bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutritional status and fat tissue distribution in health adults from some places in central Banat
Authors: Pavlica Tatjana , Bozic-Krstic Verica , Rakic Rada , Srdic Biljana
Published: September 2010

Introduction. The aim of this study was to determine, relying on anthropological parameters, nutritional status, fat tissue distribution and possible health risk in adult population of Central Banal. Material and methods. 730 subjects of both genders (average age 4O.19?11.36y) underwent following measurements: height, weight, waist and hip circumference. Results and discussion. Central Banat population was characterized by great height (males: 178.40?7.24 cm: females: 163.06?6.32 cm). The average BMI was at the lower limit of overweight category (males: 26.59 kg/m2; females: 25.29 kg/m2. Overweight and obesity were found in 55.5% of examined subjects. In males, normal weight was recorded only in the youngest age group (20-29y), while in older age groups the percentage of overweight and obese males increased with age. In females, normal weight was recorded till the age of 50, after which overweight category was mainly present. Regarding both of the sexes, obesity was most frequent in the age group 50-59 (22%). The average waist circumference was lower than the cut-off values recommended by WHO (96.43 cm in males and 82.49 cm in females). According to fat distribution, normal values were recorded in males younger that 39y, after which there was an increase m risk central obesity. In females, normal fat distribution was mainly present in all ages, although the percentage of the risk category increased with age. The highest percentage of the subjects of both sexes showed no health risk. Conclusion. Our results indicate the need for preventive action towards obesity consequences and obesity inducing surroundings.
The influence of occupational stress on lipid status of road traffic professional vehicle drivers
Authors: Stefanovic Violeta , Jovanovic Jovica , Jovanovic Milan
Published: September 2010

Introduction. Professional stress can damage all organs and systems of exposed workers. The aim of this study was to assess the influence of occupational stress on lipid state of exposed professional drivers in road traffic. Material and methods. The atherogenic risk in vehicle drivers professionally exposed to stress was assessed by measuring total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. The examination included a group of 200 vehicle drivers professionally exposed to stress. The occupational stress index was calculated using the standardized questionnaire authorized by Karen Belkic. Serum lipid parameters were examined by standard methods. Results All lipid parameters increased with the occupational stress index values. Atherogenic risk increased with the values of occupational stress index too. Workers exposed to occupational stress index over the 90 were at the highest atherogenic risk. Conclusion. The highest occupational stress index and the highest values of total cholesterol, triglycerides and LDL-cholesterol were recorded in professional bus drivers at inter urban traffic.
Medical treatments in aortic stenosis: Role of statins and angiotensin-converting enzyme inhibitors
Authors: Davicevic Zaklina , Tavciovski Dragan , Matunovic Radomir
Published: September 2010

Calcific arotic stenosis and atherosclerosis. Aortic stenosis is the most frequent valvular heart disease in-western world and its incidence continues to rise. Aortic sclerosis is the first characteristic lesion of the cusps, which is today considered a process similar to atherosclerosis. The progression of the disease is an active process leading to forming of bone matrix and heavily calcified stiff cusps by inflammatory cells and osteopontin. Aortic stenosis is a chronic, progressive disease which can remain asymptomatic for a long time even in the presence of severe aortic stenosis. Medical treatment for aortic stenosis. The need for alternative to aortic valve surgery is highlighted by increasing longevity of the population and new therapeutic strategies to limit disease progression are needed to delay or potentially avoid, the need for valve surgery. Currently, there are no established disease modifying treatments in regard to the progression of aortic stenosis. The first results about influence of angiotenzin-converting enzyme inhibitors and statins on aortic sclerosis and stenosis progression are promising. Statins are likely to reduce cardiovascular events rather than disease progression, but may be potentially a valuable preventive treatment in these patients. The prejudice against the use of angiotenzin-converting enzyme inhibitors by patients with aortic stenosis is changing. The cautious use of angiotenzin-converting enzyme inhibition by patients with concomitant hypertension, coronary artery disease, and heart failure seems appropriate. Definite evidence from large clinical trials is awaited.
Resistance of Escherichia coli, the most frequent cause of urinary tract infection in children, to antibiotics
Authors: Stojanovic Vesna , Milosevic Biljana
Published: September 2010

Introduction. Urinary tract infections (UTI) take the second place in the incidence of bacterial infection in children. Escherichia coli is a cause of infection in 85-90%. A periodic evaluation of the resistance to antimicrobial drugs has to be performed in each geographic region, since investigations confirmed that the resistance of bacteria causing UTI has been in progress. Material and methods. A retrospective investigation has been performed, comprising the two time periods in the range of 10 years in order to identify the prevalence and resistance of the bacteria causing UTI in the patients treated at the Department of Nephrology of Institute for Child and Youth Health Care of Vojvodina. Results. During the first investigated period from January 1996 up to December 1997, there were 163 urin analyses performed vs 134 urine analyses in the second period, starting from January 2006 to December 2007. In both periods, Escherichia coli, was the most frequent cause of UTI (82.1% in 1996/97 vs 86.50% in 2006/07). During this ten-year period, the resistance of Escherichia coli increased both to ampicillin (from 53% to 69% (p>0.05) and to trimethoprim/sulfamethoxazole (34% vs 55%; p<0.05) as well as to cephalexin (4% vs 36%; p<0.05) which has been lately used in our region as a drug of choice in empiric therapy of the suspect UTI. Discussion. There have been records on a slow increase of the Escherichia coli resistance to ceftazidim, gentamycin and nalidixic acid, but significant increase to ampicillin, trimethoprim/sulfamethoxazole and cephalexin. Conclusion. For the initial therapy of UTI in the Province of Vojvodina we recommend: per orally - cephalosporins I, II and III generation, and in case when the child is not capable to get therapy perorally, or in the case of highly febrile infant - cephalosporins III generation parenterally.
Quality of life of patients with unipolar depression
Authors: Zikic Olivera , Tosic-Golubovic Suzana , Slavkovic Violeta
Published: September 2010

Introduction. Quality of life has gained increasing attention as an important component of functional outcome in mood disorders. The aim of our study was to investigate the relationship between unipolar depression and quality of life. Material and methods. The group consisted of 84 patients with unipolar depression (depressive episode or recurrent depression, without psychotic presentation) and 30 healthy controls. We applied socio demographic questionnaire, World Health Organization Quality of Life-Brief and The Patient Health Questionnaire - 9. Results. The impact of unipolar depression on quality of life was significant. The patients had significantly lower scores in all 4 domains of quality of life (Physical health, Psychological health, Social relations, Environment) compared with healthy controls. The biggest influence was on physical (43.71 vs. 76.67) and psychological (36.01 vs. 65.83) domains. The quality of life decreased with the increase of severity of depressive episode and duration of current episode, as well as with incidence of depressive episodes. The absence of emotional relationship had also a very negative influence. There were no differences in quality of life between male and female depressive patients. The level of education had an impact on physical and psychological domain. Discussion. Generally, the quality of life in unipolar depression is very modest. One of the reasons for such influence could be the main pathological factor in depression - negative view of self world and future. Beside that, the reason could be significant psychological suffering and decreased function in depression. Conclusion. Unipolar depression has negative influence on quality of life.
Effects of tirofiban and percutaneous coronary intervention in an old patient with acute myocardial infarction and cardiogenic shock
Authors: Canji Tibor , Jovelic Aleksandra , Srdanovic Ilija , Petrovic Milovan , Panic Gordana , Dodic Slobodan
Published: September 2010

A 75 year old man presented in our institutiton with acute inferoposterior and right ventricular ST-segment elevation myocardial infarction and cardiogenic shock, 40 minutes after the pain onset. He was pretreated with 300 mg of aspirin, 600 mg of clopidogrel, and was taken to the catheterization laboratory. Door to needle time was 35 minutes. Primary percutaneous coronary intervention with bare-metal stent implantation first in infarct related right coronary artery, with subsequent high-bolus dose (25 fig/kg) tirofiban, and then in suboccluded RCx were done. The procedures were done during the cardio-pulmo-cerebral reanimation because of relapsing ventricular fibrillation, with final TIMI 3 coronary flow established. Subsequently, intraaortic balloon pump was inserted. Echocardiography taken on the second day showed globaly hypokinetic left ventricle, with 10% ejection fraction and competent valves. During the next three weeks of hospital follow-up, there were no major adverse cardiac events, a transient azotemia and fall in hemoglobin concentration without major bleeding, and no episodes of severe thrombocytopenia were recorded. After six months, the patient was without chest pains, 2/3 class according to the New York Heart Association, without major adverse events, and echocardiographic left ventricular ejection fraction increment for 30%.
Diabetes mellitus as a cause of sudden natural death: Case report
Authors: Pavlekic Snezana , Savic Slobodan , Stankovic Veroslava , Trbojevic Bozo
Published: September 2010

Introduction. Forensic medicine may face a serious problem when solving the death cause associated with disorders in glucose metabolism, especially in cases when dying due to diabetes mellitus is characterized as unclear natural death. Case report. In this article the authors present a case of sudden death of a 31-year-old male, allegedly an active healthy sportsman. On the basis of microscopical findings (hyalinisation of arterioles, vacuolisation of nuclei of hepatocytes, nodular intercapillar glomerulosclerosis as characteristic diabetic change of kidney, and diffuse myocardial fibrosis) it was concluded that this person had suffered from unrevealed diabetes mellitus that caused an early onset of atherosclerotic microangiopathy and chronic ischaemic heart disease leading to sudden death probably due to fatal arrhythmia (electrical cardiac death). Conclusion. In this particular case diabetes mellitus was unexpectedly suspected only because of the changes detected by the microscopic examination. Therefore, a possible fatal influence of diabetic hyperglycemia or hypoglycemia could not be excluded on the basis of the applied diagnostic procedures.
Molecular dynamics simulation of manipulation of metallic nanoclusters on stepped surfaces
Authors: Mahboobi Seyed , Meghdari Ali , Jalili Nader , Amiri Farshid
Published: September 2010

Molecular dynamics simulations are carried out to investigate the manipulation of metallic clusters on stepped surfaces. Five surface forms are considered in the simulations. The system parts are made of pure transition metals and Sutton-Chen many-body potential is used as interatomic potential. The conditions which are subjected to change in the tests include: materials used for particles and substrate, and surface step conditions. In addition to qualitative observations, two criteria which represent the particle deformation and substrate abrasion are utilized as evaluation tools and are computed for each case. Simulation results show the effect of the aforementioned working conditions on the particle behavior as well as changes in the pushing forces. Obtaining this sort of knowledge is highly beneficial for further experiments in order to be able to plan the conditions and routines which guarantee better success in the manipulation process.
A continuum based microstructure model of inhomogeneous hardening and recovery as a pre-stage of recrystallization nucleation
Authors: Mitter Werner , Sommitsch Christof
Published: September 2010

Starting from the fundamental relation between the diffusion flux of point defects (vacancies, interstitials) and the gradient of the diffusion potential the diffusion equation is set up and applied to the calculation of the concentrations of both types of point defects. Thereby, all possible sources and sinks and their mutual effects are taken into consideration. These equations are coupled with the equations for the temporal derivatives of dislocation density, porosity, pore size and temperature. For the close-up region of spherical inhomogeneities (pores, hard inclusions) and a grain boundary this system of six partial differential equations is solved numerically. For simplicity a one dimensional model in space is used and uniaxial tension or pure shear load is assumed. Hardening and the simultaneous recovery are characterized by the local and temporal development of the point defect concentrations and especially of the dislocation density, which is proportional to the intrinsic strain energy. The gradients of both strain energy and lattice rotation determine the formation and growth of recrystallization nuclei. It is the aim of this work to present a new mathematical model and also to give a perceptual general view on the concerted action of the fundamental physical processes, which necessarily lead to hardening, recovery (softening) and recrystallization nucleation. Moreover it seems to be a basis of a future general theory of microstructure changes.
Stress-corrosion cracking susceptibility of AZ31 alloy after varied heat-treatment in 3.5 wt.% NaCl solution
Authors: Tsao L. C.
Published: September 2010

The stress corrosion cracking behavior of a commercial AZ31 magnesium alloy after T5 and T6 heat treatments under a vacuum of 10−3 torr has been evaluated via slow strain rate tensile tests in an aqueous 3.5 wt.% NaCl solution. The experimental results show that this material displays a high sensitivity to stress corrosion cracking. The fractured surface was consistent with a significant transgranular component. Double-line cracking that resulted from twinning could be readily spotted on the cleavage plane. The presence of such deformation twins accompanied by the formation of voids is the main reason for the stress corrosion cracking susceptibility of this alloy. The disappearance of twins after artificial aging at 260 °C for 4 h significantly improves the corrosion resistance, increases the breakdown potential difference ΔΦ (thus lowering the pitting tendency), and decreases the corrosion current density in a 3.5 wt.% NaCl solution.
Measuring Nonuse Damages Using Contingent Valuation: An Experimental Evaluation of Accuracy
Authors: Desvousges William , Johnson F. Reed , Dunford Richard , Boyle Kevin , Hudson Sara , Wilson K. Nicole
Published: September 2010

This second edition of Measuring Nonuse Damages Using Conjoint Valuation is essentially a reprint of a 1992 monograph that has been in steady demand since its original appearance. The RTI Press edition, which is intended to meet continued inquiries and requests for the monograph, contains a Foreword and a Preface to the second edition that put the original work into historical perspective. These studies of ways to value stated preferences, as applied then to the Exxon Valdez oil spill, continue to be a timely and still-rigorous examination of such methods; even with the passage of time and statistical advances from the past two decades, the conclusions and insights as to whether and how these techniques might still be employed in valuing use or nonuse losses from similar events remain valid.
Implementing the CLASS Act: Six Decisions for the Secretary of Health and Human Services
Authors: Wiener Joshua
Published: September 2010

This policy brief analyzes some of the major issues that must be decided in implementing the CLASS Act insurance program: How can adverse selection be prevented? What should actuaries assume in setting insurance premiums? What level of disability should be required to receive benefits? How will eligibility for benefits be determined? How much will the benefits be and what can they be used for? What should be the relationship between the CLASS insurance program and private long-term care insurance?
A 49-year-old Man with Worsening Depression
Authors: Nemiary Deina S. , Penagaluri Praveen J. , Evans-Cosby Deirdre
Published: September 2010

CME Educational Objectives

1.

Recognize the importance of effectively treating patients with comorbid anxiety and depression.

2.

Review the pharmacology of monoamine oxidase inhibitors (MAOI).

3.

Review the current literature about the transdermal selegiline system.
A 14-year-old Girl with Seizures, Gait Problems, Paralysis
Authors: Bhatti Nadeem Hanif , Khan Mohammad Amjad Ullah , Wilson Edna Reyes , Ledger Elizabeth
Published: September 2010

CME Educational Objectives

1.

Identify the clinical features and longitudinal course of conversion disorder.

2.

Explain the diagnostic clarification of conversion disorder and how this can improve patient outcome.

3.

Describe the complexity of the clinical presentation of conversion disorder.
A 38-year-old Woman with Depression, Stomach Pain
Authors: Hashmi Seema , Lamontanaro Laura , Zubair Adeel , Pal Monica , Nisar Mohammad Asim
Published: September 2010

CME Educational Objectives

1.

Review how cultural backgrounds can influence a patient's psychological status.

2.

Describe the differential diagnosis for conversion disorder.

3.

Discuss futuristic methods of diagnosing and treating conversion disorder.
Can High-Flexion Tibial Inserts Improve Range of Motion After Posterior Cruciate-Retaining Total Knee Arthroplasty?
Authors: Crow Bradley D. , McCauley Julie C. , Ezzet Kace A.
Published: September 2010

Interest in high-flexion total knee arthroplasty (TKA) prostheses designed to provide better postoperative range of motion (ROM) is widespread. We sought to determine whether changes in surface geometry of the tibial polyethylene insert could improve postoperative ROM in a consecutive series of patients undergoing TKA with retention of the posterior cruciate ligament (PCL). Two cohorts with Smith & Nephew (Memphis, Tennessee) Posterior Cruciate-Retaining Genesis II total knee prostheses were compared, 79 knees (65 patients) using standard tibial inserts and 85 knees (72 patients) using high-flexion inserts. The standard insert has a slightly raised posterior lip, whereas the high-flexion insert is recessed downward at the posterior margin to facilitate femoral rollback in flexion and eliminate impingement of the femoral component on the back of the polyethylene during rollback.

Mean ROM 1 year postoperatively was 112.0° in patients receiving the standard insert and 119.3° in patients receiving the high-flexion insert. Preoperative ROM was similar in both groups. Flexion improvement in the high-flexion group over the standard insert group was statistically significant (
P
<.001). Final Knee Society Scores did not differ amongst patients receiving the standard and high-flexion inserts.

Our study demonstrates that improved postoperative flexion can be achieved without changing surgical technique, bony cuts, or metallic prosthetic parts. This is the first report that we are aware of that documents improvement in ROM after PCL-retaining TKA through the use of high-flexion inserts.
Latent Pisotriquetral Arthrosis Unmasked Following Carpal Tunnel Release
Authors: Stahl Shalom , Stahl Shy , Calif Edward
Published: September 2010

The causes of persistent wrist pain following carpal tunnel release include scar tenderness and pillar pain. The goal of this study was to evaluate latent pisotriquetral arthrosis as a source of ulnar-sided wrist pain following open carpal tunnel release.

Seven hundred consecutive carpal tunnel releases were reviewed, looking for postoperative presentation of pisotriquetral arthrosis, as well as management and outcome. Fourteen patients with long-standing postoperative pain at the base of the hypothenar eminence had clinical and radiographic signs of pisotriquetral degenerative arthrosis, which conceivably had existed preoperatively and been unmasked thereafter. In 6 patients with persistent symptoms despite conservative measures, excision of pisiform was curative. Altered isometric stresses over the pisotriquetral articulation as a result of releasing the transverse ligament, which constitutes a major radial static stabilizer of this joint, seems to cause articular maltracking, and consequently aggravates a preexisting asymptomatic pisotriquetral arthrosis. Long-standing discomfort is characteristically associated with loss of grip strength and dexterity.

Pisotriquetral dysfunction and arthrosis should always be considered in the differential diagnosis of persistent wrist pain following either open or endoscopic carpal tunnel release that does not respond to nonoperative measures. Clinical scrutiny, adequate clinical inspection, and radiographic evaluation readily establish the diagnosis. Conservative treatment includes immobilization, nonsteroidal anti-inflammatory drugs, and intra-articular injection of corticosteroids under fluoroscopic control. The corticosteroid injection combined with a local anesthetic also serves as a diagnostic test. Excision of the pisiform is indicated where conservative treatment has failed.
Evaluation of High-Strength Orthopedic Sutures: A Head-to-Head Comparison
Authors: Miller Timothy , Feinblatt Jeff , Craw John , Litsky Alan , Flanigan David
Published: September 2010

The goal of this study was to determine whether a difference in cycles to failure or mode of failure would be observed among specimens of 3 high-strength suture materials, and whether different suture configurations would affect knot security. Ten representative specimens of Ethibond (Ethicon, Inc, Somerville, New Jersey), FiberWire (Arthrex, Inc, Naples, Florida), MaxBraid (Biomet, Inc, Warsaw, Indiana), and Orthocord (DePuy Orthopaedics, Warsaw, Indiana) were tied in 6 different knot configurations commonly used in orthopedic procedures. Each specimen was cyclically loaded between 9 and 180 N at a rate of 1 Hz until the specimen failed or reached a maximum of 3500 cycles. Each suture material was subjected to tensile loading until failure at a rate of 1.25 mm/s. The 3 most secure knots all included the 3 reverse half-hitch on alternating posts (3-RHAP) configuration. All specimens tied with these 3 knot types failed by suture rupture. All knots using the overhand with 3 of the same half-hitches on the same post (O-3SHSP) configuration failed by knot slippage regardless of suture material. When the 3 strongest knots were combined, FiberWire resisted a significantly greater number of fatigue cycles than Orthocord or MaxBraid. In the single load to failure tests, Orthocord, FiberWire, and MaxBraid all had significantly higher ultimate strength than Ethibond.

Knots using the 3-RHAP configuration provide security superior to that of those without this configuration. All 3 high-strength sutures tested outperformed Ethibond in single load to failure testing, with FiberWire resisting the greatest number of cycles. Postoperative strength and reliability of a soft tissue repair is inherently dependent on the properties of the suture materials used.
The Proximal Modular Neck in THA: A Bridge Too Far: Opposes
Authors: Cameron Hugh U.
Published: September 2010

Neck/cup impingement is a serious issue, especially with hard/hard bearings. It can produce noise, locking mechanism failure, and an increase in wear debris and dislocation. The double taper neck used by the author has cogs on the neck/stem taper junction for additional rotational stability. One hundred forty-six procedures were performed using the thin mantle cement technique. Mean follow-up was 5 years (range, 3–8 years). A 32-mm neck was used in 73.8% of cases and a 35-mm neck in 26.2%, because most of the patients were elderly women. The neck was anteverted in 1.4%, neutral in 26.4%, and retroverted in the rest (mild in 34.2%, moderate in 14.3%, and maximum in 13.4%). There were no dislocations and no loosenings. Problems were encountered with the neck/stem taper in 3 cases. The stem was therefore taken off the market. The taper was lengthened and the strength doubled.

Since its reintroduction 3 years ago, a further 187 cemented stem procedures have been performed with no failures and no dislocations. Of interest in this series, no necks were anteverted, 23.5% were in neutral, 35.8% were in mild retroversion, 31.1% were in moderate retroversion, and 9.6% were in maximal retroversion. Most necks were placed in retroversion to avoid impingement. This suggests that if a nonmodular neck had been used, some degree of impingement would have occurred in 70% of cases.
Unexplained Pain After THR: What Should I Do?
Authors: Cuckler John M.
Published: September 2010

Early causes of hip pain within the first year of total hip replacement (THR) include failure of fixation, infection, instability, other sources of pain (eg, lumbar spine), and mechanical dysfunction such as psoas tendon impingement or other soft tissue irritation. Metal-on-metal THRs may present with pain due to hypersensitivity within the first 1 to 3 years after arthroplasty. Late causes of pain include loosening, wear reactions, or mechanical dysfunction such as subluxation associated with wear of the articular couple. Late hematogenous infection is often sudden in onset, but may be subtle. Other sources of pain such as spinal stenosis or lumbar degenerative disk disease may also present as hip pain. Evaluation of the painful hip should start with a careful history: is the current pain similar or different to the preoperative symptoms? A review of the preoperative radiographs will provide clues as to the extent of the pathology, and if not obvious, may suggest other sources for the pain syndrome. Careful comparison of serial radiographs is necessary to identify loosening. Serologic tests should include a sedimentation rate and C-reactive protein; if both are elevated, aspiration of the joint under radiograph control for culture is indicated. In the absence of abnormalities in the studies described above, serial Technetium bone scans performed every 6 to 12 months may suggest loosening if progressive increases in uptake are observed about a component. Malposition of the acetabular component may be associated with psoas tendon impingement (symptomatic with active flexion of the hip) and may be confirmed by computed tomography scan or a psoas tenosynogram. Hypersensitivity of metal-on-metal THRs should be suspected in the presence of early (subtle) osteolysis, and the presence of predominantly mononuclear cells on the sterile aspirate. Perseverance and patience are encouraged in the pursuit of an accurate diagnosis, and objective analysis of the data is necessary. Do not operate without sufficient cause.
The Proximal Modular Neck in THA: A Bridge Too Far: Affirms
Authors: Dunbar Michael J.
Published: September 2010

Modular necks are a relatively new innovation in total hip arthroplasty (THA), with several companies now offering modular neck options. The proposed advantages of reduced impingement, reduced dislocation rate, and better reconstitution of leg length and offset are compelling. However, few reports in the literature address the outcomes of these devices, and those that are published at best demonstrate equivalence to conventional THA.

There are numerous disadvantages to this new technology. Neck dissociation has been reported with a specific design of the modular taper. Numerous case reports exist of the fracture of titanium modular femoral necks, with 1 large series of 5000 cases reporting a fracture rate of 1.4%. Fractures occurred more frequently in heavy men (>100 kg), with the preponderance of fractures occurring around the 2-year mark. Retrieval analysis demonstrates failure of the titanium components at the Morse taper junction of the neck and femoral stem at the point of maximal tension, likely related to notch sensitivity. The additional interface of modular necks in the effective joint space has the potential to generate significant metal ions through a pitting corrosion process. Evidence exists of highly elevated serum cobalt and chromium ions in a modular junction used in large-head THA supporting these concerns. The use of particular neck geometries, such as long retroverted necks, may adversely affect the local biomechanical forces on the femoral component. The proposed mechanism is an increased lever arm leading to increased torque on stair climbing or rising from a chair. Finally, modular necks add significant costs to the implant and the health care system. On balance, based on the literature, the proximal modular neck in THA is a bridge too far.
Acetabular Fractures: The Role of Arthroplasty
Authors: Haidukewych George J.
Published: September 2010

Acetabular fractures are generally treated with open reduction and internal fixation, with the goals of anatomic reduction and preservation of the native hip joint. Modern techniques of internal fixation have resulted in good to excellent outcomes in the vast majority of patients when anatomic reduction can be obtained. Total hip arthroplasty (THA) has a role in the treatment of these injuries in 2 general situations: the acute fracture in the elderly patient with joint impaction, and for the sequelae of acetabular fracture, namely posttraumatic arthritis or osteonecrosis. Preoperative planning with plain radiographs and computed tomography (CT) scanning, including 3-dimensional reconstructions, is recommended.

Recent data show that fractures in the elderly that exhibit joint impaction of the acetabular dome (the so-called gull sign) or impaction of the femoral head generally did not benefit from internal fixation attempts. Restoration of columnar continuity, typically with plates and uncemented acetabular components with multiple screw fixation, remains the preferred strategy. Cemented acetabular components have demonstrated a high failure rate in this setting and should be avoided. Plating of the posterior column will usually provide continuity of the acetabular dome, the quadrilateral plate, and ishium, which will facilitate stable uncemented acetabular component implantation. Rarely, an antiprotrusio device is necessary. Liberal use of autograft from the resected femoral head is recommended for acetabular defects. For posttraumatic sequelae, the surgeon must be prepared for heterotopic bone, scarring, bony defects, and retained hardware. Preoperative CT scanning can help localize heterotopic bone or bony defects. Hardware that does not interfere with acetabular component implantation can generally be left in situ.
Management of Bone Loss in Revision TKA: It’s a Changing World
Authors: Lombardi Adolph V. , Berend Keith R. , Adams Joanne B.
Published: September 2010

Bone deficiency represents a common theme in revision total knee arthroplasty (TKA). The etiology of bone deficiency may be aseptic loosening resulting in direct mechanical bone loss, osteolysis, stress shielding, septic loosening, or iatrogenic resulting from implant removal. Not all revisions are created equal. The surgeon must assess the degree of complexity and have a broad armamentarium available. Principles to consider in bone loss management are defect size and location and patient demographics, including body mass index, activity level, age, and life expectancy. Treatment options include polymethylmethacrylate (PMMA) with or without reinforcing screws; modular TKA systems including optional stems, wedges, and metal augments; orthopedic salvage systems such as mega- or tumor prostheses; autograft; and morselized or structural allograft. Morselized allograft is better suited for reconstitution of contained deficits and may be associated with a higher rate of incorporation. Disadvantages of allograft include late resorption, fracture or nonunion of structural allograft, and risk of disease transmission. A recent innovation has been a variety of augments and cones fabricated in the new ultraporous metals to address structural defects in revision TKA. Recommendations for bony reconstruction include: for deficits <5 mm, PMMA fill; for deficits 5 to 10 mm and <50% of the femoral condyle or tibial plateau, PMMA with reinforcing screws; for contained deficits >5 mm, morselized allograft; for noncontained deficits 5 to 15 mm and >50% of the femoral condyle and tibial plateau, TKA modular systems with stems and augments; and for noncontained deficits >15 mm, structural allografts, megaprostheses, and ultraporous metal augments.
Periprosthetic Joint Infection: Treatment Options
Authors: Parvizi Javad , Zmistowski Benjamin , Adeli Bahar
Published: September 2010

Periprosthetic joint infection has become the most common cause of failure following total knee arthroplasty. Over the past 4 decades, treatment of this disease has evolved with technological innovations and pathogen profiling. The appropriate treatment selection is dependent on patient immune system quality, timing of symptom onset, and pathogen type. Antibiotic suppression alone is reserved for those cases without drainage, low-virulent antimicrobial-susceptible pathogens, and patients whose level of health increases the risk of surgery past any risk associated with chronic infection. In patients with an acute onset of symptoms and antimicrobial-susceptible pathogens, irrigation and debridement with exchange of modular components is moderately successful and offers the advantage of component retention and maximum knee function. In failed irrigation or chronic periprosthetic joint infection, resection of all components is necessitated. Resection and reimplantation can either be performed in one or two stages. A single-stage exchange has the potential to decrease the number of surgeries and therefore cost. However, the success rate of direct exchange is lower than that of two-stage revision. This has led to two-stage revision, with the placement of an intra-stage antibiotic-loaded spacer, to become the “gold” standard for periprosthetic joint infection eradication. In an immunocompromised patient with an uncontrollable periprosthetic joint infection, salvage procedures are necessitated. Complete eradication of periprosthetic joint infection is achieved by resection of all components without reimplantation through arthrodesis or above-the-knee-amputation. While amputation may be unpopular with patients it provides a greater ability to reconstruct, with an external prosthesis, a functioning joint.
Encountering Cancer or Its Sequelae at the Hip
Authors: Rosenberg Aaron
Published: September 2010

The orthopedist may need act as an adjunct to the medical oncologist in the management of the cancer patient with hip disease. While management of the cancer patient with routine hip pathology is relatively straightforward, the surgeon should be aware that the cancer patient may be on treatment protocols that affect wound healing, the immune system, and the risk of deep venous thrombosis. An additional factor that may complicate management of patients who have completed treatment of peripelvic cancer may be local radiation therapy, which can lead to necrosis of the acetabular bone stock.

Operating on these patients must include consultation with previous radiation therapy providers to estimate the dose sustained by the local tissues under consideration. Greater than 500 cGy has been associated with high fixation failure rates in several series. Increased rates of infection and wound healing have also been noted secondary to long-term lymphatic obliteration caused by radiation. These concerns also affect the surgeon who must manage patients with acute metastatic disease. The principles of managing metastatic disease include recognizing the presence of lesions in bone about the hip, the occasional need for biopsy, the use of radiation in sensitive tumors, surgical stabilization of impending fracture, or joint replacement when needed. The amount of tumor, as well as the effect of chemotherapy and radiation on the healing process, potentially complicates these treatment modalities.
Metal–Metal Reactivity: Houston, We Have a Problem!
Authors: Schmalzried Thomas P. , Tiberi John V.
Published: September 2010

In this single-surgeon series, both resurfaced hips in 1 woman and a total hip arthroplasty in another were revised for symptomatic pseudotumor (3 of 588 hips; 0.51% overall incidence; 2.2% in women). All 3 hips had 50-mm acetabular components. There was no difference in mean lateral opening angle (mean 38.7° vs 42.8° for the others) but these 3 hips all had increased acetabular anteversion (mean 27.1° vs 16.4° for the others;
P
<.05). Increased combined anteversion is a mechanical common denominator in pseudotumor formation. Female sex and small component size are variables associated with congenital dysplasia, which typically has a small, shallow socket and high combined anteversion. Thus, native anatomy may predispose to the joint mechanics that lead to pseudotumor formation, and not sex or size. The aggregate results indicate that the determination of satisfactory component position includes (1) assessment of the acetabular component lateral opening, (2) acetabular component version, and (3) femoral version.

A mechanical problem suggests a mechanical solution. To insure capture of the femoral head by the socket and the intended bearing tribology, acetabular lateral opening angles should be <50°, assuming a femoral neck-shaft angle of 130° to 135°. Combined anteversion should not exceed 40°. In resurfacing of dysplastic cases where the neck-shaft angle exceeds 140°, the acetabular lateral opening angle needs to be correspondingly lower to achieve equivalent head capture and bearing contact.
Stiffness After TKR: How to Avoid Repeat Surgery
Authors: Su Edwin P. , Su Sherwin L. , Valle Alejandro Gonzalez Della
Published: September 2010

Stiffness after total knee replacement (TKR) is a frustrating complication that has many possible causes. Although the definition of stiffness has changed over the years, most would agree that flexion <75° and a 15° lack of extension constitutes stiffness. The management of this potentially unsatisfying situation begins preoperatively with guidance of the patient's expectations; it is well-known that preoperative stiffness is strongly correlated with postoperative lack of motion. At the time of surgery, osteophytes must be removed and the components properly sized and aligned and rotated. Soft tissue balancing must be attained in both the flexion/extension and varus/valgus planes. One must avoid overstuffing the tibiofemoral and/or patellofemoral compartments with an inadequate bone resection. Despite these surgical measures and adequate pain control and rehabilitation, certain patients will continue to frustrate our best efforts. These patients likely have a biological predisposition for formation of scar tissue. Other potential causes for the stiff TKR include complex regional pain syndrome or joint infection. Close follow-up of a patient's progress is crucial for the success in return of range of motion. Should motion plateau early in the recovery phase, the patient should be evaluated for manipulation under anesthesia. The results of reoperations for a stiff TKR are variable due to the multiple etiologies. A clear cause of stiffness such as component malposition, malrotation, or overstuffing of the joint has a greater chance of regaining motion than arthrofibrosis without a clear cause. Although surgical treatment with open arthrolysis, isolated component, or complete revision can be used to improve TKR motion, results have been variable and additional procedures are often necessary.
Gap Balancing Through Small Incisions: Competing Goals
Authors: Kusuma Sharat K. , Wasielewski Ray C.
Published: September 2010

Significant controversy exists in the literature regarding the pitfalls and benefits of minimally invasive total knee arthroplasty (TKA). Regardless, most surgeons today use smaller exposures than in previous years. Although more difficult, rigid adherence to classical gap balancing techniques can allow a surgeon to achieve ideal ligament and flexion/extension gap balance in TKA through a minimally invasive approach. There are certain groups of patients (obesity/medical comorbidities/vascular insufficiency) in whom small incision approaches should not be attempted due to increased risks of wound complications. Additionally, achievement of gap balance requires sequential and safe removal of bone starting with the patellar cut, followed by the distal femoral cut, then by the tibial cut, and concluding with completion of the femoral component cuts. Use of special instruments such as protective metal patellar buttons, medial to lateral distal femoral cutting blocks, and low profile spacer blocks can facilitate the surgical process. Accurate femoral component rotation is more difficult in minimally invasive approaches and must be carefully checked. A tight extensor mechanism in flexion can mislead the surgeon to place the femoral component in an internally rotated position. Furthermore, with limited visualization, surgeons must avoid overaggressive ligament releases early in the procedure prior to completion of bone cuts. However, with appropriate patient selection and a systematic approach to minimally invasive total knee arthroplasty, surgeons can continue to achieve ideal ligament balance with a more soft tissue friendly operation.
New Oral Antithrombotic Agents for the Prevention of Deep Venous Thrombosis and Pulmonary Embolism in Orthopedic Surgery
Authors: Merli Geno J.
Published: September 2010

As the population ages and medical care, along with a functional life style, continues to improve the health of this group, the number of joint replacement surgeries will continue to rise each year in the United States. This growing volume carries with it the risk of venous thromboembolism associated with joint replacement surgery. The American College of Chest Physicians and the American Academy of Orthopedic Surgery have provided guidelines for preventing this complication with the use of warfarin, low molecular weight heparins, pentasaccharides, and aspirin. These agents have had variable efficacy and safety preventing postoperative and out-of-hospital venous thromboembolism. New classes of oral agents, which inhibit Factor II or Factor X, have been shown to be an effective and safe class of anticoagulants that do not require monitoring or have food and drug interactions. This paper will review the current data on the new oral anticoagulants in joint replacement surgery.
Antibiotic Resistance
Authors: Emanuele Patricia
Published: September 2010

This article reviews the causes and consequences of antibiotic resistance and efforts to control its growth. Antibiotic-resistant infections and related morbidity and mortality are on the rise in the United States and around the world. At the same time, the effectiveness of many antibiotics has declined. Antibiotic resistance is a natural biological outcome of antibiotic use. Although it cannot be prevented, antibiotic resistance can be controlled. New health care reform laws focus on prevention and safety, offering occupational health nurses an opportunity to raise public awareness of antibiotic resistance and promote disease prevention in the workplace.
Comparison of Stereo Disc Photographs and Alternation Flicker Using a Novel Matching Technology for Detecting Glaucoma Progression
Authors: Radcliffe Nathan M. , Sehi Mitra , Wallace Ira B. , Greenfield David S. , Krupin Theodore , Ritch Robert
Published: September 2010

Background and Objective:

To compare agreement of automated alternation flicker and serial stereophotograph inspection for detection of progressive glaucoma.

Patients and Methods:

Serial photographs of patients with glaucoma with at least 36 months of follow-up and perimetry every 4 months were assessed by four graders using predefined criteria with both flicker and stereophotography. The main outcome measure was progressive neuroretinal rim deterioration as identified by each technique.

Results:

Forty eyes (20 patients) were included and 12 eyes progressed with perimetry. Using stereophotography, the overall agreement (kappa ± standard error) was 0.19 ± 0.06 for rim change, 0.78 ± 0.06 for disc hemorrhage, and −0.04 ± 0.06 for vessel movement. Using flicker, the overall agreement was similar for rim change (0.28 ± 0.06;
P
= .29), worse for disc hemorrhage (0.43 ± 0.06;
P
< .001), and better for vessel movement (0.22 ± 0.06;
P
= .002). The agreement between perimetric and disc progression was similar using stereophotography (0.10 ± 0.05) and flicker (0.19 ± 0.05;
P
= .20).

Conclusion:

Agreement between flicker and stereophotography was similar.
Nodular Sclerochoroidopathy Simulating Choroidal Malignancy
Authors: Hatef Elham , Wang Jianmin , Ibrahim Mohamed , Turkcuoglu Peykan , Khwaja Afsheen , Channa Roomasa , Suan Eric P. , DiBernado Cathy , Sepah Yasir J. , Do Diana V. , Nguyen Quan Dong
Published: September 2010

A 55-year-old man who had multiple subretinal and choroidal yellowish lesions and episcleral nodules for 1.5 years was diagnosed as having nodular sclerochoroidopathy after developing classic features of posterior scleritis with choroidal and serous retinal detachment. Long-term therapy with steroids in combination with mycophenolate mofetil resulted in regressed posterior scleritis and nodular lesions, as well as improved visual acuity. Nodular sclerochoroidopathy should be suspected in patients with subretinal and choroidal lesions and should be distinguished from choroidal neoplasm.
Management of Ruptured Retinal Arterial Macroaneurysm with Intravitreal Bevacizumab
Authors: Javey Golnaz , Moshfeghi Arlanna N. , Moshfeghi Andrew A.
Published: September 2010

The authors report the management of a ruptured retinal arterial macroaneurysm and associated hemorrhages with intravitreal injections of bevacizumab. A 79-year-old woman presented with a history of systemic arterial hypertension and a ruptured retinal arterial macroaneurysm with pre-retinal, intraretinal, and subretinal hemorrhages extending into the macula. Visual acuity at presentation was 20/400. The patient was treated with two intravitreal injections of bevacizumab at 4-week intervals. Steady clearing of the pre-retinal, intraretinal, and subretinal hemorrhages was observed with restoration of final visual acuity to 20/20 in the 12 months after the initial presentation. It appears that the novel application of intravitreal bevacizumab may be used in the treatment of ruptured retinal arterial macroaneurysm.
From the edges to the center: Disability, "Battlestar Galactica," and fan fiction
Authors: Sasha_feather -
Published: September 2010

As a fan of Battlestar Galactica, I was intrigued by the inclusion of disabled main characters, but disappointed by the show's resolution of their stories. Fan fiction provided an alternate way to talk about these concerns, although many works fetishize or romanticize disability. I credit fandom for continuing to educate me and allow me to educate others.
Interview with Elisa Kreisinger
Authors: Coppa Francesca
Published: September 2010

Elisa Kerisinger, self-described "pop-culture pirate," is interviewed by Francesca Coppa.