bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pseudo Os Trigonum Sign: Missed Posteromedial Talar Facet Fracture
Authors: Giuffrida A. Ylenia , Lin Sheldon S. , Abidi Nicholas , Berberian Wayne , Berkman Avril , Behrens Fred F. 
Published: January 2017

Background: Posteromedial talar facet fracture (PMTFF) is a rare injury, sparsely reported in the literature. This article proposes that PMTFF is often left undiagnosed by orthopaedic surgeons and suggests the routine application of advanced radiographic studies (i.e., CT scan) in the recognition of PMTFF. It also evaluates nonoperative management of PMTFF. Methods: After obtaining Institutional Review Board approval, the medical records over a 5-year period (1997–2001) were retrospectively reviewed from the foot and ankle service of a level 1 trauma center, identifying all cases of PMTFF. Charts were reviewed for relevant data. Results of treatment were assessed during follow-up physical examination. Results: Six cases of PMTFF were identified over a 5-year period. All injuries were associated with medial subtalar joint dislocation. Four of six (66%) patients were not initially diagnosed with PMTFF, but instead misdiagnosed as an os trigonum. The remaining two patients had an established diagnosis of PMTFF at the time of initial treatment. All had short leg cast immobilization for medial subtalar dislocation. CT evaluation yielded additional diagnoses in all six patients. All six patients showed a PMTFF. Five patients (83%) revealed persistent subtalar joint subluxation. Five of six (83%) patients required at least one additional procedure as a result of an undiagnosed or nonoperatively treated PMTFF. Four patients underwent subtalar joint fusion, and one patient underwent tibiotalar calcaneal fusion secondary to concomitant ankle/subtalar arthritis. The patient who did not undergo recommended fusion continued to be symptomatic. Conclusions: Diagnosis of PMTFF necessitates a heightened clinical suspicion, especially when a medial subtalar joint dislocation is present. Proper imaging studies, such as coronal CT scan, should be performed after any subtalar dislocation. Timely treatment, in the form of open reduction and internal fixation for large fragments involving the articular surface or surgical excision for smaller fragments, is recommended in order to restore proper anatomy and function of the subtalar joint. This study verifies the significant morbidity associated with an undiagnosed or nonoperatively treated PMTFF.
Distal Lower Extremity Sarcomas: Frequency of Occurrence and Patient Survival Rate
Authors: Zeytoonjian Trisha , Mankin Henry J. , Gebhardt Mark C. , Hornicek Francis J. 
Published: January 2017

Background: Primary sarcomas in the distal leg, tibia, fibula, ankle, and foot are uncommon and are believed to be less malignant than those that arise in other sites, but only limited information is available to support this contention. Methods: Using a computerized system containing extensive information regarding over 14,000 patients, mostly with tumors treated by our center over a 25-year period, 175 sarcomatous lesions with MSTS stage I, II, and III were located in the distal lower extremity. These were compared with 2367 lesions of similar diagnoses in other body parts. The principal studies included diagnostic distribution and outcome (recorded as death as a result of disease). Data were compared for diagnosis, gender, age, Musculoskeletal Tumor Society (MSTS) stage, anatomic site, and treatment methods and evaluated statistically by chi-square methods. Results: The most frequent distal lower limb tumors were synovial cell sarcoma, osteosarcoma, and Ewing's tumor and the percentage distribution of the various tumors for that site as compared with the rest of the body was quite different. Of even more importance was the remarkable difference in outcome with the death rate for the lower limb tumors set at 10%, while the same tumors at other sites had a death rate of 27% ( p < .000002). Furthermore, gender, stage, age, and the type of operative procedure showed highly significant differences between the tumors of the lower leg and those of the remainder of the body. Conclusions: On the basis of these data, it is evident that far fewer sarcomas occur in the lower leg, tibia, fibula, ankle, and foot than in other body sites and that their diagnostic distribution is different. Of perhaps greater interest is the fact that the rate of metastasis and death is markedly reduced for this site as compared with others. The authors speculate on the causes of this remarkable alteration in numbers and outcome.
Rheumatoid Necroses in the Forefoot
Authors: Berger Irina , Martens Klaus-Dieter , Meyer-Scholten Carola 
Published: January 2017

Background: The incidence and morphological features of rheumatoid necroses (RN) in the forefoot are unknown. Methods: Biopsy material from 223 patients with seropositive rheumatoid arthritis (RA) was examined morphologically. The incidence and morphological features of RN in the forefoot were evaluated. Results: RN was found in 65% of cases, which had not been suspected clinically. It was correlated with pain in 69% of cases. Conclusions: Rheumatoid necrosis contributes to the development of pain and foot deformation. It can be a significant factor worsening the clinical behavior in seropositive RA patients.
Calculation of the Opening Wedge for a Low Tibial Osteotomy
Authors: Warnock Kenneth Mathew , Johnson Brian Douglas , Wright John Braxton , Ambrose Catherine Glauber , Clanton Thomas Oscar , McGarvey William Christopher 
Published: January 2017

Background: Medial opening wedge distal tibial osteotomy, a relatively new technique for treatment of intermediate ankle joint arthritis, is a technically demanding procedure that requires preoperative planning to determine the size of the wedge that will restore anatomic alignment of the joint surface. The purpose of this study was to facilitate the preoperative planning process for distal tibial osteotomy by determining angular correction obtained with various wedge heights. Methods: Measurements of the distal tibia were taken from cadaver specimens to develop a database of average distal tibial widths. A distal tibial osteotomy was then done on the cadaver specimens with the placement of wooden block wedges of various heights at the osteotomy site. Preoperative and postoperative radiographic measurements of the joint surface angle were obtained on all specimens. The measured amount of angular change was compared to the mathematically predicted angular change using the formula ta θ = H/W. Results: The mathematical model accurately predicted the amount of measured angular correction of the distal tibial articular surface. There was an approximate 2-degree angular change of the articular surface per millimeter of wedge height. As the tibial width increased, a smaller amount of angular correction per millimeter of wedge height was noted, and as wedge height increased with the same tibial width, less angular correction was obtained per millimeter of wedge height. Conclusion: With appropriate preoperative planning, an accurate prediction can be made as to the amount of ankle joint correction that should be obtained with surgery. The size of the wedge that will provide the desired amount of correction can be accurately determined preoperatively.
The Effect of Bone Quality on the Stability of Ankle Arthrodesis. A Finite Element Study
Authors: Alonso-Vázquez Ana , Lauge-Pedersen Henrik , Lidgren Lars , Taylor Mark 
Published: January 2017

Background: Despite uniform operating techniques, lack of fusion still occurs after ankle arthrodesis. Differences in the biological healing potential may be a factor but the mechanical performance of the arthrodesis construct because of varying bone quality also may be important. Internal compression techniques are preferred because of higher union rates, shorter fusion times, and fewer complications. A three-screw configuration has been shown to be more stable than a two-screw configuration, but it is not obvious when it should be used. Methods: Three-dimensional finite element models of intact and flat-cut ankle arthrodeses were built, using two and three screws in different configurations. Poor bone quality was simulated by decreasing Young's modulus of the bone. The constructs were loaded in torsion and dorsiflexion, and micromotions at the fusion site were measured. Results: Bone quality had a marked effect on the stability at the arthrodesis site. Inserting two screws at 30 degrees relative to the longitudinal axis of the tibia in an intact arthrodesis seemed the best option, especially as bone quality worsened. The addition of a third screw increased the stability at the arthrodesis site. Conclusions: Overall, intact joint surfaces and three-screw fixation, with the lateral and medial screws inserted produced the most stable arthrodesis constructs when bone quality was poor. Clinical Relevance. Ankle arthrodeses are technically demanding because of the shape and small size of the talus. Preoperative planning is an absolute necessity to determine placement and number of screws. This study shows that poor bone quality decreases the stability of the arthrodesis constructs, suggesting that an attempt should be made to create the most stable three-screw configuration. Finite element models can be used as an effective preoperative tool for planning screw number and placement.
The Effects of Amlodipine on Left Ventricular Mass and Diastolic Function in Concentric and Eccentric Left Ventricular Hypertrophy
Authors: Fak Ali Serdar , Okucu Metin , Tezcan Hakan , Bodur Gökhan , Oktay Ahmet 
Published: January 2017

Background: The effects of the antihypertensive therapy with amlodipine (5-10 mg/day) on left ventricular mass and diastolic function were examined in 30 mild to moderate essential hypertensive patients who have left ventricular hypertrophy (LVH) and diastolic dysfunction. Methods and Results: Each patient's left ventricular mass was measured, and left ventricular diastolic function was assessed by echocardiographic Doppler examination at entry, and at 3 and 6 months after the initiation of the treatment. Amlodipine reduced both blood pressure (from 164 ± 14/10 ± 6 mmHg to 134 ± 9/83 ± 4 mmHg) and left ventricular mass index (from 160 ± 30 g/m2 to 137 ± 26 g/m2) significantly at 3 months and both parameters maintained at these levels for 6 months. When the patients were classified according to the type of the LVH. a significant regression in left ventricular mass index was seen only in the patients who had concentric LVH with a relative wall thickness ≥ 0.44 (n = 16), but not in the eccentric LVH group (n = 14), although both groups were not significantly different from each other regarding the basal hemodynamic parameters. baseline left ventricular mass index and the decrease in blood pressure in response to amlodipine treatment. The mitral inflow E/A ratio did not show any significant change in either group. Conclusions: Across the three chronic heart disease risk strata, lovastatin appears to be significantly more potent than fluvastatin, on a per milligram basis, in lowering cholesterol levels.
Influence of ACE Inhibition on Fluid Metabolism in Chronic Heart Failure and Its Pathophysiologic Relevance
Authors: Agostoni Piergiuseppe , Marenzi Giancarlo , Guazzi Marco , Guazzi Maurizio D. 
Published: January 2017

Background: In congestive heart failure with water retention. subtraction of body fluid by ultrafiltration causes greater diuresis and clinical improvement in patients who are angiotensin-converting enzyme (ACE)-inhibited. suggesting an influence of ACE inhibitors on fluid metabolism. Methods and Results: Patients with moderate congestive heart failure were subjected to ultrafiltration (around 2000 mL) and followed up for 3 months. Usual outpatient therapy, consisting of digoxin, furosemide. and ACE inhibitors (18 patients, group A) and of digoxin and furosemide only (18 patients, group B), was continued throughout the trial. Hemodynamics, renal function, body fluid and electrolytes. plasma norepinephrine, renin activity, aldosterone. and plasma volume were monitored. At 30 and 90 days after ultnfiltration. hormones, renal function, functional capacity (based on cardiopulmonary tests), and extravascular lung water (chest radiograph score) were determined. Soon after ultrafiltration. body weight. plasma volume, and diuresis were reduced (hypovolemia) and hormones were raised (reaction to hypovolemia). In the next 4 days. all these variables reverted to the pre-ultrafiltration values in group B; in group A diuresis and plasma volume recovered, body weight was still reduced, and hormones became lower than baseline. These changes persisted in the next 3 months. An early reduction of extravascular lung water continued long term in group A only, associated with increase of exercise tolerance time and oxygen uptake and decrease of the dead space/tidal volume ratio. Conclusions: In congestive heart failure. ACE inhibition persistently prevented fluid accumulation once the excess of body fluid had been withdrawn with a nonpharmacologic method, resulting in sustained improvement in functional capacity. Reduction in circulating norepinephrine, aldosterone. and renin did not seem to be the cause but the consequence of this action, whose mechanisms remain undefined.
Pathway to Dry Skin Prevention and Treatment
Authors: Guenther Lyn , Lynde Chuck W. , Andriessen Anneke , Barankin Benjamin , Goldstein Eric , Skotnicki Sandra P. , Gupta Samir N. , Choi Kenneth Lee , Rosen Nathan , Shapiro Lori , Sloan Kevin 
Published: January 2017

Background: This article presents an evidence-supported clinical pathway for dry skin prevention and treatment. Objective: The development of the pathway involved the following: a literature review was conducted and demonstrated that literature on dry skin is scarce. To compensate for the gap in the available literature, a modified Delphi method was used to collect information on prevention and treatment practice through a panel, which included 10 selected dermatologists who currently provide medical care for dermatology patients in Ontario. An advisor experienced in this therapeutic area guided the process, including a central meeting. Panel members completed a questionnaire regarding their individual practice in caring for these patients and responded to questions on assessment of dry skin etiology, frequency of skin care visits for consultation and follow-up, assessment, and referral to other specialties. The panel members reviewed a summary of all responses and reached a consensus. The result was presented as a clinical pathway. Conclusion: The panel concluded that our current awareness of dry skin and therefore prevention and effective treatment is limited; that identifying dry skin and its clinical issues requires tools such as clinical pathways, which may improve patient outcomes; and that additional research on dry skin etiology, prevention, and treatment is necessary.
An Economic Evaluation Comparing Two Schedules of Antenatal Visits
Authors: Henderson Jane , Roberts Tracy , Sikorski Jim , Wilson Jennifer , Clement Sarah 
Published: January 2017

Objectives: To conduct an economic evaluation comparing a traditional antenatal visiting schedule (traditional care) with a reduced schedule of visits (new style care) for women at low risk of complications. Methods: Economic evaluation using the results of a randomised controlled trial, the Antenatal Care Project. This took place between 1993 and 1994 in antenatal clinics in South East London and involved 2794 women at low risk of complications. Results: The estimated baseline costs to the UK National Health Service (NHS) for the traditional schedule were £544 per woman, of which £251 occurred antenatally, with a range of £327–1203 per woman. The estimated baseline costs to the NHS for the reduced visit schedule was £563 per woman, of which £225 occurred antenatally, with a range of £274–1741 per woman. Savings from new style care that arose antenatally were offset by the greater numbers of babies in this group who required special or intensive care. Sensitivity analyses based on possible variations in unit costs and resource use and modelled postnatal stay showed considerable variation and substantial overlap in costs. Conclusions: Patterns of antenatal care involving fewer routine visits for women at low risk of complications are unlikely to result in savings to the Health Service. In addition, women who had the reduced schedule of care reported greater dissatisfaction with their care and poorer psychosocial outcomes which argues against reducing numbers of antenatal visits.
Do Physician Practice Styles Persist over Time? Continuities in Patterns of Clinical Decision-Making among General Practitioners
Authors: Davis Peter , Gribben Barry , Scott Alastair , Lay-Yee Roy 
Published: January 2017

Objectives: This study seeks to determine whether there are identifiable differences in patterns of clinical decision-making among family physicians, and whether these patterns persist over time. Methods: A representative cross-sectional survey of general practice encounters in the Waikato region of New Zealand in 1979–1980 was repeated in 1991–1992. Patterns of clinical decision-making were operationalised as practitioner rates for writing a prescription, ordering a laboratory test or radiological examination and the recommendation of a future follow-up office visit at a specified date. Comparable data were available for a cohort of 50 physicians in both surveys. Multi-level techniques and a simulation exercise were used to study the patterns of decision-making over time. Results: Raw, unadjusted correlations for the 50 family physicians between the two surveys were 0.24, 0.14 and 0.55 for rates of prescribing, investigations and follow-up, respectively. However, these correlations increased substantially, to 0.55, 0.41 and 0.70, once account was taken of case mix, data clustering and inter-practitioner variation in patient sample size. The extent of this recovery of the underlying correlations was confirmed in a parallel simulation exercise. Conclusions: This study confirms the existence of substantial and durable individual practice styles in primary medical care, with implications for the development and successful implementation of clinical guidelines.
Does Gender Bias Exist in the Use of Specialist Health Care?
Authors: Raine Rosalind 
Published: January 2017

Objectives: To investigate the evidence for the existence of gender bias (defined as care provided independently of clinical need) in the use of specialist services by critically appraising the literature. Methods: A computer-assisted search of the bibliographic databases PubMed, Medline, EMBASE, Healthstar and Social Science Citation Index for English language papers published from 1966 until May 1999. In addition, four journals were handsearched and the reference lists of identified papers were explored. Retrospective studies were only used when there were insufficient prospective studies. Results: One hundred and thirty-eight studies were identified covering five major topics: coronary artery disease; renal transplantation; human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS); mental illness; and other (mainly invasive) procedures. The majority (94) examined coronary artery disease. It appears that men are more likely to undergo non-invasive investigations than women, but that subsequent investigation and treatment shows no clear evidence of gender differences. Men are more likely to undergo renal transplantation and, for those with HIV and AIDS, to receive azidothymidine (zidovudine, AZT) than women. There are some indications that disparities in favour of men also occur for those suffering from cardiac arrhythmias and cerebrovascular disease, and for those undergoing vascular surgery, hip replacement and heart transplantation. In contrast, women are more likely to undergo liver transplantation and cataract surgery. Mental health services may be provided differently for men and women. All these findings are limited by a lack of accurate denominator information and insufficient ability to adjust for prognostic factors. Conclusions: Differences in health care use can be due to demand factors (e.g. differences in the prevalence and severity of disease or in patient preferences), supply factors (particularly clinical judgement), or both. There is a need to examine these explanations thoroughly for gender inequalities in order to ensure that equity (lack of bias) is achieved. There is also a need for higher quality studies if differences are to be attributed conclusively to bias or not.
Outcome after Transthoracic Resection of Carcinoma of the Oesophagus and Oesophago-Gastric Junction
Authors: Jensen L. S. , Pilegaard H. K. , Puho E. , Pahle E. , Melsen N. C. 
Published: January 2017

Aims: To assess the postoperative morbidity and mortality, length of stay and long-term survival after resection of carcinoma of the oesophagus and gastro-oesophageal junction, after establishment of a new surgical team unit between thoracic and gastroenterologic surgeons. Methods: We analysed the prospective collected data of 166 consecutive patients who underwent a transthoracic oesophageal resection between June 1997 and December 2003. Results: There were 119 men and 47 women. The median age was 63 years (range 36–81). Fifty-five patients (33 %) had squamous cell carcinoma and 111 (67 %) had adenocarcinoma. Postoperative complications occurred in a total of 60 patients (36 %). Ten patients (6 %) died postoperatively, eight (4.8 %) due to medical and two (1.2 %) due to surgical complications. The median postoperative length of stay was 11 days (range 6–75). The overall 3- and 5- years survival was 35.6 % and 30.6 % respectively. Survival was adversely affected by patient age and tumor stage. Conclusions: Concentrating resection for carcinoma of the oesophagus and oesophagogastric junction to a dedicated team of specialists, including both gastrointestinal and thoracic surgeons as well as thoracic-anaesthesiological know-how, results in acceptable complication rates as well as low mortality rates especially due to surgical complications.
Intraoperative Cholangiography Can Be Safely Omitted during Laparoscopic Cholecystectomy: A Prospective Study of 413 Consecutive Patients
Authors: Lepner U. , Grünthal V. 
Published: January 2017

Background and Aims: The aim of the study was to show that laparoscopic cholecystectomy (LC) can be performed safely without intraoperative cholangiography (IOC). Material and Methods: We conducted a prospective study of 413 consecutive patients with symptomatic gallstone disease, who underwent LC. According to the preoperative clinical, laboratory and ultrasound criteria, 38 patients (9.2 %) were selected for preoperative endoscopic retrograde cholangiography (ERC). All patients were followed postoperatively for symptoms and signs of common bile duct (CBD) stones. Results: Preoperative ERC allowed to make a diagnosis of choledocholithiasis in 22 (58 %) of the 38 selected patients. Stone clearance was achieved with endoscopic sphincterotomy (ES) in all cases. Three patients (7.9 %) had an episode of mild self-limited pancreatitis after the procedure. Eight patients (1.9 %) of 413 required conversion from LC to open cholecystectomy. There were no CBD injuries and no death cases. Of the postoperative complications, 1.5 % were recorded during hospital stay. During the follow-up period, for at least 2 years after surgery, retained CBD stones were verified in 6 patients (1.5 %); however, the supposed rate of residual stones was 2.4 %. Conclusions: This study demonstrates that performance of selective preoperative ERC with ES when necessary, followed by LC, is an appropriate and safe approach to the treatment of patients with cholecystolithiasis and unsuspected choledocholithiasis. This approach allows to omit IOC and to perform LC safely without biliary duct injuries, ensuring low rate of retained CBD stones in the late follow-up period.