , Chechik Ofir , Amar Eyal , Rak Ofer , Rath Ehud , Mozes Gavriel
Published: August 2014

Proximal humerus fractures comprise approximately 5% of all fractures, with isolated greater tuberosity fractures accounting for approximately 20% of proximal humerus fractures. Although performing shoulder arthroscopy in situations including a fracture is technically demanding, it allows surgeons the opportunity to identify and treat other coexisting lesions that could have otherwise been missed. The incidence of these pathologies in combination with greater tuberosity fractures has not been established. This study aimed to identify the various types of pathologies that may coexist with greater tuberosity fractures but not be detected before fixation. Displaced 2-part greater tuberosity fractures were treated arthroscopically in the authors’ department. All patients initially underwent diagnostic arthroscopy during which other coexisting pathologies were detected and assessed, including rotator cuff tears, labral tears (Bankart or superior labral anterior posterior lesions), or long head of the biceps pathologies. Twenty-four patients underwent arthroscopic (n=10) or arthroscopic-assisted (n=14) greater tuberosity reduction and fixation. Thirteen (54.2%) fragments were fully displaced. Four (16.7%) patients had fracture dislocation of the glenohumeral joint. The concomitant soft-tissue pathologies were identified and treated arthroscopically in 22 (92%) patients. Arthroscopic evaluation before greater tuberosity fracture fixation revealed a high percentage of concomitant soft tissue pathologies. These pathologies may be overlooked otherwise, but they are easily detected arthroscopically, enabling their treatment during the same procedure.
Arthroscopic Biceps Tenodesis Compared With Repair of Isolated Type II SLAP Lesions in Patients Older Than 35 Years
Authors: Denard Patrick J. , Lädermann Alexandre , Parsley B. K. , Burkhart Stephen S.
Published: August 2014

This study compared arthroscopic biceps tenodesis with biceps repair for isolated type II superior labrum anterior and posterior (SLAP) lesions in patients older than 35 years. The authors identified isolated type II SLAP lesions that were surgically managed over a 5-year period. Minimum 2-year follow-up data were available for 22 patients who underwent biceps repair (repair group) and for 15 patients who underwent a primary biceps tenodesis (tenodesis group). Mean age at surgery was 45.2±5.5 years in the repair group and 52.0±8.0 years in the tenodesis group. In the repair group, functional outcome improved from baseline to final follow-up using the American Shoulder and Elbow Surgeons (ASES) (47.5 to 87.4, respectively;
P
<.0001) and University of California, Los Angeles (UCLA) scores (18.5 to 31.2, respectively;
P
<.0001). In the tenodesis group, similar findings were observed for the ASES (43.4 to 89.9, respectively;
P
<.0001) and UCLA scores (19.0 to 32.7, respectively;
P
<.0001). No difference was found in functional outcome between the groups. Full range of motion recovery was delayed by approximately 3 months in the repair group compared with the tenodesis group (
P
=.0631). Two patients in the repair group required a secondary capsular release. Seventy-seven percent of patients in the repair group and 100% of patients in the tenodesis group were satisfied and returned to normal activity (
P
=.0673). In the current study, individuals older than 35 years with an isolated type II SLAP lesion had a shorter postoperative recovery, a more predictable functional outcome, and a higher rate of satisfaction and return to activity with a biceps tenodesis compared with a biceps repair. Based on these observations, biceps tenodesis is preferable to biceps repair for isolated type II SLAP lesions in nonoverhead athletes older than 35 years.
Anatomy of the Sural Nerve and Its Relation to the Achilles Tendon by Ultrasound Examination
Authors: Kammar Haguy , Carmont Michael R. , Kots Eugene , Laver Lior , Mann Gideon , Nyska Meir , Mei-Dan Omer
Published: August 2014

Sural nerve injury is a relatively common complication after surgery on the Achilles tendon. Studies to determine the course of the sural nerve have been performed on cadaveric specimens. The purpose of this cross-sectional study was to use ultrasound to determine the relations of the sural nerve in a healthy population. The authors performed ultrasound examination of the posterior triangle of the ankle and Achilles tendon to determine the course of the sural nerve relative to the Achilles tendon in healthy participants. The mean distance between the nerve and the tendon was 21.48, 11.47, 5.8, and 0.81 mm lateral to the Achilles tendon as measured at the insertion and 4, 8, and 11 cm proximally, respectively. Male participants tended to have a nerve that was initially more lateral to the Achilles insertion compared with women. The distance between the sural nerve and the Achilles tendon was found to be lower in older participants, with the nerve passing significantly closer to the tendon at all levels (
P
<.01). Three anatomical variants were reported, with the nerve crossing the lateral border of the Achilles low or high or with multiple branches yet to converge. The course of the sural nerve can be visualized and plotted relative to the Achilles tendon using ultrasound examination in healthy participants. Older patients may be at an increased risk of iatrogenic nerve injury because the nerve courses closer to the Achilles tendon than that in young patients. Intraoperative ultrasound examination may be a useful modality to prevent sural nerve injury during Achilles tendon surgery.
Prediction of Prognosis in Patients With Cervical Spinal Cord Injury Without Radiologic Evidence of Trauma Using MRI
Authors: Sun Lai-Qing , Shen Yong , Li Yong-Min , Cao Jun-Ming
Published: August 2014

The purpose of this study was to investigate whether pre- to postoperative changes of increased signal intensity (ISI) of the spinal cord as seen on T2-weighted magnetic resonance imaging (MRI) reflect the surgical outcome in patients with cervical spinal cord injury without radiologic evidence of trauma (SCIWORET). In this study, 54 patients with SCIWORET who underwent expansive laminoplasty were retrospectively analyzed. All patients underwent MRI at an average of 1.9 days (range, 1–5 days) after injury and 7.9 days (range, 6–10 days) postoperatively. The pre- and postoperative range and degree of ISI were measured on computer software using the same sagittal view on T2-weighted MRI. Then, the post-preoperative ratio of range and degree of ISI were calculated. Pre- and postoperative neurologic evaluations were performed according to the criteria proposed by the Japanese Orthopedic Association (JOA). A significant negative correlation existed between the ratio of range of ISI and the recovery rate (
r
=−0.504,
P
<.01). The ratio of degree of ISI negatively correlated with the recovery rate, but this was not statistically significant. Patients were divided into 2 groups according to the ratio of degree of ISI: group A included patients with a ratio of degree of ISI of ≤1 (n=24) and group B included patients with a ratio of degree of ISI of >1 (n=30). Patients’ mean recovery rate was 65.0%±6.3% in group A and 52.4%±7.4% in group B. A significant difference was found between the 2 groups (
P
<.001, Student’s
t
test) when comparing recovery rate. The pre- to postoperative changes of the range and degree of ISI significantly reflected prognosis for surgical outcome in patients with SCIWORET.
Multiple Anterior Tibial Stress Fractures Complicated by Acute Complete Fracture of the Distal Tibia
Authors: Burke Richard , Chiang Andrew L. , Lomasney Laurie M. , Demos Terrence C. , Wu Karen
Published: August 2014

A 61-year-old man presents with an open wound over the tibia after a minor fall.
Microbial Surface Contamination After Standard Operating Room Cleaning Practices Following Surgical Treatment of Infection
Authors: Balkissoon Rishi , Nayfeh Tariq , Adams Kerri L. , Belkoff Stephen M. , Riedel Stefan , Mears Simon C.
Published: August 2014

At the authors’ institution, some joint arthroplasty surgeons require the operating room to be terminally cleaned before using the room after infected cases, in theory to decrease exposure to excessive microbial contamination for the subsequent patient. The authors found no guidance in the literature to support this practice. To test this theory, the authors measured microbial surface contamination from 9 surfaces in operating rooms after standard operating room turnover following 14 infected cases vs 16 noninfected cases. A check was made for an association between organisms isolated intraoperatively from infected surgical patients immediately preceding standard cleaning and organisms isolated from common operating room surfaces. Colony counts were made at 24 and 48 hours, and organisms were identified. No significant difference was noted in colony counts between infected and noninfected cases, and no relationship was found between organisms isolated from infected cases and those from operating room surfaces. Furthermore, the largest colony count from both groups (0.08 cfu/cm
2
) was an order of magnitude less than the recently proposed 5 cfu/cm
2
threshold for surface hygiene in hospitals. This finding indicates that standard operating room turnover results in minimal surface contamination, regardless of the previous case’s infection status, and that there is no need for a more extensive terminal cleaning after an infected case.
Proximally Coated Cementless Bipolar Hemiarthroplasty in Dorr Type C Bone
Authors: Bonutti Peter M. , Stroh Alex D. , Issa Kimona , Harwin Steven F. , Patel Dipak V. , Mont Michael A.
Published: August 2014

The current study was conducted to examine the clinical and radiographic outcomes of cementless bipolar arthroplasty in patients who had type C bone at the time of the procedure. A total of 87 patients (105 hips) who had type C femora and had undergone cementless bipolar hemiarthroplasty with a proximally coated cementless prosthesis for the treatment of displaced femoral neck fractures at a single institution were reviewed. Patients included 83 women and 4 men who had a mean age of 84 years (range, 72–100 years) and were followed for a mean of 6 years (range, 2–11 years). Outcomes evaluated included aseptic implant survivorship, surgical complications, Harris Hip scores, and radiographic findings. At final follow-up, there were no revisions for aseptic implant loosening. The overall aseptic implant survivorship was 95%, with 5 patients undergoing revision surgery for aseptic reasons. Three revisions were because of periprosthetic fractures after falls, 1 revision was because of intractable groin pain, and 1 revision was because of recurrent dislocations. The surgical complication rate was 8.5%, which included 3 septic revisions, 2 avulsion fractures of the greater trochanter after falls, 2 superficial wound infections, 1 recurrent dislocation, and 1 wound hematoma. The mean Harris Hip score had improved to 80 points (range, 30–97 points) at final follow-up. Despite generally poor bone quality and medical comorbidities, elderly patients with displaced femoral neck fractures achieved excellent clinical outcomes, with few perioperative complications, through the use of proximally coated cementless bipolar hemiarthroplasty.
Mediolateral Subchondral Tibial Bone Mineral Density Difference Does Not Predict Osteoarthritis Progression
Authors: Tat Lim Chin , Singh Gurpal , Jonathan Sng Bo Yan , Leng Low Siew , Liang Shen , Awiszus Friedemann , Lohmann Christoph H. , De Shamal Das
Published: August 2014

Data on the relationship between osteoporosis and osteoarthritis are conflicting. Most studies report “snapshot” prevalences, and there are few studies evaluating localized knee bone mineral density (BMD) measurements with respect to subsequent osteoarthritis progression. The authors hypothesize that increased mediolateral difference of the proximal tibial BMD may predict progression of knee osteoarthritis. In this study, 246 female volunteers were followed up prospectively over 2 years. Baseline BMD measurements of bilateral proximal (subchondral) tibiae were performed, and the mediolateral BMD ratio was calculated. Precision studies were performed on healthy volunteers to validate the technique. The patients were divided into osteoarthritis progressors and non-progressors based on Kellgren-Lawrence radiographic criteria at 2-year follow-up. Patients who were taking bisphosphonates or who had a history of inflammatory, infectious, or metabolic bone disease and previous hip and knee surgery were excluded. Demographic data, calcium supplementation, physical activity, baseline knee radiographs, and radiographs at 2-year follow-up were obtained. The study was adequately powered to detect an effect size of 0.4. There were 121 progressors and 125 non-progressors. Mean mediolateral BMD ratio was 1.02 among the progressors and 1.01 among the non-progressors (
t
=0.632,
P
=.528). Potential confounders were equally distributed among both groups. The data suggest that there is no link between proximal tibial BMD ratio and progression of knee osteoarthritis.
Spinal Epidural Lipomatosis in Lumbar Magnetic Resonance Imaging Scans
Authors: Sugaya Hisashi , Tanaka Toshikazu , Ogawa Takeshi , Mishima Hajime
Published: August 2014

The goal of this study was to quantify the frequency of advanced spinal epidural lipomatosis (SEL) detected on lumbar magnetic resonance imaging (MRI) scans performed at the authors’ hospital and to compare the frequency, cause, and progression of SEL in these cases with that reported in the literature. The total number of MRI examinations of the lumbar spine performed at this hospital over 45 months was 1498 (705 men and 793 women; mean age, 60.3 years). After the MRI data were reduced (T1- and T2-weighted sagittal and axial images) on the basis of the exclusion criteria, the anterior and posterior diameters of the dural sac and spinal canal were measured, as well as the thickness of the epidural fat. On the basis of these parameters, the severity of SEL was classified as grade 0 to grade III. Five cases of grade III SEL were diagnosed. The frequency of grade III SEL noted in this study was 0.33% (5/1498). Obesity (body mass index greater than 27.5) was noted in 3 cases, and the use of exogenous corticosteroids was noted in 3 cases. Exogenous steroid usage associated with advanced SEL in this study was greater than that reported in the literature. Most symptoms of SEL progress slowly, and early diagnosis allows for a dose reduction of the prescribed steroids. Thus, lumbar MRI examinations should be conducted aggressively in patients with exogenous steroid use and presenting with low back pain or buttock pain.
Functional Outcomes After Fixation of “Terrible Triad” Elbow Fracture Dislocations
Authors: Fitzgibbons Peter G. , Louie Dexter , Dyer George Sinclair Mitchell , Blazar Philip , Earp Brandon
Published: August 2014

Historically, the published literature on “terrible triad” injuries has shown a high rate of unacceptable results. The use of systematic treatment protocols may improve functional outcome. The authors performed a retrospective study of all patients aged 18 years or older who underwent surgical treatment for “terrible triad” elbow fracture dislocation at their institution over a period 7 years. Surgical treatment involved fixation or replacement of the radial head, repair of the anterior capsule or coronoid fracture in most cases, and repair of the lateral collateral ligament. Outcomes included grip strength, range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, and a visual analog score for pain as well as radiographic assessment of arthritis, maintenance of reduction, and development of heterotopic ossification. Eighteen patients were identified and 11 enrolled. Seven patients had suture fixation of the coronoid fragment and anterior capsule, 2 had screw fixation, and 2 had no repair of the coronoid. The radial head was replaced in 9 patients and repaired in 1, and a fracture fragment was excised in another. The average follow-up was 38 months. The average arc of motion of the injured elbow was 112° and that of the contralateral elbow was 142°. The average DASH score was 19.7 (scale, 0–100). The average visual analog score for pain was 2.2 (scale, 0–10). No patients had recurrent elbow instability. Three patients underwent further surgical procedures, all for loss of motion. The authors concluded that a systematic approach to the fixation of “terrible triad” elbow fracture dislocations can provide predictable elbow stability and functional range of motion in the medium term.
Ewing Sarcoma Superimposed on a Previous Osteochondroma in Multiple Osteochondromatosis
Authors: Marrero Barrera Pablo A. , Marrero Ortiz Pablo V.
Published: August 2014

It has been reported that patients with hereditary multiple exostoses (called multiple osteochondromatosis by the World Health Organization) are at increased risk for malignant transformation of osteochondromas to secondary chondrosarcomas. A review of the literature found 14 cases showing transformation of osteochondromas into osteosarcomas; however, Ewing sarcoma has never been reported superimposed on an osteochondroma. This article presents the case of a boy who underwent biopsy of a previously existent osteochondroma for which the pathology report showed cytologic and immunohistochemical properties consistent with Ewing sarcoma. A 13-year-old boy with hereditary multiple exostoses (multiple osteochondromatosis) presented to an orthopedic clinic because of waxing and waning pain superficial to a previous osteochondroma on the lateral aspect of the right leg, below the knee, of 1 month’s duration. On examination, inflammation was noted over a bony mass associated with tenderness to palpation of the affected area. There was no evidence of penetrating injury or trauma, and the patient reported no constitutional symptoms, including fever. Radiographs showed marked osteolysis and signs of periosteal reaction. Magnetic resonance imaging showed evidence of cortical bone erosion and extension of the mass into soft tissue. Malignant transformation was suspected, and the patient underwent biopsy. The pathology findings were consistent with Ewing sarcoma. The highly uncommon presentation of this malignancy must serve as a red flag to other physicians who treat patients with hereditary multiple exostoses. Ewing sarcoma tends to be of higher grade and have a worse prognosis than other malignancies that are more commonly seen in these patients.
Pseudarthrosis of the Clavicle
Authors: Galvin Joseph W. , Dannenbaum Joseph H. , Grassbaugh Jason A. , Eichinger Josef K.
Published: August 2014

A 21-year-old active duty soldier presented with right shoulder pain and prominence over his right clavicle, with no history of trauma. He recalled that the deformity had been present for a long time, but only recently became painful. The onset of shoulder pain coincided with the beginning of his military service and the requirement to wear over-the-shoulder equipment such as back packs and load-bearing equipment. Physical examination revealed a prominence over the right midshaft clavicle with tenderness to palpation, full active range of motion of the shoulder, and that he was neurovascularly intact.
Pediatric Anterior Cruciate Ligament Reconstruction Using Low-Profile Hybrid Tibial Fixation
Authors: Mistovich R. Justin , Ganley Theodore J.
Published: August 2014

The authors introduce the application of a low-profile hybrid fixation technique for pediatric anterior cruciate ligament graft fixation into the tibia using both an interference screw and knotless anchors. This technique allows for physeal avoidance while maintaining fixation strength. [
Orthopedics.
2014; 37(5):325–328.]
Tissue Levels of Leukemia Inhibitory Factor Vary by Osteoarthritis Grade
Authors: Jiang YuWen , Xiao Qiang , Hu ZhenMing , Pu Bo , Shu Jun , Yang QingQiu , Lao HanChang , Hao Jie
Published: August 2014

The objective of this study was to observe the expression of leukemia inhibitory factor (LIF) in animals and in different clinical grades of patient osteoarthritic tissues. Thirty-five rabbits were used in a Colombo model of experimental osteoarthritis (OA). Five rabbits each were sacrificed on postoperative days 3, 7, 14, 28, 42, 56, and 84. Immunohistochemistry analysis for LIF expression and distribution in the cartilage and synovium of animals was performed at these times. Sixty-seven samples of human articular tissue were obtained from patients with different grades of OA according to symptoms and radiographic inspection. The mRNA expression of LIF was determined by reverse transcription polymerase chain reaction, and LIF protein was determined by enzyme-linked immunosorbent assay (ELISA). The results showed a slight expression of LIF in normal cartilage tissue but less in synovium tissue; however, the expression of LIF was marked in synovial lining cells and superficial and middle-layer cartilage in animal OA (
P
<.05). Leukemia inhibitory factor mRNA was expressed at the highest level in moderate degrading subchondral bone, and LIF was expressed at the highest level in seriously degrading articular cartilage tissue. These results were similar to those found with ELISA. This study suggests that LIF in OA articular tissues varies by clinical symptoms and grade. It plays an important role in the pathogenesis of OA.
Anterior Longitudinal Decompression in the Management of Severe Ossification of the Posterior Longitudinal Ligament in the Cervical Spine
Authors: Lei Tao , Shen Yong , Wang Lin Feng , Ding Wen Yuan , Zhang Di , Zhang Peng , Du Wei , Li Jia
Published: August 2014

The advantages of anterior surgery for severe ossification of the posterior longitudinal ligament in the cervical spine have been reported. However, it is more technically demanding and associated with a high risk of surgery-related complications. The purpose of this study was to evaluate the feasibility of longitudinal decompression techniques in anterior surgery for severe ossification of the posterior longitudinal ligament in the cervical spine. Between June 2008 and December 2011, twenty-two patients (16 men and 6 women; average age, 58 years [range, 45–72 years]) who underwent anterior corpectomy and fusion for severe ossification of the posterior longitudinal ligament were studied retrospectively. The clinical efficacy, canal narrowing ratio, fused segment height, and complications were investigated. After a mean 25.4-month follow-up, mean Japanese Orthopaedic Association score increased from 8.8±1.4 preoperatively to 14.0±1.2 at final follow-up (
P
<.05), an improvement rate of 63.5%±12.5%. Mean canal narrowing ratio decreased from 62.0%±6.0% preoperatively to 8.2%±4.9% postoperatively (
P
<.05). Mean fused segment height increased 2.3±0.5 mm from pre- to postoperatively and decreased 2.8±0.4 mm from postoperatively to final follow-up (
P
>.05). Five patients developed cerebrospinal fluid leakage, and 1 patient experienced hematoma. No instrument failure was observed, and all patients had successful fusion. Anterior longitudinal decompression is a relatively effective procedure in the management of severe ossification of the posterior longitudinal ligament in the cervical spine. It can be applied to treat closed-base ossification of the posterior longitudinal ligament (defined as no space between the lateral margin of the ossified base and the spinal canal lateral wall), but it is associated with a high risk of cerebrospinal fluid leakage.
Arthroscopic Lysis of Adhesions for the Stiff Total Knee: Results After Failed Manipulation
Authors: Tjoumakaris Fotios Paul , Tucker Bradfords Chofield , Post Zachary , Pepe Matthew David , Rozco Fabioo , Ong Alvin C.
Published: August 2014

Arthrofibrosis after total knee arthroplasty (TKA) is a potentially devastating complication, resulting in loss of motion and function and residual pain. For patients in whom aggressive physical therapy and manipulation under anesthesia fail, lysis of adhesions may be the only option to rescue the stiff TKA. The purpose of this study is to report the results of arthroscopic lysis of adhesions after failed manipulation for a stiff, cruciate-substituting TKA. This retrospective study evaluated patients who had undergone arthroscopic lysis of adhesions for arthrofibrosis after TKA between 2007 and 2011. Minimum follow-up was 12 months (average, 31 months). Average total range of motion of patients in this series was 62.3°. Average preoperative flexion contracture was 16° and average flexion was 78.6°. Statistical analysis was performed using Student’s
t
test. Pre- to postoperative increase in range of motion was significant (
P
<.001) (average, 62° preoperatively to 98° postoperatively). Average preoperative extension deficit was 16°, which was reduced to 4° at final follow-up. This value was also found to be statistically significant (
P
<.0001). With regard to ultimate flexion attained, average preoperative flexion was 79°, which was improved to 103° at final follow-up. This improvement in flexion was statistically significant (
P
<.0001). Patients can reliably expect an improvement after arthroscopic lysis of adhesions for a stiff TKA using a standardized arthroscopic approach; however, patients achieved approximately half of the improvement that was obtained at the time of surgery.
Chondroblastoma With Secondary Aneurysmal Bone Cyst of the Capitate
Authors: Sato Eiichi , Ichikawa Jiro , Ando Takashi , Sato Nobutaka , Kawasaki Tomonori , Haro Hirotaka
Published: August 2014

Chondroblastoma is a benign tumor that typically arises in the epiphysis of a long bone. There have been only 2 reported cases of chondroblastoma involving the capitate. This is the first report of chondroblastoma with secondary aneurysmal bone cyst involving the capitate. A 33-year-old man presented with a 3-year history of pain and swelling of the right wrist. Radiography as well as computed tomography showed a radiolucent area and no matrix calcification within the capitate. Magnetic resonance imaging revealed a homogeneous signal that was low on T1-weighted images and high on T2-weighted images and showed only slight enhancement. On the basis of imaging findings, the authors chose excisional biopsy. The bone tumor in the capitate was explored through a dorsal approach by dividing the extensor tendons. After repeated curettages, bone graft substitute using allograft bone was packed into the capitate. Histologically, the authors diagnosed this tumor as a chondroblastoma with a secondary aneurysmal bone cyst. At the final 2-year follow-up, there was evidence of bone union, full range of motion, and recovery and no evidence of recurrence. Although the recurrence of chondroblastoma is occasionally reported, the principal treatment is intralesional curettage and bone graft. High-speed burring, phenol, bone cement, and cryosurgery have been reported to reduce local recurrence. Complete excision of the carpal bone seems to be overtreatment.
Nursing Student Attitudes Toward Statistics
Authors: Mathew Lizy , Aktan Nadine M.
Published: August 2014

Nursing is guided by evidence-based practice. To understand and apply research to practice, nurses must be knowledgeable in statistics; therefore, it is crucial to promote a positive attitude toward statistics among nursing students. The purpose of this quantitative cross-sectional study was to assess differences in attitudes toward statistics among undergraduate nursing, graduate nursing, and undergraduate non-nursing students. The Survey of Attitudes Toward Statistics Scale-36 (SATS-36) was used to measure student attitudes, with higher scores denoting more positive attitudes. The convenience sample was composed of 175 students from a public university in the northeastern United States. Statistically significant relationships were found among some of the key demographic variables. Graduate nursing students had a significantly lower score on the SATS-36, compared with baccalaureate nursing and non-nursing students. Therefore, an innovative nursing curriculum that incorporates knowledge of student attitudes and key demographic variables may result in favorable outcomes. [
J Nurs Educ.
2014;53(4):233–237.]
Understanding Poisson Regression
Authors: Hayat Matthew J. , Higgins Melinda
Published: August 2014

Nurse investigators often collect study data in the form of counts. Traditional methods of data analysis have historically approached analysis of count data either as if the count data were continuous and normally distributed or with dichotomization of the counts into the categories of occurred or did not occur. These outdated methods for analyzing count data have been replaced with more appropriate statistical methods that make use of the Poisson probability distribution, which is useful for analyzing count data. The purpose of this article is to provide an overview of the Poisson distribution and its use in Poisson regression. Assumption violations for the standard Poisson regression model are addressed with alternative approaches, including addition of an overdispersion parameter or negative binomial regression. An illustrative example is presented with an application from the ENSPIRE study, and regression modeling of comorbidity data is included for illustrative purposes. [J Nurs Educ.2014;53(4):207–215.]
Online Biostatistics: Evidence-Based Curriculum for Master’s Nursing Education
Authors: Shillam Casey R. , Ho Grace , Commodore-Mensah Yvonne
Published: August 2014

Rapid changes in health care delivery require nurses to attain advanced knowledge, skills, and attitudes in biostatistics to provide high-quality, safe patient care. Advances in educational technologies support the delivery of graduate nursing education in online formats. Given the diversity of learning styles among graduate nursing students and the specific challenges in delivering biostatistics content in traditional formats, it is vital to include different delivery formats to engage and meet the learning needs of graduate nursing students who take biostatistics courses online. This article describes the pioneering approach of one graduate nursing program to implementing best practices for delivering an online biostatistics course to help master’s-prepared nurses attain both statistical literacy and statistical communication skills. [
J Nurs Educ
. 2014;53(4):229–232.]
Critical Theory as a Framework for Academic Nursing Practice
Authors: Swartz Martha K.
Published: August 2014

In academic centers of nursing, faculty or academic practice has become more widespread and integrated into the expectations and criteria for appointment and promotion. Yet, the concept of academic practice is not fully embraced among all schools of nursing. Numerous models of academic nursing practice have evolved and vary widely according to the clinical site, the roles of the practitioners, and the systems for generating revenue. Although most models are related to the mission statements of the schools of nursing, few seem to be based on a distinct philosophy of practice. In this article, a consideration of critical theory that provides a framework for practice-based nursing education is presented. By applying the philosophical underpinnings and assumptions of practice that are guided by critical theory, educators may begin to better identify the values of academic nursing practice and incorporate this activity more fully into the educational environment. [
J Nurs Educ.
2014;53(5):271–276.]
An Academic–Service Partnership to Promote and Support RNs’ Return to School
Authors: Murray Teri A. , Palmer Janice L. , Wunderlich Rita , Giancola Jennifer , Shaw JoAnn M.
Published: August 2014

This article describes an academic–service partnership that promotes the educational progression of RNs in response to the Institute of Medicine’s recommendation that 80% of RNs hold a baccalaureate degree or higher by 2020. Using the logic model as a framework, this article describes a sustainable, replicable, and mutually beneficial partnership that supports the national movement toward baccalaureate education for RNs. [
J Nurs Educ.
2014;53(5):291–294.]
Differentiation in Retinoblastoma and Histopathological Risk Factors in Mexico
Authors: Gómez-Martínez Ricardo , Rosales-Gradilla María Elena , Silva-Padilla Noemí , Corona-Macías Adrián
Published: August 2014

Purpose:

To describe the relationship between retinoblastoma differentiation, histopathological risk factors, age at enucleation, laterality, and genetic type (hereditary or sporadic) in a series of enucleated eyes in a referral hospital. The criteria used in other studies to classify retinoblastoma differentiation are discussed.

Methods:

The authors retrospectively studied histopathological preparations of eyes with retinoblastoma treated with primary enucleation. Tumors were classified as well differentiated, undifferentiated, and moderately differentiated. Patient age at enucleation, laterality of disease, genetic form (hereditary or sporadic), and presence of histopathological risk factors (massive choroidal infiltration, postlaminar optic nerve invasion, tumor in optic nerve cut, scleral invasion, and involvement of orbital soft tissues) were analyzed. The chi-square test was used for categorical variables and analysis of variance for test mean differences.

Results:

Histopathological risk factors were present in 23 (36%) of 63 eyes. Moderately differentiated tumors occurred at advanced ages and were more frequently associated with histopathological risk factors.

Conclusions:

A consensus is needed to establish the histopathological criteria of retinoblastoma differentiation. The value of rosettes as a marker of cell differentiation should be reviewed.

[J Pediatr Ophthalmol Strabismus 2013;50(3):174–177.]
Retinopathy of Prematurity in Extremely Low Birth Weight Infants in Turkey
Authors: Demir Selim , Sayin Osman , Aygün Canan , Ortak Hüseyin , Yücel Özlem Eski , Küçüködük Sükrü , Beden Ümit
Published: August 2014

Purpose:

This study was designed to determine the incidence rate of retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) infants in the middle Black Sea region of Turkey.

Methods:

The charts of 1,719 preterm infants were reviewed between January 2003 and September 2011. Of them, 225 (13.1%) infants with birth weights of less than 1,000 g were enrolled in the study. ROP was classified according to the international classification of retinopathy.

Results:

Of the 225 ELBW infants, 47.6% had advanced ROP, 23.1% had mild ROP, and 29.3% did not have ROP; 30.2% infants required treatment. ROP was detected in 75.6% of multiple births versus 69.6% of singleton births; there were no significant differences between the two groups (
P
= .388).

Conclusion:

Extremely premature infants with low gestational ages had high incidence rates of advanced ROP. Most ELBW infants require ROP treatment. In addition, increased survival of ELBW infants owing to advancements in neonatal care warrants the specialization of ophthalmologists in regard to improved diagnosis and treatment of ROP.

[J Pediatr Ophthalmol Strabismus 2013;50(4):229–233.]
Scheimpflug-Based Tomography and Biomechanical Assessment in Pressure-Induced Stromal Keratopathy
Authors: Faria-Correia Fernando , Ramos Isaac , Valbon Bruno , Luz Allan , Roberts Cynthia J. , Ambrósio Renato
Published: August 2014

PURPOSE:

To report the tomographic and biomechanical findings before and after treatment of a case of pressure-induced stromal keratopathy (PISK), which was misdiagnosed as diffuse lamellar keratitis (DLK).

METHODS:

A case report of a referred patient with supposed diagnosis of DLK after LASIK in the right eye. Scheimpflug-based corneal tomography and biomechanical assessment were provided by the Pentacam HR and CorVis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany).

RESULTS:

A layer of corneal opacity beneath the flap with a presumably fluid-filled interface area was observed on slit-lamp biomicroscopy. Scheimpflug image from Pentacam revealed a hyperreflective area underneath the flap interface. Goldmann applanation tonometry was 12 mm Hg, whereas CorVis intraocular pressure was 53.5 mm Hg with deformation amplitude of 0.42 mm. Two days after starting oral and topical ocular hypotensive therapy, CorVis intraocular pressure was 14 mm Hg and deformation amplitude was 1.02 mm.

CONCLUSIONS:

Ocular hypertension in PISK was associated with lower deformation response, along with steepening and thickening of the cornea.

[
J Refract Surg.
2013;29(5):356–358.]
Combining Ocular Response Analyzer Metrics for Corneal Biomechanical Diagnosis
Authors: Ruiseñor Vázquez Pablo R. , Delrivo Marianella , Bonthoux Fernando Fuentes , Pförtner Tomás , Galletti Jeremías Gastón
Published: August 2014

PURPOSE:

To evaluate corneal biomechanical properties in non-keratoconic myopic eyes and to identify descriptors for improving the specificity of the Ocular Response Analyzer (ORA) (Reichert Ophthalmic Instruments, Depew, NY) testing for subclinical keratoconus detection.

METHODS:

Observational case series of 52 non-keratoconic non-myopic eyes and 97 non-keratoconic myopic eyes (spherical equivalent ⩽ −5 diopters [D]) in dataset 1 and 87 non-keratoconic eyes and 73 eyes with subclinical keratoconus in dataset 2. Examination included corneal topography, tomography, and biomechanical testing with the ORA. Receiver operating characteristic curves and logistic regression were used to identify optimal combinations of biomechanical indices for keratoconus detection. Main outcome measures were corneal thickness-corrected hysteresis (DifCH) and resistance factor (DifCRF), the difference between these two (CH-CRF), and the diagnostic performance of their combinations.

RESULTS:

Compared to non-keratoconic non-myopic eyes, non-keratoconic myopic eyes with flat corneas (average corneal power < 44.0 D) had reduced DifCH (mean ± standard deviation, 0.11 ± 1.27 vs −0.79 ± 1.50,
P
< .01) and DifCRF (0.24 ± 1.16 vs −0.70 ± 1.59,
P
< .01) values, whereas non-keratoconic myopic eyes with steep corneas showed no difference. Keratoconic eyes exhibited lower DifCH and DifCRF values than non-keratoconic myopic eyes. Combinations of DifCH, DifCRF, and CH-CRF had increased specificity (> 80%) for subclinical keratoconus compared to the DifCRF index alone (71%).

CONCLUSIONS:

In biomechanical keratoconus screening, some non-keratoconic myopic eyes show altered ocular biomechanical properties and are identified as false-positive cases. The low specificity of DifCRF when dealing with these non-keratoconic eyes could be improved by considering additional biomechanical descriptors such as DifCH and CH-CRF, which seem to be indicative of the aforementioned biomechanical profile.

[
J Refract Surg.
2013;29(9):596–602.]
Preoperative Topographic Characteristics of Eyes That Developed Postoperative LASIK Keratectasia
Authors: Bühren Jens , Schäffeler Thomas , Kohnen Thomas
Published: August 2014

PURPOSE:

To assess the suitability of corneal anterior and posterior surface aberrations and pachymetry profile data to discriminate between eyes that later developed postoperative LASIK iatrogenic keratectasia and eyes that remained stable.

METHODS:

Ten eyes of five patients that later developed iatrogenic keratectasia and 245 control eyes of 245 patients with a stable postoperative LASIK follow-up of 12 months or more were included. Zernike coefficients from anterior and posterior cornea, data from corneal pachymetry profiles, and output values of discriminant functions (input from Zernike coefficients, pachymetry data, and age) were assessed for their usefulness to discriminate between preoperative eyes with iatrogenic keratectasia eyes and controls using receiver operator characteristic (ROC) curve analysis. Furthermore, Randleman Ectasia Risk Scores were calculated for each eye.

RESULTS:

Anterior horizontal coma (C
3
1
) was the coefficient with highest discriminative ability (area under the ROC curve [A
Z
ROC] = 0.819). For posterior coefficients and pachymetry data, A
Z
ROC values were lower. Constructing discriminant functions increased A
Z
ROC values. The function containing anterior and posterior Zernike coefficients, pachymetry data, and age reached an A
Z
ROC of 0.991. The other functions ranged from 0.858 (pachymetry) to 0.981 (anterior and posterior Zernike coefficients and age). With the Randleman Ectasia Risk Scores, 80.4% were classified correctly if eyes with 4 points or more were excluded from treatment (87.1% for 3 points or more).

CONCLUSIONS:

Preoperative corneal topographic characteristics of eyes that developed iatrogenic keratectasia were different than those of eyes that remained stable. However, topography patterns were not identical with those found in eyes with subclinical keratoconus in previous studies. Discriminant functions from Zernike coefficients and pachymetry data were useful to discriminate between normal eyes and eyes with preoperative iatrogenic keratectasia.

[
J Refract Surg.
2013;29(8):540–549.]
Repeatability of Ocular Biomechanical Data Measurements With a Scheimpflug-Based Noncontact Device on Normal Corneas
Authors: Nemeth Gabor , Hassan Ziad , Csutak Adrienne , Szalai Eszter , Berta Andras , Modis Laszlo
Published: August 2014

PURPOSE:

To analyze the repeatability of a new device measuring ocular biomechanical properties, central corneal thickness (CCT), and intraocular pressure (IOP) and to investigate these parameters and their correlations in healthy eyes.

METHODS:

Three consecutive measurements were performed on each eye using the CorVis ST device (Oculus Optikgeräte, Inc., Wetzler, Germany). Ten specific parameters, CCT, and IOP were measured. Biometric data were recorded with IOLMaster (Carl Zeiss Meditec, Jena, Germany).

RESULTS:

This study comprised 75 eyes of 75 healthy volunteers (mean age: 61.24 ± 15.72 years). Mean IOP was 15.02 ± 2.90 mm Hg and mean CCT was 556.33 ± 33.13
μ
m. Intraclass correlation coefficient (ICC) was 0.865 for IOP and 0.970 for CCT, and coefficient of variation was 0.069 for IOP and 0.008 for CCT. ICC was 0.758 for maximum amplitude at highest concavity and 0.784 for first applanation time, and less than 0.6 for all other parameters. The device-specific data showed no significant relationship with age and axial length. Flattest and steepest keratometric values and IOP showed a significant correlation with the 10 device-specific parameters.

CONCLUSIONS:

The CorVis ST showed high repeatability for only IOP and pachymetric values. Single measurements are not reliable for the 10 device-specific parameters. The device allows for conducting clinical examinations and screening for surgeries altering ocular biomechanical properties with some form of averaging of multiple measurements.

[
J Refract Surg.
2013;29(8):558–563.]
Acetazolamide-Induced Bilateral Choroidal Effusion Following Insertion of a Phakic Implantable Collamer Lens
Authors: de Rojas Victoria , González-López Félix , Baviera Julio
Published: August 2014

PURPOSE:

To present the case of a 28-year-old man with acetazolamide-induced bilateral choroidal effusion after uneventful surgery of the second eye in delayed sequential bilateral insertion of an implantable collamer lens for hyperopia.

METHODS:

Case report.

RESULTS:

Surgery of the left eye was uneventful, and the implantable collamer lens was implanted 3 weeks later in the right eye. Twenty-four hours after surgery, the patient presented with bilateral shallow anterior chamber, vault 0, and myopic shift (−8 diopters) in both eyes. B-scan ultrasound showed choroidal thickening in both eyes, which was consistent with choroidal effusion syndrome. A causal relationship was suspected with oral acetazolamide, which had been prescribed after surgery. When the drug was stopped, the condition improved slowly and resolved completely within 5 days.

CONCLUSIONS:

Choroidal effusion should be included in the differential diagnosis of shallow anterior chamber after implantation of an implantable collamer lens.

[
J Refract Surg.
2013;29(8):570–572.]
Comparison of Keratometric Changes After Myopic Ablation: Ray Tracing Versus Simulated Keratometry
Authors: Mello Glauco Reggiani , Roberts Cynthia J. , Smadja David , Serpe Crislaine C. , Krueger Ronald R. , Santhiago Marcony R.
Published: August 2014

PURPOSE:

To compare the changes in corneal power (ΔK) induced by myopic ablations estimated by Placido-disk and total corneal power (TCP) ray tracing methods to the refractive change (ΔSE).

METHODS:

Manifest refraction, simulated keratometry from a Placido-disk based system, and TCP from a dual-Scheimpflug analyzer were obtained from 35 patients (58 eyes) before and 3 months after a myopic ablation. The change in the manifest refraction that occurred after surgery was then vertex distance corrected and compared to the changes observed in corneal power with the various systems analyzed.

RESULTS:

The Placido-based simulated keratometry overestimated the corneal power after the procedure by 0.50 ± 0.53 diopters (D) when compared to refractive change in the corneal plane induced by the laser surgery (ΔSE-ΔK). The ray tracing method showed the opposite trend, with the TCP simulated keratometry showing an underestimation of the corneal power of −0.25 ± 0.48 D. The Placido system showed a direct correlation between the overestimation of the corneal power and the level of myopia, whereas the ray tracing method showed an underestimation, which was more pronounced in higher levels of myopia.

CONCLUSIONS:

Ray tracing methods underestimate corneal power as opposed to the overestimation in corneal power after refractive surgery, directly related to the level of myopia, observed in Placido-based systems. They have the potential to overcome the errors in calculations based on anterior curvature alone. However, ray tracing methods need to be validated and optimized before it can be used routinely in IOL calculation.

[
J Refract Surg.
2013:29(9):604–610.]