bluuebunny/crossref_metadata_2025 huggingface dataset:
Mortality Following Revision Joint Arthroplasty: Is Age a Factor?
Authors: Fehring Thomas K. , Odum Susan M. , Fehring Keith , Springer Bryan D. , Griffin William L. , Dennos Anne C.
Published: October 2010

With the demand for total joint arthroplasty and overall life expectancy increasing, there will be an increase in the need for revision arthroplasty surgeries. Given that revision joint surgeries are more demanding for both surgeon and patient with longer operative times, increased blood loss, and multiple patient comorbidities, the current mindset is that older patients who undergo a total hip revision or total knee revision have higher mortality rates than younger patients. We identified 1737 revision total joint patients who were at least 2 years postoperative for inclusion in the study. The overall perioperative mortality rate (defined as deaths occurring between 0 and 3 months following revision joint surgery) was calculated and then stratified by revision knee surgery, revision hip surgery, and age. In addition, mortality rates were compared for patients younger than 70 years, between 70 and 80 years and older than 80 years. The overall perioperative mortality rate after revision total hip or knee surgery was 0.7%. After stratifying by age, the perioperative mortality rate was 0.2% in patients younger than 70 years, 0.8% in patients 70 to 79 years, and 2.63% in patients older than 80 years. Of the 1737 patients, 541 died >1 year following their revision surgery at an average time to death of 6.9 years. The observed perioperative mortality rates following revision total joint surgery at a single center were extremely low among all age groups. Therefore, the age of patients undergoing revision surgery should not be the sole determinant of perioperative survival. Additionally, it appears that the mean postoperative survival noted here seems to justify the additional resources used in revision surgery regardless of age. As limited resources exert pressure on an already overburdened healthcare system, rationing of care for certain procedures may ensue using age as a specific criteria. This study should add clarity to this issue.
The Study of Epidurography and Multispiral CT Scanning Examinations in the Diagnosis of Lumbar Nerve Root Canal Stenosis
Authors: Yan Liang , Li Jinjun , Zhao Weiguang , Cui Zhun , Wang Hao , Xin Lin
Published: October 2010

Both computed tomography (CT) and magnetic resonance imaging (MRI) scans are used for the diagnosis of lumbar nerve root canal stenosis by imaging measurement, but the findings have considerable variability and the specificity of these examinations is difficult to estimate. A prospective study was conducted to determine the association between epidurography and multispiral CT scanning and the diagnosis of lumbar nerve root canal stenosis. Twenty-nine patients underwent multispiral computed tomography epidurographies from December 2007 to October 2008, and among them 26 patients underwent all 3 examinations of CT, MRI, and multispiral computed tomography epidurography. Twenty-three patients underwent surgical treatment. The imaging features were investigated, and the sensitivity, specificity and total consistency rates were analyzed. Multispiral computed tomography epidurographies show the extent of soft-tissue as well as bone. The sensitivity of CTs, MRIs, and multispiral computed tomography epidurographies is 76.5%, 88.2% and 94.1%, specificity 60.0%, 60.0%, and 80.0%, and total consistent rate 72.7%, 81.0%, and 90.9%, respectively, for diagnosis of lumbar nerve root canal stenosis. Multispiral computed tomography epidurography could obtain the image findings giving consideration to both bone and soft-tissue by contrast medium and 3-dimensional reconstruction. Multispiral computed tomography epidurography was used because of its contrast medium distribution rather than its imaging measurement because it could avoid the variability between image findings and clinical pathological process. Multispiral computed tomography epidurography had better imaging characteristics for the diagnosis of lumbar nerve root canal stenosis than CT or MRI scans.
Inhibition of TGF-β-Induced Collagen Production in Rabbit Flexor Tendon with Mannose-6-Phosphate in Vitro
Authors: Xia Chang-Suo , Yang Xuan-Ying , Yingzhen Wang , Sun Kang , Tian Shaoqi
Published: October 2010

The flexor tendon affects postoperative range of motion in the hand. Transforming growth factor-beta (TGF-β) is a key cytokine in the adhesion formation between the flexor tendon and its surrounding fibro-osseous sheath. The purpose of this study was to examine the inhibition of TGF-β-induced collagen-I production in rabbit flexor tendons with mannose-6-phosphate in vitro. Sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes from rabbit flexor tendons were isolated and each was supplemented with TGF-β along with increasing doses of mannose-6-phosphate. The enzyme-linked immunosorbent assay (ELISA) and reverse-transcription polymerase chain reaction (RT-PCR) measured collagen-I production. The luciferase assay measured TGF-β bioactivity. Results were compared with TGF-β alone and unsupplemented controls. TGF-β-induced collagen-I production was downregulated significantly with the addition of mannose-6-phosphate in a dose-dependent manner in all 3 cells cultures. The mannose-6-phosphate also reduced TGF-β bioactivity. The study shows that mannose-6-phosphate was effective in TGF-β inhibition in cultured flexor tendon cells. The findings presented here encourage further experiments that use the agents to modulate TGF-β levels and reduce adhesion formation after flexor tendon repair.
Mechanical Evaluation of Cross Pins Used for Femoral Fixation of Hamstring Grafts in ACL Reconstructions
Authors: Bellisari Gregory E. , Kaeding Christopher C. , Litsky Alan S.
Published: October 2010

The goal of this study was to test the mechanical strength of 4 different cross pins currently available for femoral fixation by loading each cross pin to failure as received and determine the effect of 1 million cycles of fatigue loading. Additionally, the strength of resorbable pins was tested after prolonged exposure to biologic conditions. Six implants each of the Arthrotek LactoSorb (Biomet, Warsaw, Indiana), Mitek RigidFix (DePuy Mitek Inc, Raynham, Massachusetts), Arthrotek Bone Mulch Screw (Biomet), cortical allograft, and control were tested for 3-point failure without prior loading and after cyclic loading between 50 to 200 N at 10 Hz for 1 million cycles. The bioabsorbable pins were placed in sterile water at 37°C and tested after 2, 4, and 6 months for 3-point failure strength. All implants tested without antecedent loading demonstrated adequate strength for initial fixation for hamstring grafts. During fatigue testing, RigidFix implants (n=6) failed at 18,893±8365 cycles (with a central deformation of 0.48±0.11 mm prior to fracture). All of the other implants tested endured 1 million cycles of loading (50–200 N) without fracture or 1.5 mm central deformation. Neither of the bioabsorbable pins demonstrated a significant change in yield strength after prolonged exposure to water.

All implants tested demonstrated adequate strength for initial fixation of hamstring grafts. The metal and bone implants far exceed the strength required to sustain mechanical fixation until biological fixation occurs; both polymeric implants demonstrated that they maintained enough mechanical strength to achieve this goal.
Better Functional Outcome of Salvage THA Than Bipolar Hemiarthroplasty for Failed Intertrochanteric Femur Fracture Fixation
Authors: Cho Chang-Hyun , Yoon Sang-Hyup , Kim Shin-Yoon
Published: October 2010

Failure of intertrochanteric fracture fixation often occurs in patients who have poor bone quality, severe osteoporosis, or unstable fracture patterns. The purpose of this study is to compare the results of total hip arthroplasty (THA) with bipolar hemiarthroplasty as the salvage procedures for failed fixation of intertrochanteric fractures of the femur. Eighteen consecutive patients who were treated for failed intertrochanteric fracture fixation were reviewed retrospectively. The patients were divided into 2 groups of salvage procedures: THA (9 patients) and bipolar hemiarthroplasty (9 patients).

In the THA group, mean Harris Hip Score (HHS), visual analog scale (VAS) score, and Salvati and Wilson score were 82.1, 0.9, and 31.3, retrospectively. In the bipolar hemiarthroplasty group, mean HHS, VAS score, and Salvati and Wilson score were 68.6, 3.1 and 25.1, retrospectively. Total hip arthroplasty was better than bipolar hemiarthroplasty treatment in HHS (
P
=.040), VAS score (
P
=.001), and Salvati and Wilson score (
P
=.033). There were no significant differences in hospital stay, operating time, and transfusion volume between the 2 groups.

Total hip arthroplasty seems to be more reliable salvage procedure for failed intertrochanteric fracture fixation in functional outcome and pain relief.
Intra-Articular Injection of Hyaluronic Acid Following Arthroscopic Partial Meniscectomy of the Knee
Authors: Thein Rafael , Haviv Barak , Kidron Amos , Bronak Shlomo
Published: October 2010

The short-term recovery period post-arthroscopic meniscectomy is characterized by pain and impaired function most likely related to the irrigation of synovial fluid from the knee intraoperatively. Consequently, along with removal of harmful debris, the irrigation fluid dilutes the hyaluronic acid layer covering the joint tissues. Hyaluronic acid contributes to the homeostasis of the joint environment and is an important component of synovial fluid and cartilage matrix. Hence, the instillation of hyaluronic acid after the procedure may relieve symptoms.

This prospective, single-blind, randomized, controlled study evaluated clinical outcome after hyaluronic acid injection to patients who underwent arthroscopic meniscectomy of the knee. Patients with ligamentous injuries or severe chondral damage were excluded. Fifty-six patients with a mean age of 34 years (range, 17–44 years) were injected with Viscoseal (TRB Chemedica International S.A., Geneva, Switzerland) or normal saline immediately post-arthroscopy and divided into the Viscoseal group or control group, respectively. Patients were evaluated for pain, swelling, and function at 1, 4, and 12 weeks postoperatively. Patients in the control group reported more pain at week 1, with a mean visual analog score (VAS) of 43, than did patients in the Viscoseal group, with a mean VAS of 28 (
P
=.006). At 4 weeks postoperatively, none of the Viscoseal patients had consumed analgesics, where 9 (of 28) in the control group reported acetaminophen intake (
P
=.039). No significant difference in knee function was found between groups. Intra-articular injection of Viscoseal after arthroscopic meniscectomy reduced pain in the short-term recovery period.
An Anatomical Update on the Morphologic Variations of S1 and S2
Authors: Karachalios Theofilos , Zibis Aristides H. , Zintzaras Elias , Bargiotas Konstantinos , Karantanas Apostolos H. , Malizos Konstantinos N.
Published: October 2010

Although percutaneous fixation with iliosacral screws has been shown to be a safe and reproducible method for sacroiliac dislocation and sacral fractures, it is a technically demanding technique, and one of its contraindications is sacral anatomical variations and dysmorphism. The incidence and pattern of S1 and S2 anatomical variations were evaluated in 61 patients (35 women and 26 men) using magnetic resonance imaging of the sacrum in an attempt to explore the possible existence of groups of individuals in whom percutaneous sacroiliac fixation is difficult due to local anatomy.

S1 and S2 dimensions in both the transverse and coronal planes were recorded and evaluated. In each individual, S1 and S2 dimensions both in the coronal and transverse planes were proportional, with S2 dimensions being 80% of those of S1 on average. Patients were separated into 4 groups based on the S1 and S2 body size and the asymmetry of dimensions in the transverse and coronal planes. In 48 patients (78.6%), dimensions in both planes were symmetrical despite the varying size of the S1 and S2 body. In 2 patients (3.3%) there was a combination of large transverse plane and small coronal plane dimensions, with large S1 and S2 body size. In 9 patients (14.8%), coronal plane dimensions were disproportionately smaller compared to those of the transverse plane, with a varying size of S1 and S2 body making effective sacroiliac screw insertion a difficult task. Thus, a preoperative imaging study, preferably computed tomography scan, of S1 and S2 body size and coronal plane dimensions and an intraoperative fluoroscopic control of S1 and S2 dimensions on the coronal plane are suggested for safe sacroiliac screw fixation.
Treatment Strategies for Intramedullary Nailing of Femoral Shaft Fractures
Authors: Wild Michael , Gehrmann Sebastian , Jungbluth Pascal , Hakimi Mohssen , Thelen Simon , Betsch Marcel , Windolf Joachim , Wenda Klaus
Published: October 2010

Intramedullary nailing has become the gold standard to treat femoral shaft fractures. It is unknown which nailing technique orthopedic surgeons prefer. The goal of this study was to determine current techniques and perioperative complications of intramedullary nailing of diaphyseal femoral fractures. Fifty-one institutions in 26 countries participated in an international survey to assess detailed descriptions of preferred operative strategies and perioperative complications. Altogether, 517 cases of diaphyseal femoral fractures were collected. The Internet-based survey incorporated information about fracture classification, time to operation, Injury Severity Score, type of nail, and operative technique, as well as perioperative complications such as infection, femoral neck fracture, and hardware failure.

The preferred position for implantation was supine (91.1%). Most surgeons used a traction table (57.1%) and an antegrade implantation technique (84.5%). Intraoperative fractures of the femoral neck occurred in 1.2% of cases when a traction table was used and in 0.2% if no traction table was used, but without statistical significance (
P
>.16). In 59.2% of the cases, an isolated femur fracture was present, while the rest sustained multiple injuries. In polytrauma patients and patients with severe thorax injuries, most surgeons chose a delayed treatment with intramedullary femoral nails. Interestingly, 38.0% of the patients with severe thorax injuries were treated on the first day with intramedullary femoral nails. The total rate of complications for intramedullary femoral nailing was low (4.9%), but a high rate of intraoperative femoral neck fractures was observed (1.4%).
The Triple PCL Sign: Bucket Handle Tears of Both Medial and Lateral Menisci in a Chronically ACL-Deficient Knee
Authors: Kakel Rafid , Russell Robert , Vanheerden Pieter
Published: October 2010

Bucket handle tears of both menisci in the setting of acute or chronic anterior cruciate ligament (ACL) tears of the same knee have rarely been reported in the literature. This article presents a case of a bucket handle tear affecting both the medial and lateral menisci in a patient with chronic ACL rupture. Both bucket handle tears were displaced and locked in the intercondylar notch. A new magnetic resonance image (MRI) sign suggested on sagittal view is called the triple PCL sign, comprising the intact posterior cruciate ligament (PCL) and the 2 displaced fragments in the intercondylar notch from the two bucket handle tears. The precise diagnosis of this condition is of obvious importance for optimal operative planning. While finding the displaced fragment from the medial meniscus is expected to cause the double PCL sign, the torn ACL may have made it easier to visualize the bucket handle tear of the lateral meniscus in the same sagittal plane as the PCL.

Only 5 other reports mention bimeniscal bucket handle tears of both the medial and lateral menisci in association with an ACL tear. None have shown the suggested triple PCL sign because of lack of overlap between the 2 bucket handle tears in the coronal plane while lying in the intercondylar notch causing them not to fall in the same sagittal plane. Our patient showed some overlap between the 2 meniscal fragments while lying in the notch to create the triple PCL sign on sagittal MRI.
Spontaneous Totally Thrombosed Pseudoaneurysm Mimicking a Tendon Tear of the Wrist
Authors: Huang Shih-Wei , Wei Ta-Sen , Liu Sen-Yung , Wang Wei-Te
Published: October 2010

Wrist pseudoaneurysm is commonly caused by iatrogenic procedures such as blood gas puncture, arterial-venous shunting for hemodialysis, or noniatrogenic causes such as blunt trauma. The mechanism of pseudoaneurysm formation is arterial wall damage with subsequent blood leakage that collects in surrounding tissue. This article presents a case of a 32-year-old woman who had sudden onset left wrist pain with a snap sound and a mass 1 cm in diameter after pulling a heavy object while working. A wrist flexor tendon tear was diagnosed after evaluation. Musculoskeletal ultrasound revealed a partially thrombosed pseudoaneurysm. The wrist pseudoaneurysm was totally thrombosed and symptoms subsided after 3 weeks of follow-up. This case study reminds us that pseudoaneurysm could be easily confused with other wrist diseases. We discuss the differential diagnosis and management of wrist pseudoaneurysm as a reference for clinical practice.
Severe Musculoskeletal Infection Variant in Lemierre’s Syndrome
Authors: Harris Joshua D. , Kaeding Christopher C. , Flanigan David C. , Naylor Andrew R. , Ellis Thomas J.
Published: October 2010

Lemierre’s syndrome is a severe complication of
Fusobacterium necrophorum
oropharyngeal infection associated with metastatic foci of infection, internal jugular vein thrombosis, and septicemia. Musculoskeletal manifestations include isolated or multifocal septic arthritis, soft tissue abscesses, pyomyositis, and osteomyelitis.

This article describes a case of a variant of Lemierre’s syndrome in a 17-year-old girl, demonstrating a relentless case of limb infection refractory to multiple surgical debridements and broad-spectrum and targeted antibiotics. The patient had
F necrophorum
within a peritonsillar abscess and multiple foci within her right lower extremity. Overall, she required 12 surgical procedures and 14 weeks of antibiotic therapy to resolve the infection. Further unique findings in this case include the presence of a recent lateral meniscus tear with associated hemarthrosis treated with a short course of oral steroids prior to the diagnosis of septic arthritis. Knee arthroscopy with lysis of adhesions and manipulation at 6 months postinfection demonstrated significant chondral damage. Outcome at >2-year follow-up revealed pain-free activities of daily living and the ability to return to competitive, club-level collegiate softball.

Clinically relevant findings illustrated in this case include potential development of antibiotic resistance within
Fusobacterium
genus with little to no response to several surgical debridements and broad-spectrum and targeted antibiotics, and development of multifocal, ipsilateral septic arthritis and soft tissue abscesses and pyomyositis in the context of steroid use and recent intra-articular knee injury.
Anatomical Reconstruction of the Knee Extensor Apparatus for Prepatellar Myxofibrosarcoma
Authors: Muramatsu Keiichi , Yoshida Koji , Fujii Kenzo , Okazaki Tomoya , Moriya Atsushi , Taguchi Toshihiko
Published: October 2010

A novel reconstruction of the knee extensor apparatus was attempted in a 69-year-old patient with prepatellar myxoid fibrosarcoma. The skin (35×25 cm), subcutaneous tumor, quadriceps tendon, patella, anterior capsule, and patella tendon were widely resected en-bloc. Following wide resection, the excised quadriceps tendon, patella, and patella tendon were anatomically reimplanted into the original site after being devitalized in liquid nitrogen. These complexes were covered by a free vascularized latissimus dorsi myocutaneous flap. At 18-month follow-up, the strength of active knee extension was 4+ of 5 in the muscle manual test. The active range of motion was 110° in flexion and −10° in extension. The tumor showed no evidence of disease. The patella and femur joint showed no osteoarthritis on plain radiographs. This procedure is the only way to achieve anatomical reconstruction. Reattachment of patella tendon to the tibial tuberosity was possible. The use of liquid nitrogen to devitalize is straightforward and the operation time can be shortened. To our knowledge, this type of reconstructive procedure has never been reported in the English literature.
Empathic Anger in Junior Nursing Students
Authors: Gunther Mary
Published: October 2010

The ideal clinical experience fosters development of psychomotor, cognitive, and affective skills while affording initial socialization into the profession. It is expected that during these experiences, nursing students will encounter illustrative exemplars of caring and professional values. The primary stressors during initial clinical experiences arise from issues related to performance and socialization. Nursing students view a good relationship with the RNs at the clinical site as the most crucial influence on their professional growth and development. Even more distressing to students than being treated poorly themselves is watching patients receive uncaring treatment. Students’ sadness and anger provoked by perceived uncaring treatment blends to form empathic distress. A content analysis of an assigned narrative from junior nursing students explores empathic anger experienced by the students during their initial clinical rotations.
Health Care for the Homeless: A Partnership Between a City and a School of Nursing
Authors: Pennington Karen , Coast Mary Jo , Kroh Maura
Published: October 2010

Although there is extant research on the homeless, less is available suggesting an innovative community partnership such as Project HOPE. This partnership provided baccalaureate nursing students with greater understanding of underserved populations and health care delivery systems, and encouraged their future work with marginalized populations upon graduation. Students collected descriptive information on the homeless population. Correlations were found among site placement: age, clothing and supplies given, wound care, referrals given, assessments, and season of the year. Student evaluations revealed paradigm shifts in attitudes and inspired advocacy toward this population. Through the descriptive information and qualitative comments, we gained insight on demographics, conditions observed, and interventions offered, which provided direction for quality improvement in curriculum design for the Community Health Nursing course, direction for future student groups working in shelters and with street outreach workers, and information useful to strengthening partnerships with local organizations working with the homeless population.
The Bucket List: A Service-Learning Approach to Community Engagement to Enhance Community Health Nursing Clinical Learning
Authors: Broussard Brenda Beverly
Published: October 2010

Community health nursing education at the undergraduate level is experiencing new and distinct challenges. Reduction in funding for public health services creates fewer resources and learning opportunities for students. To effectively deal with this problem, it is necessary to reconsider how clinical experiences are implemented. Using a service-learning theoretical framework to engage students in a mutually beneficial relationship with underserved and vulnerable populations could address the issue. The “Bucket List” of service-learning and community engagement activities was developed with the goals of improving quality and comprehension of community health didactic, addressing the need to restructure community health clinical experiences, and meeting projected demands for community health nursing services in partnership with communities.
Effects of Accommodation Training on Accommodation and Depth of Focus in an Eye Implanted with a Crystalens Intraocular Lens
Authors: Tahir Humza J. , Tong Jian L. , Geissler Sydney , Vedamurthy Indu , Schor Clifton M.
Published: October 2010

Purpose:

To investigate objective measures of the effects of accommodative training of a pseudophakic eye implanted with a Crystalens AT-52SE (eyeonics Inc) intraocular lens (IOL) on reading performance, accommodation, and depth of focus.

Methods:

Objective dynamic measures of accommodation, pupil size, and depth of focus were quantified from wavefront measures before and after 1 week of accommodative training that began 29 months after implantation of an accommodating IOL in one patient. Depth of focus was estimated from 50% cut-off of peak performance levels for defocus curves that were computed from the image quality metric VSOTF based on ocular wavefront aberrations.

Results:

The patient reported improved near vision reading performance after completing the training procedure. After training, there was a shift in conjugate focus in the hyperopic direction, yet the depth of focus increased significantly for near objects. Simulated retinal images and the calculated modulation transfer function of the eye both demonstrated improved quality for near vision after training.

Conclusions:

The subjective report of improved near vision after training was correlated with improvement of objective measures. Depth of focus increased for near objects with attempts to accommodate after training. This change was linked to increases in aberrations and pupil size and occurred despite the conjugate focus shifting in the hyperopic direction. These results demonstrate that accommodative training may be useful in improving near vision in patients with accommodating IOLs.
A New Coordinate System Convention in Schematic Eye Modeling
Authors: Simpson Michael J.
Published: October 2010

Purpose:

To discuss standardizing methods for presenting results from schematic eye calculations where light is entering the eye and forming an image on the retina.

Methods:

Published methods, measurement equipment, and software were evaluated.

Results:

The methods already used by ray tracing software are proposed, where everything is viewed from behind the eye and a conventional (x,y) coordinate system is used for images and plots. For meaningful evaluation in comparison to the image, any representations of the cornea, pupil, imaging wavefront, point spread function (PSF), and spot diagram are rotated by 180° about the optical axis for display to match the image orientation of a standard text chart. If a Zernike sag surface is used for a corneal surface of a schematic eye, this is also defined from the rear; however, care must be taken to ensure that the ordering of the Zernike terms is correct.

Conclusions:

Simulated images can be viewed from behind the eye and oriented so that text has a normal appearance. This requires a rotation of the imaging wavefront and PSF by 180° about the optical axis.
Effect of Incident Light Wavelength and Corneal Edema on Light Scattering and Penetration: Laboratory Study of Human Corneas
Authors: Peyrot Donald A. , Aptel Florent , Crotti Caroline , Deloison Florent , Lemaire Simon , Marciano Tal , Bancelin Stéphane , Alahyane Fatima , Kowalczuk Laura , Savoldelli Michèle , Legeais Jean-Marc , Plamann Karsten
Published: October 2010

Purpose:

The outcome of ultrashort pulse laser surgery of the cornea is strongly influenced by the light scattering properties of the tissue, for which little data are available. The purpose of the present study is to provide quantitative values for light scattering and its relation to the degree of edema.

Methods:

An experimental optical measuring setup based on confocal geometry was used to measure the unscattered and scattered fractions of light transmitted by eye bank corneas presenting various degrees of edema. From these measurements, the effective light penetration depth in the cornea was calculated as a function of wavelength.

Results:

Corneal transparency depends on the pathological state of the cornea and on wavelength. It may be predicted as a function of corneal thickness, ie, the degree of edema. In healthy and edematous cornea, the percentage of scattered light decreases with increasing wavelength. The total penetration depths at the wavelengths of ∼1050 nm (which is used in typical clinical systems) and 1650 nm (which is recommended for future devices) are comparable; however, the former is limited by scattering, which degrades the laser beam quality, whereas the latter is only limited by optical absorption, which may be compensated for.

Conclusions:

The use of longer wavelengths should help improve the surgical outcome in ultrashort pulse laser surgery of the cornea when working on pathological tissue. A wavelength of approximately 1650 nm appears to be a good compromise, as it allows for reduced light scattering while keeping optical absorption reasonably low.
LASIK for −6.00 to −12.00 D of Myopia with up to 3.00 D of Cylinder Using the ALLEGRETTO WAVE: 3- and 6-Month Results with the 200- and 400-Hz Platforms
Authors: Stonecipher Karl G. , Kezirian Guy M. , Stonecipher Megan
Published: October 2010

Purpose:

To report the refractive results after LASIK for high myopia and cylinder at one center with one surgeon comparing two laser platforms.

Methods:

A total of 206 eyes of 121 patients were treated for −6.00 to −12.00 diopters (D) of spherical equivalent refractive error with up to 3.00 D of cylinder. All eyes underwent LASIK with the ALLEGRETTO WAVE 200-Hz (n=141) or 400-Hz (n=65) laser (Alcon Laboratories Inc) between 2003 and 2009. Corneal flaps were created with the IntraLase femtosecond laser (Abbott Medical Optics) at an intended thickness of 100 or 110
μ
m in all cases.

Results:

At 3- and 6-month follow-up in the 200-Hz group, 77% (109/141) and 86% (121/141) of eyes, respectively, were within ±0.50 D of intended correction. In the 400-Hz group, 98.5% (64/65) and 100% (65/65) of eyes were within ±0.50 D of intended correction at 3 and 6 months postoperatively. At 3- and 6-month follow-up, 84% (119/141) and 77% (109/141) of eyes, respectively, in the 200-Hz group and 80% (52/65) and 92% (60/65) of eyes, respectively, in the 400-Hz group had 20/20 or better uncorrected distance visual acuity. At 6-month follow-up, refractive predictability and visual acuity were statistically superior in eyes in the 400-Hz group (chi square,
P
<.01). No eyes underwent retreatment as a secondary procedure during the time of analysis.

Conclusions:

LASIK with the ALLEGRETTO WAVE 200- and 400-Hz laser is effective and predictable for the treatment of high myopia with astigmatism in appropriately selected patients. The acuity and predictability of refractive results may be slightly better when using the 400-Hz platform.
LASIK for Mixed Astigmatism Using the ALLEGRETTO WAVE: 3- and 6-Month Results with the 200- and 400-Hz Platforms
Authors: Stonecipher Karl G. , Kezirian Guy M. , Stonecipher Kody
Published: October 2010

Purpose:

To report the refractive results after LASIK for mixed astigmatism at one center with one surgeon comparing two laser platforms.

Methods:

A total of 137 eyes of 69 patients were treated with LASIK for mixed astigmatism up to 3.33 diopters (D) using either the ALLEGRETTO WAVE 200- or 400-Hz laser (Alcon Laboratories Inc) between April 2006 and December 2009. The degree of astigmatism was higher in the 400-Hz group. Corneal flaps were created with the IntraLase femtosecond laser (Abbott Medical Optics) in all cases.

Results:

The refractive outcomes with both laser systems were statistically similar. At 6 months, 78% of eyes had 20/20 or better uncorrected distance visual acuity (UDVA) with all but one eye achieving 20/30 or better UDVA. At 6 months, 10% of eyes treated with the 200-Hz system lost one line of corrected distance visual acuity (CDVA) whereas no eyes treated with the 400-Hz system lost any lines of CDVA. Residual astigmatism was <0.50 D for all eyes treated with both platforms.

Conclusions:

Both laser platforms provided predictable and effective treatment of mixed astigmatism in the patient populations treated, with over 90% of eyes achieving UDVA of 20/25 or better 6 months after surgery.
Technical Aspects of the WaveLight FS200 Femtosecond Laser
Authors: Mrochen Michael , Wüllner Christian , Krause Johannes , Klafke Mario , Donitzky Christof , Seiler Theo
Published: October 2010

Purpose:

To demonstrate the feasibility and technical features of the WaveLight FS200 femtosecond laser (WaveLight GmbH) in refractive and corneal laser surgery.

Methods:

The reproducibility of femtosecond laser–created flap dimensions and channels used for corneal ring segment implantation were measured by means of an optical coherence tomography system in porcine corneas. The increase in the intraocular pressure (IOP) during applanation with the corneal interface was measured by means of an IOP sensor. The possibility of creating a channel for gas diffusion within the stroma was investigated to minimize opaque bubble layer formation.

Results:

The technical features, such as optical design, pulse energy, and scanning algorithms at a high repetition rate, allow reproducibility for tissue cutting with a standard deviation of <10 μm in depth and 0.1 mm laterally. Intraocular pressure increases up to 150 mmHg during applanation. The use of a gas channel minimizes the creation of an opaque bubble layer during the femtosecond laser procedure.

Conclusions:

The WaveLight FS200 femtosecond laser provides a high reproducibility for cutting three-dimensional tissue structures. The IOP increase is comparable to other microkeratomes and femtosecond lasers. The minimized opaque bubble layers allow the surgeon to perform an excimer laser treatment immediately after FS200 flap creation.
Correlation Among Ocular Spherical Aberration, Corneal Spherical Aberration, and Corneal Asphericity Before and After LASIK for Myopic Astigmatism with the SCHWIND Amaris Platform
Authors: Mosquera Samuel Arba , de Ortueta Diego
Published: October 2010

Purpose:

To determine the spherical wave aberration of the human eye based on corneal topography.

Methods:

Based on the pre- and postoperative status of 146 consecutive eyes (median patient age 36 years), the correlations between spherical aberration and asphericity and between corneal and ocular spherical aberrations were determined using simple linear regression methods. The asphericity (Q) values for which spherical aberration equals zero as well as the reference Q values for which corneal spherical aberration equals ocular spherical aberration have been determined. Patients underwent LASIK using the AMARIS excimer laser platform (SCHWIND eye-tech-solutions). All ablations were based on aspheric aberration-neutral profiles.

Results:

Corneal and ocular spherical aberrations correlate well with Q value and the value
p
·
R
−3
in patients before and after LASIK for myopic astigmatism. A Q value of −0.19 to −0.27 can provide zero ocular spherical aberration in patients before and after LASIK for myopic astigmatism. Ocular spherical aberration is induced at a rate of half the induced corneal spherical aberration. A reference Q value of −0.12 to +0.01 can provide corneal spherical aberration equal to ocular spherical aberration in patients before and after LASIK for myopic astigmatism.

Conclusions:

Ocular and corneal wave aberrations are two different concepts that are not interchangeable. As for spherical aberration, a simple static model with a reference cornea deviating from a Cartesian oval can provide a 2:1 correspondence between corneal and ocular spherical aberration.
Hands-On Learning versus Learning by Demonstration at Three Recall Points in University Students
Authors: Hearns Morna Kathleen , Miller Barbara Kopp , Nelson David L.
Published: October 2010

This randomized study compared the effect of two teaching/learning methods (hands-on versus demonstration) on immediate, 15-minute, and 24/48-hour recall in 60 university students. Each student either made no-bake cookies or observed the demonstrated process. Inter-rater reliability concerning recall scores was strong (intraclass correlation coefficient = .98). Analysis of variance across all three levels of recall supported the hands-on condition ( F [1,58] = 4.45, p = .039). However, only one of the three t tests (recall at 24/48 hours) comparing hands-on learning to demonstration at the three points of recall, was statistically significant ( t [58] = 2.48, p = .008, with effect size d = .648). Generally, the results are consistent with occupational therapy theory, but the lack of a statistically significant difference in terms of immediate recall requires probing as to the meaningfulness of the occupational form to the particular individuals being observed. Meta-analysis of various studies investigating this important principle of occupational therapy is needed to clarify the results of this study in the context of other related studies.
Imaging Modalities for Localization of an iStent
®
Authors: Ichhpujani Parul , Katz L. Jay , Gille Rick , Affel Elizabeth
Published: October 2010

The iStent (Glaukos Corporation, Laguna Hills, CA) is a 1-mm, titanium trabecular bypass stent implanted across the inner wall of Schlemm’s canal under direct gonioscopy. This study was designed to determine the best modality to identify iStent placement when gonioscopic visualization is not possible. In this in vitro study on a human cadaver eye, ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (AS-OCT), and B-scan ultrasonography were done to visualize and precisely locate two intentionally misplaced iStents. UBM could localize both intentionally misplaced stents, whereas AS-OCT could not visualize the iStent that was lodged in the sulcus. B-scan ultrasonography was unable to detect either of the stents. UBM may be a useful imaging modality to identify iStent in the anterior or posterior chamber, whereas AS-OCT is limited to detection of stents in the anterior chamber alone. B-scan ultrasonography is unable to identify iStent in either the anterior or posterior chamber.
Sleeve Technique to Maintain a Large Mucosal Ostium During Endoscopic Dacryocystorhinostomy
Authors: Jo Young-Joon , Kim Kyoung-Nam , Lee Yeon-Hee , Kim Jung-Yeul , Lee Sung-Bok
Published: October 2010

Currently, many surgeons use bicanalicular silicone tubes as a stent to keep the intranasal mucosal ostium patent when they perform endoscopic dacryocystorhinostomy. The authors describe the sleeve technique using bicanalicular silicone tubes. After inserting the bicanalicular silicone tube, a sleeve is passed over it. The sleeve prevents the nasal mucosa from obstructing the intranasal mucosal ostium and enlarges the mucosal ostium. In primary acquired nasolacrimal duct obstruction, the sleeve technique was applied to 61 cases (group 1); the other 75 cases (group 2) were intubated by bicanalicular silicone tube only. The overall success rate was 95.1% in group 1 and 90.7% in group 2 (
P
= .51), and the average mucosal ostium at 6 months postoperatively was 3.2 ± 1.1 and 1.9 ± 1.0 mm (
P
= .04), respectively. The authors believe that the sleeve technique has the advantage of maintaining a larger intranasal mucosal ostium.
Narrow- and Open-Angle Measurements with Anterior-Segment Optical Coherence Tomography and Pentacam™
Authors: Mou Dapeng , Fu Jing , Li Shuning , Wang Lan , Wang Xiaozhen , Wu Gewei , Qing Guoping , Peng Yi , Wang Ningli
Published: October 2010

Background and Objective:

To assess the agreement of the Pentacam (Oculus, Wetzlar, Germany) and anterior-segment optical coherence tomography (AS-OCT) in measuring open and narrow angles.

Patients and Methods:

Prospective observational case series in which 39 healthy normal subjects (39 eyes) and 25 patients with narrow angles (37 eyes) were enrolled between May and September 2008. The anterior chamber measurements were performed by AS-OCT and the Pentacam.

Results:

There was no significant difference in the open-angle measurements between the Pentacam and AS-OCT (
P
> .05). However, in patients with narrow angles, the average values of nasal and temporal anterior chamber angles taken by the Pentacam were larger than those of AS-OCT (25.5° ± 5.66° and 25.77° ± 5.15° vs 13.40° ± 6.81° and 12.13° ± 6.47°;
P
< .001).

Conclusion:

Both AS-OCT and the Pentacam can reliably measure anterior chamber angles in healthy normal subjects. The difference in measuring narrow angles by the two instruments was due to inability to view the angle recess or the scleral spur with the Pentacam.
Ocular Findings in a Patient with Castleman’s Disease Before and After Treatment with Immunosuppression and Plasmapheresis
Authors: Jorge Rodrigo , Scott Ingrid U. , Oliveira Rafael C. , Costa Rogério A. , Siqueira Rubens C. , Louzada-Júnior Paulo
Published: October 2010

A 12-year-old girl with a 3-month history of epistaxis and Castleman’s disease presented with blurred vision in both eyes for 2 weeks. Indirect ophthalmoscopy revealed a blurred optic disc margin, venous engorgement and tortuosity, intraretinal hemorrhages and cotton wool spots, and serous detachment of the neurosensory retina in the posterior pole of each eye. Fluorescein angiography and laboratory tests revealed abnormalities consistent with the clinical examination. Six months following institution of immunosuppressive treatment, cryoglobulin levels decreased and visual acuity and funduscopic abnormalities were markedly improved. However, a few microaneurysms, retinal hemorrhages, and venous engorgement and tortuosity persisted. One month after the cessation of immunosuppressive treatment, symptoms related to the hyperviscosity syndrome recurred and the patient was treated with one session of plasmapheresis. One month after the plasmapheresis, the patient’s symptoms resolved, laboratory values were normal, visual acuity was 20/15 in both eyes, and the funduscopic examination of each eye was unremarkable.
Creutzfeldt–Jakob disease-like syndrome induced by gabapentin toxicity
Authors: Chau Vicky , Prasad Sadhana , Stewart Dwight , Heckman George
Published: October 2010

Patients with Creutzfeldt–Jakob disease (CJD) may exhibit characteristic abnormalities on the electroencephalogram (EEG). However, these abnormalities have been associated with a number of cases of drug toxicity. We report a case of CJD-like syndrome associated with gabapentin. A 78-year-old man was hospitalized for recurrent falls. Three months prior to admission, gabapentin was prescribed to treat symptoms of trigeminal neuralgia. The patient subsequently presented with a two-month history of worsening gait abnormalities, negative myoclonus, and cognitive impairment. The EEG showed diffuse background slowing with larger amplitude delta discharges, which at times appeared triphasic, raising the possibility of CJD. The gait abnormalities and myoclonus resolved and the EEG normalized after the gabapentin was discontinued. Several cases of drug-induced CJD-like syndrome have been reported, mainly presenting with cognitive impairment, myoclonus, Parkinsonism, and EEG abnormalities. This patient may have been predisposed to adverse neurological effects from gabapentin owing to age, concurrent renal insufficiency, and cardiac disease. We concluded that it is imperative to include drug toxicity in the differential diagnosis of patients presenting with clinical manifestations and EEG findings suggestive of CJD, particularly in the setting of advanced age and comorbidities.
A characterization of the expression of 14-3-3 isoforms in psoriasis, basal cell carcinoma, atopic dermatitis and contact dermatitis
Authors: Raaby Line , Otkjær Kristian , Salvskov-Iversen Maria Luise , Johansen Claus , Iversen Lars
Published: October 2010

14-3-3 is a highly conserved protein involved in a number of cellular processes including cell signalling, cell cycle regulation and gene transcription. Seven isoforms of the protein have been identified; β, γ, ε, ζ, η, σ and τ. The expression profile of the various isoforms in skin diseases is unknown. To investigate the expression of the seven 14-3-3 isoforms in involved and uninvolved skin from psoriasis, basal cell carcinoma (BCC), atopic dermatitis and nickel induced allergic contact dermatitis. Punch biopsies from involved and uninvolved skin were analyzed with quantitative reverse transcription-polymerase chain reaction to determine the mRNA expression of the 14-3-3 isoforms. The protein level of 14-3-3 isoforms was measured by Western blot technique in keratome biopsies from patients with psoriasis. Evaluation of dermal and epidermal protein expression was performed by immunofluorescence staining. Increased 14-3-3τ mRNA levels were detected in involved skin from patients with psoriasis, contact dermatitis and BCC. 14-3-3σ mRNA expression was increased in psoriasis and contact dermatitis, but not in BCC. In atopic dermatitis no significant difference between involved and uninvolved skin was found. The expression of the 14-3-3 isoforms was also studied at the protein level in psoriasis. Only 14-3-3τ expression was significantly increased in involved psoriatic skin compared with uninvolved skin. Immuno­fluorescence staining with 14-3-3τ- and 14-3-3σ-specific antibodies showed localization of both isoforms to the cytoplasm of the keratinocytes in the various skin sections. These results demonstrate a disease specific expression profile of the 14-3-3τ and 14-3-3σ isoforms.
Temperature and brain death determination: need for updated criteria
Authors: Meyer Michael A.
Published: October 2010

For an excellent review on the diagnosis of brain death, the interested reader is directed to the review of Machado appearing in this journal; the author reviews all aspects of brain death and cites nine different references where the minimum temperature for brain death exams appear to have been at least 32°C. Given the new data listed above, it is clearly time for a reconsideration of the how we approach the exam for diagnosis of brain death – normal or near normal temperatures of 36°C and above are very reasonable starting points.
Conservative Management, Immunosuppressive Treatment or both for Patients with Primary Immunoglobulin a Nephropathy?
Authors: Goumenos Dimitrios S.
Published: October 2010

Immunoglobulin A nephropathy (IgAN) is the most commonly encountered primary glomerulonephritis and it usually follows an indolent clinical course. However, hypertensive patients with proteinuria and renal insuf-ficiency at presentation and patients with severe histological involvement are at high risk to develop end-stage renal failure. Patients with normal renal function, mild proteinuria (<1 g/24h) and mild histopathological involvement need only observation, whereas patients with heavy proteinuria, impaired renal function and moderate to severe histopathological involvement are usually treated with immunosuppressive drugs. Angiotensin converting enzyme (ACE) inhibitors are used in patients with arterial hypertension and/or proteinuria 1–2 g/24h. Corticosteroids are indicated in patients with heavy proteinuria (>3 g/24h) and in progressive disease despite treatment with ACE inhibitors. Combinations of corticosteroids and cytotoxic drugs are saved for patients with IgA nephropathy and a rapidly progressive course. Fish oil might be an alternative to cor-ticosteroids in cases with renal insufficiency and chronic histological lesions.