bluuebunny/crossref_metadata_2025_split huggingface dataset:
Baclofen Toxicity in Patients with Severely Impaired Renal Function
Authors: Chen Kuo-Su , Bullard Michael J , Chien Yu-Yi , Lee Sheng-Yuan 
Published: January 2017

OBJECTIVE: To report the toxic effects of baclofen in patients with severely impaired renal function. DATA SOURCES: From 1991 to 1995, nine patients with severely impaired renal function (2 not receiving dialysis, 1 undergoing continuous ambulatory peritoneal dialysis [CAPD], and 6 receiving maintenance hemodialysis), who exhibited clinical toxicity after baclofen therapy at our hospital were included for analysis. Another seven cases from the literature obtained by computerized (MEDLINE) and manual ( Index Medicus) search methods published between 1980 and 1995 were also reviewed. INTERVENTION: Among our nine patients, the six undergoing chronic hemodialysis and one not undergoing dialysis received early (<48 h) hemodialysis after toxic symptoms developed. The patient undergoing CAPD received late hemodialysis (>72 h), and the other patient who had not undergone dialysis received only supportive care. RESULTS: A review of these 16 cases revealed that most patients received only small doses and very short-term baclofen therapy. Altered consciousness was the major presenting feature. Severe acute complications, such as seizures and respiratory depression, were relatively uncommon among patients with severely impaired renal function. However, abdominal pain, which has previously rarely been reported, was noted in five of our nine patients. Most patients showed clinical improvement after hemodialysis. An analysis of these nine patients revealed that those who received early hemodialysis had a shorter recovery time than the patient who received only supportive care (2.71 ± 0.42, respectively, vs. 9 d; p < 0.01). A lag of several hours between the end of the hemodialysis session and an improvement in the level of consciousness was noted. DISCUSSION: As most patients with severely impaired renal function developed toxic symptoms soon after initiating a low-dose baclofen regimen, the accumulated dosage was small and severe complications were less common. Abdominal pain may have occurred as a result of the γ-aminobutyric acid—mediated cholinergic effect exerted by baclofen. The delay in conscious recovery after hemodialysis may be due to a delay in the clearance of baclofen from the central nervous system. CONCLUSIONS: Patients with severely impaired renal function generally develop baclofen intoxication soon after the initiation of low-dose therapy. Thus, the administration of baclofen, regardless of the dosage, in these patients is not appropriate. Abdominal pain, in addition to altered consciousness, is a common presenting feature in patients with renal failure who have baclofen intoxication. Hemodialysis is effective in alleviating the clinical symptoms and shortening the recovery time for such patients.
Agranulocytosis Induced by Vancomycin or Ticarcillin/Clavulanate
Authors: Mandl Delbert L , Garrison Mark W , Palpant Samuel D 
Published: January 2017

OBJECTIVE: To reacquaint clinicians with a reportedly rare adverse event of agranulocytosis occurring after long-term administration of vancomycin and ticarcillin/clavulanate, with a subsequent review of other reported cases in the literature. CASE SUMMARY: A 45-year-old white woman with spina bifida developed agranulocytosis (2.7 × 103/mm3 white blood cells with only 3% polymorphonuclear leukocytes and no reported eosinophils or basophils) after long-term administration of vancomycin and ticarcillin/clavulanate for decubitus ulcers and chronic osteomyelitis. Consequently, the cell counts rebounded rapidly on discontinuation of both medications and returned to normal within 1 week. DISCUSSION: The incidence of vancomycin-associated neutropenia is presumably rare, but the increased use of vancomycin may disclose a more frequent occurrence. It is suggested that the mechanism for the reaction is immunologically mediated, yet this remains unclear. Although it is difficult to determine the causative agent in this case, vancomycin was most suspect clinically. Ticarcillin/clavulanate is less likely because our patient has since been readmitted and treated with oxacillin, imipenem/cilastatin, and amoxicillin/clavulanate without affecting the white blood cell count. In that regard, it could be reasoned that an immunologic reaction to ticarcillin would have resulted in a similar outcome with other penicillins. CONCLUSIONS: This case serves as a reminder to clinicians that patients receiving long-term treatment with vancomycin should have their white blood cell count monitored at least weekly.
Recombinant Human Tumor Necrosis Factor Receptor (P75) Fc Fusion Protein (Tnfr: Fc) in Rheumatoid Arthritis
Authors: Murray Kim M , Dahl Stephen L 
Published: January 2017

BACKGROUND: Tumor necrosis factor (TNF) is the dominant mediator of the cytokine cascade that causes inflammation and joint destruction in rheumatoid arthritis. A new class of agents under investigation, the biologic TNF inhibitors, inhibits the activity of TNF. Recombinant human TNF receptor p75 Fc fusion protein (TNFR: Fc; Enbrel) blocks the activity of the cytokine TNF. The preclinical, Phase I, and Phase II data of TNFR: Fc in rheumatoid arthritis are reviewed in this article. METHODS: All available data on TNFR: Fc in rheumatoid arthritis were reviewed. These data included published literature and data on file at the manufacturer. RESULTS: TNFR: Fc has been effective in many models of inflammation, including animal models of rheumatoid arthritis and in clinical rheumatoid arthritis trials. Conclusions from a study with TNFR “knockout” mice (genetically altered mice incapable of producing TNFR proteins) demonstrated that p75 TNFR is a natural antagonist of TNF-mediated inflammation. A placebo-controlled, dose-escalation, Phase I trial evaluated the safety and efficacy of TNFR: Fc in patients with rheumatoid arthritis. There were no serious adverse effects reported. A Phase II, randomized, double-blind, placebo-controlled trial evaluated 180 patients with active rheumatoid arthritis whose previous therapy had failed. A dose-response relationship was observed in the number of tender and swollen joints; patients who received the highest dose (16 mg/m2) of TNFR: Fc had the greatest improvement. Treatment was generally well tolerated. TNFR: Fc is nonimmunogenic; no antibodies to TNFR: Fc have been detected thus far in human studies. CONCLUSIONS: Preliminary data indicate that TNFR: Fc is an excellent candidate for future long-term studies in the treatment of rheumatoid arthritis.
Prehospital-Initiated Thrombolysis
Authors: Spinler Sarah A , Mikhail Peter A 
Published: January 2017

OBJECTIVE: To evaluate the feasibility, safety, and efficacy of prehospital-initiated thrombolysis in decreasing the mortality rate due to acute myocardial infarction. DATA SOURCES: English-language clinical studies, abstracts, and review articles identified from MEDLINE searches and bibliographies of identified articles. Epidemiologic data were extracted from the Internet. STUDY SELECTION: Eight randomized clinical trials and two metaanalyses that compared prehospital-initiated thrombolysis with in-hospital-initiated thrombolysis. DATA EXTRACTION: Pertinent studies were selected and the data were synthesized into a review format. DATA SYNTHESIS: Early reperfusion of an infarct-related coronary artery is associated with lower mortality rates. Most of the delay in initiating treatment is caused by patient delay rather than transport delay or hospital delay. In addition, more than 30% of eligible patients do not receive thrombolytic therapy. Prehospital initiation of thrombolysis has been evaluated as a means of decreasing hospital delay and increasing the number of eligible patients receiving thrombolysis. Clinical trials document that prehospital-initiated thrombolysis is feasible and safe, and saves time. Of the eight randomized trials, three demonstrated a decrease in either cardiac or total mortality with prehospital thrombolysis. All studies were limited by relatively small sample sizes. Two published metaanalyses suggest a 16-17% reduction in mortality with prehospital thrombolysis. In the US, prehospital thrombolysis is not routinely recommended due to medical issues related to diagnostic accuracy and monitoring, legal concerns, and economic implications. Additional strategies, such as community-wide education and prehospital diagnostic electrocardiograms (ECGs), are being studied. CONCLUSIONS: In clinical trials, prehospital-initiated thrombolytic therapy was shown to be safe and probably more effective than in-hospital administration of thrombolytic therapy, but this has not proven feasible in the US at this time. Despite time-savings by decreasing treatment delay with prehospital-initiated thrombolysis, patient delay still persists and accounts for the majority of delay. Future investigations will center on increasing the number of patients treated with thrombolytic agents through patient education, in-patient and out-patient programs that rapidly identify eligible patients, as well as prehospital diagnostic ECGs.
The Effects of Rotation on Radiographic Evaluation of the Tibiofibular Syndesmosis
Authors: Pneumaticos Spiros G. , Noble Philip C. , Chatziioannou Sofia N. , Trevino Saul G. 
Published: January 2017

Radiographs of 12 normal cadaveric lower extremities were prepared with each extremity in seven increments of axial rotation, ranging from 5° of external rotation to 25° of internal rotation. The tibiofibular clear space, the tibiofibular overlap, the width of the tibia and fibula, and the medial clear space were measured on each film. The width of the tibiofibular clear space (syndesmosis A) averaged 3.9±0.9 mm (range, 2 to 5.5 mm), but did not change significantly with rotation. Its size was independent of the size of tibia and fibula. All other measurements changed dramatically with rotation. In our specimens, a true mortise view of the ankle joint was obtained by internally rotating the extremity an average of 13.6±0.7° (range, 12.0° to 17.0°). Based on our results the width of the tibiofibular clear space on the anterior-posterior view is the most reliable parameter for detecting widening of the syndesmosis on plain radiographs. However, due to its variability among different individuals, comparison views of the contralateral extremity are warranted for confirmation of clinical suspicion of syndesmosis disruption.
The Orthopaedic Research Institute-Ankle Strength Testing System: Inter-Rater and Intra-Rater Reliability Testing
Authors: Paoloni Justin A. , Appleyard Richard C. , Murrell George A. 
Published: January 2017

Achilles tendinosis is a degenerative overuse tendinopathy involving the primary ankle plantarflexors, namely the soleus and gastrocnemius muscles forming the tendo Achilles. The Orthopaedic Research Institute-Ankle Strength Testing System (ORI-ASTS) was designed to record objective measurements of force generated with a resisted ankle plantarflexion test. Testing normal subjects (n=6) was used to establish the reliability of the ORI-ASTS for measuring ankle plantarflexion force. Testing patients with Achilles tendonitis (n=5) over time and comparing Achilles tendon analogue pain scores to ankle plantarflexion force measurements was used to assess the validity of the ORI-ASTS for monitoring progression of Achilles tendinopathy. Inter-rater reliability of the ORI-ASTS with normal subjects was excellent, with single measure intraclass correlation coefficients (ICC) for right mean peak force of 0.92, left mean peak force of 0.96, right mean total force of 0.89, left mean total force of 0.91. The ORI-ASTS also had excellent intra-rater reliability for normal subjects with the following single measure ICC scores: right mean force 0.96, left mean force 0.92, right mean total force 0.97, left mean total force 0.92. The relative technical errors of measurement were calculated from these results, and ranged from 1.0% to 2.7%. Testing patients with Achilles tendinosis (n=5), and comparing analogue activity pain scores to ORI-ASTS testing demonstrated a strong negative relationship between the two parameters (Spearman Rho −0.87 to −1.0, Kendall tau b −0.82 to −1.0). The relationship was statistically significant at the p=0.01 level for two of the five patients. The ORI-ASTS shows excellent reliability for testing ankle plantarflexor force, and appears valid for objectively assessing and monitoring patients with Achilles tendinosis.
The Relationship of the Anterior Drawer Sign to the Shape of the Tibial Plafond in Chronic Lateral Instability of the Ankle
Authors: Kanbe Katsuaki , Hasegawa Atsushi , Nakajima Yasushi , Takagishi Kenji 
Published: January 2017

To determine what factors correlate with values for tested anterior drawer (AD) sign, we investigated stress radiographs in 71 patients with severe chronic lateral instability of the ankle as well as 320 normal controls. We found no correlation between AD and talar tilt (TT), but measurement of the anterior tip ratio (ATR) (ATR=tanA × 100) demonstrated a link of ATR with AD (r=0.74, p<0.001). The posterior tip ratio (PTR) (PTR=tanP × 100) was not correlated with AD (r=0.34, p=0.16). The ankle mortise angle (AMA) (the anterior opening of the lateral ankle mortise) was also not correlated with AD (r=0.27, p=0.23). Investigation of 320 normal ankles revealed a mean ATR of 9.1%±1.4%. The ATR in patients was 7.6%±1.7%, significantly lower than in the control patients. The values in female patients with chronic lateral instabilities were significantly less than the values in the females in the control group. But values for male patients were not different from the control group. Thus the anterior tip of the lateral tibial plafond, as it affects the ATR, may influence instability in anterior drawer function, especially in female patients with chronic lateral ligamentous instability of the ankle.
Proprioception of the Ankle: A Comparison Between Female Teenaged Gymnasts and Controls
Authors: Aydin Taner , Yildiz Yavuz , Yildiz Cemil , Atesalp Sabri , Kalyon Tung Alp 
Published: January 2017

Proprioceptive mechanisms appear to play a role in stabilizing the joints and may serve as a means for interplay between static stabilizers and dynamic muscular restraints. The purpose of our study was to investigate whether or not gymnastic training has any effect on the balance and on proprioception in an ankle, as seen in gymnasts and in nongymnasts. We evaluated the proprioceptive ability of the ankle using four different tests (a one-leg-standing test, a single-limb-hopping test, an active angle-reproduction test, and a passive angle-reproduction test). Proprioception of the ankle was measured in 40 subjects who were assigned to two experimental groups. Group 1 (n: 20) were healthy control subjects, and group 2 (n: 20) were teenaged female gymnasts. The sense of position of a joint was actively measured using a Cybex NORMTM isokinetic dynamometer and measured passively with a proprioception-testing device. A Mann-Whitney U test was used to compare mean values of the gymnasts to the controls. Results revealed statistically significant differences (p<0.05) between two groups. We found no statistically significant differences between the dominant and nondominant ankle in volunteers or in gymnasts, in all tests. The results of this study suggest that gymnastic training has a positive influence on sense of position of the ankle joint and on balance, in addition to increasing muscle tone.
Arthrodesis of the Ankle for Non-Inflammatory Conditions—Healing and Reliability of Outcome Measurements
Authors: Anderson Thomas , Montgomery Fredrik , Besjakov Jack , Verdier Hans , Carlsson Åke 
Published: January 2017

This is a retrospective study of 30 consecutive primary ankle arthrodeses in 29 patients with osteoarthrosis, operated on in our hospital between 1984 and 1994. Two different techniques were utilized: internal fixation with screws or external fixation using Charnley or Hoffman frames. Only 25 ankles in 24 patients were available for clinical examination. They were examined by two independent surgeons on an average of 51 months after surgery (13 to 187 months). Two radiologists separately examined the radiographs that were available — in this case, 29 ankles, without knowledge of clinical data, and 26/29 (89%) were unanimously considered as fused. This is comparable with what is reported in other series. Unanimity among all four observers regarding healing of the arthrodesis occurred in 20/25 ankles (80%). We consider that both a radiological and a clinical evaluation is important for a fair judgement of fusion. We found high consistency among the observers with respect to the clinical scores. However, the consistency was somewhat better for the Mazur than for the Kofoed system.
Surgical Treatment of Superficial Peroneal Neuroma
Authors: Chiodo Christopher P. , Miller Stuart D. 
Published: January 2017

Background: Several techniques have been described for the surgical treatment of symptomatic superficial peroneal neuromas, including transection of the nerve with burial in muscle or bone to prevent recurrence. Methods: We compared in 27 consecutive patients the results of transection and burial of the proximal peroneal nerve stump into muscle (group A) with results of transection and burial of the proximal stump into bone (group B). Results: The perceived pain relief and improvement in mean pain score were significantly higher ( p < .05) in group B than in group A. In addition, four patients in group A required revision neurotomy compared to none in group B. Conclusion: For symptomatic superficial peroneal neuromas, transection with transposition of the proximal nerve stump into bone provides superior results compared with those of neurotomy with transposition of the proximal stump into muscle.
The Obliquity of the First Metatarsal Base
Authors: Hyer Christopher F. , Philbin Terrence M. , Berlet Gregory C. , Lee Thomas H. 
Published: January 2017

Background: The degree of obliquity of the base of the first metatarsal is thought to predispose to metatarsus primus varus deformity. Radiographs currently are used to interpret the obliquity of the proximal first metatarsal but are subject to error. A ‘normal’ obliquity of the first metatarsal base has not yet been established. Methods: Direct measurements of 77 human first metatarsals were used to establish mean values for the proximal first metatarsal obliquity angle with respect to age, gender, and ethnicity in this sample population. The overall length of the first metatarsal and the width of the base were measured. The measured values were compared in relation to age, gender, and ethnicity of the specimens. Results: The overall mean obliquity angle was 3.42 degrees (range, −3 to 8 degrees, SD 2.54). The mean obliquity angle in females was 3.67 degrees (range, −3 to 8 degrees, SD 2.91). The mean obliquity angle in males was 3.30 degrees (range, −2 to 7 degrees, SD 2.24). Mean base obliquity angle in the African-American specimens was 3.0 degrees (range, 3 to 7 degrees, SD 2.59), while the average first obliquity angle in the Caucasian specimens was 3.83 degrees (range, −2 to 8 degrees, SD 2.34). The obliquity of the first metatarsal base increased with age from a mean of 3.5 degrees in the youngest group to 5.13 degrees in the oldest. Conclusions: Exaggerated obliquity of the first metatarsal base is a proposed cause for metatarsus primus varus. No average values had been established for the proximal first metatarsal obliquity. These mean values are useful in determining if pathologic obliquity is present. In this study group, the mean medial obliquity angle was 3.42 degrees.
Functional Outcome (SF-36) of Patients with Displaced Calcaneal Fractures Compared to SF-36 Normative Data
Authors: van Tetering Elisabeth A. A. , Buckley Richard E. 
Published: January 2017

Background: The purpose of this study was to demonstrate the general health status after treatment of displaced intraarticular calcaneal fractures compared to normative data, other orthopaedic procedures, and other medical conditions. Methods: Three hundred and twelve patients between 25 and 64 years of age were treated for displaced intraarticular calcaneal fractures at a Level I trauma center. Followup ranged from 2 to 8 years. The Short Form 36 Health Status Survey (SF-36) was used for outcome measurement. Results: The scores in eight SF-36 categories in patients with displaced intraarticular calcaneal fractures differed by more than five points from the population norms. This suggests that there is clinical and social relevance to this injury. Outcomes in patients with displaced intraarticular calcaneal fractures were not as good across most SF-36 categories as were outcomes of patients with other orthopaedic conditions. Outcomes in patients with intraarticular calcaneal fractures also were worse across most categories than outcomes in patients who had organ transplants or myocardial infarctions. Conclusion: By comparing treatment for displaced intraarticular calcaneal fractures with treatment for orthopaedic problems or other disease processes, we concluded that intraarticular calcaneal fractures are serious life-changing events.
Informed Consent for Ankle Fracture Surgery: Patient Comprehension of Verbal and Videotaped Information
Authors: Rossi Michael , McClellan Robert , Chou Loretta , Davis Kristin 
Published: January 2017

Background: The purpose of our study was to evaluate the effectiveness of using a videotape to give patients information about the risks, benefits, alternatives, and treatment of a common orthopaedic procedure before they sign consent forms. Methods: During a 9-month period, 48 patients with isolated closed ankle fractures requiring surgical intervention were randomized into two groups that received either videotaped or conventional verbal information regarding consent for surgery. The study group watched a videotape containing information about the risks, benefits, and treatment alternatives, while the control group obtained this information verbally. To determine comprehension and retention, all patients completed a multiple-choice questionnaire immediately after receiving the information, and 37 patients (77%) were available to complete a questionnaire at an average of 10 weeks later. Results: The videotape group outperformed the verbal consent group by 40.1% on the initial questionnaire ( p = .0002) and by 27.2% on the followup questionnaire ( p = 0.0139). Patients with educational levels of less than or equal to the 12th grade performed 67.8% better on the initial questionnaire after watching the video than after receiving the information verbally. ( p = .0001). Conclusion: Patients who received information about their surgery on a videotape before giving their consent demonstrated a significant increase in comprehension compared to patients who received this information verbally. The benefit was even greater for patients with lower education levels.