bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epiretinal membrane in a 12-year-old immunocompetent girl with cytomegalovirus infection
Authors: Costagliola Ciro , Romano Mario R. , Parmeggiani Francesco , Dell'Omo Roberto , Cultrera Rosario 
Published: March 2018

Purpose To report the case of a 12-year-old immunocompetent girl presenting bilateral epiretinal membrane formation in conjunction with systemic human cytomegalovirus (HCMV) infection. Methods The patient had a sudden onset of blurred vision and floaters in both eyes. Her medical history was unremarkable, except for allergic asthma that she had had for several years and that she was treating with inhaler corticosteroids prescribed by her pediatrician. The patient underwent a complete ophthalmic examination and serologic blood test. Results The ocular examination revealed an epiretinal membrane confirmed by optical coherence tomography, which showed a band of high optical reflectivity compatible with a proliferation of abnormal tissue on the surface of the retina. The patient had serologic evidence of exposure to HCMV, which was verified by a strongly positive HCMV IgM antibody test result (320 IU), with detectable IgG antibodies against HCMV, which significantly rose further in consecutive blood samples, due to IgG antibody seroconversion. Conclusions Our patient had allergic asthma that she was treating with inhaled corticosteroids. The immunosuppressive properties of corticosteroids could induce endogenous reactivation of latent HCMV.
Three-dimensional depiction of the vitreous pocket using triamcinolone acetonide
Authors: Shimada Hiroyuki , Nakashizuka Hiroyuki , Hattori Takayuki , Mori Ryusaburo , Mizutani Yoshihiro , Yuzawa Mitsuko 
Published: March 2018

Purpose To clarify the three-dimensional morphology of the vitreous pocket by direct injection of triamcinolone acetonide (TA) into the vitreous pocket. Methods Ten eyes of 10 subjects with incomplete posterior vitreous detachment (PVD) were studied. During vitreous surgery, TA was directly injected into the vitreous pocket. A 25-G cutter was then inserted into the vitreous pocket and TA was removed by aspiration. The anterior surface of the vitreous pocket was removed with the 25-G cutter, and the posterior side of the vitreous pocket was observed. Results Injecting TA allowed visualization of the circular vitreous pocket located anterior to the optic disk and macular area in all 10 eyes. The surface of the anterior border had a bright appearance. In 2 eyes without PVD, the posterior side of the vitreous pocket was depicted as a flat plate-like structure encompassing the macular region and the optic disc. In 8 eyes with partial PVD around the optic disc, a larger flat plate with the macula as the center and a smaller plate with the optic disc as the center were observed. Conclusions The vitreous pocket is a disc-shaped liquefied lacuna spreading anterior to the optic disc and macular region, which is surrounded by a dense network of fibrils. In patients with partial PVD around the optic disc, the posterior wall was visualized as being composed of two plate-like structures with the macula and the optic disc at their centers.
Long-Term Refractive and Phoric Changes in Visual Display Unit (VDU) Operators
Authors: Grignolo F.M. , di Bari A. , Bellan B. , Camerino L. , Maina G. 
Published: March 2018

Purpose This study assessed the phoric and refractive changes possibly caused by visual display unit (VDU) activity. Methods In a longitudinal trial nearly 6000 VDU operators received two ophthalmological examinations at intervals ranging from 34 to 43 months. The findings from the two examinations were correlated to VDU work (hours daily and years of VDU work), age and sex. Results Changes in the refractive state seemed to be mainly age-related. There was a slight tendency toward hyperopia (imbalance of latent hyperopia). Conclusions In the analysis of ocular motility, the results show no worsening capable of causing a definitive change from heterophoria to heterotropia. Heterophoric subjects, however, tend to improve both with regular office work and with additional VDU activity.
Analysis of Tear-Protein Patterns as a Diagnostic Tool for the Detection of Dry Eyes
Authors: Grus F.H. , Augustin A.J. , Evangelou N.G. , Toth-Sagi K. 
Published: March 2018

Purpose To analyze the electrophoretic patterns of tear proteins from diabetic (DIDRY) and non-diabetic (DRY) patients with dry-eye disease in comparison with the patterns in healthy subjects (CTRL). The patterns were classified using multivariate statistical methods. Methods A total of 119 eyes were examined in this study (50 DIDRY, 39 DRY, 30 CTRL). The patients were primarily grouped according to the results of the basic secretory test (BST) and subjective symptoms (burning, foreign body sensations, tearing, “dryness” of the eyes). Patients with values ≤ 10/5’ plus subjective symptoms were classified as dry-eye patients. Tear proteins were separated by sodium-dodecyl-sulfate poly-acrylamide gel electrophoresis (SDS-PAGE). Digital image analysis was done using the ScanPacK (Biometra, Gottingen, Germany). A data set was created from each electrophoretic pattern. The data were analyzed by multivariate analysis of discriminance, k-means cluster analysis and with a factor analysis before k-means cluster analysis as a data reduction tool. Results The protein patterns of the three groups were significantly different (Wilks’ lambda: 0.1425; p<0.01): P < 0.05 (CTRL - DRY), P < 0.00005 (CTRL-DIDRY), and P < 0.0005 (DIDRY-DRY). There were more peaks/electrophoretic lane in the DRY and DIDRY groups (P < 0.05) than CTRL. Classification of all samples as DRY and CTRL gave the following results: known patterns 97% correct; unknown patterns 71.4% correct. Classification in DIDRY, DRY or CTRL was 92% correct for known patterns and 43% for unknown patterns. Using k-means cluster analysis, 72% of patients previously classified as “dry-eye” according to the BST value were classified as “dry-eye” based on their electrophoretic data too. Conclusions Analysis of protein patterns and statistical evaluation are suitable for the detection of dry eyes. Tear-protein pattern analysis can provide more information on the pathogenesis of the disease. Thus, this new method might be more reliable than the BST value for both diagnostic and therapeutic purposes.
Ultrastructural Study of the Conjunctiva in Patients with Keratoconjunctivitis Sicca not Associated with Systemic Disorders
Authors: Rivas L. , Toledano A. , Alvarez M. I. , Sanz A. I. , Oroza M. A. , Murube J. 
Published: March 2018

Purpose The aim of this work was to evaluate ultrastructural alterations of the conjunctiva during the clinical course of keratoconjunctivitis sicca (KCS), and to detect its earliest and most characteristic morphological changes. Methods The conjunctiva was studied in biopsies from 75 patients and 10 controls. Patients were classified according to the results of the Schirmer I test, break-up time, rose Bengal staining, osmolarity and impression cytology. Results The conjunctiva in these KCS patients showed progressive hyperplasia, hypertrophy and cellular flattening, with diminution of goblet cell density and microvilli. In the severe cases, the epithelial cells lost their organelles, and fibrous material increased. From the early phases of KCS, clear nuclear alterations (indentation, binucleation) were found, but pyknotic nuclei or anucleated cells were only observed in the most severe cases. From the earliest stages to the most severe cases of KCS, decreases in cell membrane interdigitations were observed parallel to increases in the number and size of desmosomes. There were also increases in the number of inflammatory cells. Alterations in blood vessels were only observed in the most severe cases. Conclusions Morphological studies alone were able even in the earliest phases of KCS, to detect the squamous metaplasia that progresses from the surface of the epithelium to the connective tissue. This degenerative or adaptative cellular process was characterized mainly by marked proliferation of the cytoskeleton and a general loss of organelles, mitochondria being the least affected.
Comparison of Topical 0.05% Levocabastine and 0.1% Lodoxamide in Patients with Allergic Conjunctivitis
Authors: Richard C. , Trinquand C. , Bloch-Michel E. ,   Study Group, Favennec F. , Helleboid L. , Hofmann B. , Lecorvec MP. , Verin P. , Zech JC. 
Published: March 2018

Purpose The aim of the study was to assess the efficacy and safety of 0.05% levocabastine eyedrops (H1 receptor blocker given BID + vehicle BID) compared with 0.1% lodoxamide ophthalmic solution (mast-cell stabilizer instilled QID) in reducing ocular signs and symptoms of allergic conjunctivitis. Methods A randomized, double-masked, parallel-group study was conducted in seven centres in France, in which 93 patients suffering from seasonal or perennial allergic conjunctivitis were randomly allocated to either 0.05% levocabastine (n = 47) or 0.1% lodoxamide (n = 46) in both eyes for a 14-day period. Efficacy was evaluated by subjective (prickling, burning, photophobia, itching) and objective (redness, chemosis, eyelid edema, tearing) sign scores at visits on days 7 and 14, and from data noted daily by the patient in a self-evaluation form. Safety was assessed as tolerance upon instillation and adverse event reports. Results The ocular allergy symptom and sign scores were comparable in the two treatment groups at baseline. With time, statistically and clinically significant reductions (p < 0.001) from baseline were observed for the subjective and objective scores, with no difference between the treatment groups. After the first instillation, signs were alleviated more rapidly in levocabastine-treated patients than in the lodoxamide group (p < 0.001). Overall assessments by the patient and investigator were similar in both groups. No serious adverse events were reported. Conclusions Levocabastine ophthalmic suspension 0.05% (BID) appears to be as effective and safe as lodoxamide 0.1% (QID) in the management of allergic conjunctivitis.
Treatment of Proptosis with Fat Removal Orbital Decompression in Graves’ Ophthalmopathy
Authors: Adenis J.P. , Robert P.Y. , Lasudry J.G.H. , Dalloul Z. 
Published: March 2018

Purpose Retrospective evaluation of 41 proptosis reduction procedures using fat removal orbital decompression (FROD) according to a modified Olivari's technique. Methods Trans-septal excision of extraconal and intraconal fat was done under the microscope through the upper and lower eyelid blepharoplasty approach. Proptosis was measured with a Hertel exophthalmometer. Results Mean excision of 7.31 + 1.9 ml (range 3.25 - 12 ml) of orbital fat reduced proptosis on average by 4.7 + 2.4 mm (range 1–11 mm). Side effects were few, limited only to ocular motility disturbances. There was no significant effect on visual fileds. A postoperative drop in IOP was noted in patients with preoperative IOP above 21 mmHg. Efficient palpebral lengthening can be achieved with combined section of the levator aponeurosis horns in the upper eyelid, and/or auricular cartilage graft in the lower eyelid. Conclusions FROD reduces proptosis in Grave's ophthalmopathy.
Precision of Dual Energy X-ray Absorptiometry in Determining Periprosthetic Bone Mineral Density of the Hydroxyapatite Coated Hip Prosthesis
Authors: Rahmy A.I.A. , Tonino A.J. , Tan W. , Ter Riet G. 
Published: March 2018

The objectives of this study were to demonstrate the potential usefulness of dual-energy X-ray absorptiometry (DEXA) in the assessment of dynamic changes in bone mineral density (BMD) around the femoral stem of non cemented hydroxyapatite-coated hip prostheses and to establish our procedures by determining the variabilities associated with error introduced by the machine, operator, and/or subject. Methods Regional BMD were measured twice by DEXA for 27 patients. All scans were analysed twice by applying large size regions of interest (ROI's), 7 in total, defined by ‘modified’ Gruen zones. The data of 27 patients were analysed for the second time using smaller size ROI's, 14 in total, 7 small ROI's on each of the medial and lateral sides of the prosthesis. Three patients, all of whom exhibited intense ectopic ossification, were scanned twice. The variation associated with rotation of the femur was assessed by scanning six patients first in neutral rotation, thereafter by ± 15° in internal and external rotation position. Results: The overall coefficient of variation (CV) using ‘modified’ Gruen zones was 2.40% and varied according to the zone assessed. When smaller zones were used, the overall CV was 3.42%. The overall CV in the patients with ectopic ossification was 7.56%. When the leg was rotated by ± 15° externally or internally, the overall CV was approximately 10%. Conclusions Patient positioning is probably the most variable condition in the clinical setting. Using large ROI's such as ‘modified’ Gruen zones yields significantly better overall precision than using smaller ROI's. Patients with intense ectopic ossification are not suitable candidates for longitudinal study.
Mechanisms of Bacterial Resistance in Implant Infection
Authors: Cordero J. , García-Cimbrelo E. 
Published: March 2018

Although prophylaxis has cut down the infection rate in any type of implant to an average of 2.3% (0.38%-10%), the increased number of orthopaedic implants worldwide results in an extremely high number of cases yearly. Infection is also one of the most serious complications of implant surgery: it provokes life-long clinical sequelae, and greatly increases the difficulty and cost of treatment. Most bacterial infections respond to antibiotics alone, but implant infections do not. Most of the hypotheses developed over the last 40 years have been confirmed in clinical practice, and the most recent ones have not replaced earlier ones (Tab. I).
The Evolution of Ceramics in Total Hip Replacement
Authors: Willmann G. 
Published: March 2018

Today's THR systems have been developed in conjunction with feedback from clinical practice, i.e. by evolution. In the 70s and 80s ceramic stems, monolithic cups, monoblock components, and skirted heads were used. Today, modular hip systems are offered, designed for ceramic heads, which articulate against ceramic or PE cups. The surgeon has the option of choosing a combination suitable to the specific situation. About 70 cups with ceramic inserts have been developed. More than 200,000 ceramic inserts have been used since the mid 80s. The article discusses which combinations of head and cup inserts have been approved by government agencies and which combinations are not recommended
Prevention of Venous Thromboembolism after Hospital Discharge Continued Pharmacological Prophylaxis versus No Prophylaxis in Patients Undergoing Total Hip Replacement
Authors: Haentjens P. , Delincé P.H. ,   Members of the The Belgian Nadroparin Post-Hospital Discharge in Orthopaedics (NPHDO) Study Group (all of the following investigators and institutions also participated in the trial):, Boghemans J. , Borms T. , Brabants K. , Bremen J. , Cuyvers P. , de Brouckére G. , De Groot E , De Smet K. , Debiére I , Delincé Ph. , Demedts D. , Dewijze M. , Dierckxsens J. , Dierickx C. , Eekhaut M. , Gohimont A.-C. , Haentjens P. , Hollaert G. , Meuris S. , Michaux M. , Peck J. , van Backlé B. , van Bouchaute P. , Van Gestel J. , van Hoye M. , van Overschelde J. , Vandevyver D. , Vanlommel D. , Velghe A. 
Published: March 2018

After total hip replacement, continued pharmacological prophylaxis following hospital discharge is controversial. The primary objective of our study was to determine the safety and efficacy of continued prophylaxis with nadroparin three weeks after hospital discharge. The secondary objective was to evaluate the association between a confirmed venous thromboembolism and risk factors for deep venous thrombosis. This study was an open-label, randomized, multicentre, prospective trial. Patients were evaluated for deep venous thrombosis with duplex ultrasonography at discharge and 3 weeks later. Walking ability (mobility score) was assessed at the same times. Patients without deep venous thrombosis at discharge were randomly assigned to continued nadroparin (n=155) versus no pharmacologic prophylaxis (n=141) for three weeks. The rate of deep venous thrombosis three weeks post discharge was significantly lower in the nadroparin group: two patients (1.3%) versus nine (6.4%) without prophylaxis (p = 0.021; relative risk reduction = 79%). No significant difference in terms of safety was observed between groups and no major bleeding occurred. Three weeks after discharge, patients who developed deep venous thrombosis were significantly less mobile (p = 0.018). In conclusion, after total hip replacement, continued prophylaxis with nadroparin for 3 weeks after hospital discharge is beneficial.
The Elastic Prosthetic Acetabulum. A New Concept and Design of An Acetabular Replacement
Authors: Maumy J.P. 
Published: March 2018

Purpose Description of a new design of acetabular replacement which combines the advantages of a real elasticity of the external metallic cup, following the natural movements of the acetabulum with those of a hard rubbing couple. Materials A trifoliate metal back cup is described: one part, zenithal, is firm while the two others, laterals and lowers, work to adapt to movements and to gradual future changes of the acetabulum. Its special design allows the polyethylene (PE) insert to remain independent of the working parts. Patients and Results A clinical experimentation of only 33 cases, by precaution, has been carried out, under rules of the French Huriet's law, and is reported after a follow up of three years. This cup has already produced promising results with the average of Mèrle d'Aubigné and Postel score at 17.31/18 and a Harris hip score at 88.4 points. Conclusion These results are an encouragement to go ahead with its development.
The Role of the Greater Trochanter in Fracture Stability in Uni- or Biaxial Dynamisation with the Medoff Sliding Plate
Authors: Lunsjö K. , Ceder L. , Hauggaard A. , Stigsson L. 
Published: March 2018

The greater trochanter and its role in stability in fixation of extracapsular hip fractures has been neglected in comparison with the lesser trochanter. In unstable fracture types, gradual medial translation of the femoral shaft occurs as a consequence of the use of sliding hip screws and, if excessive, may be associated with fixation failure. In a live bio-mechanical trial with the Medoff sliding plate (MSP), we wanted to evaluate how the fracture configurations of the lateral and the medial femoral cortices affected the reduction and the impaction of the fracture as well as the femoral medialisation. The MSP is a modified hip screw-plate, which acts to prevent medialisation by allowing only vertical impaction of the fracture along the femoral shaft (uniaxial dynamisation). It also has an optional lag screw sliding along the neck of the femur, allowing biaxial dynamisation. Intertrochanteric fractures in 189 elderly patients were treated by either uni- or biaxial dynamisation and followed for one year with serial radiographs. Fractures with a broken lateral cortical spike from the femoral shaft commonly had medial reduction as well as medialisation and also had a significant increase in both lag screw and plate slide compared with fractures with an intact lateral cortical spike. A medial cortical fracture with a major defect larger than the size of the lesser trochanter had less influence on sliding or on medialisation. We conclude that involvement of the greater trochanter is an important factor in determining stability in complex intertrochanteric fractures
Cortical Strut Allograft in Revision Total Hip Arthroplasty
Authors: Wong P.K.C. , King A. , Hutchison C.R. , Gross A.E. 
Published: March 2018

Fifty-two patients with significant uncontained but non-circumferential femoral bone loss were reconstructed using cortical strut allografts. The allografts used were deep frozen and irradiated with 2.5 Mrads. The mean age was 65. The average follow-up was 4.8 (1.6–10.0) years. The following radiographic parameters were studied: location and the dimension of the allografts, resorption and incorporation of the allografts, and union between the cortical strut allografts and host bone. Union between the allografts and host bone took an average of 10 months. There were 2 non-unions (union rate 96%) but no graft fractures. Severe graft resorption occurred in two cases. The overall radiographical failure rate was 8% (4/52). The process of incorporation could take over two years to complete. The average length of the strut allografts immediately post-operatively was 154 mm (66–280 mm). The length of the strut allografts at final follow-up was 143 mm (54–258 mm). The percentage decrease in the length of the struts was 8% (0–48%). The mean pre-operative and post-operative Harris hip score was 39.4 and 65.6 respectively. Six of the fifty-two patients had further femoral revision surgery (12%). None of these re-revisions was done for reasons directly related to the cortical struts. Cortical strut allografts are useful to augment uncontained, non-circumferential femoral defects. They can remodel with time to enhance femoral bone stock. They unite consistently to host bone without significant resorption.
The Femoral Cement Mantle in JRI Furlong Total Hip Replacements
Authors: Mellor S.J. , Ripley L.G. , Ricketts D.M. 
Published: March 2018

The creation of an adequate femoral cement mantle in cemented total hip replacement (THR) can reduce the incidence of cement fracture, focal osteolysis and subsequent aseptic loosening. Excavating a suitably sized cavity within the femoral canal with an appropriate broach is an essential step in this process. We measured the size and volume of the femoral broaches and stems supplied with the JRI Furlong THR system. Least Significant Difference Multiple Comparison revealed that the volume of all 4 broaches was significantly less than the equivalent stems (p<0.001). Using an in vitro method, we created cement mantles that could be directly measured. We found the cement mantles created by these broaches were of inadequate thickness, with numerous cement defects (mean thickness = 0.89 mm, cement defects at 23% of measurement sites). JRI have developed a new set of broaches to be used with the original femoral stems. Assessment of these broaches showed that all four sizes were significantly larger (CI 14.20 – 26.96) than the original design (CI 10.45 – 13.21, p = 0.011). Volumetric analysis confirmed this significant difference (p<0.001). The cement mantles created by these broaches were significantly thicker and more uniform, with fewer cement defects (mean thickness = 1.99 mm, p<0.05, cement defects at 3% of sites). We conclude that, in vivo, the original broaches would fail to excavate an appropriate cavity and may not prevent direct bone-stem contact. The newer broaches are significantly larger, and may have an unpredictable effect on subsequent stem longevity when used in vivo.
Displacement of Femoral Stem during Closed Reduction of Total Hip Arthroplasty
Authors: Cordes J. , Sperling K. , Kramhøft M. 
Published: March 2018

In the literature, only one case of displacement of a cemented femoral stem from its cement bed during closed reduction of a dislocation has been reported. In that case, it was suggested that the stem design may in part be the explanation for the displacement. Another case with a cemented Müller straight stem is now presented, emphasizing the use of image intensification if reduction proves difficult.
The MRL Stem: A Decade of Follow-Up of 100 Primary Implants
Authors: Ravaglia L. , Zucchi M. 
Published: March 2018

The Authors report the results with the MRL prosthesis in 100 hips, reviewed on the basis of specific chronological parameters, with a mean follow-up of 11 years and 6 months, range 10–14 years. Results were excellent or good in 97%. A valgus cervicodiaphyseal angle of the stem constitutes a relative contraindication in some cases of coxa vara. We recommend widening the range to include stems with greater lateralizing effect and a physiological cervicodiaphyseal angle.