bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exogenous Surfactant Use in Neonates
Authors: Ishisaka Denis Y 
Published: January 2017

OBJECTIVE: To review exogenous surfactant use in the treatment of respiratory distress syndrome (RDS) in premature neonates. DATA SOURCES: A MEDLINE search and extensive review of journals was conducted to identify the information for this review from 1983 to 1995 using the following key words: prematurity, surfactant, clinical trials, beractant, Survanta, colfosceril, Exosurf, and neonatal respiratory distress syndrome. STUDY SELECTION AND DATA EXTRACTION: All articles were considered for possible inclusion in the review. Emphasis was placed on controlled studies involving beractant and colfosceril palmitate. DATA SYNTHESIS: Results of published clinical trials using beractant or colfosceril palmitate in premature infants at risk for RDS have shown improvement in the need for supplemental oxygen and ventilatory support over the course of RDS and a reduction in pneumothorax. However, there was little impact on the incidence of intraventricular hemorrhage. Clinical trials studying the treatment of established RDS have also shown similar improvements. In a comparison of prophylactic versus late treatment, no distinct advantage of preventive treatment was found, except among infants less than 26–28 weeks gestation. Single- versus multiple-dose studies have shown no specific advantage of more than two doses of colfosceril palmitate. A comparison trial of beractant and colfosceril palmitate has shown no difference in outcome. Long-term follow-up studies have been encouraging among infants being treated with exogenous surfactant. CONCLUSIONS: The use of beractant and colfosceril palmitate in premature infants has clearly decreased morbidity and mortality associated with RDS. Only one trial has compared the efficacy of beractant with that of colfosceril in the treatment of RDS. There does not appear to be a distinct advantage of one product over another. Early treatment of infants at highest risk for RDS, those less than 26–28 weeks gestation, seems to be beneficial over waiting for RDS to progress in severity. Further research needs to be performed to determine the optimal dosing and timing of these agents, as well as comparative trials studying efficacy. Criteria for use of these products need to be further defined to decrease the incidence of unnecessary treatment.
The Cholesterol Controversy
Authors: Geurian Kristi L 
Published: January 2017

OBJECJIVE: To provide information about the controversy associated with lowering of cholesterol concentrations to preventcoronary heartdisease(CHD). DATA SOURCFS: Studies, review articles, and editorials identified from MEDLINE searches (from 1966 to 1995) and bibliographies of identified articles. STUDY SELECTION: Studies, review articles, and editorials addressing controversial issues related to cholesterol lowering. DATA EXTRACTION: Pertinent information was selected and the data synthesized into a review format. DATA SYNTHESIS: Hypercholesterolemia is a well-known CHD risk factor. Reduction of serum cholesterol concentrations has been shown to reduce the incidence of CHD. Unfortunately, cholesterol lowering also appears to increase the risk for cancer, accidental and violent death, stroke, and oddly enough, CHD when certain medications are used. CONCLUSIONS: Significant reductions in serum cholesterol concentrations can be achieved with cholesterol-lowering interventions. However, the benefits associated with cholesterol reduction may not outweigh the risks in all patients with hypercholesterolemia. Cholesterol-lowering interventions should be recommended with caution in patients at increased risk for cancer, stroke, and depression. Caution should also be used when recommending fibric acid derivatives for patients with existing CHD.
Severe Vaginal Bleeding Associated with Recombinant Interferon Beta-1B
Authors: Pakulski Leslie A , DiMarco Linda M 
Published: January 2017

OBJECTIVE: To report a case of severe vaginal bleeding associated with interferon beta-1b (IFN-β). CASE SUMMARY: A 19-year-old white woman diagnosed with multiple sclerosis was treated with IFN-β 4 million IU every other day for 1 month. After 1 month, the dosage was increased to 8 million IU. The patient subsequently experienced severe vaginal bleeding. Because her hemoglobin was 3.9 g/dL, she was admitted to the hospital for treatment and observation. IFN-β was discontinued and she was treated with conjugated estrogens and received 2 units of packed red blood cells. The bleeding ceased and the patient was discharged in stable condition. DISCUSSION: Menstrual disorders of mild-to-moderate severity were reported during clinical trials with IFN-β. This is the first case report regarding severe vaginal bleeding probably associated with IFN-β. The mechanism for development of IFN-β-reiated menstrual disorders is unknown. CONCLUSIONS: Reports of menstrual disorders associated with recombinant IFN-β are rare; however, clinicians should be aware that this complication can occur. Should menstrual disorders occur with no other etiologic factors identified, IFN-β should be discontinued, with improvement expected shortly thereafter.
Tissue Oxygenation and Skin Blood Flow in the Diabetic Foot: Responses to Cutaneous Warming
Authors: Boyko Edward J. , Ahroni Jessie H. , Stensel Victoria L. 
Published: January 2017

We previously reported an unexpected statistically significant decline in the mean transcutaneous partial pressure of oxygen (TcPO2) with cutaneous warming from 37°C to 44°C on the plantar diabetic foot, as opposed to the expected increase seen at the dorsal sites. To elucidate this relationship we compared changes with cutaneous warming in TcPO2 and skin circulation measured by laser Doppler flowmetry on the right plantar foot surface of 20 consecutive subjects. Neuropathy by monofilament testing was present in 55% of the cases. Right dorsal foot TcPO2 increased with cutaneous warming from 37°C to 44° by a mean change of +43.6 ± 20.7 mmHg (± standard deviation) in 95% of the cases. In 42% of cases right plantar first metatarsal head TcPO2 fell with warming from 37°C to 44°C by a mean change of −10.7 ± 7.6 mmHg. In the remaining 58% of cases right plantar first metatarsal head TcPO2 rose by 6.8 ± 6.3 mmHg. In 95% of cases right plantar great toe laser Doppler perfusion units (LDPU) increased with warming from 36°C to 44°C by a mean change of +50.4 ± 37.1. Blood flow measured by laser Doppler flowmetry increased in 95% of the subjects with heating. The finding that blood flow was increased with warming contradicts the hypothesis that arterioles in the plantar great toe cannot vasodilate in response to thermal stimuli. This finding supports the hypothesis that the decline in TcPO2 with warming might be due to an increase in epidermal oxygen consumption that exceeds the increase in oxygen delivery due to increased blood flow. The pathological mechanisms behind microvascular dysfunction in skin microcirculation in the diabetic foot need further investigation.
Biomechanical Comparison of Two Fixation Methods for First Metatarsophalangeal Joint Arthrodesis
Authors: Molloy Sean , Burkhart Bradd G. , Jasper Louis E. , Solan Matthew C. , Campbell John. T. , Belkoff Stephen M. 
Published: January 2017

Purpose: The aim of this study was to compare the mechanical stability of two methods of fixation for arthrodesis of the hallux metatarsophalangeal joint: a technique using an intramedullary screw and a standard technique using crossed interfragmentary compression screws. Methodology: The metatarsophalangeal joint was mechanically evaluated in cantilever bending using a servohydraulic testing machine. Differences in stiffness and strength parameters between the two techniques were checked for significance (P<0.05) using a paired t-test. Results: Fixation provided by the intramedullary screw was stiffer and stronger than that from crossed compression screws. Conclusions: The stronger and stiffer intramedullary screw technique offers mechanical advantages over the crossed interfragmentary screw technique.
Comprehensive Reconstruction of the Lateral Ankle for Chronic Instability Using a Free Gracilis Graft
Authors: Coughlin Michael J. , Schenck Robert C. , Grebing Brett R. , Treme Gehron 
Published: January 2017

Purpose: The purpose of this retrospective study was to assess the results of a novel surgical technique for the treatment of chronic lateral ankle instability using both a direct repair of the anterior talofibular ligament and a free gracilis tendon transfer to reconstruct anatomically the anterior talofibular and calcaneofibular ligaments. Methods: Between December 1998 and February 2002, 28 patients (29 ankles) underwent an anatomic reconstruction of the lateral ankle ligaments for chronic ankle instability. Patients returned for a clinical and radiologic follow-up evaluation at an average of 23 months following surgery (range, 12–52 months). Outcomes were assessed by comparison of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analog pain scores as well as a postoperative Karlsson score. A subjective self-assessment rating was also obtained. All patients underwent preoperative and postoperative radiographic assessment including talar tilt and anterior drawer stress radiographs. Results: Twenty-eight patients (29 ankles) (100%) returned for final evaluation. Good or excellent outcome was noted on patient subjective self-assessment, pain scores, AOFAS, and Karlsson scores at final follow-up in all patients. Ankle range of motion was not affected by lateral ankle reconstruction. The talar tilt was reduced from a mean of 13° to 3° ( p < .0001) and the anterior drawer was reduced from a mean of 10 mm to 5 mm ( p < .0001) by the lateral ankle ligamentous reconstruction. Conclusion: In the present study, lateral ankle reconstruction with a direct anterior talofibular ligament repair and free gracilis tendon graft augmentation resulted in a high percentage of successful results, excellent ankle stability with a minimal loss of ankle or hindfoot motion, and marked reduction of pain at an average follow-up of almost 2 years.
Scarf Osteotomy for Hallux Valgus Deformity: An Intermediate Followup of Clinical and Radiographic Outcomes
Authors: Aminian Arash , Kelikian Armem , Moen Todd 
Published: January 2017

Background: The scarf osteotomy is a versatile and reproducible procedure for the correction of moderate to severe hallux valgus deformity (intermetatarsal angle 12 to 20 degrees hallux valgus angle 20 to 46 degrees). Methods: We evaluated the results of 27 consecutive scarf osteotomies at an average followup of 16.1 months. Radiographic parameters, foot pressure analysis, and AOFAS scores were analyzed before and after surgery. Results: Hallux valgus angles improved from 34.5 to 16.9 degrees, intermetatarsal angles improved from 15.4 to 10.1 degrees, AOFAS scores improved from 54.5 to 86.5. There was no change between the preoperative and postoperative relative lengths of the first and second metatarsals, defined as the difference between the first and second metatarsal lengths. The measurement was based on the anteroposterior standing radiographs and measured by a line intersecting the midway point at the diaphyseal-metaphyseal junction of the metatarsal and extending from the most proximal to distal aspects of the bone. The angle of Meary (talo-first metatarsal angle) did not change, except in one patient. Foot pressure analysis showed no evidence of transfer metatarsal lesions. The complication rate was 1.1% including superficial infection and recurrence. Conclusions: The scarf osteotomy provides a predictable and effective correction of moderate to severe hallux valgus deformities.
Metatarsophalangeal Joint Arthrodesis after Failed Keller-Brandes Procedure
Authors: Vienne Patrick , Sukthankar Atul , Favre Philippe , Werner Clement M.L. , Baumer Andrea , Zingg Patrick O. 
Published: January 2017

Background: Keller-Brandes resection arthroplasty for correction of symptomatic hallux valgus deformity can obtain early good results, but late complications, such as recurrence of the deformity and instability of the first ray, have been described. Arthrodesis of the first metatarsophalangeal, (MTP) joint can be done as a salvage procedure. The aim of this prospective study was to evaluate the clinical outcome of the arthrodesis and its effect on the biomechanics of the first ray. Methods: Between October, 1999, and December, 2002, arthrodesis of the MTP joint was done after a failed Keller-Brandes procedure in 28 feet of 26 consecutive patients. Twenty patients (22 feet) with a minimum of 24 months followup were available for clinical and radiographic assessment. Pedobarographic measurements were obtained at latest followup in 16 patients (17 feet). Results: Sixteen feet (72%) were pain-free and six feet (28%) had mild, occasional pain. The American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score increased from a preoperative 44 (range 29 to 67) points to 85 (range 73 to 90) points at longest clinical followup (average 34 months, range 23 to 48, p < 0.001). The average hallux valgus angle was corrected from 24.0 (range 7 to 47) degrees preoperatively to 16.0 (range 0 to 40) degrees postoperatively ( p < 0.001). Two feet had pseudoarthroses. Biomechanically, the MTP joint arthrodesis could not fully restore the function of the hallux but produced a significant improvement, allowing a more physiologic loading pattern under the hallux and the metatarsal heads. Conclusions: First MTP joint arthrodesis after a failed Keller-Brandes procedure is a technically safe and reliable technique. It resulted in a marked reduction of pain and gain of function that produced high patient satisfaction.
Achilles Tendon Torsion Has No Effect on Percutaneous Triple-Cut Tenotomy Results
Authors: Hoffman Brian , Nunley James 
Published: January 2017

Background: Achilles tendon lengthening is an important part of the operative management of numerous foot and ankle disorders. The most commonly used percutaneous technique involves three hemitenotomies: medial, lateral, and medial. The discovery that Achilles tendon fibers may undergo external torsion created concern that improper consideration of this feature could result in fiber division insufficient to allow adequate percutaneous lengthening. Varying degrees of torsion have been reported since it was originally described. We hypothesized that torsion of the Achilles tendon does not decrease the effectiveness of a percutaneous lengthening procedure. This hypothesis was tested by comparing the medial-lateral- medial tenotomy pattern to a lateral-medial-lateral pattern. If tendon torsion affects fiber division, then asymmetrical tenotomy patterns should yield different results. Methods: Mechanical testing was performed using 22 human fresh tissue lower extremities. Specimens were divided into two groups (11 in each group): “MLM” which underwent testing using a medial-lateral-medial pattern and “LML” which underwent a lateral-medial-lateral pattern. Dorsiflexion load was applied evenly across the forefoot and measured with a force transducer. Dorsiflexion measurements were made from reproducible reference marks. After testing, specimens were dissected to examine tenotomy gap widths and other tissue effects. Results: All specimens lengthened successfully. None of the following parameters were statistically different: pre-tenotomy or post-tenotomy dorsiflexion, force to lengthen, total tissue lengthening, and individual gap widths. In no specimen was there complete disruption of the Achilles tendon, and in 18 of 22 specimens (81.8%) the paratenon sleeve was intact except for the tenotomy puncture. In one LML specimen, the sural nerve was partially cut at the distal tenotomy site. Conclusions: Regardless of pattern, percutaneous triple-cut Achilles tendon lengthening was effective in achieving additional dorsiflexion at roughly one-third degree per millimeter of tissue lengthening. The pattern of the Achilles tendon lengthening used and, by inference, Achilles tendon torsion had no effect on achievable dorsiflexion. One explanation is that both patterns cut all tendon fibers at least once. We concluded that a properly designed triple-cut tenotomy would be successful regardless of Achilles torsion. Percutaneous Achilles tendon lengthening also appears to be a safe procedure if care is taken to avoid the sural nerve.
Aircast Walking Boot and Below-Knee Walking Cast for Avulsion Fractures of the Base of the Fifth Metatarsal
Authors: Shahid Mohammad Kamran , Punwar Shahid , Boulind Caroline , Bannister Gordon 
Published: January 2017

Background: Acute avulsion fractures of the base of the fifth metatarsal are common and are treated in a variety of ways. The aims of this study were to compare pain, functional outcome, and time taken off work after treatment with a walking boot or a short-leg cast. Methods: Of 39 patients with acute avulsion fractures of the base of the fifth metatarsal, 23 were treated with a short-leg cast and 16 with a walking boot, according to the preference of the consultant present at outpatient clinic. Functional outcome was assessed by the Visual Analogue Scale Foot and Ankle Questionnaire (VAS FA), pain, and other complaints on presentation and at 3, 6, 9, and 12 weeks after injury. The VAS FA scores were compared between the 2 groups by a paired Student t test. Results: The mean time to return to the level of pain and function before injury was approximately 9 weeks after treatment in the walking boot group and 12 weeks with a short-leg cast. Patients with walking boots reported less pain between 3 and 12 weeks than did those with short-leg casts after 6 ( P = .06), 9 ( P = .020), and 12 weeks ( P = .33). Function was significantly better with Aircast walking boots after 3 ( P = .006), 6 ( P = .002), and 9 weeks ( P = .002) but not after 12 weeks ( P = .09). Patients returned to their preinjury level of driving after 6 weeks with walking boots and 12 weeks with short-leg casts ( P = .006). Employed patients took a mean of 35.8 days off work (range, 28-42 days), fewer with boots (31.5 days) than with short-leg casts (39.2 days). Conclusion: The walking boot was better treatment than a short-leg cast for avulsion fractures of the base of the fifth metatarsal. Patients had an improved combined level of pain and function 3 weeks earlier, at 9 weeks post injury, when managed in a walking boot. Level of Evidence: Level II, prospective comparative series.
Cavovarus Foot Realignment to Treat Anteromedial Ankle Arthrosis
Authors: Krause Fabian G. , Henning Julia , Pfander Gilles , Weber Martin 
Published: January 2017

Background: Adult patients with cavovarus feet were seen with symptomatic anteromedial ankle arthrosis and, frequently, lateral hindfoot instability. Static and dynamic realignment was performed to redistribute joint contact pressures and restore stability. Methods: Thirteen patients with fixed cavovarus feet (6 neurogenic, 7 idiopathic; 6 with hindfoot instability, 7 without) and mild to moderate anteromedial ankle arthrosis were treated by osteotomies and tendon transfers but no lateral ligament reconstruction. Anteromedial cheilectomy of the ankle was added to increase dorsiflexion and alleviate anteromedial impingement. Results: Failure occurred in 2 patients, who required additional procedures. The remaining 11 patients improved from preoperative 45 to 71 points (American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score) at the latest follow-up (average 84 months). Ankle dorsiflexion improved 7 degrees on average. There was no recurrent hindfoot instability and no progression of anteromedial ankle arthrosis over time. Conclusion: Cavovarus foot realignment with anteromedial ankle cheilectomy reliably improved patients’ symptoms related to ankle arthrosis, restored lateral hindfoot stability, and stabilized the extent of anteromedial ankle arthrosis when talar varus tilt was reduced. Level of Evidence: Level IV, retrospective case series.
Treatment of Displaced Intra-Articular Calcaneal Fractures With Combined Transarticular External Fixation and Minimal Internal Fixation
Authors: Fu Te-Hu , Liu Hao-Chen , Su Yu-Sheng , Wang Ching-Jen 
Published: January 2017

Background: The aim of this study was to evaluate clinical outcomes after surgery for displaced intra-articular fractures using an external fixator and minimal internal fixation. Methods: In this retrospective observational study, a total of 39 patients (32 [82%] men and 7 [18%] women) with 48 displaced intra-articular calcaneal fractures were included. An extended lateral approach was used to stabilize fractures using multiple sagittal plane screws, axial percutaneous threaded Kirschner wires for the frontal fracture plane, and an external fixator for reduction assistance and maintenance. The following variables were assessed: preoperative and postoperative Böhler’s angle; calcaneal length, height, and width; postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores; and complications. Mean duration of follow-up was 74 ± 26 months. Results: The mean time from surgery to external fixator removal was 12 ± 1 weeks. The mean preoperative Böhler’s angle (–3 ± 21 degrees), calcaneal length (7.9 ± 0.6 cm), and calcaneal height (3.6 ± 0.5 cm) were significantly increased ( P < .05) at final follow-up (28.3 ± 6.5, 8.3 ± 0.6, and 4.5 ± 0.5, respectively), whereas the mean preoperative calcaneal width (4.2 ± 0.5) was significantly decreased from the final follow-up mean (3.8 ± 0.5). There were no significant differences between any of the normal and postoperative measures. The mean AOFAS score was 82 ± 12. Complications included superficial pin tract infection (n = 7, 15%), superficial wound edge necrosis (n = 4, 8%), and deep infection (n = 2, 4%). Conclusion: Our findings suggest that use of an external fixator with minimal internal fixation is an effective option for treating displaced intra-articular calcaneal fractures. Level of Evidence: Level IV, retrospective case series.
The Effectiveness of Extracorporeal Shock Wave Therapy on Chronic Achilles Tendinopathy
Authors: Al-Abbad Hani , Simon Joel Varghese 
Published: January 2017

Background: Achilles tendinopathy is a pathological state resulting from repetitive loading or stress on the tendon. Extracorporeal shock wave therapy (ESWT) is hypothesized to be an effective alternative intervention to surgery when other conservative therapies fail. This systematic review investigated the effectiveness of ESWT in the treatment of insertional and noninsertional Achilles tendinopathies. Methods: Articles were electronically searched from the Cochrane Controlled Trials Register, MEDLINE, CINAHL, EMBASE, and SPORTDiscus using a comprehensive search strategy. Studies were included if they were prospective clinical trials examining the effectiveness of ESWT for insertional or noninsertional Achilles tendinopathies. Methodological quality of included studies was assessed using PEDro scale and Modified McMaster tool. The strength of the evidence was reported using the National Health and Medical Research Council body of evidence framework. A narrative summary of the findings was presented. Results: Four of the included studies were randomized controlled trials, and 2 were pre-post study designs. Common methodological deficiencies included not blinding the clinician and participants. There was consistent evidence from 4 reviewed studies on the effectiveness of ESWT in the management of patients with chronic Achilles tendinopathies at a minimum 3 months’ follow-up. Conclusion: Overall, our review showed satisfactory evidence for the effectiveness of low-energy ESWT in the treatment of chronic insertional and noninsertional Achilles tendinopathies at a minimum 3 months’ follow-up before considering surgery if other conservative management fails. However, combining ESWT with eccentric loading appears to show superior results. Level of Evidence: Level 1, systematic meta-analysis