bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of sildenafil citrate in nicotine-induced ischemia: An experimental study using a rat model
Authors: Baykan Halit , Ozyazgan Irfan , Selçuk Caferi Tayyar , AltıParmak Mehmet , Özköse Mehmet , Özyurt Kemal
Published: November 2017

Recent experimental and clinical studies have demonstrated the negative effects of nicotine on the viability of skin flaps. Necrotic damage to skin flaps can result in significant complications including delayed wound healing, dehiscence and wound contraction. Phosphodiesterase type 5 inhibitors, such as sildenafil citrate, have a protective effect in ischemic injuries of the brain, kidney, myocardium, spinal cord, ileum and testes. In the present study, the authors evaluated the effect of sildenafil citrate on the viability of skin exposed to nicotine-induced ischemia in Sprague Dawley rats. In the preoperative period, the rats were divided into three groups of 10 rats each. Group C was treated with subcutaneous saline and group S and group N were treated with 2 mg/kg nicotine, administered subcutaneously twice per day for 28 days. McFarlane flaps were created in all experimental animals using an incision measuring 7 cm × 3 cm. Postoperative treatment varied among the groups: group S was treated with 20 mg/kg/day sildenafil citrate, while group C and group N were treated with equivalent doses of saline for seven days. A laser Doppler flow meter was used to monitor the microvasculature. Preoperative measurements of the microvasculature revealed decreased blood flow in group N and group S, both of which were treated with subcutaneous nicotine. During the postoperative evaluation, a trend toward increased blood flow was observed in group S compared with the group with nicotine-induced ischemia treated with saline alone postoperatively (group N). A visual fluorescein dye test was used to predict skin viability and demonstrated diminished skin viability in group N and group S (P<0.05) during the preoperative period. Following treatment with sildenafil for seven days, a statically significant improvement in skin viability was observed in group S (P<0.05). Nicotine decreased blood flow within the skin and impaired skin viability, while postoperative application of sildenafil significantly ameliorated the ischemic effects of nicotine and improved skin viability. Future studies will be required to evaluate the clinical use of sildenafil for the improvement of blood flow in ischemic injury of the skin.
Muscle hernias of the leg: A case report and comprehensive review of the literature
Authors: Nguyen Jesse T , Nguyen Jenny L , Wheatley Michael J , Nguyen Tuan A
Published: November 2017

A case involving a retired, elderly male war veteran with a symptomatic peroneus brevis muscle hernia causing superficial peroneal nerve compression with chosen surgical management is presented. Symptomatic muscle hernias of the extremities occur most commonly in the leg and are a rare cause of chronic leg pain. Historically, treating military surgeons pioneered the early documentation of leg hernias observed in active military recruits. A focal fascial defect can cause a muscle to herniate, forming a variable palpable subcutaneous mass, and causing pain and potentially neuropathic symptoms with nerve involvement. While the true incidence is not known, the etiology has been classified as secondary to a congenital (or constitutional) fascial weakness, or acquired fascial defect, usually secondary to direct or indirect trauma. The highest occurrence is believed to be in young, physically active males. Involvement of the tibialis anterior is most common, although other muscles have been reported. Dynamic ultrasonography or magnetic resonance imaging is often used to confirm diagnosis and guide treatment. Most symptomatic cases respond successfully to conservative treatment, with surgery reserved for refractory cases. A variety of surgical techniques have been described, ranging from fasciotomy to anatomical repair of the fascial defect, with no consensus on optimal treatment. Clinicians must remember to consider muscle hernias in their repertoire of differential diagnoses for chronic leg pain or neuropathy. A comprehensive review of muscle hernias of the leg is presented to highlight their history, occurrence, presentation, diagnosis and treatment.
Obtaining a good lip roll in congenital, secondary and traumatic cleft lip repairs
Authors: Chandran Geethan , Lalonde Donald H
Published: November 2017

The present article includes a video designed to show the reader/viewer how to obtain a better lip roll in primary and secondary cleft lips as well as in traumatic cleft lips. The key is to not damage the delicate glands and fat in the lip roll. The actual surgery demonstrated in the video is a cleft lip redo with an effaced lip roll.
Operative trends and physician treatment costs associated with Dupuytren's disease in Canada
Authors: Liu Wendy , O'Gorman David B , Gan Bing Siang
Published: November 2017

Purpose

To examine treatment trends and costs associated with Dupuytren's disease (DD) in Canada.

Methods

Data regarding fasciectomies, fasciotomies and digit amputations performed for DD from 2005 to 2010 were extracted from the Canadian Institute for Health Information database. The data were analyzed according to year, sex and five-year age groups. The estimated annual physician reimbursement costs for DD in Ontario were calculated using Ontario Health Insurance Plan billing information and the 2010 Physician Schedule of Benefits.

Results

The number and rate of fasciectomies remained stable from 2005 to 2009 (mean of 4067 and 1.24 per 10,000, respectively), but increased in the 2009/2010 fiscal year (to 4458 and 1.32 per 10,000). The number of fasciotomies increased from 133 in 2005/2006 to 201 in 2008/2009, but dropped to 183 in 2009/2010. The mean number of amputations remained stable (12 procedures). The ratio of males to females undergoing fasciectomies remained stable (4:1). The highest rate of fasciectomies was performed for the age groups 65 to 69 years and 70 to 74 years. Estimated mean physician remuneration for DD in Ontario remained stable ($3.2 million per annum).

Discussion

The results regarding patient demographics are comparable with results from previous literature. There was a trend toward an increasing number of fasciectomies and fasciotomies annually, with fasciotomies increasing faster than fasciectomies, which is reflective of the aging population and the recent attention to fasciotomies in the literature. The present study was the first to investigate treatment trends and physician reimbursement costs for the management of DD in Canada.
Failure properties of 352 explanted silicone-gel breast implants
Authors: Peters Walter , Smith Dennis , Lugowski Stanley
Published: November 2017

There have been three generations of silicone-gel breast implants. First generation implants (thick wall – thick gel with Dacron patches) were made from 1963 to 1972. Second generation implants (thin wall-thin gel) were made from 1972 until the mid 1980s. The introduction of third generation implants (stronger wall, low-bleed) was geographically dependent. In Canada, Dow Corning Silastic II implants were introduced in 1986, and Surgitek SCL implants were introduced in 1988. In the present study, a total of 352 silicone-gel breast implants were removed from 239 patients between 1981 and 1995. Their failure properties were dependent upon their generation (year of manufacture) and, for second generation implants, their duration in situ. Of the 352 implants, 20 were first generation, and all were fully intact. Twenty-eight were third generation implants, and 27 were fully intact. Failure properties of the 302 second generation implants were dependent upon their duration of implantation. A survival curve indicated that these implants began to fail (by leaking or rupturing) after four years in situ. By six years, 40% had failed. After 12 years, 95% had failed. Of the 171 second generation implants removed between 1991 and 1995, 77% had failed. The failure properties were similar for the three main manufacturers: Dow Corning, Heyer-Schulte and Surgitek. The failure rate for second generation implants is much higher than was previously believed. This is particularly significant in view of the current difficulty in diagnosing implant failure.
The business education of Canadian plastic surgeons
Authors: Bliss Joy A , Caputy Gregory G
Published: November 2017

Business and economic aspects of a medical practice are rapidly becoming more complex. Physicians are at a crossroads in the manner by which medical and surgical care will be delivered in Canada, at the very base of which are the business aspects and management of health care. The purpose of this research study was to determine the business acumen of plastic surgeons in active practice. The resource base was Canadian plastic surgeons who are members of the Canadian Society of Plastic Surgeons. The intent of the questionnaire research study was to evaluate whether these surgeons perceive this area as necessary and whether they feel adequately prepared to manage this aspect of their practice. The findings of the research indicate that the plastic surgeons surveyed did perceive a need for business acumen in the practice of medicine. The majority felt they were not prepared adequately to deal with the business side of operating a medical practice and perceived a need for basic knowledge in the area of business. The implications of this research are that medical education has ignored this important aspect of preparing a physician to practise medicine in the present economic environment. Educational materials to structure and systematically disseminate business resource information need to be developed so that this group would be able to deal adequately with business-related problems when faced with them in medical practice. Due to the specialty-specific nature of the business needs, this education should likely occur during residency or fellowship training.
Baclofen and trazodone: New culprits in toxic epidermal necrolysis
Authors: Huq N Sam , Sproat Janet E
Published: November 2017

Two case reports involving drugs suspected of causing toxic epidermal necrolysis, that have not been previously implicated in this rare cutaneous drug reaction, are presented.
Congenital adducted thumb: Role of the index transposition flap
Authors: Thomson Hugh G , Grace Douglas
Published: November 2017

This study examines the results of a large length:width ratio transposition flap used for the correction of the congenitally adducted thumb. The flap is elevated from the radial side of the index finger and transposed into the palm parallel to the thenar crease. Long term analysis of flap results included the disappearance of a transverse palmar white line; length:width ratios; angle of abduction of thumb; sensation of flap; and functional assessment of thumb and index finger. There were 49 adducted thumbs operated on and 26 flaps were clinically examined with an average length:width ratio of 3.5:1, with some flaps having ratios of up to 6:1. All adducted thumbs were adequately released with no complications encountered.
Congenital giant pigmented nevi: Clinical features and risk of malignancy
Authors: Weinberg Michael J , Al-Qattan Mohammed M , Zuker Ronald M , Thomson Hugh G , Lindsay William K
Published: November 2017

There is general agreement that congenital giant pigmented nevi (CGPN) are precursors to malignant melanoma; however, the magnitude of the risk of malignant transformation is the subject of wide controversy. The goal of this study was to present the authors' experience with CGPN and more specifically their experience with the risk of malignancy. To identify the general features of CGPN a detailed retrospective chart review was performed at The Hospital for Sick Children in Toronto (1979 to 1994, n=84). There were 39 boys and 45 girls. The average size at presentation was 5.24% of the body surface area, and 36.9% of the nevus were located on the head and neck. An important finding was the high percentage of associated extra cutaneous disorders in patients with CGPN (23%) including a case of leptomeningeal melanocytosis. Tissue expansion was the most commonly used treatment modality. One case of malignant melanoma arising from CGPN was identified. To ensure that all cases of malignant melanoma were identified in this cohort, a questionnaire was sent to all plastic surgeons in Ontario (n=118), and data from the Ontario Cancer Registry were reviewed using the diagnostic codes for malignant melanoma and for pigmented nevus. One case of malignant melanoma was identified in all records. Thus CGPN poses a significant management challenge to the plastic surgeon and the risk of malignancy is low.
Factors affecting the emergency room treatment of boxer's fractures
Authors: Mian Rizwan , Scilley Christopher
Published: November 2017

There is considerable controversy over the point at which boxer's fractures need to be reduced. This study characterizes the features of fractures that prompted reduction. A retrospective review of 57 consecutive patients with 57 boxer's fractures presenting to the emergency room was carried out. Forty percent of the fractures were reduced. With reduction, the average angulation on lateral radiographs improved from 40.5° to 31.6°. The improvement of angulation, after reduction, was statistically significant (P<0.005). After an average of 17 days follow-up period the angulation was 35.2°. There was no significant loss of reduction shown between the post reduction and follow-up radiographs (P>0.1).
Long term objective lip assessment following electrical burns to the oral commissure in infancy and childhood
Authors: Al-Qattan Mohammed M , Gillett D , Thomson Hugh G
Published: November 2017

Long term lip assessment was performed in 10 patients who sustained electrical burns to the oral commissure in childhood with a mean follow-up time of 15 years. None of the patients had any subjective symptoms and all were happy with the cosmetic appearance of the lips. Objectively, the lip elasticity index was within normal limits in all patients, but the soft tissue gap between the lips with maximum mouth opening was slightly below normal in 50% of patients. At rest, all patients had symmetric commissure positions. However, with wide grin, the injured commissure moved to a lesser extent than the uninjured side. Using the pommeter, the sphincteric power of the orbicularis oris was found to be within the normal range in all patients. Although none of the patients had any subjective sensory abnormalities of the lips, 50% of patients were found objectively to have a higher two-point discrimination and pressure threshold values in the injured commissure than the contralateral uninjured side.
Migration of metallic mercury in the hand
Authors: Wells Neil J , Boyle James C , Wood Victor
Published: November 2017

A case of an unusual injury to the hand involving a broken thermometer, resulting in migration of mercury within the tissues requiring surgical removal, is described.
Riche-Cannieu connection in median nerve injuries
Authors: Carr Mm , Boyd Jb , Bowen Cva
Published: November 2017

The Riche-Cannieu connection between the deep branch of the ulnar nerve and the recurrent motor branch of the median nerve was first noted in hand dissections almost 100 years ago. It was then considered rare and unimportant. Electrophysiologists have recently shown that this connection occurs in a large proportion of normal volunteers and accounts for a variable proportion of motor response in the thenar musculature. This report describes two cases of median nerve injuries with intact thenar function and postulates that this anomalous clinical presentation is due to the Riche-Cannieu connection. The unusual clinical situations emphasize the need for careful evaluation of nerve injuries.
Topical 2% lidocaine gel versus placebo in burn wound debridement pain
Authors: Maxwell Donna , O'brien J , Sparkes G , Lalonde Dh
Published: November 2017

This prospective, randomized, double blind study compared the effectiveness of topical 2% lidocaine gel versus placebo in the reduction of burn wound debridement pain. Each of the 19 patients in this study acted as his/her own control by having his/her burn wound debrided four times; twice with lidocaine and twice with placebo. Topical 2% lidocaine gel was found to be superior to placebo in decreasing the pain of burn wound debridement (P=0.0048 at a 1% level of significance).
Inverted Nipple and Nipple Reconstruction: The ‘Parachute’ Flap
Authors: Kirwan Laurence
Published: November 2017

The inverted nipple is a condition seldom discussed at length in standard works on breast surgery. The pathophysiology is a relatively short ductal system, which prevents the nipple from everting. Surgical procedures to correct the inverted nipple are divided into those that preserve ductal integrity and those that do not. Current techniques tend to be ineffective and are often complicated by a deformed nipple. A star-shaped flap is described which, when elevated by partial division of the ducts, looks like a parachute. Elevation allows collapse of the triangular flaps to form two concentric circles with a smaller diameter. The advantages of this technique are its simplicity, efficacy and lack of recidivism. The disadvantages are that it reduces the size of the areola and may result in a nipple that is too large. The method is also applicable to nipple reconstruction.
Split-Thickness Skin Graft Coverage following Release of Postburn First Web Space Adduction Contracture
Authors: Snelling Charles Ft , Germann Eva
Published: November 2017

Twelve patients from 11 to 57 years of age who underwent surgical release of postburn first web space thumb adduction-pronation contracture had the resulting defect resurfaced successfully with a medium-thickness, unmeshed, split-thickness skin graft (STSG). This procedure provided satisfactory, durable cover and maintained the gain in thumb abduction. All hands had combined dorsal and volar scarring that required incision. If indicated, partial division of the midbelly of the distal border of the adductor and distal midborder of the first dorsal interosseous was performed to increase both radial and palmar thumb abduction. Immediate or delayed skin grafting, the latter with a dynamic grafting splint, was carried out. Fifteen hands (from 12 patients) were assessed one year or more after surgical release. The mean postoperative radial abduction angle measured on photographs between the first metacarpal shaft and index proximal phalanx was 42°±13°, which was greater than the preoperative mean of 23°±12° (P=0.001) but less than the mean of 57°±12° for 20 nonburned control subjects (P=0.002). The mean postoperative palmar abduction angle measured between the first metacarpal and the proximal phalanx of the index finger was 54°±19°, which was greater than the preoperative mean of 18°±21° (P<0.001). An STSG was simple and quick to harvest for the burned hand at or near full growth size, and was successful in maintaining the increased abduction gained in the first web space for most of the patients who were treated.
A Review of 100 Consecutive Free Flaps
Authors: Classen Dale A
Published: November 2017

This study is an analysis of the first 100 consecutive free flaps performed by the author. During a 61 month period, 100 free flaps were performed in 90 patients. The overall flap success rate was 93%. A review of the indications, donor sites, recipient sites, outcomes and complications is presented. A comparison is made between the first 50 free flaps and the second 50 free flaps to examine evolving practice patterns. Techniques that were of value are discussed.
Axillary Hyperhidrosis Treatment by Simple Skin Excision and Undermining
Authors: Kettle Charles , Freiberg Arnis
Published: November 2017

The current literature of axillary hyperhidrosis is reviewed. Excision of the gland-containing skin of the axilla has been a mainstay in the treatment of axillary hyperhidrosis for many years. A retrospective study was performed using data accumulated from 56 consecutive patients who underwent a surgical procedure modified from that originally described by Hurley and Shelley. Excision of the hair-bearing portion of the axilla with undermining of the adjacent skin and simple closure was performed under local or general anesthesia. Ninety-two per cent of patients were satisfied with the results. Five patients wished to undergo a second procedure, either because they still had excessive perspiration or because they were unhappy with their scars. Complication rates were low and were compared with other series. Thus, the described procedure provides a simple, safe and effective modality for the treatment of axillary hyperhidrosis.
Volar Ulnar Approach to the Distal Radius and Carpus
Authors: Pourgiezis Nicholas , Bain Gregory I , Roth James H , Woolfrey Michael R
Published: November 2017

This safe and extensile approach provides excellent exposure of the flexor tendons in the palm, distal radius, distal radioulnar joint and carpus, and can be used to expose any pathology on the volar aspect of the wrist. Using a volar ulnar incision, the ulnar neurovascular bundle is identified and extensively released. The transverse carpal ligament is divided at its ulnar attachment, and the finger flexor tendons are retracted radially to expose the volar wrist capsule and the pronator quadratus. These latter structures can be divided to expose the carpus and distal radius, respectively. Forty-four patients were reviewed, and 46 procedures were performed. The approach was used for a spectrum of indications and often included complex injuries or disorders of the wrist. Patients reported a low level of pain and a high level of satisfaction. There were no neurovascular complications.
Disruption of quadriceps tendon after total knee arthroplasty: Case report of four cases
Authors: Soong JW , Silva AN , Andrew Tan HC
Published: November 2017

Quadriceps tendon rupture after total knee arthroplasty (TKA) is a rare but dire complication. It is associated with adverse outcomes and morbidities. Studies on such complications are scarce in the literature. In this study, we share our experience in the management of four patients who sustained quadriceps tendon rupture in the early postoperative period. Efforts should be focused on prevention. Meticulous surgical techniques during the medial parapatellar approach to preserve the integrity of quadriceps can reduce the risk of rupture. The importance of prompt diagnosis is emphasized as delayed treatment may lead to poor outcomes. However, making a diagnosis can be challenging, as worsening of the quadriceps strength after TKA is expected because of the surgical approach that violates the quadriceps muscle. In an event of postoperative trauma with resultant extensor weakness, an ultrasound evaluation to exclude a quadriceps tendon rupture should be promptly performed after a fracture is excluded.
Improved external rotation with concomitant reverse total shoulder arthroplasty and latissimus dorsi tendon transfer: A systematic review
Authors: Wey Aaron , Dunn John C , Kusnezov Nicholas , Waterman Brian R , Kilcoyne Kelly G
Published: November 2017

Background:

In conjunction with reverse total shoulder arthroplasty (RSA), latissimus dorsi and teres major (LD-TM) transfer has been advocated in the setting of combined loss of elevation and external rotation. The purpose of this systematic review is to summarize the clinical outcomes following RSA with LD-TM transfer.

Methods:

A search of PubMed, EMBASE, CINAHL, Medline, and Cochrane databases was performed between January 1, 1990 and March 1, 2016 and included articles related to outcomes following RSA with LD-TM transfer. Primary outcomes of interest were constant score, shoulder range of motion, and patient satisfaction. Secondary outcomes of interest included subjective shoulder value, simple shoulder test, activities of daily living requiring external rotation, and visual analog pain score. Additional outcomes evaluated included complications and reoperations. Frequency-weighted values of outcome data were utilized.

Results:

Five level IV studies involving 98 shoulders met the inclusion criteria. The mean age of the cohort was 69.1 ± 5.19 years (range 47–85). RSA with LD-TM transfer was performed for rotator cuff arthropathy (94%) or proximal humerus fracture (6%). The average follow-up was 44.5 ± 10.38 months (range 12–105 months). The constant score improved from 28 to 65 ( p < 0.0005). Active external rotation improved from −7.4° to 22.9° ( p < 0.0005). There was a 22.4% overall complication rate, including dislocation (5.1%), infection (5.1%), and transient nerve palsy (3.4%).

Conclusion:

Patients undergoing RSA with LD-TM transfer in the setting of loss of external rotation demonstrate reliable clinical improvements in shoulder function with complication rates which are comparable to RSA alone.
Does preoperative mental health affect length of hospital stay and functional outcomes following arthroplasty surgery? A registry-based cohort study
Authors: Singleton Neal , Poutawera Vaughan
Published: November 2017

Aim:

It has been reported in the literature that patients with poor preoperative mental health are more likely to have worse functional outcomes following primary total hip and knee arthroplasty. We could find no studies investigating whether preoperative mental health also affects length of hospital stay following surgery. The aim of this study was to determine whether preoperative mental health affects length of hospital stay and long-term functional outcomes following primary total hip and knee arthroplasty. We also aimed to determine whether mental health scores improve after arthroplasty surgery and, finally, we looked specifically at a subgroup of patients with diagnosed mental illness to determine whether this affects length of hospital stay and functional outcomes after surgery.

Method:

Through a review of prospectively collected regional joint registry data, we compared preoperative mental health scores (SF-12 MH) with length of hospital stay and post-operative (1 and 5 years) functional outcome scores (Oxford and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)) in 2279 primary total hip and knee arthroplasty surgeries performed in the Bay of Plenty District Health Board between 2006 and 2010.

Results:

Based on Pearson product–moment correlation coefficients, there was a significant correlation between preoperative mental health scores and post-operative Oxford scores at 1 year as well as post-operative WOMAC scores at both 1 and 5 years. There was no significant correlation between preoperative mental health and length of hospital stay. Mental health scores improved significantly after arthroplasty surgery. Those patients with a formally diagnosed mental illness had significantly worse preoperative mental health and function scores. Following surgery, they had longer hospital stays although their improvement in function was not significantly different to those without mental illness.

Conclusion:

The results of this study support reports in the literature that there is a correlation between preoperative mental health and long-term functional outcomes following primary total hip and knee arthroplasty. Patients with poor preoperative mental health are more likely to have worse functional outcomes at 1 and 5 years following surgery. No correlation between preoperative mental health and length of hospital stay was identified. Mental health scores improved significantly after surgery. Patients with mental illness had longer hospital stays and despite worse preoperative mental health and function had equal improvements in functional outcomes.
Effect of sodium hyaluronate/carboxymethyl cellulose (Guardix-sol) on retear rate and postoperative stiffness in arthroscopic rotator cuff repair patients: A prospective cohort study
Authors: Jeong Jeung Yeol , Chung Pill Ku , Yoo Jae Chul
Published: November 2017

Purpose:

Hyaluronate-based anti-adhesive agents are expected to enhance rotator cuff healing; however, their effect on the incidence and extent of postoperative complications such as stiffness and retears has not been investigated.

Methods:

From July 2012 to February 2013, 80 patients undergoing arthroscopic rotator cuff repair surgery were prospectively enrolled. Forty patients were assigned to the control group, while the other 40 were assigned to the injection group and received a Guardix-sol injection immediately after surgery. Passive range of motion, pain visual analog scale, and functional score were assessed at 8 weeks, 6 months, and 24 months postoperatively. Gliding motion between the deltoid muscle and the greater tuberosity of the proximal humerus was evaluated using ultrasonography at 2 and 8 weeks postoperatively, and tendon integrity was evaluated using magnetic resonance imaging at 6 months postoperatively.

Results:

We found no significant difference between the groups regarding gliding motion at 2 weeks postoperatively. However, at 8 weeks, the incidence of poor gliding motion was 2.5% and 15% for the injected patients and control group, respectively, which was statistically significant. At 6 months after surgery, the retear rate between the two groups was not statistically significant. We found no statistically significant difference between the two groups regarding retear rate and clinical score throughout the follow-up period. We noted no complications related to the use of Guardix-sol.

Conclusions:

Patients who received the Guardix-sol injection showed improved gliding motion between the deltoid muscle and the greater tuberosity in the early postoperative period.
Analysis of functional outcome of Hoffa fractures: A retrospective review of 32 patients
Authors: Trikha Vivek , Das Saubhik , Gaba Sahil , Agrawal Prabhat
Published: November 2017

Purpose:

Hoffa fractures are uncommon intra-articular fractures of femoral condyle in coronal plane. The purpose of our study is to assess radiologic and functional outcome in operatively treated Hoffa fractures.

Methods:

We retrospectively reviewed 32 patients of isolated Hoffa fracture from January 2010 to March 2015. All were treated with open reduction and internal fixation using lateral approach for lateral Hoffa and medial approach for medial Hoffa fracture. Cancellous screws in lag mode and/or antiglide plate were employed for fixation in accordance with fracture anatomy. All patients were subjected to aggressive physical therapy postoperatively. Knee Society Score (KSS), International Knee Documentation Committee Score (IKDC), and Knee range of motion (ROM) were documented at final follow-up for functional evaluation.

Results:

All fractures united by mean time of 11.56 ± 1.5 weeks. No evidence of subsequent displacement or fixation failure, arthritis, Avascular necrosis (AVN) of femoral condyle was elicited in any of the patients. Documented mean KSS and mean IKDC Score at final follow-up were 83.19 ± 8.43 and 81.62± 6.95, respectively. ROM at final follow-up was ranging from 0° to mean 116.41° ± 13.98°. Complications included stiffness of the involved knee in four patients, including one patient who developed infection and had to undergo implant removal after fracture union.

Conclusion:

Operative treatment of Hoffa fractures yields fairly good functional outcome. One must endeavor to achieve adequate intraoperative exposure and stable congruous articular reconstruction. Early aggressive physical therapy is a harbinger of optimal outcome.
Primary Carcinosarcoma of the Pancreas With CD10-Positive Sarcoma Component
Authors: Salibay Christine J. , Rewerska Julia , Gupta Shweta , Ree Nicholas
Published: November 2017

Carcinosarcomas of the pancreas are rare entities with a dismal prognosis. We report a rare case of pancreatic carcinosarcoma in a 49-year-old African American female who underwent a total abdominal hysterectomy with right salpingo-oophorectomy and exploration of the pancreatic mass. The surgery revealed a sclerotic mass in the body and tail of the pancreas that was surgically unresectable, and a pancreatic biopsy confirmed the pathology of pancreatic carcinosarcoma. Histologically, the lesion showed a high-grade spindle cell sarcoma and adjacent moderately differentiated adenocarcinoma. On immunohistochemical examination, the carcinomatous component was positive for epithelial markers, and the sarcomatous component was focally positive for SMA and desmin. In addition, the sarcomatous component showed diffuse immunoreactivity for CD10 with a surrounding myofibroblastic proliferation. Reports have associated expression of CD10 in pancreatic stellate cells with increased tumor aggressiveness. In this article, we report a case of pancreatic carcinosarcoma that shows sarcomatous CD10 immunoexpression with higher Ki67 labeling in the sarcoma than the carcinoma raising the question if the sarcomatous component could be potentiating the aggressiveness of the carcinomatous component.
Bone–Patellar Tendon–Bone Versus Hamstring Tendon Autografts for Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review of Overlapping Meta-analyses
Authors: Schuette Hayden B. , Kraeutler Matthew J. , Houck Darby A. , McCarty Eric C.
Published: November 2017

Background:

Previous meta-analyses have compared bone–patellar tendon–bone (BPTB) with hamstring tendon (HT) autografts for primary anterior cruciate ligament reconstruction (ACLR).

Purpose:

To conduct a systematic review of overlapping meta-analyses comparing BPTB with HT autografts for ACLR to determine which meta-analyses provide the best available evidence.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic review was performed by searching the PubMed and Cochrane Library databases. Search words included “anterior cruciate ligament” AND “patellar tendon” AND “hamstring tendon” AND “meta-analysis.” Results were reviewed to determine study eligibility. Patient outcomes and postoperative complications were extracted from the included meta-analyses. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) scores. The Jadad decision algorithm was then utilized to determine which meta-analyses provided the best level of evidence.

Results:

Sixteen meta-analyses containing an average of 1396 patients met the eligibility criteria. Most studies found BPTB autografts to provide superior stability but more postoperative complications, such as anterior knee pain and kneeling pain. Studies by Gabler et al (2016), Mohtadi et al (2011), and Xie et al (2015) received the highest Oxman-Guyatt and QUOROM scores, and therefore, these meta-analyses proved to provide the highest level of evidence. Additionally, Xie et al was selected as the highest-quality study in this systematic review based on the Jadad decision algorithm.

Conclusion:

The current best evidence suggests that ACLR with BPTB autografts provides superior static knee stability and that there are fewer postoperative complications in ACLR with HT autografts.
Missing the Mark? A Two Time Point Cohort Study Estimating Intestinal Parasite Prevalence in Informal Settlements in Lima, Peru
Authors: Cooper Michael Townsend , Searing Rapha A. , Thompson David M. , Bard David , Carabin Hélène , Gonzales Carlos , Zavala Carmen , Woodson Kyle , Naifeh Monique
Published: November 2017

Objectives: The World Health Organization’s (WHO) recommendations list Peru as potentially needing prevention of soil-transmitted helminthiasis (STH). Prevalence of STH varies regionally and remains understudied in the newest informal settlements of the capital city, Lima. The purpose of this study was to evaluate the need for Mass Drug Administration (MDA) of antiparasitic drugs in the newest informal settlements of Lima. The aim of this study was to estimate the season-specific prevalence of STH to determine if these prevalence estimates met the WHO threshold for MDA in 3 informal settlements. Methods: A 2 time point cohort study was conducted among a sample of 140 children aged 1 to 10 years living in 3 purposively sampled informal settlements of Lima, Peru. Children were asked to provide 2 stool samples that were analyzed with the spontaneous sedimentation in tube technique. The season-specific prevalence proportions of MDA-targeted STH were estimated using a hidden (latent) Markov modeling approach to adjust for repeated measurements over the 2 seasons and the imperfect validity of the screening tests. Results: The prevalence of MDA targeted STH was low at 2.2% (95% confidence interval = 0.3% to 6%) and 3.8% (95% confidence interval = 0.7% to 9.3%) among children sampled in the summer and winter months, respectively, when using the most conservative estimate of test sensitivity. These estimates were below the WHO threshold for MDA (20%). Conclusions: Empiric treatment for STH by organizations active in the newest informal settlements is not supported by the data and could contribute to unnecessary medication exposures and poor allocation of resources.
Prescribing Outdoor Physical Activity to Children: Health Care Providers’ Perspectives
Authors: Christiana Richard W. , James J. Joy , Battista Rebecca A.
Published: November 2017

Little evidence exists on health care provider (HCP) prescriptions for children’s outdoor physical activity (PA). Semistructured interviews were conducted with 15 children’s HCPs to explore perspectives on outdoor PA prescription programs for children and barriers to implementation. Thematic analytic techniques were used to analyze the data. Most participants reported an awareness of health benefits to children being in the outdoors. Ten themes emerged from the data related to 3 thematic categories: (1) current strategies that HCPs are using to promote PA among children, (2) barriers that HCPs see to prescribing outdoor PA, and (3) potential strategies for promoting outdoor PA among children. Assessment of the local outdoor PA environment and resource development must be done prior to a prescription program. HCPs should be skilled in conducting conversations and setting goals related to outdoor PA tailored to the patient. Developing a system for follow-up with patients on established goals should also be included.
Disease Knowledge, Illness Perceptions, and Quality of Life in Adolescents With Sickle Cell Disease: Is There a Link?
Authors: Asnani Monika Rani , Barton-Gooden Antoinette , Grindley Marlyn , Knight-Madden Jennifer
Published: November 2017

Disease knowledge, illness perceptions, and quality of life (QOL) were examined in 150 adolescents (mean age = 16.1 years, SD = 1.9; 49.3% males) with sickle cell disease (SCD). Females had higher knowledge ( P = .004), lower QOL ( P = .02), and perceived their illness to be more unpredictable ( P = .03). Those with more severe disease perceived their illness to be unpredictable with worse outcomes. Those with higher knowledge scores perceived their illness to be chronic, made more sense of their illness, and perceived greater personal and treatment control. Final hierarchical regression model showed that secondary education as compared to primary education level ( P < .001) was positively correlated whereas disease severity ( P < .001), perceived unpredictability ( P = .024), and negative emotions ( P < .001) were negatively correlated with QOL. Health practitioners should assess adolescents’ illness perceptions and encouraging continuing schooling and addressing emotional/psychological problems could improve their QOL.
Determinants and Outcome of Metabolic Acidosis in Diarrheal Children Under 5 Years of Age in an Urban Critical Care Ward in Bangladesh
Authors: Sharifuzzaman  , Sarmin Monira , Ahmed Tahmeed , Alam Tahmina , Islam Shoeb Bin , Islam Md. Munirul , Chisti Mohammod Jobayer
Published: November 2017

We evaluated the independent determinants and outcome of metabolic acidosis in diarrheal children. Children under 5 years of age admitted with diarrhea and severe respiratory distress in the critical care ward at Dhaka Hospital of icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh) from April 2010 to April 2014 who had their reports of arterial blood gas analyses were enrolled in the study. We compared clinical and laboratory characteristics between the study children with (cases = 74) and without metabolic acidosis (controls = 65). Metabolic acidosis was defined if pH < 7.35 and HCO3 < 22 mmol/L in ABG. Cases had higher mortality (53% vs 29%, P = .01) compared to controls. After adjustment of potential confounders, for instance, hypokalemia and dehydration, the cases were independently associated with severe sepsis and raised serum creatinine (for both P < .05). Thus, early identification of these features of metabolic acidosis in diarrheal children may help clinicians to have prompt management that may further help reduce mortality in such children especially in resource-limited settings.
Who Is This “We” You Speak of? Grounding Activist Identity in Social Psychology
Authors: Horowitz Jonathan
Published: November 2017

What is an activist identity? Prior answers have focused almost exclusively on collective identity, without (a) considering the possibility of role-based identities or (b) grounding collective identities in broader social-psychological theories. The present study investigates activist identity through the lens of role-based and category-based identities and reports two major findings. First, there is a distinct role-based activist identity, one that involves internalizing role responsibilities and the expectations of friends and family. Second, collective identity represents a relationship between a social identity and an injustice frame; it either involves incorporating an injustice frame into a preexisting social identity or using the injustice frame to create a new in-group. The present findings help to illuminate the processes underlying collective identity, indicate that a great deal of role-based activist identity is mistaken for collective identity, and suggest new directions for the study of micro-mobilization and organizational forms and tactics in social movements.
“Super Bowl Babies”: Do Counties with Super Bowl Winning Teams Experience Increases in Births Nine Months Later?
Authors: Hayward George M. , Rybińska Anna
Published: November 2017

Following the claim of a highly publicized National Football League (NFL) commercial, we test whether the Super Bowl provides a positive exogenous shock to fertility in counties of winning teams. Using stadium locations to identify teams’ counties, we analyze the number of births in counties of both winning and losing teams for 10 recent Super Bowls. We also test for state effects and general effects of the NFL playoffs. Overall, our results show no clear pattern of increases in the number of births in winning counties nine months after the Super Bowl. We also do not find that births are affected at the state level or that counties competing in the playoffs are affected. Altogether, these results cast doubt on the NFL’s claim that winning cities experience increases in births nine months after the Super Bowl.
Mapping MOS-HIV to HUI3 and EQ-5D-3L in Patients With HIV
Authors: Joyce Vilija R. , Sun Huiying , Barnett Paul G. , Bansback Nick , Griffin Susan C. , Bayoumi Ahmed M. , Anis Aslam H. , Sculpher Mark , Cameron William , Brown Sheldon T. , Holodniy Mark , Owens Douglas K.
Published: November 2017

Objectives: The Medical Outcomes Study HIV Health Survey (MOS-HIV) is frequently used in HIV clinical trials; however, scores generated from the MOS-HIV are not suited for cost-effectiveness analyses as they do not assign utility values to health states. Our objective was to estimate and externally validate several mapping algorithms to predict Health Utilities Index Mark 3 (HUI3) and EQ-5D-3L utility values from the MOS-HIV. Methods: We developed and validated mapping algorithms using data from two HIV clinical trials. Data from the first trial (n = 367) formed the estimation data set for the HUI3 (4,610 observations) and EQ-5D-3L (4,662 observations) mapping algorithms; data from the second trial (n = 168) formed the HUI3 (1,135 observations) and EQ-5D-3L (1,152 observations) external validation data set. We compared ordinary least squares (OLS) models of increasing complexity with the more flexible two-part, beta regression, and finite mixture models. We assessed model performance using mean absolute error (MAE) and mean squared error (MSE). Results: The OLS model that used MOS-HIV dimension scores along with squared terms gave the best HUI3 predictions (mean observed 0.84; mean predicted 0.80; MAE 0.0961); the finite mixture model gave the best EQ-5D-3L predictions (mean observed 0.90; mean predicted 0.88; MAE 0.0567). All models produced higher prediction errors at the lower end of the HUI3 and EQ-5D-3L score ranges (<0.40). Conclusions: The proposed mapping algorithms can be used to predict HUI3 and EQ-5D-3L utility values from the MOS-HIV, although greater error may pose a problem in samples where a substantial proportion of patients are in poor health. These algorithms may be useful for estimating utility values from the MOS-HIV for cost-effectiveness studies when HUI3 or EQ-5D-3L data are not available.
Determining the Patient Acceptable Symptomatic State for the ASES, SST, and VAS Pain After Total Shoulder Arthroplasty
Authors: Chamberlain Aaron M , Hung Man , Chen Wei , Keener Jay D , McAllister Jared , Ebersole Gregory , Granger Erin K , Bowen Randy C , Tashjian Robert Z
Published: November 2017

Background

The Patient Acceptable Symptom State (PASS) is a symptom state that a patient considers acceptable. No prior study has determined the PASS for the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and the Visual Analog Scale (VAS) pain score after shoulder arthroplasty. The purpose of this study was to determine the PASS for the ASES score, the SST score, and VAS pain for patients treated with a total shoulder arthroplasty.

Methods

A total of 326 patients had a primary anatomic total shoulder arthroplasty (TSA) or primary reverse total shoulder arthroplasty (RSA) by 1 of 5 shoulder and elbow surgeons at 1 of 2 institutions. Each patient completed the SST, ASES score, and a VAS pain preoperatively and at a minimum of 2 years postoperative (average 3.5 years). The PASS value for the ASES score, SST, and VAS pain was calculated.

Results

The PASS for the ASES score, SST, and VAS pain was 76, 8.4, and 1.5, respectively. Neither hand dominance nor age had a significant effect on PASS for SST, VAS, and ASES ( P > .05). Gender had significant effect on SST and ASES scores with P-values of < .01 and .034, respectively. Duration of follow-up is correlated with VAS ( P = .004) but not with ASES or SST scores.

Conclusions

Patients treated with a shoulder arthroplasty consider ASES score of 76, SST score of 8.4, and a VAS pain level of 1.5 to be acceptable symptomatic states. Females typically consider a slightly higher ASES and SST score to reach an acceptable state.