bluuebunny/crossref_metadata_2025 huggingface dataset:
Medicolegal Cases for Spinal Epidural Hematoma and Spinal Epidural Abscess
Authors: French Keisha L. , Daniels Eldra W. , Ahn Uri M. , Ahn Nicholas U.
Published: December 2012

Educational Objectives

As a result of reading this article, physicians should be able to:

1.

Diagnose spinal epidural hematoma and spinal epidural abscess.

2.

Outline the most common neurological deficits that occur from a spinal epidural hematoma or spinal epidural abscess.

3.

Identify indications for a good or poor prognosis.

4.

Minimize adverse outcomes for the provider.

Spinal epidural hematoma and spinal epidural abscess are rare surgical emergencies resulting in significant neurologic deficits. Making the diagnosis for spinal epidural hematoma and spinal epidural abscess can be challenging; however, a delay in recognition and treatment can be devastating. The objective of this retrospective analysis study was to identify risk factors for an adverse outcome for the provider.

The LexisNexis Academic legal search database was used to identify a total of 19 cases of spinal epidural hematoma and spinal epidural abscess filed against medical providers. Outcome data on trial verdicts, age, sex, initial site of injury, time to consultation, time to appropriate imaging studies, time to surgery, and whether a rectal examination was performed or not were recorded. The results demonstrated a significant association between time to surgery more than 48 hours and an unfavorable verdict for the provider. The degree of permanent neurologic impairment did not appear to affect the verdicts. Fifty-eight percent of the cases did not present with an initial deficit, including loss of bowel or bladder control.

All medical professionals must maintain a high level of suspicion and act quickly. Physicians who are able to identify early clinical features, appropriately image, and treat within a 48 hour time frame have demonstrated a more favorable medicolegal outcome compared with their counterparts in filed lawsuits for spinal epidural hematoma and spinal epidural abscess cases.
Balance 1 Year After TKA: Correlation With Clinical Variables
Authors: Bascuas Iria , Tejero Marta , Monleón Sandra , Boza Roser , Muniesa Josep Maria , Belmonte Roser
Published: December 2012

Knee osteoarthritis results in changes that affect balance. It has been reported that osteoarthritis worsens proprioception and increases the risk of falling. The objective of this study was to assess changes in balance among patients with knee osteoarthritis at 1 year after total knee arthroplasty (TKA) surgery and its relationship with clinical variables.

This prospective, observational study evaluated 44 patients before and 1 year after TKA. Variables analyzed included age, body mass index, pain, range of motion for both knees, bilateral quadriceps and hamstrings muscle strength, gait velocity, and Knee Society score. Balance and posture control were assessed using the following computerized posturography tests: the weight bearing test, modified Clinical Test of Sensory Interaction on Balance (mCTSIB) test, and sit-to-stand test. Pre- and postoperative differences were analyzed using Wilcoxon and chi-square tests, and effect size was measured using standardized response mean. Correlations were assessed by the Spearman test. One year after TKA, some improvement in balance tests was observed. Significant differences were observed in the mCTSIB test: foam surface with open eyes (
P
⩽.001), foam surface with closed eyes (
P
⩽.001), and composite value (
P
⩽.001). Effect size was moderate to high. Age showed significant correlation with mCTSIB composite value changes (−0.369;
P
=.037). No significant correlations were found between posturographic tests and other analyzed variables.

Balance measured by computerized posturography improved 1 year after TKA. Significant changes were observed between open and closed eyes using a foam surface for the mCTSIB test. A mild negative correlation was found between age and posturographic changes.
Functional Data for the Diagnosis of Patellofemoral Laxity Obtained by MRI During Quadriceps Isometric Contraction
Authors: Lomasney Laurie McAdams , Demos Terrence C. , Neveu Melissa , Fedors Nathan Holt , Tonino Pietro , Cheung Leo Wang-Kit
Published: December 2012

Patellofemoral instability is related to anatomy. Magnetic resonance imaging (MRI) provides anatomic detail, but spoiled gradient echo (SPGR) imaging during isometric quadriceps contraction provides objective functional data for diagnosing patellofemoral laxity.

Knee MRI studies and medical charts of 398 patients were retrospectively reviewed. Two independent blinded observers evaluated the knee MRI studies for patellofemoral morphology and patellar position on axial SPGR images during relaxation and isometric quadriceps contraction for lateral patellar migration. Charts were reviewed for history of patellofemoral instability or dislocation. Patients were divided into 2 groups: group 1 comprised patients with 2.5 mm or more of lateral patellar migration on axial SPGR images, and group 2 comprised patients with less than 2.5 mm of patellar subluxation. Logistic regression models were used to determine relationships between patellofemoral subluxation of 2.5 mm or more and (1) history of dislocation or clinical patellofemoral instability, (2) grade 4 chondromalacia on MRI, (3) corrected central trochlear height, and (4) differential trochlear height (corrected for lateral condylar height). Statistically significant associations were found between patellar subluxation and each of the above 4 clinical/morphologic measures. Lateral patellar migration of 2.5 mm or more on SPGR obtained during quadriceps contraction had statistically significant associations with the above 4 measures.

Evaluation of SPGR of quadriceps contraction provides objective functional information about patellofemoral instability for management decisions.
Articulating Spacers for the Treatment of Infected Total Knee Arthroplasty: Effect of Antibiotic Combinations and Concentrations
Authors: Nettrour John F. , Polikandriotis John A. , Bernasek Thomas L. , Gustke Kenneth A. , Lyons Steven T.
Published: December 2012

Performing 2-stage procedures using articulating antibiotic cement spacers to eradicate infection while providing pain relief and maintaining function has become common among many surgeons. Despite the efficacy of antibiotic cement spacers in the treatment of infected total knee arthroplasty, questions remain regarding the dosing of the antibiotic cement.

The authors assessed their experience with different antibiotic regimens and concentrations for the eradication of infection. Sixty-nine infected total knee arthroplasties with an average follow up of 31 months (range, 6–70 months) treated with articulating antibiotic spacers were retrospectively reviewed. Treatment groups were divided according to spacer antibiotic agents used and the amount of antibiotics added to the cement. Low-dose spacers were defined as those incorporating less than 4 g of antibiotic per 40-g bag of cement, and high-dose spacers were defined as those incorporating 4 g or more of antibiotic per 40-g bag of cement. High- vs low-dose spacers using a single or multiple antibiotic agents were compared. The overall rate of infection eradication was 88%. Dose dependency was not detected for spacers that incorporated single or multiple antibiotic agents, and multiple-agent spacers produced comparable success rates despite more frequent use in patients with impaired immune function.

Further study of optimal combinations and concentrations of antibiotic agents incorporated into these spacers is needed to help minimize treatment failures while maximizing treatment efficacy.
Deltoid Muscle Pressures During Arthroscopic Rotator Cuff Repair
Authors: McBrayer Daniel E. , Debelak Benjamin P. , Fernicola Patrick J. , Tu Renjin , Baker Champ L.
Published: December 2012

The purpose of this study was to investigate deltoid compartment pressures during arthroscopic rotator cuff repair using modern pressure pumps to achieve visualization.

Twelve patients undergoing arthroscopic rotator cuff repairs were monitored for deltoid compartment pressure changes intraoperatively. Pre-, intra-, and postoperative intramuscular pressures were recorded. All patients demonstrated varying degrees of swelling due to fluid extravasation. Swelling was qualified as mild, moderate, or severe by clinical assessment and quantified objectively using a pressure monitor to record deltoid compartment pressures. Clinically, severe swelling occurred in 4 patients, all of whom underwent procedures lasting longer than 90 minutes. Objectively, no patient had evidence of dangerously elevated pressure measurements. The mean increase in compartment pressures was 9 mm Hg. All patients were treated and discharged as outpatients. No patient required more than oral narcotic analgesics for postoperative pain control beyond the postanesthesia care unit stay.

Arthroscopic rotator cuff repair may lead to clinically impressive swelling, but within the current study group, no evidence existed of clinically significant, persistent elevation of deltoid compartment measures using current arthroscopic techniques and arthroscopic pump systems. However, caution should be observed with regard to extended operative times and elevation of pump pressures.
Comparison of Arthroscopic Osteochondral Substitute Grafting and Remplissage for Engaging Hill-Sachs Lesions
Authors: Garcia Grant H. , Park Min Jung , Baldwin Keith , Fowler John , Kelly John D. , Tjoumakaris Fotios P.
Published: December 2012

The optimum management for recurrent glenohumeral instability with significant humeral head defects remains controversial. The purpose of this study was to compare outcomes and recurrence rates between patients who underwent osteochondral substitute grafting and patients who underwent remplissage to treat recurrent shoulder instability from an engaging Hill-Sachs defect with a Bankart lesion.

Twenty consecutive patients who underwent remplissage and 19 consecutive patients who underwent osteochondral substitute grafting with Bankart repair were studied. Mean follow-up was 29.6 months for the remplissage group and 32.1 months for the osteochondral substitute grafting group. All patients had an engaging Hill-Sachs lesion, and indications for surgery were identical between groups. Three postoperative recurrences occurred in the remplissage group and 6 occurred in the osteochondral substitute grafting group (
P
=.18). Nineteen patients in the remplissage group and 7 patients in the osteochondral substitute grafting group had a large humeral head defect. Patients in the remplissage group had better Western Ontario Shoulder Instability Index [WOSI] scores than those in the osteochondral substitute grafting group for large lesions (74.7 vs 50.4, respectively), although they were not statistically significant (
P
=.077). After controlling for age, sex, lesion size, and follow-up differences, the remplissage group reported significantly better WOSI scores (
P
=.016).

This study demonstrated a potential advantage of remplissage compared with osteochondral synthetic grafting in patients who experienced recurrent anterior shoulder instability, particularly in shoulders with a large humeral head defect.
MRI Study of Associated Shoulder Pathology in Patients With Full-thickness Subscapularis Tendon Tears
Authors: Li Xinning , Fallon Jonathan , Egge Natalie , Curry Emily J. , Patel Ketan , Owens Brett D. , Busconi Brian D.
Published: December 2012

Subscapularis tendon tears are a well-established cause of shoulder pain. The objective of the current study was to evaluate the associated shoulder pathology in patients with full-thickness subscapularis tendon tears using magnetic resonance imaging. Forty-seven magnetic resonance imaging studies taken between 2008 and 2009 with a diagnosis of full-thickness subscapularis tendon tears were reviewed. The size of the subscapularis tendon tear, amount of muscle volume loss, Goutallier grade, biceps tendon pathology, coracohumeral distance, and associated rotator cuff tears were recorded. Statistical analysis was performed. Patients 55 years and older vs those 54 years and younger had an average subscapularis tear size of 35 vs 19 mm, an average Goutallier grade of 2.7 vs 0.8, and a total muscle volume loss of 25% vs 5%, respectively. Patients with a dislocated vs normal biceps tendons had an average subscapularis tear size of 37 vs 23 mm, an average Goutallier grade of 3 vs 0.9, and a total muscle volume loss of 28% vs 7%, respectively. Patients with vs without concomitant rotator cuff tears had an average subscapularis tear size of 32 vs 17 mm, an average Goutallier grade of 2.3 vs 0.6, and a total muscle volume loss of 21% vs 3%, respectively. Overall average coracohumeral distance measured in the axial plane was 10.8±4.6 mm. Average coracaohumeral distance was 14.8 vs 8.1 mm in patients with a Goutallier grade of 0 vs 3 or 4, resepectively, and 13.6 vs 8.5 mm in patients with no rotator cuff tear vs those with a supra- and infraspinatus tear, respectively.

Increased age, dislocated biceps tendons, and concomitant rotator cuff tears in patients with full-thickness subscapularis tendon tears are associated with larger subscapularis tendon tear size, higher Goutallier grades, and increased subscapularis muscle volume loss. Decreased coracohumeral distance is associated with a higher Goutallier grade and rotator cuff tears.
Computer-aided Analysis of Radial Head Morphometry
Authors: Puchwein Paul , Heidari Nima , Dorr Katrin , Struger Lukas , Pichler Wolfgang
Published: December 2012

Operative treatment of displaced and comminuted radial head fractures involves internal fixation with plates and screws in cases where reconstruction is possible and replacement with a radial head prosthesis when comminution renders the radial head unreconstructable. The purposes of this study were to evaluate the morphometry of the radial head using a modern technique and to compare the findings with several commercially available radial head prostheses.

Computed tomography scans of 30 cadaveric elbows and 3-dimensional reconstructions were used to analyze the morphometry of the proximal radius. Results were compared with the manufacturer data of several radial head prostheses. Mean diameter of the radial head at the level of the fovea was 19±1.58 mm (range, 15.82–21.81 mm) in the anteroposterior plane and 18.62±1.78 mm (range, 15.48–22.21 mm) in the radioulnar plane. Mean diameter of the radial head at its widest part was 23.15±1.94 mm (range, 19.45–26.49 mm) in the anteroposterior plane and 22.44±1.73 mm (range, 19.64–25.44 mm) in the radioulnar plane. Mean diameter of the radial head at the level of the head–neck junction was 15.42±1.59 mm (range, 11.80–18.46 mm) in the anteroposterior plane and 14.75±1.39 mm (range, 12.32–17.31 mm) in the radioulnar plane. Statistically significant sex differences existed in the maximum diameter of the radial head, the diameter at the level of the head–neck junction, and the length of the radial head. Currently available radial head prostheses cover the range of sizes encountered. Products with a choice of head and stem sizes in any combination are preferable. In unstable elbow fractures, correct implant size is an important factor to avoid subluxation of the radial head (Mason type IV fractures) if collateral ligaments are sufficient.
Anatomic Mapping for Surgical Reconstruction of the Proximal Tibiofibular Ligaments
Authors: See Aaron , Bear Russell R. , Owens Brett D.
Published: December 2012

Injury to the proximal tibiofibular joint is uncommon. Previous studies regarding the anatomy of this region have predominantly focused on joint orientation. As radiographic technology has advanced, later studies have attempted to evaluate the capsular anatomy. However, no reports specifically map the ligaments to this joint. The objectives of the current study were to define specific ligamentous structures that provide stability to the proximal tibiofibular joint, describe easily identifiable and reproducible surgical landmarks to aid in surgical reconstruction, and add to the understanding of the posterolateral structures of the knee previously described by other authors.

The proximal tibiofibular joint ligaments were identified in 10 fresh-frozen cadaveric specimens. Average ligament length, width, and thickness and area of the footprints of the tibial and fibular attachments were measured. Distances from the ligament footprints to known anatomic landmarks (eg, Gerdy’s tubercle, tibial articular surface, and fibular styloid) were also measured. The anterior ligament tibial attachment was a mean of 15.6 mm lateral and posterior to Gerdy’s tubercle and 17.3 mm anterior and inferior from the fibular styloid. Posterior ligament tibial insertion was a mean of 15.7 mm inferior to the tibial articular surface on the tibial side and 14.2 mm medial and slightly inferior from the fibular styloid.

Definable ligaments provide stability to the proximal tibiofibular joint and can be reconstructed in an anatomic fashion using the landmarks and parameters described. This information allows for an anatomic reconstruction of the proximal tibiofibular joint, which should provide patients with better outcomes and fewer postoperative sequelae.
Platelet-rich Plasma as an Effective Treatment for Proximal Hamstring Injuries
Authors: Wetzel Robert J. , Patel Ronak M. , Terry Michael A.
Published: December 2012

Proximal hamstring injuries can be disabling, and several traditional conservative treatments, including physiotherapy and nonsteroidal anti-inflammatory drugs, have been inconsistent. Corticosteroid injections have demonstrated success but can adversely affect local tissues. Platelet-rich plasma (PRP) has emerged as a safe, effective treatment for several orthopedic pathologies. The authors propose a PRP injection at the muscle origin as a novel treatment for proximal hamstring injuries.

A retrospective review yielded 15 patients with 17 proximal hamstring injuries. Twelve injuries failed traditional conservative treatment and were ultimately treated with a PRP injection at the hamstrings muscle origin. Five patients were treated with traditional conservative treatment alone. Analysis included pre- and posttreatment visual analog scale scores, Nirschl Phase Rating Scale scores, and return to sport. No significant difference existed between the groups’ pretreatment visual analog scale scores (
P
=.28) and Nirschl Phase Rating Scale scores (
P
=.15) and their posttreatment visual analog scale scores (
P
=.38) and Nirschl Phase Rating Scale scores (
P
=.22). The PRP group demonstrated a reduction in visual analog scale scores (
P
<.01) and Nirschl Phase Rating Scale scores (
P
<.01), but the traditional conservative treatment group did not demonstrate the same reduction (
P
=.06 and .06, respectively). All athletes returned to their desired activity level with no major complications.
Surgical Results of Zones I and II Fifth Metatarsal Base Fractures Using Hook Plates
Authors: Choi Jae Hyuck , Lee Kyung Tai , Lee Young Koo , Lee Jun Young , Kim Hwa Rye
Published: December 2012

The purpose of this study was to evaluate the results of surgical treatment of fifth metatarsal base fractures using a mini-hook plate. Seventeen patients with Lawrence classification zones I (n=6) and II (n=11) fifth metatarsal base fractures with an initial fracture displacement more than 2 mm and a small (less than 2 mm) comminuted avulsion fragment were included in the study. Patients treated using a mini-hook plate fixation method were prospectively evaluated. A mini-hook tubular plate was designed so that the last hole functioned as a hook for the application of compression force, grasping of comminuted fragments, and rotational stabilization in metatarsal base fractures. Clinically, the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale questionnaire was administered preoperatively and 1 year postoperatively. Union was determined by 3-dimensional computed tomography as clinically nontender callus formation. Time to union and return to sports were calculated. Mean AOFAS midfoot scale scores were 48±8 points (range, 35–60 points) preoperatively and 91±7 points (range, 85–100 points) 1 year postoperatively. Mean time to complete union, as determined by computed tomography, was 54±11 days (range, 38–74 days). All patients reported returning to prior activities of daily living at a mean of 74±10 days (range, 63–98 days). One patient reported hardware irritation secondary to inadequate plate bending and screw curving.

Mini-hook plate fixation is an effective alternative surgical method for zones I and II displaced fifth metatarsal base fractures or comminuted small fragment fractures.
Modified Plate-only Open-door Laminoplasty Versus Laminectomy and Fusion for the Treatment of Cervical Stenotic Myelopathy
Authors: Yang Lili , Gu Yifei , Shi Jueqian , Gao Rui , Liu Yang , Li Jun , Yuan Wen
Published: December 2012

The purpose of this study was to compare modified plate-only laminoplasty and laminectomy and fusion to confirm which of the 2 surgical modalities could achieve a better decompression outcome and whether a significant difference was found in postoperative complications. Clinical data were retrospectively reviewed for 141 patients with cervical stenotic myelopathy who underwent plate-only laminoplasty and laminectomy and fusion between November 2007 and June 2010. The extent of decompression was assessed by measuring the cross-sectional area of the dural sac and the distance of spinal cord drift at the 3 most narrowed levels on T2-weighted magnetic resonance imaging. Clinical outcomes and complications were also recorded and compared. Significant enlargement of the dural sac area and spinal cord drift was achieved and well maintained in both groups, but the extent of decompression was greater in patients who underwent laminectomy and fusion; however, a greater decompression did not seem to produce a better clinical outcome. No significant difference was observed in Japanese Orthopaedic Association and Nurick scores between the 2 groups. Patients who underwent plate-only laminoplasty showed a better improvement in Neck Dysfunction Index and visual analog scale scores. In addition, limited decompression, rigid reconstruction of the spinal canal, and preservation of cervical mobility combined with preservation of the posterior structure resulted in a lower rate of postoperative C5 palsy and axial pain in the modified laminoplasty group. For this reason, modified laminoplasty may be a more viable option for patients with cervical stenotic myelopathy.
New Clinical Classification System for Atlantoaxial Dislocation
Authors: Xu JunJie , Yin QingShui , Xia Hong , Wu ZengHui , Ma XiangYang , Zhang Kai , Wang ZhiYun , Yang JinCheng , Ai FuZhi , Wang JianHua , Liu JingFa , Mai XiaoHong
Published: December 2012

The purpose of this study was to define a new clinical classification of atlantoaxial dislocation based on its clinical manifestations, namely reducible atlantoaxial dislocation (RAAD), irreducible atlantoaxial dislocation (IAAD), and fixed atlantoaxial dislocation (FAAD). A total of 107 patients with atlantoaxial dislocation were respectively treated based on this clinical classification, including 66 patients with RAAD, 39 patients with IAAD, and 2 patients with FAAD. Six of the 66 patients with RAAD with rotatory atlantoaxial dislocation were treated with traction and a cervical collar, 9 with fresh type II dens fracture were treated with cannulated screw fixation, and 51 were treated with posterior atlantoaxial or occipitocervical arthrodesis. Thirty-eight patients with IAAD received a transoral atlantoaxial reduction plate system, and 1 with a giant cell tumor was treated with lesion resection and vertebral reconstruction by a shaped titanium mesh system followed by posterior occipitocervical screw–rod fixation. The 2 patients with FAAD underwent anterior decompression and received a transoral atlantoaxial reduction plate system. Follow-up data were obtained for a minimum of 6 months. All patients’ neurological symptoms improved postoperatively. Bony union was accomplished by 3-month follow-up. Donor-site infection was found in 1 patient, with no occurrence of other complications.

This article proposes a new classification of atlantoaxial dislocation indicating the severity and difficulty in reduction of the atlantoaxial joint. The classification system assists with decision making regarding therapeutic options. Transoral atlantoaxial reduction plate fixation and posterior atlantoaxial screw–rod fixation are commonly performed for atlantoaxial dislocation.
Ceramic Liner Fatigue Fracture: 3-D CT Findings in a Late Recurrent THA Dislocation
Authors: Trivellin Giacomo , Sandri Andrea , Bizzotto Nicola , Marino Marco Andrea , Mezzari Silvio , Sambugaro Elena , Regis Dario
Published: December 2012

Dislocation is one of the most common complications of total hip arthroplasty (THA). To the authors’ knowledge, late recurrent dislocation of a THA with a ceramic-on-ceramic coupling secondary to fatigue fracture of the ceramic liner has never been described.

A 76-year-old woman with right hip osteoarthritis underwent cementless modular THA with a ceramic-on-ceramic coupling. Approximately 10 years postoperatively, she experienced right hip pain with no trauma, which resolved in 14 days. Family members reported that the patient had shown a progressive cognitive and muscular decline in the previous months. Six months later, the patient was admitted for THA dislocation, which was immediately reduced. Computed tomography revealed that the right acetabular component had a retroversion of 4° and an inclination angle of 45°. An orthopedic brace was applied, but dislocation recurred 2 days after discharge. A 3-dimensional CT reconstruction showed a fracture of the ceramic liner in the posterolateral region. The patient underwent revision surgery, and the ceramic liner breakage was confirmed. After removal of the acetabular components, a cemented polyethylene cup was implanted. The stability of the stem was verified. The existing modular neck was replaced with a chromium–cobalt neck, and a new ceramic head was applied. At 7-month follow-up, the patient had good functional recovery with no hip instability.

Fatigue failure of a ceramic liner should be considered as responsible for late dislocation after ceramic-on-ceramic THA. As part of the diagnostic strategy, 3-dimensional CT reconstruction should be used to evaluate ceramic liner breakage.
Rotational Osteoplasty for Femoral Head Fracture With Cartilage Loss
Authors: Au Brigham , Jamieson Marissa Daniels , Banerjee Rahul
Published: December 2012

Femoral head fractures often result in damage to the articular cartilage. This article describes a patient who sustained a femoral head fracture–dislocation with significant damage to the articular cartilage of the weight-bearing portion of his femoral head (A). After anatomic reduction of the fracture, a 2×4-cm osteochondral articular defect existed at the weight-bearing portion of the femoral head (B). The femoral head fragment was rotated such that the superior weight-bearing surface was congruent (C). This created a small gap at the inferior aspect of the femoral head, which was filled using a small corticocancellous graft harvested from the greater trochanter. The femoral head fragment was fixed with countersunk 3.5-mm screws. At 18-month follow-up, the patient had returned to full-time construction work with no limitations. He reported no pain in his hip or any activity limitations, and his Harris Hip Score was 91 points. Radiographs obtained 18 months postoperatively showed healing of the femoral head and preservation of the hip joint.
Two-stage Arthroplasty for the Treatment of Chronic Osteomyelitis After Routine Arthroscopic Knee Surgery
Authors: Moyad Thomas F.
Published: December 2012

Corynebacterium pseudodiphtheriticum
is a normal inhabitant of the upper respiratory tract and is rarely thought of as a true pathogen. Although this microorganism has been associated with respiratory complications, a few case reports have demonstrated its ability to cause orthopedic infections. A recent review of the literature was performed regarding this specific bacteria and its association with bone and joint infection.

To the author’s knowledge, the current case is the first reported case of chronic osteomyelitis from
Corynebacterium pseudodiphtheriticum
after arthroscopic knee surgery. Isolation of this bacterial species on routine microbial cultures has been proven to be challenging in prior studies. In the current case, difficulty isolating this bacterial species on routine cultures led to a significant delay in diagnosis, which ultimately resulted in end-stage joint destruction. Treatment of the infection was accomplished using a 2-stage total knee arthroplasty technique, with the initial placement of an articulated, antibiotic-loaded spacer followed by a subsequent conversion to total knee arthroplasty. This case serves as a useful reminder that clinically subtle infections can occur after minor orthopedic surgery. Surgeons must remain vigilant to render a timely diagnosis and avoid severe sequelae that can result from an undetected pathogen after arthroscopic surgery.
Ewing’s Sarcoma/Primitive Neuroectodermal Tumor of the Proximal Humeral Epiphysis
Authors: Morris Parisa , Dickman Paul S. , Seidel Matthew J.
Published: December 2012

Ewing’s sarcoma/primitive neuroectodermal tumor (ES/PNET) of bone is a rare childhood tumor most commonly located in the metadiaphysis. In skeletally immature patients, lesions of the epiphysis are rarely malignant, with the most common diagnosis being chondroblastoma. This article presents a case of ES/PNET of the proximal humeral epiphysis in a 12-year-old boy. To the authors’ knowledge, this is the first reported case of epiphyseal ES/PNET confirmed with molecular testing. Radiographs of the patient’s painful shoulder showed a well-defined lytic lesion within the humeral epiphysis. Magnetic resonance imaging suggested a chondroid tumor with surrounding edema. Based on the imaging characteristics, the patient’s age, and the lesion’s location, a preliminary diagnosis of chondroblastoma was made. A trochar biopsy of the lesion demonstrated a small, round, blue cell tumor on frozen section. Subsequently, immunohistochemical staining was uniformly positive in a membrane pattern for CD99, and molecular diagnostic testing demonstrated a EWSR1/FLI1 fusion transcript, confirming the pathologic diagnosis of ES/PNET. Although metadiaphyseal locations for ES/PNET are most common, this case adds to previously reported cases of epiphyseal ES/PNET, suggesting that the diagnosis be considered for pediatric epiphyseal tumors. This case also demonstrates why following rigorous oncologic treatment algorithms by obtaining a limited trochar biopsy, even in the case of a confident radiographic diagnosis, is critically important; the biopsy results can lead to a major change in treatment and avoid contamination of a larger area of soft tissue and bone.
Triceps Tendon Reconstruction Using Ipsilateral Palmaris Longus Autograft in Unrecognized Chronic Tears
Authors: Scolaro John A. , Blake Matthew H. , Huffman G. Russell
Published: December 2012

Injury to the distal triceps tendon is uncommon and can be difficult to diagnose, especially when a partial rupture or tear occurs. In situations where an incomplete disruption to the musculotendinous unit occurs, a palpable defect or clear functional loss may not be present. Advanced imaging techniques, such as magnetic resonance imaging or ultrasound, can be used to confirm the diagnosis and define the extent of injury. The treatment of a complete rupture of the distal triceps tendon is repair or reconstruction, whereas the management of a patient with a partial triceps rupture is related to the pain, functional deficit, and expectations of the patient.

This article presents 2 patients with chronic, near complete disruptions of the distal triceps tendon. In both patients, surgical reconstruction of the injured tendon was accomplished using ipsilateral palmaris longus autograft. This technique allows the treating surgeon to harvest the graft from the ipsilateral upper extremity. The palmaris autograft is then used to reconstruct the injured portion of the triceps tendon using a Pulvertaft weave technique through the intact triceps tendon and osseous tunnels within the proximal ulna. This technique allows for easy surgical setup and harvest of autograft tendon and provides a structurally sound technique for a tension-free reconstruction of the injured tendon. It also permits early postoperative elbow range of motion, with active elbow extension allowed at 6 weeks. The authors have used this technique successfully in the treatment of chronic partial tears of the distal triceps tendon.
Additional Merits of Two-dimensional Single Thick-slice Magnetic Resonance Myelography in Spinal Imaging
Authors: Aggarwal Abhishek , Azad Rajiv , Ahmad Armeen , Arora Pankaj , Gupta Puneet
Published: December 2012

Objective:

To validate the additional merits of two-dimensional (2D) single thick-slice Magnetic Resonance Myelography (MRM) in spinal imaging.

Materials and Methods:

2D single thick-slice MRM was performed using T2 half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence in addition to routine Magnetic resonance (MR) sequences for spine in 220 patients. The images were evaluated for additional diagnostic information in spinal and extra-spinal regions. A three-point grading system was adopted depending upon the utility of MRM in contributing to the detection of spinal or extra-spinal findings. Grade 1 represented no contribution of MRM while grade 3 would indicate that it was essential to detection of findings.

Results:

Utility of MRM in spine was categorized as grade 3 in 10.9% cases (24/220), grade 2 in 21.8% (48/220) cases and grade 1 in 67.3% cases (148/220). Thus, the overall additional merit of MRM in spine was seen in 32.7% (72/220) of cases. Besides in 14.1% cases (31/220) extra-spinal pathologies were identified.

Conclusion:

2D single thick-slice MRM could have additional merits in spinal imaging when used as an adjunct to routine MR sequences.
Effect of Magnesium Sulfate on Doppler Parameters of Fetal Umbilical and Middle Cerebral Arteries in Women with Severe Preeclampsia
Authors: Farshchian Nazanin , Rezavand Negin , Mohammadi Saeed
Published: December 2012

Objective:

To assess the effect of injecting magnesium sulfate on Doppler parameters of fetal umbilical and middle cerebral arteries (MCA) in women with severe preeclampsia.

Materials and Methods:

A total of 21 patients with severe preeclampsia admitted to Imam Reza Hospital, Kermanshah (Iran), were evaluated. Before and after administration of magnesium sulfate, Doppler ultrasound scan was carried out to measure fetal middle cerebral artery and umbilical artery blood flow. Paired t-test was used for statistical analysis.

Results:

After injection of magnesium sulfate, the mean resistivity index (RI)-umbilical, and pulsatility index (PI)-cerebral showed a statistically significant reduction (P < 0.001). The cerebroumbilical C/U ratio increased after the intervention (P < 0.001). The PI-umbilical (P = 0.1) and pre- and post-RI-cerebral (P = 0.96) did not have statistically significant changes.

Conclusions:

Infusion of magnesium sulfate significantly decreases the flow in the fetus RI-umbilical and PI-MCA, and it increases C/U ratio indices in color Doppler ultrasound.
Mesenteric Air Embolism Following Enteroscopic Small Bowel Tattooing Procedure
Authors: Chen Natalie , Lamba Ramit , Lee John , Lall Chandana
Published: December 2012

Double balloon enteroscopy (DBE) is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the mesenteric veins. Mesenteric air can be seen after other endoscopic procedures such as biopsy, mucosal clip placement and polypectomy, or following a colonoscopy. Mesenteric air embolism following small bowel tattooing procedure has not been previously reported in the literature. Mesenteric air when present may be attributed to mesenteric ischemia and can subject the patient to unnecessary surgical intervention if misdiagnosed. Thus, this report holds significance for the radiologist as computed tomography (CT) findings of mesenteric air embolism must be evaluated in the context of appropriate clinical history before treatment decisions are made.
External Memory Aid Training after Traumatic Brain Injury: ‘Making it Real’
Authors: Armstrong Jonathan , McPherson Kathryn , Nayar Shoba
Published: December 2012

Introduction:

A number of options exist for the rehabilitation of memory after traumatic brain injury, and research suggests that the use of external memory aids is one of the best approaches. Unfortunately, there is very little evidence to guide therapists in training clients to use external memory aids and to ensure the sustainable use of the aids long term.

Method:

Grounded theory methodology was used to explore the question of how occupational therapists train clients to use external memory aids after a traumatic brain injury. Semi-structured interviews, with eight occupational therapists working in neurological rehabilitation, were conducted until data collection reached a saturation point. The data were analysed following the constant comparative method proposed by Strauss and Corbin.

Findings:

Analysis revealed four overlapping processes: developing client insight, getting client buy-in, getting others on board and making it real. Making it real emerged as the core process that encompassed and ran through the other three. It emphasised the need for occupational therapists to use meaningful, functional activities in order to establish an aid that fitted the client's real life.

Conclusion:

The processes uncovered by this study give occupational therapists working in the field of brain injury rehabilitation guidance for clinical practice.
Light Retrograde Massage for the Treatment of Post-Stroke Upper Limb Oedema: Clinical Consensus Using the Delphi Technique
Authors: Jackson Thérèse , van Teijlingen Edwin , Bruce Julie
Published: December 2012

Background:

Oedema of the hemiplegic upper limb is a common complication following stroke and can restrict mobility and function. Limited evidence is available regarding the assessment and treatment of post-stroke upper limb oedema by occupational therapists.

Objective:

To determine consensus amongst occupational therapists with regard to the use of light retrograde massage for the treatment of post-stroke upper limb oedema.

Method:

A Delphi technique was used to gather opinion from a national sample of stroke occupational therapists. Two rounds of questionnaires were undertaken. Data were analysed from the 31 respondents to round two, using the chi-square goodness of fit to determine consensus in relation to statements about the use of light retrograde massage.

Results:

Of the 85 therapists who volunteered for the study, 58 returned round one questionnaires and 56 were eligible to participate. Most of the therapists who responded to round one (41/56, 73%) used light retrograde massage to reduce post-stroke upper limb oedema. Agreement regarding the definition and application of light retrograde massage was identified in round two.

Conclusion:

Despite a lack of evidence for the efficacy of light retrograde massage in stroke patients, this study found that it is often used in clinical practice and that consensus exists about many components of the treatment method. Further research is recommended to investigate the efficacy of light retrograde massage for reducing post-stroke upper limb oedema.
The Usefulness of the Person-Environment-Occupation Model in an Acute Physical Health Care Setting
Authors: Maclean Fiona , Carin-Levy Gail , Hunter Heather , Malcolmson Lorna , Locke Elizabeth
Published: December 2012

Background:

Limited evidence is available to illustrate the use of theory to underpin occupational therapy practice in acute physical health care settings in the United Kingdom.

Method:

A generic qualitative method investigated the views, knowledge and perceptions of seven Scottish occupational therapists about the potential usefulness of the Person-Environment-Occupation Model (PEO Model) in acute care. This convenience sample participated in two focus groups: the first to examine and understand the PEO Model and the second to explore further reflections of the strengths and limitations of its use in practice.

Findings:

The PEO Model has the potential to provide a meaningful framework in which to conceptualise patients in an acute physical health care setting.

Conclusion:

The PEO Model offers flexibility regarding the extent to which occupational performance is addressed, in a setting characterised by short hospital admission stays. Also, a range of occupation-focused models was valued to practise effectively in this setting.
No Reproductive Interference from an Alien to a Native Species in Cerastium (Caryophyllaceae) at the Stage of Seed Production
Authors: Takakura Koh-Ichi
Published: December 2012

Reproductive interference, adverse interspecific interaction during the mating process, has been regarded as a powerful driver of species displacement between species. Recent empirical reports have described its importance in biological invasions. This study was undertaken to test whether a rare herbaceous plant species indigenous to Japan suffered reproductive interference from an alien species of the genus Cerastium. Field observations and a transplanting experiment were conducted to ascertain the effects of coexistence with an alien species on the seed production of the native species. Results show that coexistence with the alien species did not significantly decrease seed numbers, but it significantly affected the seed weight only in field observations. In this study, the reproductive process of the native species was examined only at or before the seed production stage. Because the interspecific pollen transfer might produce hybrids with low viability or fertility, reproductive interference cannot be denied in this study. To test reproductive interference at such latter stages, additional studies should be conducted. Consequently, detection of reproductive interference demands high costs in some species. Based on these results and suggestions, the necessity of narrowing down the target species for testing of reproductive interference is discussed to elucidate the universality of reproductive interference.
Logical Sensor Network: An Abstraction of Sensor Data Processing over Multidomain Sensor Network
Authors: Namatame Naoya , Nakazawa Jin , Tokuda Hideyuki
Published: December 2012

This paper focuses on a sensor network virtualization over multidomain sensor network and proposes an abstraction called “logical sensor network (LSN)” for sensor data processing.
In the proposed abstraction, processing is a directed acyclic graph that consists of nodes and streams, which represents a small data processor and communication rules between them, respectively. We have added a notion of a trigger to this graph. A trigger represents a timing of the process execution. We have implemented the middleware named LSN-Middle to run a virtualized sensor network and proved its feasibility.
Merge-Optimization Method of Combined Tomography of Seismic Refraction and Resistivity Data
Authors: Bery Andy A.
Published: December 2012

This paper discussed a novel application called merge-optimization method that combines resistivity and seismic refraction data to provide a detailed knowledge of the studied site. This method is interesting because it is able to show strong accuracy of two geophysical imaging methods based on many of data points collected from the conducted geophysical surveys of disparate data sets based strictly on geophysical models as an aid for model integration for two-dimensional environments. The geophysical methods used are high resolution methods. The resistivity imaging used in this survey is able to resolve the subsurface condition of the studied site with low RMS error (less than 2.0%) and 0.5 metre electrodes interval. For seismic refraction method, high resolution of seismic is used for correlation with resistivity results. Geophones spacing is 1.0 metre and the total number of shot-points is 15, which provides very dense data point. The algorithms of merge-optimization have been applied to two data sets collected at the studied site. The resulting images have been proven to be successful because they satisfy the data and are geometrically similar. The regression coefficient found for conductivity-resistivity correlation is 95.2%.
External Beam Therapy in a Four-Field Box Technique with Paclitaxel versus a Two-Field Technique with Cisplatin in Locally Advanced Carcinoma Cervix: A Phase II Monocentric Trial
Authors: Narayanan Vijayakumar , Bista Bibek , Sharma Samir
Published: December 2012

Introduction. External beam pelvic radiotherapy with cisplatin and brachytherapy is the standard of care for patients with advanced cervical malignancy. This study was aimed at evaluating the toxicity of a two-field radiotherapy with cisplatin and brachytherapy compared to a four-field box technique with paclitaxel and brachytherapy for stages IIB/IIIB cervical cancer. The differences in response to the overall treatment were also examined. Methods. 35 patients were enrolled in this phase II prospective randomized trial conducted from February 2006 to February 2007. In arm I, up to 40 Gy in 20 fractions followed by 10 Gy in 5 fractions in split field with cisplatin 40 mg/M2 and, in arm II, 50 Gy in 25 fractions with paclitaxel 50 mg/M2 were given. Results. Toxicity in genitourinary, lower gastrointestinal, and hematological tissues was significantly higher in arm I. The duration of concurrent chemoradiotherapy in either arm was similar. The overall treatment time was less in arm II. No statistically significant difference in the objective response was observed between arms. Conclusion. Two-field radiotherapy with cisplatin is a tolerable regime but more toxic than four-field box radiotherapy with paclitaxel. The major setbacks are that a radiotherapy technique as well as chemotherapy is different; hence, toxicity and outcome of treatment should be viewed as a collective response of the whole treatment regimen and the small sample size.
Use of Charge Transfer Complexation Reactions for the Spectrophotometric Determination of Sumatriptan in Pharmaceuticals
Authors: Prashanth Kudige N. , Kanakapura Basavaiah , Raghu Madihalli S. , Vinay Kanakapura B.
Published: December 2012

Studies were carried out to use the charge-transfer reactions of sumatriptan (SMT), extracted from neutralized sumatriptan succinate (STS), as n-electron donor with the π-acceptor, 2,3-dichloro-5,6-dicyano-1,4-benzoquinone (DDQ) and σ-acceptor, and iodine (I2). The formation of the colored complexes was utilized for the development of simple, rapid, and accurate spectrophotometric methods for the determination of SMT in pure form as well as in its tablets. The quantification of colored products was made spectrophotometrically at 585 nm for the CT complex formed between SMT and DDQ (DDQ method) and at 375 nm for the CT complex formed between SMT and I2 (I2 method). Beer’s law is obeyed over the concentration ranges of 4.0–56.0 μg mL−1 and 2.0–28.0 for DDQ and I2, respectively, with correlation coefficients () of 0.9997 and 0.9998. The analytical parameters such as apparent molar absorptivity, Sandell’s sensitivities, and limits of detection (LOD) and quantification (LOQ) are also reported for both methods. The described methods were successfully applied to the determination of SMT in tablets. No interference was observed from the common excipients present in tablets. The reaction stoichiometry in both methods was evaluated by Job’s method of continuous variations and was found to be 1 : 1 (donor : acceptor).