bluuebunny/crossref_metadata_2025_split huggingface dataset:
Orbital Depth Measurements of Human Skulls in Relation to Retrobulbar Anesthesia
Authors: Karampatakis V. , Natsis K. , Gigis P. , Stangos N.T. 
Published: March 2018

To investigate the orbital depth in human skulls in relation to retrobulbar anesthesia, we measured the distance between the lateral margin of the optic foramen and the border of the medium and outer third of the inferior orbital rim (retrobulbar needle pathway) in 50 skulls (25 males and 25 females). This distance varied from 4.4 to 5.7 cm in males (mean 5.024, SD 0.272) and from 4.5 to 5.5 cm in females (mean 4.9, SD 0.204). There was no real difference between males and females (p>0.05). For the total of 50 skulls the mean distance was 4.962 cm (SD 0.246). Shallow and deep orbits exist in both males and females but individuals with shallow orbits are obviously more susceptible to optic nerve injury by the retrobulbar needle.
Changes in the Conjunctival Flora after Conjunctivodacryocystorhinostomy (CDCR): A Preliminary Report
Authors: Can I. , Aribal E. , Yarangümeli A. , Ataoğlu H. , Kural G. 
Published: March 2018

Purpose To describe changes in the conjunctival flora due to retrograde flow after conjunctivodacryocystorhinostomy (CDCR) with Jones’ tube implantation. Methods In 20 patients, one year after unilateral CDCR with Jones’ tube implantation and a functionally successful outcome, conjunctival and nasal mucosal specimens were taken from the operated side for bacteriological analyses and non-operated eye conjunctival specimens were simultaneously taken as the control group. The samples were cultivated in conventional media and also in hypertonic media in order to isolate L-forms of bacteria and to increase the isolation rate and sensitivity. Results Bacterial growth was detected in 16 operated (80%) and 11 non-operated eyes (55%) and 26 bacteria were isolated from nasal mucosa in 20 cases (isolation rate 100%). Bacteria isolated from the non-operated specimens were S. epidermidis (63.6%, seven cases), S. aureus (27.2%, three cases) and Corynebacterium sp. (9.0%, one case). Conjunctival cultures of the operated eyes yielded S. epidermidis in three (18.7%), S. aureus in six (37.5%), Corynebacterium sp. in two (12.5%) and other bacteria in five (31.3%). Nasal mucosal cultures contained S. epidermidis in nine cases (45%), S. aureus in eight (40%), Corynebacterium sp. in two (10%) and miscellaneous bacteria in seven cases (35%). Conclusions After CDCR the conjunctival flora of the eye undergoes differentiation and becomes similar to the nasal flora.
Expression of p53 Protein in Pterygium
Authors: Onur C. , Orhan D. , Orhan M. , Sak S. Dizbay , Tulunay Ö. , İrkeç M. 
Published: March 2018

Purpose The pathogenesis of pterygium is still not completely understood and many environmental factors, including ultraviolet (UV) radiation, play an important role in its etiology. Chronic exposure to UV radiation causes mutations in the p53 tumor suppressor gene, eventually leading to tumor formation. We analyzed the immunohistochemical expression of p53 proteins in pterygial tissues to determine the role of the p53 tumor suppressor gene in the development of pterygium. Methods Pterygial specimens were studied immunohistochemically using antibodies against p53 protein. Results Out of 38 specimens studied, 35 (92.1%) had conjunctival epithelial cells without p53 specific nuclear staining. Only three specimens (7.9%) had a few p53 stained cells. The role of UV radiation in the pathogenesis of pterygium is supported by epidemiological, geographical and microscopic findings. However, our results are not consistent with these data on a genetic basis. Conclusions We conclude that defective p53 tumor suppressor gene function seems to have no role in the pathogenesis of pterygium.
The Risk of Optic Nerve Injury in Retrobulbar Anesthesia: A Comparative Study of 35 and 40 Mm Retrobulbar Needles in 12 Cadavers
Authors: Karampatakis V. , Natsis K. , Gigis P. , Stangos N.T. 
Published: March 2018

Purpose This study was designed to demonstrate the increased risk of optic nerve injury by the 40 mm needle when fully inserted into the orbit. Methods Retrobulbar anesthesia needles 35 and 40 mm long were inserted into the orbits of 12 well-embalmed cadavers, as for typical retrobulbar anesthesia. The needle was seen directly through a fenestration of the orbital roof and by dissection of the orbital structures overlying the optic nerve. Results In all orbits the 40 mm needle reached and in seven cases significantly pushed against the optic nerve and could obviously penetrate its sheaths. The 35 mm needle could just slightly touch the outer optic nerve sheath only in two cases. Conclusions We conclude that the 40 mm retrobulbar needle should not be fully inserted into the orbit and the 35 mm retrobulbar needle must be used with caution.
The Association of Conjunctival Snake-Like Chromatin with Keratoconjunctivitis Sicca
Authors: Rivas L. , Oroza M.A. , Sanz A.I. , Chen Z. , Shalaby O. , Murube J. 
Published: March 2018

Purpose This work describes the snake-like chromatin cells in the conjunctiva of patients with keratoconjunctivitis sicca (KCS), assessing the relationship between tear function parameters and the severity of the disease, and searching for any differential pattern that could lead to early and diagnosis help clarify the etiology of KCS. Methods The conjunctiva of 366 eyes from 187 patients with KCS, and 30 eyes from 15 controls, were classified according to the results of the Schirmer I test, break-up time, rose Bengal staining, osmolarity, ferning tests and electrophoresis; they were then studied by impression cytology and electron microscopy. Results Snake-like chromatin cells, other nuclear changes, and a decreased number of goblet cells were found by impression cytology in different areas of the KCS conjunctiva. The presence of snake-like chromatin was significantly correlated with the severity of the disease. No nuclear changes were found in the control group. Conclusions We assume these findings can be attributed to a natural regeneration of conjunctival cells and to resistance to a pathological reaction to KCS.
The Endocrine Stress Response after Oral Premedication with Low-Dose Midazolam for Intraocular Surgery in Retrobulbar Anaesthesia
Authors: Kiefer R.T. , Weindler J. , Ruprecht K.W. 
Published: March 2018

Purpose It was the purpose of this study to examine the endocrine stess response in patients undergoing elective intraocular surgery in retrobulbar anaesthesia (RBA), and the effect of an oral premedication with 3.75 mg midazolam on this reaction. Methods In a prospective double-blind study, 23 patients were randomly assigned to either group I (n=12), receiving 3.75 mg midazolam, or group II (n=11), receiving a matched placebo 60 min before RBA. Plasma concentrations of known mediators of the endocrinological stress response were analysed at five perioperative times: adrenocorticotropic hormone (ACTH), cortisole (CORT), somatotropic hormone (STH), epinephrine (EPI), norepinephrine (NOR), and dopamine (DOP). Results The observed endocrinological reaction was moderate. Perioperative anxiety and, above all, RBA were the main stressors. The endocrine stress response could best be seen within the fast-reacting sympathoadrenergic system. Midazolam significantly suppressed the epinephrine and the cortisole answer (p < 0.01). After RBA an ACTH plasma peak only was observed after placebo. Plasma-STH showed extreme variability. An STH-peak after midazolam is presumably due to a gonadotropic hormone-releasing hormone (GHRH) secretion directly stimulated by midazolam. Midazolam had no significant effect upon norepinephrine. A significant (p<0.01) increase for plasma-cortisole was seen 60 min after the operation when compared to preoperative values. Conclusions The results indicate that even at a low dose midazolam positively influences the endocrine stress response. The combination of this stress-reducing effect with the well-known hemodynamic stability, the distinct anxiolytic and sedative action, suggest low-dose midazolam as a favourable premedication for intraocular surgery.
The Effect of In-Stem versus Around-Stem Centralizers on Cement Mantle Thickness and Stem Alignment in Total Hip Arthroplasty
Authors: Wright J.M. , Saleh K. J. , Tolo E. T. , Bostrom M.P G. , Pellicci P. , Salvati E.A. 
Published: March 2018

The long term success of cemented total hip arthroplasty has been attributed to the presence of a well pressurized, thick cement mantle around a properly designed stem that has been placed in neutral alignment. Femoral centralizers were developed to achieve this goal more consistently. While some centralizers fit into the distal tip, others fit around the tip of the prosthesis. We undertook a study to compare the effect of an into-distal-tip (IDT) centralizer versus around-distal-tip (ADT) one. A retrospective review of three groups of primary total hip arthroplasty (THA) patients was performed. Group I consisted of a control population of the last 100 consecutive cases performed with no distal centralizer. Group II consisted of the first 100 consecutive cases performed with the IDT design. Group III consisted of 51 consecutive patients performed using an ADT centralizer. All cases were performed with similar cementing technique by the same senior surgeon (E.S.). Our results show that, while adequate mantles can be obtained, either with or without the use of a centralizer, an around-stem centralizer on a tapered distal stem consistently gave a more neutral stem alignment and a thicker, concentric cement mantle.
Age and Surgical Management Determine Quality of Life after Trochanteric Fracture
Authors: Guillemin F. , Cao M.M. , Delagoutte J.P. , Mainard D. 
Published: March 2018

Purpose The aim of the study was to determine factors influencing functional ability and quality of life six months after trochanteric fracture treated surgically. Patients and method: A multicentre cohort included 459 patients (356 females and 103 males, mean age 80 years) in Eastern France. Sixty-two percent of the fractures were stable and 38% were unstable. Determinants of functional ability assessed by the Merle d'Aubigné and Harris scores, of quality of life by the Duke Health profile, and of return to home at 6 months after surgery were considered using logistic regression analyses. Result Older age was the most prominent factor predicting bad functional ability (p<.001) and quality of life (p<.05). The material for surgery predicted 6-month poor functional ability (p<.001), probably through the different strategies for care management involved. The quality of fracture reduction assessed on lateral radiographs, as well as post-operative complications were predictors of a better functional ability (p<.001) and less frequent return to home (p<.001). Conclusion Age and surgical management procedure are determinants of outcome at 6 month after trochanteric fracture.
Histological Investigation of Polyethylene Particles in Total Hip Replacement: Ceramic versus Metal Heads
Authors: Bos I. 
Published: March 2018

Pseudocapsules and interface membranes around hip prostheses with ceramicand metal polyethylene combinations from 128 revision cases and 40 autopsy cases were histomorphologically analysed, including a semiquantitative grading of the wear particles and histological changes. The amount of wear particles increased with increasing implant duration. Comparing the revision cases with metal-on-polyethylene combinations and ceramic-on polyethylene combinations 4 to 8 years in situ, more than twice as many polyethylene wear particles were produced from prostheses with metallic heads. In the autopsy cases with stable prostheses 3 times more polyethylene wear was found. The synovial layer was found to be thicker in the metal-polyethylene couplings, the villous transformation of the synovial surface and the scar-like fibrosis of the pseudocapsules appeared to be more pronounced too. Differences between the different types of prostheses with metal-polyethylene combinations were not apparent with the exception of the bipolar prostheses, which showed markedly increased polyethylene wear.
Radionuclide Bone Scan Appearances in Asymptomatic Patients following Hip Hemiarthroplasty
Authors: Khaleel A. , Harden S. , Tuson K.W.R. , Flanagan J.J. , Conry B.G. 
Published: March 2018

We report the radionuclide bone scan appearances following hemiarthroplasty of the hip in 15 asymptomatic, active patients at a mean of 14 months following surgery. All patients had a normal clinical examination, white cell count and erythrocyte sedimentation rates. Tracer activity was graded. Minimal tracer activity especially along the lateral stem and acetabulum were consistent findings. We conclude that this should be regarded as normal in this situation.
The Difficulties of Nutritional Assessment in Major Hip Surgery
Authors: Costa M. , Shepstone L. , Donell S.T. 
Published: March 2018

There are many factors affecting the outcome of major hip surgery. One postulated factor is the patient's peri-operative nutritional status. Several papers have confirmed the benefits of dietary supplements for malnourished patients. Despite this, there are currently no guidelines as to how best to assess nutrition in orthopaedic patients. The aim of this study was to find a simple diagnostic test that accurately reflects nutritional status in patients undergoing major hip surgery. Twentyfive patients with fracture neck of femur and 25 total hip replacement patients were assessed. Nutritional risk assessment scores, body mass index (BMI), anthropometric and biochemical tests were applied. The different indices were correlated. Length of hospital stay was used as a measure of morbidity. The correlations between the individual indices of nutritional status were disappointingly low. The only significant correlations for the Total Hip Arthroplasty group were BMI to triceps skinfold thickness (rs=0.769, 95%CI: 0.505 to 0.900, p=0.0001) and BMI to skeletal muscle mass (rs=0.501,95%CI: 0.092 to 0.766, p=0.018). The assessment of BMI is in practice very difficult in patients with fractures of the neck of the femur. There were no statistically significant correlations between any of the nutritional indices measured and postoperative morbidity. This study was unable to accurately assess nutritional status in patients undergoing major hip surgery. A simple nutritional assessment that can be used on a busy orthopaedic ward has not been identified.
Anatomic Cementless Total Hip Arthroplasty with Ceramic Bearings and Modular Necks: 3 to 5 Years Follow-Up
Authors: Toni A. , Paderni S. , Sudanese A. , Guerra E. , Traina F. , Giardina F. , Antonietti B. , Giunti A. 
Published: March 2018

The authors reviewed 216 anatomic cementless hip arthroplasties with ceramic bearings and modular necks, followed up for a minimum of 3 years (range 3–5 years), consecutively implanted in 208 patients between June 1995 and December 1997. The titanium femoral component, proximally hydroxyapatite coated, has 5 different types of prosthetic neck each available in 2 different lengths and is usually articulated with a ceramic on ceramic coupling with a hydroxyapatite coated hemispheric cup. The Mèrle d'Aubigné-Charnley hip score and the Gruen radiographic analysis were used for the clinical and radiological evaluation. Apart from one revision of both cup and stem for a loose implant after 2 years, no osteolysis was noted in the periprosthetic bone, where 99.4% of the prostheses showed good osseointegration. The survival analysis predicted 98.6% good results at 5 years, where survival analysis was performed for all the parts of the prosthesis. The advantage of this prosthesis is the possibility of adaptation to different diaphyseal and extradiaphyseal anatomical conditions. With regard to the neck modularity, for primary arthritis a straight neck was chosen for 81% of the cases, for congenital dysplasia of the hip, a neck with a retroversion of 8°or 15° was used in 34% and a straight neck in 59% of the cases.
Long-Term Results of Charnley Low Friction Arthroplasty for Ankylosing Spondylitis
Authors: Sochart D.H. , Porter M.L. 
Published: March 2018

The authors determined the long-term results of 95 Charnley low friction arthroplasties performed on 58 patients with ankylosing spondylitis. The average age at the time of operation was 39.7 years (range, 19 - 70 years) and average duration of follow-up was 19 years (range, 10–30 years). All patients had substantial relief of pain, improvement of function, and range of motion of the joint, and 55 patients (95%) were completely free of pain. Twelve acetabular and nine femoral components were revised for aseptic loosening at an average of 13.9 years (range, 4.2 - 20 years) with 79 original femoral components (83%) and 78 acetabular components (82%) remaining in situ. Six femoral and eight acetabular components were radiologically loose and a total of 20 acetabular components (21%) and 15 femoral implants (16%) had loosened aseptically. There was no heterotopic ossification in 71 hips (75%), with 22 hips (23%) having minor changes (Brooker Class I or 2), two hips (2%) having clinically important ossification (Class 3) and none having reankylosis. Survivorship of the acetabular component (with 95% confidence intervals) was 92% at 10 years (87% - 98%), 85% at 15 years (77% - 93%), and 77% at 25 years (67% - 87%). Femoral implant survivorship at the same time intervals was 90% (84% - 96%), 87% (79% - 94%), and 77% (80% - 99%), respectively. Charnley low friction arthroplasty provided good long-term results in this series of young and active patients, without the increased risk of the development of heterotopic ossification and reankylosis that has been reported previously.
Slipped Capital Femoral Epiphysis – Initial Results of Treatment with Fixclips, a Modification of Kirschner Wire Fixation
Authors: Herron M. , Clegg J. , Bache E. 
Published: March 2018

26 cases (21 patients) with Slipped Upper Femoral Epiphysis were treated by internal fixation with Fixclips. Of the 19 males and two females with a mean age of 12 l/2 years (range 10–15), 22 were fixed in situ and 4 required Dunn's osteotomies. The Fixclip allows two 2mm K wires, transfixing the proximal femoral epiphysis, to be anchored to the lateral femoral cortex. Post-operatively partial weight bearing was commenced at 6 weeks. The mean follow-up was 17 months (range 8–26), 10 cases being followed up to epiphyseal union. There were no failures of fixation and no significant complications. Given that the size of implant used to treat slipped femoral epiphyses may be related to the chance of developing avascular necrosis, the small cross sectional area of simple K wires offers a potential advantage. The Fixclip prevents K wire penetration or extrusion, previously a problem with this type of fixation. In addition, ease of removal offers a significant advantage given the inevitability that a proportion of these patients will outgrow their primary fixation and require revision of fixation.
Cementless Bicon Cup in Total Hip Replacement
Authors: Janeček M. , Buček P. 
Published: March 2018

The purpose of this study was to evaluate the mid-term results of 462 primary implanted Bicon acetabular components. These cups are self-tapping, biconical threaded implants made of titanium and inserted without cement. The mean follow-up was 5 years. The patients ranged from 17 to 81 years at the time of surgery (mean, 65 years). The mean HHS was 31 points (range, 5 to 70 points) pre-operatively and 95 points (range, 75 to 200 points) post-operatively. Three patients underwent two stage revision surgery because of septic loosening. In one case, the cup was re-implanted because of aseptic loosening in serious osteoporotic bone. In nine cases, we observed radiolucencies between cups and bone. In ten patients hip dislocation occurred. We treated eight dislocations non-operatively and the other two cases were solved by insertion of a new PE inlay because of incorrect primary position. The mid-term results are fully comparable with other acetabular components. The osseointegration also promises good long-term outcomes and the authors hope to be able to report on it in next the few years.
Revision of Failed Cemented Total Hip Arthroplasty Using the Charnley Technique and Implants
Authors: Babis G. CH. , Pantazopoulos TH. , Ioannidis TH. , Hartofilakidis G. 
Published: March 2018

The authors present the results of 57 revisions in 54 patients performed for aseptic loosening of cemented total hip arthroplasties. The Charnley technique and implants were used in all cases. The mean follow-up was 8 years and 6 months with a minimum of 5 years. The failure rate for the femoral component was 15% and for the acetabular component it was 19.1%. The cumulative success rate at 8 years was 81.7% for the femoral component and 83.4% for the acetabular component. The Charnley technique and implants were found efficient for revision of cemented total hip arthroplasties in the long term, but there are limitations to their use in the presence of severely compromised bone stock.
Effect of Pelvic Tilt on Radiographic Migration and Wear Measurements after Total Hip Arthroplasty
Authors: Ilchmann T. , Kesteris U. , Wingstrand H. 
Published: March 2018

Tilt effects on radiographic measurements after total hip arthroplasty should be studied. A new computerized method for measurement, called EBRA, making three-dimensional calculations and intended to identify tilted radiographs was evaluated for its clinical usefulness. In an experimental set-up repeated radiographs were taken with a human pelvis tilted gradually around its horizontal and vertical axes. Migration and wear were measured with the EBRA method and the results were compared with those made using standard methods. Tilted radiographs were identified and excluded from analysis by the EBRA method, significantly reducing the maximum error of measurement. A systematic error of measurement was found in the presence of consecutively changing tilt in a single direction. Wear measurements were only slightly affected by pelvic tilt. A pelvic tilt can cause considerable errors in the measurement of cup migration-i.e. up to 8.2 mm. The EBRA method improves the accuracy of measurements by taking the effects of tilt into account.
Natural History and Conservative Treatment of Osteonecrosis (ON) of the Femoral Head
Authors: Mazières B. , Laroche M. , Cantagrel A. 
Published: March 2018

Until now the natural history of nontraumatic osteonecrosis of the femoral head (ON) has been poorly understood. The spontaneous course of ON with radiographic changes (even asymptomatic) is regarded as poor with progression in 50–80% of the cases within two years. In contrast, stabilisation or disappearance of the lesions on MRI can occur in early ON with normal radiographs (stage 1), leading to the definition of a purely “magnetic ON”. Furthermore MRI allows us to study the volume of the necrotic area, which seems to be the most important prognostic factor in early ON. If this volume is less than 20% of the femoral head, the percentage of spontaneous progression is very low. The natural history of ON, especially in the early onset of the disease, has be redefined by MR imaging studies. Conservative treatment in ON is generally regarded as not very successful. Discontinuing weightbearing has shown to be ineffective in numerous studies. Pulsed electromagnetic fields have given promising results in some studies, but the value of this approach is still controversial. Vasoactive drugs have been shown to reduce pain significantly in ON and there might be a possible role for treating early cases. Some other ON disease modifying drugs may be helpful in carefully selected patients in the future. Nevertheless so far no conservative or surgical therapeutic method has been shown to heal the necrotic lesion. Therefore prevention is the only way which may prevent collapse in patients with a high ON risk, other than treatable aetiological factors.