bluuebunny/crossref_metadata_2025 huggingface dataset:
Posterolateral Spondylodesis Using Bioactive Glass S53P4 and Autogenous Bone in Instrumented Unstable Lumbar Spine Burst Fractures
Authors: Rantakokko J. , Frantzén J. P. , Heinänen J. , Kajander S. , Kotilainen E. , Gullichsen E. , Lindfors N. C.
Published: March 2013

Background and Aims

A prospective long-term follow-up study of bioactive glass (BAG)-S53P4 and autogenous bone (AB) used as bone graft substitutes for posterolateral spondylodesis in treatment of unstable lumbar spine burst fractures during 1996–1998 was conducted.

Material and Methods

The lumbar fractures were fixed using posterior USS instrumentation. BAG was implanted on the left side of the fusion-bed and AB on the right side. The operative outcome was evaluated on X-rays and CT scans, and a clinical examination was also performed.

Results

The Oswestry score was excellent, and the mean pain score 1. The mean compression rate of the injured vertebral body was 25%. A solid bony fusion was seen on CT scans on the AB side in all patients and on the BAG side in five patients, and a partial fusion in five patients, resulting in a total fusion-rate of 71% of all fused segments in the BAG group.

Conclusions

Our long-term results show that BAG-S54P4 bone graft material is safe to be used as a bone graft extender in spine surgery.
Hybrid Procedures as a Novel Technique in the Treatment of Critical Limb Ischemia
Authors: Aho P.-S. , Venermo M.
Published: March 2013

In hybrid reconstructions, patients are treated using both endovascular and open revascularization techniques simultaneously. In recent years, these multilevel reconstructions have been increasingly used especially by vascular surgeons as they have adopted new knowledge and endovascular skills and the endovascular techniques have evolved. The first reports of combined endovascular and open surgical procedures are from the 1970s. Since then, most reports have dealt with femoral endarterectomy or femoro-femoral bypass combined with inflow iliac percutaneous transluminal angioplasty (PTA) and stenting. Primary success rates have been high: 93%–100%. In our institution 213 hybrid procedures were performed during 2003–2011 with 98.6% technical success rate. The annual number of hybrid procedures ranged from 4 in 2004 to 73 in 2011. Inflow endovascular procedure was performed in 60% and outflow in 40 % of the cases. The proportion of the endovascular component performed by vascular surgeons increased from 0% in 2004 to 86.3% in 2011.

In the current report we review the results published in the literature, report our own experience and present some technical notes and cases.
Nasoenteric Tube Complications
Authors: Prabhakaran S. , Doraiswamy V. A. , Nagaraja V. , Cipolla J. , Ofurum U. , Evans D. C. , Lindsey D. E. , Seamon M. J. , Kavuturu S. , Gerlach A. T. , Jaik N. P. , Eiferman D. S. , Papadimos T. J. , Adolph M. D. , Cook C. H. , Stawicki S. P. A.
Published: March 2013

The use of nasoenteric tubes (NETs) is ubiquitous, and clinicians often take their placement, function, and maintenance for granted. NETs are used for gastrointestinal decompression, enteral feeding, medication administration, naso-biliary drainage, and specialized indications such as upper gastrointestinal bleeding. Morbidity associated with NETETs is common, but frequently subtle, mandating high index of suspicion, clinical vigilance, and patient safety protocols. Common complications include sinusitis, sore throat and epistaxis. More serious complications include luminal perforation, pulmonary injury, aspiration, and intracranial placement. Frequent monitoring and continual re-review of the indications for continued use of any NETET is prudent, including consideration of changing goals of care. This manuscript reviews NET-related complications and associated topics.
Perioperative Morbidity, Mortality and Early Outcome of the First 360 Gastric Bypass Operations Performed in a District Hospital
Authors: Victorzon M. , Peromaa-Haavisto P. , Tolonen P.
Published: March 2013

Background and Aims:

We report the results for the first consecutive 360 Roux-en-Ygastric bypass (RYGB) operations performed in a district hospital in Finland.

Material and Methods:

Demographic data, perioperative characteristics, and follow-up data were entered prospectively in the hospital's database for bariatric patients.

Results:

We performed 325 primary laparoscopic Roux-en-Ygastric bypass (LRYGB) operations, one open RYGB, and 34 revisions. Mean BMI before the operations was 47.5 ± 7.8 kg/m2 (31.5–91.0 kg/m2). The percentage of patients with type 2 diabetes mellitus (T2DM) was high; 52.3% (170 patients). The mean operative time decreased from 110 minutes during the first 108 operations to 82 minutes for the second 108 operations, and to 74 minutes for the last 109 operations (P < 0.001). Postoperative hospital stay was significantly reduced (P < 0.001) for the last 109 patients compared to the first and second group of patients. Overall morbidity averaged 19.1% (62/325). Severe complications were detected in 15 patients (4.6%). There was a tendency to more serious complications in the first group of patients. There was one death (mortality 0.3%). With a follow-up rate of 97% at 3 months T2DM had resolved in 48.2%, and had resolved or improved in a minimum of 92.9% of the diabetic patients. Weight loss (WL) and excess weight loss (EWL) averaged 20% and 46% respectively.

Conclusions:

Operative time and postoperative hospital stay decrease significantly with increasing experience. The first one hundred patients may be at higher risk for complications. LRYGB operations may have an important impact on the resolution of T2DM in the operated population.
Increased Energy Intake in Hip Fracture Patients Affects Nutritional Biochemical Markers
Authors: Gunnarsson A.-K. , Åkerfeldt T. , Larsson S. , Gunningberg L.
Published: March 2013

Background and Aims:

We have previously shown that nutritional guidelines decreased the incidence of pressure ulcers in hip fracture patients. In the present study, we evaluate whether the nutritional biochemical markers S-IGF-1 (Insulin-like Growth Factor 1), S-Transthyretin and S-Albumin are affected by patients' energy intake, and whether the markers are useful as predictors of postoperative complications.

Material and Methods:

Quasi-experimental design, with one intervention and one control group, as well as pre- and post-study measurements. Eighty-eight hip fracture patients were included: 42 in the control group and 46 in the intervention group. The control group received regular nutritional support pre- and postoperatively, while the intervention group received nutritional support that followed new, improved clinical guidelines from admission to five days postoperatively. S-Albumin, S-Transthyretin, C-Reactive Protein (S-CRP) and S-IGF-1 were analysed at admission and five days postoperatively as well as complications like pressure ulcer and infection.

Results:

The intervention group had a significantly higher energy intake; for example, 1636 kcal versus 852 kcal postoperative day 1. S-IGF-1 levels decreased significantly in the control group, while no decrease in the intervention group. S-Albumin and S-Transthyretin decreased and S-CRP increased significantly in both groups, indicating that those markers were not affected short-term by a high-energy intake. There was no correlation between short-term postoperative complications and S-IGF-1, S-Transthyretin or S-Albumin at admission.

Conclusion:

The results of our study showed that S-IGF-1 can be used as a short-term nutritional biochemical marker, as it was affected by a five-day high-energy regimen. However, neither S-IGF-1, S-Transthyretin or S-Albumin were useful in predicting postoperative complications within five days postoperatively.
Femoral Neck Bone Mineral Density after Resurfacing Hip Arthroplasty
Authors: Tapaninen T. , Kröger H. , Jurvelin J. , Venesmaa P.
Published: March 2013

Introduction:

Resurfacing hip arthroplasty (RHA) has been suggested to provide an alternative to conventional total hip arthroplasty in younger, active patients. It seems to have an ability to conserve the bone mass on the femoral side. Some controversy exists regarding to the possible disadvantages of RHA and some of them are connected to poor femoral bone quality after surgery. Hence we wanted to study the bone mineral density changes 3 and 12 months after RHA.

Materials and Methods:

A total of 26 patients (22 men and 4 women, 28 hips) underwent a hip resurfacing arthroplasty. The mean age of the patients was 55,2 (range 38–69) years. Bone mineral density (BMD) of the proximal femur was measured by using the dual-energy X-ray absorptiometry (DXA) postoperatively and within 3 and 12 months from surgery. For analysis, we divided the femoral neck area into four equal-sized regions of interest ranging from the prosthesis to the trochanter level.

Results:

At three months follow-up the BMD changes varied between −5.1% (ROIC) and + 1.9% (ROIA), as compared with the immediate postoperative values. After one year follow-up the BMD changes were + 1.1% in the ROIA, + 5.4% in the ROIB, −3.9% in the ROIC and + 1.3% in the ROID. The changes in BMD were not statistically significant.

Discussion:

While there is still much debate and room for additional research in this topic, the results suggest that BMD is conserved in the femoral neck one year after hip resurfacing arthroplasty.
A Critical Analysis of Postoperative Complications of Antebrachium Ten-Nailing in 35 Children
Authors: Salonen A. , Salonen H. , Pajulo O.
Published: March 2013

Background:

Unstable antebrachium diaphyseal fractures in children are nowadays increasingly treated operatively by elastic intramedullary nailing.

Aim:

Aim of the study was to critically assess both radiological and functional outcome of antebrachium fractures treated by titanium elastic nail (TEN) in a pediatric cohort.

Material and Methods:

This retrospective study investigated 75 consecutive children, who were treated for antebrachium shaft fractures at Tampere University Hospital during the time period from January 2001 to December 205. All the fractures were classified according to OTA. Thirty-five children (mean age 12.3 years) were treated by TEN-nailing. Twenty four of the forearm fractures were instable, five were open, five were re-fractures and one had ulnar nerve deficit. In all but one patient both forearm bones were fractured. Twelve (34%) operations were managed by closed reduction, open reduction was needed in 23 (66%) patients. In 29 cases both bones were fixed with TEN-nail. In the four patients with re-fracture in both ulna and radius only the radius was TEN-nailed. In one case radius was fixed with TEN-nail and ulna with K-wire and in another case radius was fixed with TEN-nail and ulna with plate. Fracture pattern, mode of reduction, surgical approach, short- and long-term complications and outcome were recorded.

Results:

Twenty three (66%) patients achieved healing of the fractures without any limitation in range of motion. Twelve patients with postoperative complication were followed up 31–74 (median of 54) months. Eleven (31%) patients had minor postoperative complications and one (0,3%) patient had a Volkmann's ischemic contracture. Five of complicated patients had more than one problem. Immediate post-operative problems were noted in these five patients. At follow-up visits four patients complained of ulnar nail discomfort, two had neural symptoms. Additionally, three children suffered from re-fractures.

Discussion:

Despite various minor complications, TEN-nailing is considered suitable treatment for unstable forearm shaft fractures. Most of the problems were related to poor technical performance in nailing.
Successful Femoral Reconstruction with a Fluted and Tapered Modular Distal Fixation Stem in Revision Total Hip Arthroplasty
Authors: Skyttä E. T. , Eskelinen A. , Remes V.
Published: March 2013

Background and Aims:

Early results of fluted and tapered distal fixation stems used in reconstruction of deficient femora in femoral revision arthroplasty have been successful in small series. We evaluated the survival of the LINK MP Reconstruction Hip Stem and factors associated with survival using data from a nation-wide arthroplasty register.

Materials and Methods:

408 femoral revisions using LINK MPReconstruction Hip Stem were performed during 1994 to 207. The mean age of the patients was 72.5 (range: 36–93) years and 63% were performed in women. Kaplan-Meier analysis and the Cox regression model were used for the survival analysis. The effects of age, sex and diagnoses were also studied.

Results:

The 9-year overall survivorship for the LINK MPReconstruction Hip Stem was 75% (95% CI 70–80). Aseptic loosening was rare; the 9-year revision rate for aseptic loosening was only 3%, which coincides with earlier reports with shorter folllow-up. The most common reason for re-revision was dislocation of the prosthesis with or without malposition of the socket (67%). Indication for revision strongly affected the survival rate with revisions for dislocation having an over 3-fold and revisions for infection a 3-fold relative risk for re-revision compared to revisions for aseptic loosening. Increasing age slightly decreased the risk of re-revision but sex did not affect the survival.

Discussion:

Based on our findings, we conclude LINK MP Reconstruction Hip Stem, as an example of a fluted and tapered distal fixation stem, appears to solve many problems with implant fixation in femoral revisions. High number of dislocations suggests that special attention should be paid to correct center of rotation, to correct implant positioning and to need of constrained implants in case of deficient abductor mechanism.
The Role of Hybrid Procedures in the Management of Peripheral Vascular Disease
Authors: Balaz P. , Rokosny S. , Bafrnec J. , Björck M.
Published: March 2013

This paper provides a summary of up-to-date information and experience with the combined treatment of patients suffering from peripheral arterial disease (PAD) with endovascular and open surgery, performed simultaneously and in a single operating room. Hybrid intervention is reported to have good results in well-indicated groups of patients with acute and chronic limb ischemia, even with older, high-risk patients. The indications for the use of this technique remain unclear with inconsistent opinions among vascular surgeons. The indications for treatment were divided into three main groups: 1) Patients with chronic limb ischemia, 2) acute limb ischemia, and 3) occlusion of a previous vascular reconstruction. The operating techniques for the most commonly used combinations are described.

In conclusion, hybrid operating techniques are often useful when treating complex problems and multilevel disease in patients with chronic or acute lower limb ischemia. Modern vascular surgeons need to master both open and endovascular techniques, and to combine them in a creative fashion to the benefit of our patients.
Periprosthetic Bone Turnover after Primary Total Hip Arthroplasty Measured by Single-Photon Emission Computed Tomography
Authors: Venesmaa P. , Vanninen E. , Miettinen H. , Kröger H.
Published: March 2013

Background and Aims:

Alterations in periprosthetic bone are common sequlae of prosthetic implants. This prospective 3-year study was performed to follow regional periprosthetic bone turnover after uncomplicated total hip arthroplasty (THA) using single-photon emission computed tomography (SPECT).

Material and Methods:

Eighteen patients (nine men, nine women: mean age 61 years, range from 50 to 73 years) with primary hip osteoarthritis underwent either uncemented or cemented THA. The SPECT measurements were taken 6, 12, and 36 months after THA. B one mineral density (BMD) measurements were performed on the patients during follow-up.

Results:

The mean SPECT uptake ratios decreased significantly in the regions of interest (ROIs) during follow-up compared to baseline value, in the trochanter major (p = 0.006), the trochanter minor (p = 0.009) and the total area (p = 0.018). Despite these decreases the uptake ratios in the medial cortex (p = 0.014), tip (p = 0.002) and total area (p = 0.016) remained significantly higher in the operated side than in the contralateral side (non-operated) 3 years after THA. Changes in bone turnover in the vicinity of the implant did not correlate with changes in periprosthetic BMD.

Conclusions:

Local periprosthetic bone turnover decreased slowly after THA and did not recover to the level typical of non-operated hips. This led us to suggest that bone turnover around the femoral implants remains increased more than 3 years after THA even if there are no signs of failure of the prosthesis.
Salmon Calcitonin (Miacalcic NS 200 IU) in Prevention of Bone Loss after Hip Replacement
Authors: Arnala I. O.
Published: March 2013

Background and Aims:

Loosening of a hip prosthesis after total arthroplasty is related to periprosthetic bone loss. Calcitonin has been used in the treatment of bone loss in osteoporosis and prevention of fractures. The main purposes of the study were firstly to evaluate the effect of calcitonin on periprosthetic bone after total hip arthroplasty, secondly investigate possible loosening of the prosthesis and thirdly examine further clinical outcome.

Patients and Methods:

60 patients who underwent total hip arthroplasty using cemented Exeter prosthesis were randomized in the treatment group (salmon calcitonin 200 IU nasal spray daily + calcium 500 mg) and the placebo group (inactive nasal spray + calcium 500 mg) for six months. Bone mineral density (BMD) was measured from different locations at the time of discharge and after six and 12 months. Dynamic histomorphometry on bone biopsies taken from femoral collum was performed. Serum bone-specific alkaline phosphatase (BAP), serum osteocalcine (OC) and cross-linked N-telopeptides (NTX) were measured after one week, one month, three months and 12 months. Clinical manifestations and the incidence of fractures and loosening of the prosthesis were followed up to eight years.

Results:

Statistically there was not significant difference in bone histomorphometry between the groups. In both groups there was a significant BMD decrease in periprosthetic bone. However, the difference between the groups was not statistically significant. In the biochemical analysis NTX increased more in the Miacalcic group than in the placebo group (p = 0.013). There were no significant differences between the groups in serum BAP or OC even though the changes within the groups were statistically significant. No loosening of the prosthesis was seen during the follow-up and there was no need for revision of any reason. Four fractures were recorded in three patients. One patient sustained a periprosthetic fracture. All the patients with fractures were allocated in the placebo group.

Conclusions:

Nasal salmon calcitonin 200 IU on a daily basis does not promote any additional value on calcium substitution to prevent bone loss after hip replacement. The durability of the Exeter prosthesis was good.
Preoperative Predictors for Good Postoperative Satisfaction and Functional Outcome in Lumbar Spinal Stenosis Surgery — A Prospective Observational Study with a Two-Year Follow-up
Authors: Aalto T. , Sinikallio S. , Kröger H. , Viinamäki H. , Herno A. , Leinonen V. , Turunen V. , Savolainen S. , Airaksinen O.
Published: March 2013

Background and Aims:

Lumbar spinal stenosis (LSS) is the most frequent indication for back surgery in adults aged over 65 years, but about one-third of operated patients have less than good/excellent results from the operation. Awareness of outcome predictors and their predictive values may help clinicians in their assessment of the prognosis of patients when considering surgical treatment. Our aim was to study the preoperative predictors in LSS for a good postoperative outcome (satisfaction with surgery and functional improvement) with a two-year follow-up.

Material and Methods:

LSS patients (n = 102) completed a questionnaire preoperatively and on two-year follow-up. Preoperative patient-related predictors, self-rated health, comorbidities and preoperative treatment were assessed. Satisfaction with the surgical outcome was assessed with a seven-category scale; satisfaction was determined to be good if the patient response was “condition has considerably improved” or “totally cured”. Other responses (“condition has slightly improved” or worse) represented poorer satisfaction. A good functional outcome was determined as > 30% relative improvement compared to the presurgery score in the Oswestry Disability Index (ODI).

Results:

The predictors for good satisfaction were age < 75 years at operation (OR 4.03; 95% CI 1.35–12.02; p = 0.012) and no previous lumbar operation (OR 3.65; 95% CI 1.13–11.79; p = 0.031). Predictors for a good improvement in the ODI score were regular preoperative analgesic use < 12 months (OR 3.40; 95% CI 1.21–9.53; p = 0.020), non-smoking (OR 3.47; 95% CI 1.09–11.03; p = 0.035) and good (above average) self-rated health (OR 3.27; 95% CI 1.06–10.12; p = 0.039).

Conclusions:

In LSS, regular analgesic treatment preoperatively for 12 months or less, self-rated health above average and non-smoking predicted a good postoperative functional improvement. An age under 75 years and no previous lumbar operation predicted good postoperative satisfaction with the surgery.
Medial Malleolar Stress Fracture in Athletes: Diagnosis and Operative Treatment
Authors: Lempainen L. , Liimatainen E. , Heikkilä J. , Alonso J. , Sarimo J. , Mattila K. , Orava S.
Published: March 2013

Background and Aims:

Stress fractures are common overuse injuries in athletes. Medial malleolar stress fractures are rare but they have an important clinical relevance because of their tendency to cause considerable disability and loss of time in sports without proper treatment. The diagnosis of medial malleolar stress fracture is often a challenge and it is therefore often delayed which may cause even further problems in the treatment. The purpose of this study was to increase the awareness of medial malleolar stress fractures as a possible cause for medial ankle pain and to stress the importance of MRI in the diagnostics as well as to evaluate the results of surgical treatment.

Patients and Methods:

Between 1995 and 2008, a total of ten athletes with a medial malleolar stress fracture were operated at our centre. All operated cases during those years were included in the study. The cases were retrospectively analyzed. Return to pre-injury level of sport was evaluated and considered as an indicator of successful treatment.

Results:

Initially all standard radiographs were negative whereas in MRI the fractures were all visible. After operative treatment all medial malleolar stress fractures healed clinically in three to four months and all except one of the athletes were able to return to their pre-injury level of sports.

Conclusion:

Early MRI is recommended if a medial malleolar stress fracture is suspected. Surgical treatment seems to result in rapid healing of the fracture and return to sports. In our opinion early surgery should be considered especially in athletes.
The Mean Seven Years' Results of the Use of Poly-L/D-Lactic Acid (PLDLA) Interposition Implant and Bone Packing in Revision Metacarpophalangeal Arthroplasty: A Prospective Cohort Study
Authors: Tiihonen R. , Honkanen P. B. , Belt E. A. , Ikävalko M. , Skyttä E. T.
Published: March 2013

Background and Aims:

Revision arthroplasty of metacarpophalangeal (MCP) joints in chronic inflammatory arthritis patients after silicone implants is challenging due of severe bone loss and soft tissue deficiencies. The aim of this study was to evaluate the outcome of revision MC Parthroplasty using poly-L/D-lactic acid 96:4 (PLDLA) interposition implant and morcelised allograft or autograft bone packing in patients with failed MCP arthroplasties and severe osteolysis.

Material and Methods:

The study group consisted of 15 patients (15 hands and 36 joints) at a mean follow-up of seven years (range 5–10 years). The radiographs were reviewed for osteolysis and incorporation of the grafted bone. The clinical assessments included active range of motion, evaluation of pain, subjective outcome and assessment of grip power.

Results:

PLDLA interposition arthroplasty combined with bone packing provided satisfactory pain relief, but function was limited. Radiographic analysis showed complete incorporation of the grafted bone to the diaphyseal portion of the host metacarpal and phalangeal bones in 30 of the 36 joints. All the patients had very limited grip strength, both on the operated and non-operated side.

Conclusions:

Due to soft tissue deficiencies long-term function and alignment problems can not be resolved with PLDLA interposition implant.
Single-Incision plus One Port Laparoscopic Anterior Resection for Rectal Cancer as a Reduced Port Surgery
Authors: Hirano Y. , Hattori M. , Douden K. , Shimizu S. , Sato Y. , Maeda K. , Hashizume Y.
Published: March 2013

Background:

Only limited data in the literature about single-incision laparoscopic rectal surgery, because the laparoscopic stapler does not allow low rectal transection without sufficient distal margins from the umbilicus port. We have developed single-incision plus one port laparoscopic anterior resection of the rectum (SILS+1-AR) as a reduced port surgery in which we can utilize the incision for drainage as an additional access route for laparoscopic procedures including the transection the lower rectum.

Methods:

A Lap protector (LP) mini was inserted through a 2.5 cm transumbilical incision, and an EZ-access was mounted to LP and three 5-mm ports were placed in EZ-access. A 12 mm port was inserted in right lower quadrant. Almost all the procedures were performed with usual laparoscopic instruments, and the operative procedures were much the same as in usual laparoscopic low anterior resection of the rectum using a flexible 5mm scope. The rectum was transected normally using only one endoscopic linear stapler inserted from the right lower quadrant port.

Results:

We underwent modified SILS+1-AR in 16 patients with advanced rectal cancer. In all cases, there was no need to extend the skin incision. We transected the lower rectum with one laparoscopic stapler in all six cases. Postoperative follow-up did not reveal any umbilical wound complications or recurrences.

Conclusions:

The safety and feasibility of SILS+1-AR for advanced rectal cancer was established in this study. However, further studies are needed to prove the advantages of this procedure to conventional laparoscopic law anterior resection.
Focused Assessment with Sonography for Trauma in Patients with Confirmed Liver Lesions
Authors: Nielsen S. Kärk , Ewertsen C. , Svendsen L. B. , Hillingsø J. G. , Nielsen M. B.
Published: March 2013

Background and Aims:

The objective was to determine the sensitivity and specificity of Focused Assessment with Sonography for Trauma (FAST) in patients with confirmed liver lesions and also to compare results from surgeons trained in FAST with results from radiologists trained in general abdominal ultrasound as part of the specialist training. Explorative laparotomy or CT served as gold standard.

Materials and Methods:

This retrospective study included all patients admitted to our institution from 2003 to 2010 registered with the diagnosis “Injury of the liver or gallbladder”. Of 405 patients, 135 patients were eligible for analysis. Seventy-two patients were examined by radiologists and 63 by surgeons.

Results:

We found FAST to have a sensitivity, specificity, PPV, and NPV of 79.6%, 100%, 100%, and 68.9%. There was no statistically significant difference between FAST performed by radiologists and surgeons trained in FAST.

Conclusion:

FAST remains an important screening tool in abdominal trauma including liver lesions, and can be performed at a satisfactory level by surgeons trained in the FAST procedure only.
Tension Suture Technique Combined with Lidocain-Adrenalin-Saline-Infiltration Decreases Complications in Abdominoplasty
Authors: Helle M. , Salmi A. , Saariniemi K. , Kuokkanen H.
Published: March 2013

Backgrounds and Aims:

Due to growing interest into body contouring has abdominoplasty become one of the most common aesthetic operations. New techniques have appeared to reduce the relatively high incidence of complications in abdominplasty. One technique is the tension suture technique, which can be combined with lidocain-adrenalin-saline-infiltration. Our aim was to analyse the results of this combined technique.

Material and Methods:

This retrospective study consisted of 95 women operated on in a private hospital by one senior plastic surgeon between years 2004 and 2009. Sixty patients had other operations in addition to abdominoplasty: 49 liposuctions, six breast reductions or mastopexies, three umbilical hernioplasties, one brachioplasty, one partial excision of labias, and one blepharoplasty.

Results and Conclusions:

The operative time was 82 minutes ranging from 45 to 173 minutes. Peroperative bleeding was a mean of 196 ml in abdominoplasty only and 254 ml when combined with additional operation. Patients did not have any major complications and the total incidence of minor — not clinically significant — complications was 12.6%. Obesity, smoking, comorbidities, previous operations on belly area or additional operations did not affect the complication rates. Our study supports the view that the tension suture technique combined with lidocain-adrenalin-saline-infiltration decrease the formation of seroma and wound complications in abdominoplasty. Lidocain-adrenalin-saline-infiltration also fastens and eases the operation without increasing the risk of bleeding in experienced hands.
Rising Incidence of Small Size Papillary Thyroid Cancers with No Change in Disease-Specific Survival in Finnish Thyroid Cancer Patients
Authors: Hakala T. , Kellokumpu-Lehtinen P. , Kholová I. , Holli K. , Huhtala H. , Sand J.
Published: March 2013

Background:

The aim of this study was to investigate trends in the incidence, diagnostics, treatment and survival of thyroid cancer in Tampere University Hospital (TAUH) region in recent decades.

Material and Methods:

New thyroid cancer cases from 1981 to 2002 were ascertained from the Finnish Cancer Registry. Follow-up data was collected from medical records of TAUH. Differentiated thyroid cancer (DTC; consisting of papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC)) patients' data was analyzed and divided into two equal time periods (1981–1991 and 1992–2002).

Results:

The total amount of thyroid cancer cases was 553, of which 427 (77%) were papillary and 72 (13%) follicular. Thyroid cancer was four times more common in females than in males and the median age at the time of diagnosis was 52 years. The incidence of DTC was 4.5/100 000 in the earlier group and 6.0/100 000 in the later group (IRR 1.33, CI 1.11–1.60). The proportion of papillary thyroid cancer rose from 81% to 89% (p = 0.02) in two study periods. Median tumour size became smaller, from 25 mm to 15 mm (p < 0.001). Surgery became more radical as total thyroidectomies were performed almost exclusively on the later group (p < 0.001). Median cumulative dose of radioiodine (I131) therapy was higher in the later group (p = 0.04). There was no difference in number of cancer recurrences (p = 0.54). The prognosis of DTC was good; 10-year disease-specific survival was 92% in the earlier group and 94% in the later group (p = 0.43).

Conclusions:

The incidence of thyroid cancer has risen and proportion of papillary cancer has increased, however, median size of tumour has decreased. No difference was seen in either all-cause or disease-specific survival.
The development of resilience in social work students and professionals
Authors: de las Olas Palma-García Maria , Hombrados-Mendieta Isabel
Published: March 2013

This study analyzes whether resilience, defined as a process rather than as a static response over time, is associated with social work. The main aim was to determine whether social work increases resilience in students and professionals during training and when practicing the profession. The sample consisted of 613 university students and professionals from Malaga (Spain).

Findings

The longitudinal study of social work students indicated statistically significant within-subjects differences during their university course in the components of resilience (personal competence, acceptance of self and life, and social support). Regarding professionals, the results show a positive association between years of experience and their acceptance of self and life and coping with workplace adversity.

Applications

Implications include the need to focus on the development of positive experiences during training and the practice of social work, such as the capacity to be resilient.
Semi-Markov processes with semi-regenerative states for the availability analysis of chemical process plants with storage units
Authors: Fink Olga , Zio Enrico
Published: March 2013

Design to capacity is an engineering principle that is increasingly applied in chemical industry, among others owing to increasing plant sizes and associated investments. This principle aims to reduce over-capacity, over-sized buffers and excessive redundancy. Concurrently, a high level of availability is targeted over the entire production chain. The consequences of unavailability of highly interconnected chemical process plants can be significant because a technical disruption in one plant is able to spread over the entire production network. In chemical process plants not only technical equipment determines the availability, but also storage units, which are able to bridge times of planned or unplanned interruptions of production. To find a balance between the principle of design to capacity and high production availability, the influence of different design parameters, such as capacity of production units, redundancy concept and the size of storage units, have to be evaluated and integrated in the design process. In this article, we present an analytical method for availability evaluation based on extending Semi-Markov processes integrating storage units and multiple production lines. Semi-regenerative states are used to capture the characteristics of storage units, and an approach is proposed in this work to assign distributions for the remaining holding times in these states. The proposed modelling and analysis are demonstrated on two case studies.
Transfer of the flexor carpi radialis to the abductor pollicis brevis tendon for the restoration of tip-pinch in severe carpal tunnel syndrome
Authors: Danoff J. R. , Birman M. V. , Rosenwasser M. P.
Published: March 2013

In patients with severe thenar atrophy secondary to carpal tunnel syndrome, we hypothesize that following open carpal tunnel release, concomitant transfer of the abductor pollicis brevis (APB) origin to the flexor carpi radialis (FCR) tendon will lead to improved patient function restoring palmar abduction and thumb opposition. We evaluated 14 patients through questionnaires and seven patients through additional physical examination (thumb range of motion, ability to tip pinch, grip/pinch strength) for a mean follow-up of 2.8 years. All patients showed evidence of palmar abduction with 71% demonstrating the ability to oppose the thumb to the tip and base of the small finger. The transfer of the APB origin to the FCR tendon can restore thumb abduction and opposition for thenar paralysis secondary to severe carpal tunnel syndrome. Patients experience good functional outcomes with the majority experiencing restored thumb opposition.
Using a Bone Allograft to Fixate Proximal Interphalangeal Joint Arthrodesis
Authors: Kominsky Stephen J. , Bermudez Roberto , Bannerjee Alvin
Published: March 2013

Digital contractures are a very common deformity of the foot and ankle that require surgical correction. It has been shown that arthrodesis provides a better long-term result than arthroplasty of the interphalangeal joints. Arthroplasties usually require K-wire fixation that presents potential complications, such as pin tract infection. This study presents a new cadaveric bone matrix allograft to be used as rigid internal fixation for proximal interphalangeal joint arthrodesis. The purpose of using the allograft as a fixation device is to achieve solid bone fusion and avoid the potential complications of external pin fixation. Arthrodesis of the proximal interphalangeal joint was performed on 63 toes in 32 patients using TenFUSE (Solana Surgical, Memphis, TN), a sterile bone matrix allograft. The authors found 97% fusion rate with no complications reported to this date. It was concluded that this bone matrix allograft provides excellent results and is a suitable alternative fixation device for correction of hammer toe deformity.

Level of Evidence: Level V
Activity-Related Outcomes of Articular Cartilage Surgery
Authors: Chalmers Peter N. , Vigneswaran Hari , Harris Joshua D. , Cole Brian J.
Published: March 2013

Objective:

The purpose of this systematic review was to compare activity-based outcomes after microfracture, autologous chondrocyte implantation (ACI), and osteochondral autograft (OAT).

Design:

Multiple databases were searched with specific inclusion and exclusion criteria for level III and higher studies with activity outcomes after microfracture, OAT, osteochondral allograft, and ACI. Activity-based outcomes included the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner Score, the Cincinnati Knee scores, the International Knee Documentation Committee (IKDC) subjective knee score, the Marx activity score, and/or the rate of return-to-sport.

Results:

Twenty studies were included (1,375 patients). Although results were heterogeneous, significant advantages were seen for ACI and OAT as compared with microfracture in Tegner scores at 1 year (ACI vs. microfracture, P = 0.0016), IKDC scores at 2 years (ACI vs microfracture, P = 0.046), Lysholm scores at 1 year (OAT vs microfracture, P = 0.032), and Marx scores at 2 years (OAT vs microfracture, P < 0.001). The only score or time point to favor microfracture was Lysholm score at 1 year (ACI vs microfracture, P = 0.037). No other standardized outcome measures or time points were significantly different. Several studies demonstrated significantly earlier return to competition with microfracture. Overall reoperation rates were similar, but of reoperations, a higher proportion of those following ACI were unplanned with the majority of performed for graft delamination or hypertrophy.

Conclusions:

ACI and OAT may have some benefits over microfracture, although return-to-sport is fastest following microfracture. Heterogeneity in technique, outcome measures, and patient populations hampers systematic comparison within the current literature.
The management of antenatal hydronephrosis detected on routine prenatal ultrasound
Authors: Westera Jurjen , Lambrianides Andreas L , Meyer Jon-Paul
Published: March 2013

Antenatal hydronephrosis (ANH) is a common abnormality seen on routine prenatal ultrasound. Although this condition is invariably transient and benign, it can result in a deterioration in renal function and other significant co-morbidities. Once detected, careful ultrasound monitoring of the ANH is recommended during pregnancy. Postnatal antibiotic prophylaxis should be commenced after birth whilst investigating in a stepwise fashion in order to elucidate the underlying cause of the hydronephrosis. The aim is to preserve renal function, prevent urinary tract infection, and protect the upper tracts.
Has the incidence of urolithiasis presenting to secondary care increased in the last 10 years?
Authors: Mangera A , Khan K , Parys BT
Published: March 2013

Objective:

Urolithiasis presenting to secondary care has been proposed to be on the increase, in the United Kingdom, based on national Hospital Episode Statistics data. We aimed to assess whether there has been an increase in stone disease presenting to a district general hospital in the last 10 years.

Methods:

A prospective stone database has been kept for all patients attending the urology department of a district general hospital from 2002. We assessed five yearly intervals to identify changes in incidence, gender and age distribution, and stone composition rates.

Results:

A 26% increase in calculi presenting to the urology department was noted in the last 10 years. This was in relation to a 2% population increase. This also resulted in a 26% increase in operations for urinary calculi. The increases were equal for men and women, and the mean age of presentation remained the same. There were no significant differences in the findings of stone composition in the last 10 years or in the surgical method of stone extraction.

Conclusion:

Urolithiasis presenting to the urologist is on the increase, leading to a greater need for urological procedures. Stone services may need to be increased to deal with this increasing demand.
Remembering the Past and Envisioning the Future in Bereaved Adults With and Without Complicated Grief
Authors: Robinaugh Donald J. , McNally Richard J.
Published: March 2013

Complicated grief (CG) is associated with impairment in the ability to retrieve specific autobiographical memories. However, previous research suggests that this impairment may not occur for memories related to the deceased. We recruited conjugally bereaved adults and assessed autobiographical memory specificity for events with and without the deceased. In addition, we examined the specificity of imagined future events both with the deceased and without. Individuals with CG were no less specific than were bereaved comparison subjects when generating events that included the deceased. However, they did exhibit difficulty recalling specific past events and imagining specific future events that did not include the deceased. Difficulty generating events without the deceased may underlie the sense of lost identity and hopelessness observed in CG. Relative ease of envisioning a counterfactual future with the deceased may provide the cognitive basis for yearning. Accordingly, memory and prospection may be important targets for CG treatments.
The Formation of a Neural Fear Network in Posttraumatic Stress Disorder
Authors: Wilker Sarah , Kolassa Iris-Tatjana
Published: March 2013

Individuals differ strongly in their vulnerability to develop posttraumatic stress disorder (PTSD) in the aftermath of traumatic stress. This review on genetic risk factors in PTSD etiology employs the perspective of a psychobiological model, which proposes that intrusive memories, the core PTSD symptom, result from the formation of an associative neural fear network, which stores sensory-perceptual representations of traumatic memories. The current state of research on the genetics of PTSD, as well as common challenges, is presented in light of this framework. Because cumulative trauma exposure increases the fear memory strength, a standardized assessment of traumatic load and the investigation of Gene × Environment interactions are recommended. The investigation of genes involved in long-term memory formation, genome-wide association studies, pathway analyses, and the interplay of genetic and epigenetic factors could contribute to a deeper understanding of the molecular pathways involved in the formation and modification of the fear network.
Achieving Improvements across the HIV Treatment Cascade
Authors: Zuniga José M. , Young Benjamin
Published: March 2013

Engagement in care is directly linked to achieving HIV viral suppression, yet over the past 2 years analyses of data related to the US HIV epidemic have revealed that many people living with HIV/AIDS are failing to successfully navigate the HIV treatment cascade, with only between an estimated 19% and 28% achieving the ultimate goal of antiretroviral therapy (ART): viral suppression. We propose a clinical management algorithm that captures key operational interventions recommended in recently published guidelines on entry into and retention in care and ART adherence.
The Pontic Greek spoken by Muslims in the villages of Beşköy in the province of present-day Trabzon
Authors: Özkan Hakan
Published: March 2013

This article consists of two parts. The first part provides general information on the language and its speakers: I describe the language, land, and livelihood of the Greek-speaking people of Beşköy in Trabzon province. In this respect it is indispensable to mention migration, which is one of the most serious threats the Greek-speaking community and their language faces today; statistical data show that Beşköy lost half of its population over the past fifty years. Despite these adverse conditions, the language has proved to be resilient enough to remain a preferred means of communication when Greek-speakers come together. In the last subsection, on language and identity, I present testimonies by native people which illustrate that positive attitudes towards both the Greek language and Turkish citizenship or Islamic identity are easily compatible.
Inhibition of Mnk kinase activity by cercosporamide and suppressive effects on acute myeloid leukemia precursors
Authors: Altman Jessica K. , Szilard Amy , Konicek Bruce W. , Iversen Philip W. , Kroczynska Barbara , Glaser Heather , Sassano Antonella , Vakana Eliza , Graff Jeremy R. , Platanias Leonidas C.
Published: March 2013

Key Points

The Mnk inhibitor cercosporamide suppresses human leukemic progenitors and exhibits antileukemic effects in a xenograft mouse model. Cercosporamide enhances the antileukemic effects of cytarabine in vitro and in vivo.
Identification of the chemokine CCL28 as a growth and survival factor for human hematopoietic stem and progenitor cells
Authors: Karlsson Christine , Baudet Aurélie , Miharada Natsumi , Soneji Shamit , Gupta Rajeev , Magnusson Mattias , Enver Tariq , Karlsson Göran , Larsson Jonas
Published: March 2013

Key Points

Chemokine (C-C motif) ligand 28 (CCL28) is a novel growth factor for human hematopoietic stem and progenitor cells. CCL28 supports the in vitro and in vivo functional integrity of cultured primitive hematopoietic cells.
Circuit lengths of graphs for the Picard group
Authors: Beşenk Murat , Güler Bahadır Ö , Değer Ali H , Kesicioğlu Yavuz
Published: March 2013

In this paper, we examine some properties of suborbital graphs for the Picard group. We obtain edge and circuit conditions, then propose a conjecture for the graph to be forest. This paper is an extension of some results in (Jones et al. in The Modular Group and Generalized Farey Graphs, pp. 316-338, 1991).
Stromal fibroblasts in the microenvironment of gastric carcinomas promote tumor metastasis via upregulating TAGLN expression
Authors: Yu Beiqin , Chen Xuehua , Li Jianfang , Qu Ying , Su Liping , Peng Yibing , Huang Jian , Yan Jun , Yu Yingyan , Gu Qinlong , Zhu Zhenggang , Liu Bingya
Published: March 2013

Background

Fibroblasts play a critical role in tumorigenesis, tumor progression and metastasis. However, their detailed molecular characteristics and clinical significance are still elusive. TAGLN is an actin-binding protein that plays an important role in tumorigenesis.

Results

We investigated the interaction between cancer cells and the tumor microenvironment to determine how the fibroblasts from human gastric carcinoma facilitate tumorigenesis through TAGLN. QRT-PCR and Western blot indicated that TAGLN expression was upregulated in gastric carcinoma-associated fibroblasts (CAFs) that promote gastric cancer cell migration and invasion. Using small interfering RNA (siRNA), we found that CAFs enhanced tumor metastasis through upregulated TAGLN in vitro and in vivo. The expression of matrix metalloproteinase-2 (MMP-2) was significantly lower after TAGLN knock-down by siRNA. TAGLN levels were elevated in human gastric cancer stroma than normal gastric stroma and associated with differentiation and lymph node metastasis of gastric cancer.

Conclusion

CAFs may promote gastric cancer cell migration and invasion via upregulating TAGLN and TAGLN induced MMP-2 production.