bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coverage of Tendon Exposure after Radial Forearm Free Flap by the Dorsoulnar Artery Perforator Flap
Authors: Foissac Rémi , Benatar Marc , Dassonville Olivier , Bozec Alexandre , Poissonnet Gilles , Camuzard Olivier 
Published: February 2017

ObjectiveThis study was designed to assess the effectiveness of an alternative technique using a perforator flap to manage secondary tendon exposure after a radial forearm free flap in head and neck oncologic surgery.Study DesignProspective cohort study.SettingPlastic Reconstructive Surgery Unit, Nice University Hospital, Pasteur 2 Hospital, France.Subjects and MethodsDespite its numerous advantages, the radial forearm free flap is associated with significant donor site morbidity and the risk of secondary tendon exposure. Conventional skin grafts for secondary tendon exposure can lead to diminished wrist range of motion and grip strength, with residual pain and cold intolerance. Between 2012 and 2015, we prospectively studied 20 patients with secondary tendon exposure after a forearm radial free flap for head and neck reconstruction. Two techniques of secondary coverage were compared: a reference technique with a secondary full skin graft (10 patients) and a dorsoulnar artery perforator (DUAP) flap (10 patients).ResultsMaximum wrist extension (100%) was observed for the DUAP group compared with only 87% for the skin graft (SG) group (P =. 001). An improvement in grip strength (+14 kg) (P =. 028) and a decrease in pain or cold intolerance (P =. 002) were also observed in the DUAP group, in addition to a better aesthetic appearance.ConclusionThe perforator flap procedure is an interesting tool in reconstructive surgery. The DUAP flap is a reliable, useful flap for secondary tendon exposure coverage after a radial forearm free flap.Level of EvidenceIII (case‐control analytic studies of 1 center).
Wrong‐Site Surgery in California, 2007‐2014
Authors: Moshtaghi Omid , Haidar Yarah M. , Sahyouni Ronald , Moshtaghi Afsheen , Ghavami Yaser , Lin Harrison W. , Djalilian Hamid R. 
Published: February 2017

ObjectiveThe implementation of a universal surgical safety protocol in 2004 was intended to minimize the prevalence of wrong‐site surgery (WSS). However, complete elimination of WSS in the operating room continues to be a challenge. The purpose of this study is to evaluate the prevalence and etiology of WSS in the state of California.Study DesignA retrospective study of all WSS reports investigated by the California Department of Public Health between 2007 and 2014.MethodsPrevalence of overall and specialty‐specific WSS, causative factors, and recommendations on further improvement are discussed.ResultsA total of 95 cases resulted in incident reports to the California Department of Public Health and were included in our study. The most common errors were operating on the wrong side of the patient’s body (n = 60, 62%), performing the wrong procedure (n = 21, 21%), operating on the wrong body part (n = 12, 12%), and operating on the wrong patient (n = 2, 2%). WSS was most prevalent in orthopedic surgery (n = 33, 35%), followed by general surgery (n = 26, 27%) and neurosurgery (n = 16, 17%). All 3 otolaryngology WSS cases in California are associated with the ear.ConclusionWSS continues to surface despite national efforts to decrease its prevalence. Future research could establish best practices to avoid these “never events” in otolaryngology and other surgical specialties.
“Proprietary Processed” Allografts: Clinical Outcomes and Biomechanical Properties in Anterior Cruciate Ligament Reconstruction
Authors: Roberson Troy A. , Abildgaard Jeffrey T. , Wyland Douglas J. , Siffri Paul C. , Geary Stephen P. , Hawkins Richard J. , Tokish John M. 
Published: February 2017

Background: The processing of allograft tissues in anterior cruciate ligament (ACL) reconstruction continues to be controversial. While high-dose irradiation of grafts has received scrutiny for high failure rates, lower dose irradiation and “proprietary-based” nonirradiated sterilization techniques have become increasingly popular, with little in the literature to evaluate their outcomes. Recent studies have suggested that the specifics of allograft processing techniques may be a risk factor for higher failure rates. Purpose: To assess these proprietary processes and their clinical outcomes and biomechanical properties. Study Design: Systematic review. Methods: A systematic review was performed using searches of PubMed, EMBASE, Google Scholar, and Cochrane databases. English-language studies were identified with the following search terms: “allograft ACL reconstruction” (title/abstract), “novel allograft processing” (title/abstract), “allograft anterior cruciate ligament” (title/abstract), “anterior cruciate ligament allograft processing” (title/abstract), or “biomechanical properties anterior cruciate ligament allograft” (title/abstract). Duplicate studies, studies not providing the allograft processing technique, and those not containing the outcomes of interest were excluded. Outcomes of interest included outcome scores, complication and failure rates, and biomechanical properties of the processed allografts. Results: Twenty-four studies (13 clinical, 11 biomechanical) met inclusion criteria for review. No demonstrable difference in patient-reported outcomes was appreciated between the processing techniques, with the exception of the Tutoplast process. The clinical failure rate of the Tutoplast process was unacceptably high (45% at 6 years), but no other difference was found between other processing techniques (BioCleanse: 5.4%; AlloTrue: 5.7%; MTF: 6.7%). Several studies did show an increased failure rate, but these studies either combined processing techniques or failed to delineate enough detail to allow a specific comparison for this study. The biomechanical studies showed overall maintenance of satisfactory biomechanical properties throughout multiple testing modes with normalization to the percentage of control specimens. Conclusion: A comparison of proprietary allograft processing techniques is difficult because of the variability and lack of specificity of reporting in the current literature. Among the available literature, except for the Tutoplast process, no notable differences were found in the clinical outcomes or biomechanical properties. Future study with a longer follow-up is necessary to determine the role and limitations of these grafts in the clinical setting.
An Empirical Analysis of Nigeria’s Current Account Sustainability
Authors: Shuaibu Mohammed , Oyinlola Mutiu Abimbola 
Published: February 2017

This study reexamines the sustainability of the current account in Nigeria over four decades using time-series analysis on annual data from 1981 to 2013. We focus on two analytical distinctions to the inter-temporal budget constraint (IBC) hypothesis in relation to previous studies. First, we extend the standard bivariate approach to a multivariate framework that accounts for the roles of oil price variations and financial deepening, which have important implications for resource allocation. Second is the use of the Toda–Yamamoto modified Wald (MWALD)-based causality test that is also carried out to arbitrage between the results with and without a structural break. It employs both the conventional unit root test (augmented Dickey–Fuller [ADF] and Phillips–Perron [PP]) and the unit root test with a structural break (Perron, 2006; Zivot & Andrews, 1992). It also carries out the conventional residual-based cointegration test (Engle & Granger, 1987) and the residual-based cointegration test with a structural break (Gregory & Hansen, 1995). Findings suggest that there is current account sustainability in Nigeria and structural changes were not very potent during the period under consideration. This implies that the Nigerian economy complied with the IBC hypothesis, suggesting that exports could actually finance imports. JEL Classification: F30, F32
Antimicrobial Prophylaxis of Gastrointestinal Surgical Procedures and Treatment of Intra-Abdominal Infections
Authors: Danziger Larry , Hassan Erkan 
Published: February 2017

Antibiotic prophylaxis and treatment regimens ideally are selected on the basis of efficacy, safety, and cost. This review evaluates current, selected literature on antibiotic prophylaxis for colorectal surgery, presumptive antibiotic administration following penetrating abdominal trauma, and treatment of intraabdominal infections. Single-drug regimens with the newer, broad-spectrum agents are assessed and compared with combination regimens; specific regimens are recommended. Colorectal procedures require an antimicrobial agent with activity against both aerobes and anaerobes. Patients undergoing elective colorectal procedures can be adequately protected with an orally administered three-dose regimen of neomycin/erythromycin. Parenteral antibiotic administration is generally not necessary, but, cefoxitin is recommended for nonelective colorectal surgery. The risk of potential infectious complications following penetrating abdominal trauma without colonic perforation is less than with colonic perforation; however, antibiotic therapy that includes activity against aerobes and anaerobes is recommended for all types of penetrating abdominal trauma. Although cephalothin, cefamandole, or cefoxitin alone may be used in abdominal trauma without perforation of the colon, only cefoxitin is recommended as a single-drug alternative to the standard clindamycin/gentamicin regimen in trauma with colonic perforation. Single-drug therapy with cefoxitin or moxalactam can be used successfully as alternatives to the standard regimens of clindamycin/gentamicin or metronidazole/gentamicin in many patients with intraabdominal sepsis. Single-drug regimens reduce the risk of developing adverse effects and are cost-effective. However, if resistant organisms are suspected, or if the patient has been hospitalized for a prolonged period or has multiple organ failure, it may be necessary to supplement cefoxitin therapy with an antibiotic that will enhance coverage against gram-negative aerobes.
Drug-Antacid Interactions: Assessment of Clinical Importance
Authors: D'arcy P.F. , Mcelnay James C. 
Published: February 2017

Antacids and adsorbents are commonly used preparations that are generally considered to be pharmacologically inert and free from adverse effects. They may, however, interact with a diverse range of primary drugs and the sequelae can be disadvantageous to the efficacy of the primary medication. Many such reports in the literature are based on animal experiments, or on single-dose studies in healthy subjects. Some reports are anecdotal and are unconfirmed; others are based solely on in vitro evidence. Potentially important interactions have been suggested for a relatively small group of drugs: tetracyclines, phenytoin, digoxin, chloroquine, cimetidine, quinidine, nonsteroidal antiinflammatory drugs, and beta-blocking agents. The evidence for these has been critically evaluated, as well as for antacid-anticoagulant and antacid-nitrofurantoin interactions that have been wrongly emphasized in the literature. The majority of literature reports on interactions with antacids have been overemphasized; only ferrous sulfate-, isoniazid-, and tetracycline-antacid interactions fall into a category I importance (scale I–III of descending importance). This category is for those interactions with good evidence of actual or potential importance in patients or in relevant studies on normal subjects.
Growth of Microorganisms in Total Nutrient Admixtures
Authors: Rowe Carl E. , Fukuyama Thomas T. , Martinoff James T. 
Published: February 2017

It has been reported that intravenous fat emulsions, because of their isotonicity and neutral pH, support microbial growth, but traditional parenteral nutrition solutions, being hypertonic and more acidic, are not as supportive. To date, few studies have documented microbial growth in total nutrient admixtures (TNA) containing dextrose, amino acids, fat, electrolytes, vitamins, and trace elements. This study was undertaken to analyze the growth of Staphylococcus aureus, Candida albicans and four gram-negative enteric bacilli in three different nutrient admixtures, with and without the inclusion of 5% fat emulsion. The composition of the admixtures was either 5, 10, or 25% dextrose; either 0 or 5% fat; and 3% amino acids, electrolytes, vitamins, and trace elements. All admixtures were innoculated with 100 colony-forming units per milliliter, incubated at room (25°C) or refrigerated (4°C) temperature, with samples withdrawn at 0, 3, 6, 12, 24, and 48 hours and plated in triplicate. Only C. albicans demonstrated any significant growth regardless of fat content. The pH of the admixtures was similar (acidic), and all solutions were hypertonic and found to inhibit bacterial growth. Conclusions suggest that TNA, when formulated with normal concentrations of additives, is no more likely to support growth of contaminant organisms than the traditional solutions. This contradicts the notion that the addition of fat to total parenteral nutrition will enhance the ability of these admixtures to support microbial growth.
Clinical Comparison of Two Total Ankle Replacements
Authors: Wood Peter L R , Clough Timothy M , Jari Sanjiv 
Published: February 2017

We compared the outcome of the cemented Thompson Parkridge Richards (TPR) ankle prosthesis with that of the cementless Scandinavian Total Ankle Replacement (STAR) ankle prosthesis in a demographically similar group of patients. These were 14 consecutive arthroplasties in 12 rheumatoid arthritis patients, all operated on by the same surgeon. The status of all patients, five years or more after surgery, is known. The mean follow-up periods for the TPR group and the STAR group are 7.2 and 5.4 years respectively. Four of the six TPR tibial components became radiographically loose within two years of surgery. Two of these have been converted to fusions. The STAR prostheses remain satisfactory both clinically and radiographically at five years.
Morton's Intermetatarsal Neuroma: Morphology and Histological Substrate
Authors: Morscher E , Ulrich J , Dick W 
Published: February 2017

Twenty-three biopsies from patients with the typical symptoms of intermetatarsal neuroma (so-called Morton's metatarsalgia) were compared histologically and semi-quantitatively with 25 plantar nerves from the intermetatarsal space III/IV gained at autopsies from cases where no problems in the forefoot had been recorded. The histomorphological examination of the nerves from autopsies revealed the same findings as were found in the biopsies. Thus, qualitatively, the nerves from patients could not be distinguished from those gained at autopsy. The only difference was the diameter of the resected nerves: semi-quantitative analysis of the nerves showed that the 17 thinnest ones were all from autopsies and the five thickest ones from biopsies of symptomatic patients. At medium diameters, however, there was wide overlap of the two groups. The study yielded a specifity of the swelling of 80 % and a sensitivity of 78%. From these results it must be concluded that diagnostic MRIs or ultrasonography, are unnecessary for decisionmaking about operative treatment and are not superior to exploratory local anaesthesia. ce histomorphological findings in intermetatarsal neuroma (so far accepted as the gold standard for confirmation of that diagnosis) were the same as findings in autopsied (normal) specimens, the value of postoperative histological examination is questioned. It merely proved that the nerve has been resected.
Classification and Treatment of Plantar Fibromatosis
Authors: Sammarco G. James , Mangone Peter G. 
Published: February 2017

A retrospective study of 18 patients (23 feet) with plantar fibromatosis who required surgical excision between January, 1991, and June, 1998, was performed. Subtotal plantar fasciectomy was performed to remove the tumor with a wide disease-free margin. 16 patients (21 feet) were interviewed and 14 patients (19 feet) were examined with an average followup of 36 months. Two patients (2 feet) with less than 12 months followup were excluded. Both subjective and objective evaluations and pre- and postoperative x-rays were reviewed to assess the alignment of the bony arch. There were nine males and nine females, age 49 years, average, at the time of diagnosis. Sixty-seven percent of patients had bilateral disease, and 28% had associated Dupuytren's contracture. There were 18 primary and five recurrent tumors. An operative staging system, I to IV, for plantar fibromatosis is presented which incorporates the extent of plantar fascia involvement, the presence of skin adherence, and the depth of tumor extension. The stage of the tumor correlated well with postoperative wound healing, skin necrosis, and recurrence. In fifteen of 21 feet, the patients were satisfied without reservations, and in three of 21 feet, they were satisfied with reservations. In 18/21 (86%) feet, the patient reported he/she would have surgery done again. There were two recurrent tumors. One was reoperated and the patient was disease free twelve months postoperatively. The other recurrence was asymptomatic 40 months postoperatively and required no treatment. One patient required an excision of a postoperative cutaneous neuroma. Eleven of 21 feet (52%) experienced delayed healing and of which four required a split thickness skin graft. Ten of the eleven feet with delayed wound healing and all four cases requiring a skin graft had a stage III or IV tumor. Pre- and postoperative weightbearing radiographs revealed a slight decrease in the calcaneal pitch angle, navicular height, and medial cuneiform height indicating a decrease in the height of the medial longitudinal arch.
Outcomes in Hallux Rigidus Patients Treated Nonoperatively: A Long-Term Follow-Up Study
Authors: Smith Ronald W. , Katchis Stuart D. , Ayson Lin C. 
Published: February 2017

The purpose of this study was to analyze radiographic outcome and patient satisfaction in non-operative care of hallux rigidus. Twenty-two patients representing 24 feet were surveyed and radiographed. Average follow-up was 14.4 years (range, 12–19 years). In 75% (18/24) of the feet, the patients would “still chose not to have surgery” if they had to make the decision again. The pain remained about the same in 22 feet, improved with time in one, and became worse in one. The most common reason given for not having surgery was that the pain was not severe enough. The most common type of self-care was a shoe with an “ample toe box.” More patients benefited from a stiff sole than a soft sole, but the majority of patients did not cite the sole of the shoe as being important. There was measurable loss of cartilage space radiographically over time in 16 of 24 feet, and in eight of the 16 feet, the loss of cartilage space was dramatic. The majority of hallux rigidus patients rated their pain as staying the same over a twelve-year period, despite significant deterioration of joint space noted radiographically. The study provides data for the hallux rigidus patient who asks, “what happens if I choose not to have surgery?”
Early Mobilization After Sliding Achilles Tendon Lengthening In Children With Spastic Cerebral Palsy
Authors: Katz K. , Arbel N. , Apter N. , Soudry M. 
Published: February 2017

Equinus deformity is a common finding in children with cerebral palsy and may be treated by Achilles tendon lengthening. To prevent recurrence, some authors recommend immobilizing the operated leg with an aboveknee cast for six weeks, followed by use of a night splint or orthosis. Nevertheless, there are recurrence rates of up to 20.5%. The aim of this study was to evaluate the long-term result of postoperative immobilization for two weeks in a below-knee cast and early weight bearing, without the use of a splint or orthosis. Thirty-six children (52 feet) with spastic cerebral palsy underwent sliding Achilles tendon lengthening. Followup of five to ten years showed a comparable recurrence rate (19.2%) to that reported with the standard, more stringent management approach. Most of the recurrences were in children operated on before five years of age. We believe earlier motion helps to sustain the tendon length achieved at surgery and allows for earlier independent gait.
Preliminary Results Comparing Two Methods of Lateral Column Lengthening
Authors: Thomas Ruth Lourdes , Wells Britton Colby , Garrison Robert Leo , Prada Stefan Alexander 
Published: February 2017

Forty-five patients (49 feet) underwent lateral column lengthening as treatment for painful pes planus. Twenty-five patients (27 feet) were available for both radiographic and clinical evaluation at least one year postoperatively. Of these 25 patients, 10 feet underwent Evans opening wedge osteotomy with tricortical iliac crest bone graft; 17 feet underwent calcaneocuboid distraction arthrodesis utilizing iliac crest bone graft. In addition, both groups underwent debridment of the posterior tibial tendon combined with transfer of the flexor digitorum longus into the navicular for reinforcement. Radiographic results documented marked improvement in all parameters. There was more improvement in the calcaneocuboid fusion group than the osteotomy group, but the difference was not statistically significant. Postoperative AOFAS rating scores averaged 87.9 for the osteotomy group and 80.9 for the distraction arthrodesis group. The difference was not statistically significant. Twenty of 25 patients (83.5%) in both groups were very satisfied. Twenty-four of 25 patients (96%) stated that knowing the final result they would have the same surgery again. Complications were reported for 32 patients (34 feet). Both the Evans opening wedge calcaneal osteotomy and calcaneocuboid distraction arthrodesis offer significant improvement in the radiographic parameters and AOFAS clinical scores for patients with painful, flexible flatfoot deformity. However, the complication rate remains high with both methods, and the rate of nonunion and delayed union with the calcaneocuboid distraction arthrodesis method remains a significant problem with this technique.
Autologous Chondrocyte Transplantation in Osteochondral Lesions of the Ankle Joint
Authors: Giannini Sandra , Buda Roberto , Grigolo Brunella , Vannini Francesca 
Published: February 2017

The aim of this study was to assess the repair of osteochondral defects of the ankle joint with hyaline cartilage. For this purpose we have been using a technique of autologous chondrocyte transplantation for osteochondral defects of the talus for the last two years. Until the method described in the paper, treatment methods proposed for the repair of cartilaginous defects have not been histologically effective in restoring the hyaline cartilage sheath, and in all cases the neoformation of cartilage was of a fibrocartilaginous nature with varying cellular characteristics. Clinical and histological results obtained using this surgical technique have confirmed its validity. Furthermore, neither subjective nor objective complications have been reported. Less pain and better articular function have also been observed. According to the AOFAS score, an improvement from an average score of 32/100 points preop. to 91/100 points at 24 months of follow up was obtained. Laboratory data have confirmed the presence of reconstructed cartilage with chondrocytes and expression of collagen II, characteristic of hyaline cartilage.