bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Medial Portal for Hip Arthroscopy in Children With Septic Arthritis: A Safety Study
Authors: Edmonds Eric W. , Lin Christina , Farnsworth Christine L. , Bomar James D. , Upasani Vidyadhar V. 
Published: September 2016

Background:
Prompt open arthrotomy is historically utilized to treat pediatric septic arthritis of the hip, but arthroscopy has been described as a valid alternative to prevent long-term sequelae. Standard hip arthroscopy in adolescents and adults utilizes lateral-based portals, but successful irrigation in infants may necessitate a medial portal due to the smaller joint size. The purpose of this study was to determine the safety of a medial hip portal in children based on its anatomic relation to neurovascular structures.

Methods:
A retrospective review of children 6 years of age or below with septic hip arthritis who obtained a preoperative magnetic resonance imaging (MRI) between 2009 and 2015 was performed. Multiple measures were recorded from the MRI to create a 3D cone with the vertex just posterior to the adductor longus at the convergence of the gluteal and inguinal creases—a previously described posteromedial portal—with the cone base being a circle defined as the central joint diameter. The distance to the femoral vessels and nerve were then recorded. An adult cadaver was then utilized to replicate the proposed portal starting point and trajectory to confirm that it could be reproducible in a clinical setting.

Results:
After applying criteria, 47 MRI were evaluated (21 boys, 26 girls) demonstrating a mean distance to femoral vessels and nerve: at insertion, 18.9 mm (minimum 10.5 mm) and at the hip joint, 11.1 mm (minimum 5.2 mm). Girls and boys did not differ significantly, but there was a significant correlation of both age (r=0.75) and body weight (r=0.84) to the measured distance (P<0.001). Imaging of the cadaver confirmed that the starting point could be replicated.

Conclusions:
There is a direct relation to size of the child and the distance from the neurovascular structures to the cannula trajectory, but even the smallest of children have at least 5.5 mm of adductor longus to protect the femoral structures. A medial-based portal that utilizes a medial needle for initial aspiration features a wide margin of safety for children requiring treatment for septic hip arthritis.

Level of Evidence:
Level IV.
Radiographic Anatomy of the Pediatric Lisfranc Joint
Authors: Knijnenberg Lisa M. , Dingemans Siem A. , Terra Maaike P. , Struijs Peter A.A. , Schep Niels W.L. , Schepers Tim 
Published: September 2016

Background:
Injuries to the Lisfranc joint in children and adolescents are rare. The incomplete ossification of the bones of the foot makes it difficult to detect injuries.
The aim of this study was to determine age-specific radiographic measurements of the Lisfranc joint to provide guidance to the radiologist, emergency physicians, and surgeons to decrease misdiagnosis of Lisfranc injuries and improve detection.

Methods:
We retrospectively reviewed all foot radiographs without traumatic injury made between August 2014 and February 2015 in all patients younger than 18. The attendance list of the Emergency Department and Outpatient Clinic of a level-1 trauma center were used. Using a non–weight-bearing anteroposterior-view of the foot the distance between the base of metatarsal 1 and metatarsal 2 (MT1-MT2) and the distance between the medial cuneiform (MC) and the base of metatarsal 2 (MC-MT2) were measured. Median normal values were calculated per age.

Results:
A total of 352 patients between the age of 0 and 18 years were screened for eligibility. Excluded were 109 patients because of anatomic abnormality, a fracture, inadequate radiograph, pain at the base of the first metatarsal, second metatarsal or MC, persisting pain at the Outpatient Clinic checkup or no follow-up. Included in the analysis were 243 patients.

Conclusions:
The distance between the base of MT1-MT2 was constant below 3 mm. Measurements for both MT1-MT2 and MC-MT2 distance approached adult values at the age of 6.

Level of Evidence:
Level III.
Femoral Neck Aspiration Aids in the Diagnosis of Osteomyelitis In Children With Septic Hip
Authors: Schlung Jedidiah E. , Bastrom Tracey P. , Roocroft Joanna H. , Newton Peter O. , Mubarak Scott J. , Upasani Vidyadhar V. 
Published: September 2016

Background:
The role of femoral aspiration (FA) in the treatment of septic arthritis of the hip is controversial. The purpose of this study was to determine if FA conducted concomitantly with irrigation and debridement (I&D) of the septic hip aids in microorganism and osteomyelitis identification and alters the treatment plan, or if the risks of the procedure outweigh its potential benefit. We also compare preoperative magnetic resonance imaging (MRI) with FA for diagnosis of osteomyelitis cooccurring with septic arthritis.

Methods:
Retrospective review was performed of all patients treated at a single institution between January 2003 and June 2014 for suspected septic hip arthritis. Eighty-three patients were identified with suspected or confirmed septic arthritis and 28 patients (33%) had cooccurring osteomyelitis. Demographic and clinical data were recorded for each patient. The sensitivity and specificity of FA and MRI for diagnosing osteomyelitis were determined.

Results:
Among the 83 patients with confirmed or suspected septic arthritis, 31 patients (37%) had a FA performed at the time of the hip I&D, resulting in positive cultures in 17 patients. All of these patients had other positive cultures (blood and/or joint fluid) that grew the same organism. 54 patients (65%) had a preoperative MRI. The MRI was falsely negative in 10 patients, 6 of whom had a positive FA resulting in appropriate management of osteomyelitis. Missed or delayed diagnosis of osteomyelitis resulted in significant morbidity in 3 patients (avascular necrosis and femoral neck fracture, extensive lower extremity osteomyelitis, and subtrochanteric fracture with malunion). No complications associated with FA were identified. FA and MRI were found to have sensitivity/specificity for osteomyelitis of 100%/100% and 38%/95%, respectively.

Conclusions:
Although FA did not improve microorganism identification, it did aid in the diagnosis of cooccurring osteomyelitis when treating children with septic arthritis, especially in patients with false negative MRI findings for osteomyelitis. We recommend FA at the time of septic hip I&D as its benefits appear to far outweigh its risks.

Level of Evidence:
Level III—diagnostic study.
Multiple Enchondromas of the Hand in Children: Long-Term Follow-Up of Mean 15.4 Years
Authors: Kadar Assaf , Kleinstern Geffen , Morsy Mohamed , Soreide Endre , Moran Steven L. 
Published: September 2016

Background:
Multiple enchodromatosis of bone, termed Ollier’s disease, or Maffucci syndrome when associated with hemangiomas, is a rare disease that can affect the pediatric hand. This condition often causes a finger mass, deformity, pain and possible pathologic fractures, and has been associated with malignant transformation to chondrosarcoma. The aim of our study is to describe the long-term sequela of multiple enchondromatosis of the hand in the pediatric population, specifically the rates of malignant transformation, tumor recurrence, rates of pathologic fracture, and phalangeal growth arrest.

Methods:
We examined 15 pediatric patients who were treated in our institute with a total of 127 phalanges and metacarpals lesions. Only patients with follow-up of at least 4 years were included. We retrospectively reviewed patients’ chart and hand radiograph for symptoms including pathologic fractures, indications for surgery, and postoperative complications including tumor recurrence, and malignant transformation. We assessed phalangeal growth arrest with radiographs and normalized phalangeal growth charts.

Results:
Mean age of diagnosis was 5.8 years and mean follow-up time was 15.4 years. Pathologic fractures were common at 46% of pediatric patients, but ceased to occur once reaching adulthood. Outcomes of pathologic fractures were excellent, regardless of treatment. Malignant transformation occurred in 1 patient and did not occur during childhood. A total of 80% of patients and 29% of lesions underwent surgical treatment of curettage and bone graft for the lesion, yet recurrence was common and affected 33% of treated patients. Phalangeal growth arrest was the most common long-term sequela and affected 11% of phalanxes and metacarpals. This sequela was significantly more prevalent in patients who had surgical excision of the tumor.

Conclusions:
Our findings reassure that malignant transformation of enchodromatosis of the hand is unlikely in the pediatric population. Pathologic fracture is common, but has excellent outcomes. When considering surgery, parents should be counseled about the possibility of phalangeal growth arrest and recurrence of the lesion.

Type of Study/Level of Evidence:
Level IV—therapeutic.
A Retrospective Evaluation of Subsurface Monopolar Radiofrequency for Lifting of the Face, Neck, and Jawline
Authors: Dendle Julia , Wu Douglas C. , Fabi Sabrina G. , Melo Diana , Goldman Mitchel P. 
Published: September 2016

BACKGROUND
Subsurface monopolar radiofrequency (SMRF) has emerged as a new method for reducing skin laxity via the controlled delivery of thermal energy below the skin using a radiofrequency probe.

OBJECTIVE
To evaluate the overall efficacy of the treatment and satisfaction ratings of subjects who underwent a single SMRF treatment to the face, neck, or jawline (or some combination).

MATERIALS AND METHODS
A retrospective, single-center study was conducted in which data were obtained via subject follow-ups at 90 and 180 days posttreatment.

RESULTS
A total of 35 subjects, 6 men and 29 women, underwent a single SMRF treatment. Overall, 77% of subjects reported improvement, and 64% reported satisfaction with the treatment site at Day 180 posttreatment.

CONCLUSION
Subsurface monopolar radiofrequency represents an effective modality to achieve skin tightening of the face, neck, and jawline. The data suggest that there is an energy delivery threshold, above which a higher percentage of subjects report satisfaction. Analysis of treatments parameters suggests an optimal treatment time and tissue temperature that should be achieved to maximize results.
Diagnostic Change From Atypical Intraepidermal Melanocytic Proliferation to Melanoma After Conventional Excision—A Single Academic Institution Cross-Sectional Study
Authors: Zhang Junqian , Miller Christopher J. , Sobanko Joseph F. , Shin Thuzar M. , Etzkorn Jeremy R. 
Published: September 2016

BACKGROUND
Atypical intraepidermal melanocytic proliferation (AIMP) is a histopathologic diagnosis with uncertain malignant potential and presents a surgical management dilemma for clinicians.

OBJECTIVE
To identify the associated clinical and histopathologic factors and the frequency of diagnostic change to melanoma after conventional excision of AIMP.

METHODS
Retrospective cross-sectional study of 306 AIMPs treated by conventional excision.

RESULTS
Diagnostic change to melanoma occurred in 4.2% (13/306) of AIMP lesions after histopathologic review of the excision specimen; melanomas were in situ in 85% (11/13) and invasive in 15% (2/13) of cases. Factors associated with diagnostic change to melanoma included anatomic location on the head and neck (Odds ratio [OR] 8.49, 95% confidence interval [CI] 2.17, 33.19; p = .001) and acral areas (OR 9.24, 95% CI 2.18, 39.24; p = .001), lesion extension to the base of the biopsy specimen (OR 13.07, 95% CI 2.98, 57.31; p = .001), biopsy using the punch technique (OR 6.06, 95% CI 1.95, 18.86; p = .013), and melanoma in the initial biopsy's histopathologic differential diagnosis (OR 13.29, 95% CI 1.71, 103.57; p = .001).

CONCLUSION
Preoperative counseling and surgical planning for AIMP should be individualized to account for potential diagnostic change to melanoma, especially when specific risk factors are present.
Fractional Laser-Assisted Topical Imiquimod 5% Cream Treatment for Recalcitrant Common Warts in Children: A Pilot Study
Authors: Park Sung-Min , Kim Gun-Wook , Mun Je-Ho , Song Margaret , Kim Hoon-Soo , Kim Byung-Soo , Kim Moon-Bum , Ko Hyun-Chang 
Published: September 2016

BACKGROUND
Conventional treatments for warts like cryotherapy are limited by the pain during procedures, especially in pediatric patients. Imiquimod is a topical immune response modifier, but the thick stratum corneum of common warts prevents drug permeation through skin.

OBJECTIVE
To evaluate the efficacy and safety of fractional laser/topical 5% imiquimod cream for the treatment of warts in children.

METHODS
Eleven pediatric patients with multiple recalcitrant common warts were included. Lesions were treated using an ablative fractional 2,940-nm Er:YAG laser at 1- or 2-week interval. After each laser treatment session, imiquimod 5% cream was self-applied once daily 5 days a week. Response and adverse effects were assessed 2 weekly until complete clearance or up to maximum of 48 weeks. Pain during fractional laser was assessed using a visual analogue scale (0–10).

RESULTS
Eight of the 11 (72.7%) children experienced complete clearance. Mean duration was 29.7 (16–48) weeks, and the mean number of fractional laser was 17.5 (8–37). No significant adverse effect was observed. Pain visual analogue scale during fractional laser was 2.4 (1–4) compared to 6.2 (5–8) during cryotherapy.

CONCLUSION
This pilot study indicates that fractional laser-assisted topical imiquimod may provide benefit for recalcitrant warts in children.
THE SECOND BLIND SPOT: SMALL RETINAL VESSEL VASCULOPATHY AFTER VACCINATION AGAINST NEISSERIA MENINGITIDIS AND YELLOW FEVER
Authors: Moysidis Stavros N. , Koulisis Nicole , Patel Vivek R. , Kashani Amir H. , Rao Narsing A. , Humayun Mark S. , Rodger Damien C. 
Published: September 2016

Purpose:
To describe a case of small retinal vessel vasculopathy postvaccination.

Methods:
We report the case of a 41-year-old white man who presented with a “second blind spot,” describing a nasal scotoma in the right eye that started 4 days after vaccinations against Neisseria meningitidis and the yellow fever virus, and after a 2-month period of high stress and decreased sleep. Clinical examination, Humphrey visual field testing, and multimodal imaging with fundus photographs, autofluorescence, fluorescein angiography, and spectral domain optical coherence tomography and angiography were performed.

Results:
Clinical examination revealed a well-circumscribed, triangular area of retinal graying of about 1-disk diameter in size, located at the border of the temporal macula. This corresponded to a deep scotoma similar in size to the physiologic blind spot on Humphrey visual field 24-2 testing. There was mild hypoautofluoresence of this lesion on autofluorescence, hypofluorescence on fluorescein angiography, and focal attenuation of a small artery just distal to the bifurcation of an artery supplying the involved area. Spectral domain optical coherence tomography through the lesion conveyed hyperreflectivity most prominent in the inner and outer plexiform layers, with extension of the hyperreflectivity into the ganglion cell and inner nuclear layers. Spectral domain optical coherence tomography angiography demonstrated arteriolar and capillary dropout, more pronounced in the superficial retinal layer compared to the deeper retinal layer. At 1-month follow-up, his scotoma improved with monitoring, with reduction from −32 dB to −7 dB on Humphrey visual field testing. There was clinical resolution of the area of graying and decreased hyperreflectivity on spectral domain optical coherence tomography, with atrophy of the inner retina. Spectral domain optical coherence tomography angiography showed progression of arteriolar and capillary dropout, more so in the superficial than in the deep capillary plexus.

Conclusion:
We describe a case of small artery occlusion in a previously healthy patient, 4 days after vaccination against N. meningitidis and yellow fever. Fluorescein angiography yielded greater diagnostic value than OCTA for evaluating the occlusion, whereas spectral domain optical coherence tomography angiography enabled better visualization of capillary dropout and layer-specific assessment. Further research is required to determine whether vaccination in general, or directed specifically at N. meningitidis or yellow fever, is associated with small vessel vasculopathy and the underlying pathogenesis.
PHENOTYPING CHOROIDEREMIA AND ITS CARRIER STATE WITH MULTIMODAL IMAGING TECHNIQUES
Authors: Ma Kevin K. , Lin James , Boudreault Katherine , Chen Royce W. S. , Tsang Stephen H. 
Published: September 2016

Purpose:
To describe findings in a patient with choroideremia (CHM) and his mother, an obligate CHM carrier.

Methods:
Case report.

Results:
A 25-year-old man with nyctalopia and poor peripheral vision since childhood, as well as a family history consistent with an X-linked retinal disorder was diagnosed with CHM. His asymptomatic 50-year-old mother, an obligate carrier, was also examined. Fundus examination of the affected man showed significant atrophy of the choroid and retinal pigment epithelium, whereas the carrier woman showed patchy pigmentary mottling. Imaging of the affected man showed diffuse retinal pigment epithelium atrophy on optical coherence tomography and extensive areas of decreased choriocapillaris flow on optical coherence tomography angiography. By contrast, the carrier woman showed subtle retinal pigment epithelium changes on optical coherence tomography and mild flow alterations on optical coherence tomography angiography.

Conclusion:
This case demonstrates the findings seen in CHM, and while CHM carrier women are often asymptomatic, they may exhibit a mosaic pattern of pigmentary change on fundus examination. Optical coherence tomography angiography may show mild choroidal flow abnormalities. This finding serves to further characterize the extent of dysfunction in CHM and its carrier state.
Antimicrobial Efficacy of Multipurpose Disinfecting Solutions in the Presence of Contact Lenses and Lens Cases
Authors: Gabriel Manal M. , McAnally Cindy , Bartell John 
Published: September 2016

Objective:
The aim of this study was to use antimicrobial efficacy endpoint methodology to determine compatibility of multipurpose disinfecting solutions (MPSs), lens cases, and hydrogel lenses for disinfection (AEEMC) against International Organization for Standardization (ISO)–specified microorganisms and clinical ocular isolates of Stenotrophomonas maltophilia.

Methods:
Six MPSs (PQ/Aldox 1, 2, and 3; PQ/Alexidine; PQ/PHMB; and PHMB) were challenged against ISO-specified microorganisms and S. maltophilia using the AEEMC test. AEEMC tests were performed with and without balafilcon A, etafilcon A, and senofilcon A lenses in lens cases with organic soil. Exposure times included disinfection time (DT) and 24 hr. Additionally, all six MPSs were challenged with two strains of S. maltophilia, based on the ISO Stand-alone test.

Results:
The efficacy against bacteria for PQ/Aldox and PQ/Alexidine MPSs was not diminished by the presence of lenses. The efficacy of PQ/PHMB and PHMB MPSs against Serratia marcescens was significantly reduced compared with the no-lens control at DT for at least one lens type. The PHMB MPS with lenses present also demonstrated reduced efficacy against Staphylococcus aureus at DT versus the control. PQ/Aldox MPSs retained activity against Fusarium solani with lenses present; however, all other test MPSs demonstrated reduced F. solani efficacy at DT with lenses present. With lenses, all MPSs showed reduced efficacy against Candida albicans.

Conclusions:
AEEMC antimicrobial efficacy test results vary based on challenge microorganism, contact lenses, and MPS biocide systems. This study highlights the importance of evaluating MPSs for compatibility with lenses and lens cases.
Simultaneous Implantation of an Ahmed and Baerveldt Glaucoma Drainage Device for Uncontrolled Intraocular Pressure in Advanced Glaucoma
Authors: Rao Veena S. , Christenbury Joseph , Lee Paul , Allingham Rand , Herndon Leon , Challa Pratap 
Published: September 2016

Purpose:
To evaluate efficacy and safety of a novel technique, simultaneous implantation of Ahmed and Baerveldt shunts, for improved control of intraocular pressure (IOP) in advanced glaucoma with visual field defects threatening central fixation.

Patients and Methods:
Retrospective case series; all patients receiving simultaneous Ahmed and Baerveldt implantation at a single institution between October 2004 and October 2009 were included. Records were reviewed preoperatively and at postoperative day 1, week 1, month 1, month 3, month 6, year 1, and yearly until year 5. Outcome measures included IOP, best-corrected visual acuity, visual field mean deviation, cup to disc ratio, number of glaucoma medications, and complications.

Results:
Fifty-nine eyes were identified; mean (±SD) follow-up was 26±23 months. Primary open-angle glaucoma was most common (n=37, 63%). Forty-six eyes (78%) had prior incisional surgery. Mean preoperative IOP was 25.5±9.8 mm Hg. IOP was reduced 50% day 1 (P<0.001, mean 12.7±7.0 mm Hg), which persisted throughout follow-up. At year 1, cup to disc ratio and mean deviation were stable with decreased best-corrected visual acuity from logMAR 0.72±0.72(20/100) to 1.06±1.13(20/200) (P=0.007). The Kaplan-Meier survival analysis showed median and mean survival of 1205 and 829±91 days, respectively. Complication rate was 47%.

Conclusions:
IOP is markedly reduced postoperative day 1 following double glaucoma tube implantation with effects persisting over postoperative year 1 and up to year 5. Complications were higher than that seen in reports of single shunt implantation, which may be explained by patient complexity in this cohort. This technique may prove a promising novel approach for management of uncontrolled IOP in advanced glaucoma.
Patterns of Retinal Nerve Fiber Layer Loss in Different Subtypes of Open Angle Glaucoma Using Spectral Domain Optical Coherence Tomography
Authors: Baniasadi Neda , Paschalis Eleftherios I. , Haghzadeh Mahdi , Ojha Pallavi , Elze Tobias , Mahd Mufeed , Chen Teresa C. 
Published: September 2016

Purpose of the Study:
The purpose of the study was to determine whether there are different patterns of retinal nerve fiber layer (RNFL) thinning as measured by spectral domain optical coherence tomography (SD-OCT) for 4 subtypes of open angle glaucoma (OAG): primary OAG (POAG), normal tension glaucoma (NTG), pseudoexfoliation glaucoma (PXG), and pigmentary glaucoma (PDG) and to compare them with normal controls.

Materials and Methods:
SD-OCT RNFL thickness values were measured for 4 quadrants and for 4 sectors (ie, superior-nasal, superior-temporal, inferior-nasal, and inferior-temporal). Differences in RNFL thickness values between groups were analyzed using analysis of variance. Paired t tests were used for quadrant comparisons.

Results:
Two hundred eighty-five participants (102 POAG patients, 33 with NTG, 48 with PXG, 13 with PDG, and 89 normal patients) were included in this study. All 4 subtypes of OAG showed significant RNFL thinning in the superior, inferior, and nasal quadrants as well as the superior-temporal and inferior-temporal sectors (all P-values <0.0001) compared with normals. POAG and NTG patients had greater RNFL thinning inferiorly and inferior-temporally than superiorly (P-values: 0.002 to 0.018 and 0.006, respectively) compared with PXG patients. In contrast, PDG patients had greater RNFL thinning superiorly and superior-nasally than inferiorly compared with other OAG subtypes (ie, POAG, NTG, PXG groups, with P-values: 0.009, 0.003, 0.009, respectively). Of the 4 OAG subtypes, PXG patients exhibited the greatest degree of inter-eye RNFL asymmetry.

Conclusions:
This study suggests that SD-OCT may be able to detect significant differences in patterns of RNFL thinning for different subtypes of OAG.