bluuebunny/crossref_metadata_2025_split huggingface dataset:
Muromonab-Cd3 and Antithymocyte Globulin in Renal Transplantation
Authors: Burk Muriel L , Matuszewski Karl A 
Published: January 2017

OBJECTIVE: To review the recently published medical literature for the practical and efficient use of muromonab-CD3 (OKT-3) and antithymocyte globulin (ATG) in renal transplantation. DATA SOURCES: MEDLINE and EMBASE were searched (1985-February 1996). Key words used were antithymocyte globulin (ATG, Atgam), muromonab-CD3 (OKT-3, Orthoclone), and kidney transplantation. Thereafter, the search was restricted to English-language articles, clinical trials, and human studies. STUDY SELECTION AND DATA EXTRACTION: The search was reviewed for articles of interest, and pertinent references from these articles were further reviewed to supplement the initial search. The review focused on antibody therapy as induction and/or rejection therapy in renal transplantation. DATA SYNTHESIS: Although ATG and OKT-3 are effective in delaying and reducing the occurrence of acute rejection, their impact on long-term graft survival has not been established. Improved graft survival has, however, been demonstrated in patients at high risk for rejection. These risks are described in the review. As first-line or steroid-resistant rejection therapy, ATG and OKT-3 have proven efficacious. Some studies have shown improved graft survival with OKT-3. Although serious infections may occur, OKT-3 has been shown to be effective in reversing rejections resistant to both steroids and ATG. Therefore, reserving OKT-3 for steroid- or ATG-resistant rejections may be preferred over the first-line use of OKT-3, which is limited by the development of antimurine antibodies with subsequent uses. However, the benefits of first-line antibody therapy may outweigh the risks of developing these antibodies in patients for whom high-dose steroids may not be the most appropriate treatment. Other factors that need to be considered are adverse effects, which appear to be lower with ATG, cost, and total hospital charges. The accuracy of treatment outcomes analysis among these studies is limited by variations in the immunosuppressive regimens of the study centers, doses of concomitant therapies, use of prophylactic antibiotics, and time to follow-up. CONCLUSIONS: While important benefits are realized from using antibody therapies in renal transplantation, their use is often associated with excess immunosuppression and increased treatment costs. Despite encouraging results from published trials, questions regarding the extent of their prophylactic use and impact on long-term outcomes need to be answered. The current literature contains no prospective, controlled, randomized comparisons of OKT-3 and ATG with standardized regimens of conventional immunosuppressive agents and antirejection protocols. The majority of studies use OKT-3 as part of the treatment protocol. Well-designed studies using ATG are lacking. Further research is needed to refine treatment protocols for ATG and OKT-3 to determine the optimal timing and dosing for these agents.
Two Modifications of the Weil Osteotomy: Analysis on Sawbone Models
Authors: Melamed Eyal A. , Schon Lew C. , Myerson Mark S. , Parks Brent G. 
Published: January 2017

Second metatarsal osteotomies (30° angle to shaft) were performed in 40 sawbones with: 1. head shifted proximally 5 mm; 2. head shifted proximally 10 mm; 3. 5-mm slice resected and head shifted proximally 5 mm; or 4. 5-mm dorsally based wedge resected and head shifted proximally 5 mm. Bone slice resection resulted in shortening (16.4 ± 1.7 mm) and mild plantar displacement of the head (3.5 + 0.8 mm). Bone wedge excision resulted in moderate shortening (7.8±0.9 mm) and essentially no plantar displacement of the head (0.8±1.4 mm).
The Management of Concomitant Tears of the Peroneus Longus and Brevis Tendons
Authors: Redfern David , Myerson Mark 
Published: January 2017

Background: Concomitant chronic tears of both peroneal tendons rarely are reported. We present our experience in treating these injuries and suggest an algorithm for surgical treatment, determined by the presence of a functioning tendon or tendons, mobility of the remaining peroneal musculature, ankle stability, and position of the heel. Methods: Twenty-eight consecutive patients (29 feet) were followed postoperatively for a mean of 4.6 (range 1.5 to 8) years. The mean age was 36 (range 19 to 54) years, and all patients had chronic ankle pain with or without instability and with combinations of complete, partial, or longitudinal tears of both tendons. Of the 28 patients, six had hindfoot varus and three had cavovarus. Eight patients had mechanical ankle instability, but there was no correlation between instability and the presence of hindfoot varus. Results: The mean postoperative American Orthopaedics Foot and Ankle Society ankle score was 82 (range 20 to 100) points, and 91% of patients achieved normal or moderate peroneal muscle strength. Ankle instability was successfully corrected in all patients and progressive worsening of varus deformity was prevented. Conclusion: The presence of chronic peroneal tendon subluxation or dislocation, chronic ankle instability, or hindfoot varus deformity, in association with retrofibular pain and swelling, should alert the surgeon to the possibility of a tear of the peroneal tendons and is an indication for surgical intervention. At the time of tendon repair, every effort should be made to treat the primary or contributing causes of the tear. Our results suggest that patients with symptomatic concomitant peroneus longus and brevis tendon tears are likely to experience substantial improvement in function if operative treatment is adequate.
Comparison between Manual and Computer-Assisted Measurements of Hallux Valgus Parameters
Authors: Panchbhavi Vinod K. , Trevino Saul 
Published: January 2017

Background: The aim of this study was to determine if there are intraobserver and interobserver differences in reliability when measuring hallux valgus angles (HVA), 1–2 intermetatarsal angles (IMA), and distal metatarsal articular angles (DMAA) manually compared to computerassisted means. Our hypothesis was that the measurements taken by computer-assisted methods of these three forefoot angles would be superior in consistency and accuracy compared to manual measurements. Methods: Four examiners studied 20 weightbearing anteroposterior radiographs of patients with hallux valgus. Manual measurements were taken on photographic prints using a goniometer and a fine point pen. Computer-assisted measurements were taken on digitized images using computer software. Three sets of measurements by both of these methods were taken 1 week apart. Results: There was no statistically significant difference between digital and manual measurements for any of the three angles measured ( p.05). However, the reliability of measurements within a range of 5 degrees for both methods was 70.6% for HVA, 84% for 1–2 IMA, and 59% for DMAA. Conclusion: There were no significant differences in interobserver and intraobserver reliability in measuring 1–2 IMA and HVA, regardless of the method of measurement; however, there was a significant difference in interobserver reliability when measuring the DMAA either on computer or manually ( p = < .05).
Trimalleolar Fractures with Impaction of the Posteromedial Tibial Plafond: Implications for Talar Stability
Authors: Weber Martin 
Published: January 2017

Background: Trimalleolar fractures usually include a lateral malleolar fracture, a triangular fracture of the posterolateral corner of the tibial plafond, and a horizontal or oblique fracture of the medial malleolus. A subtype of a trimalleolar fracture is reported, differing in the shape and extent of the medial malleolar fracture and the posterior lip fracture, with implications for treatment. Methods: In a 3-year period, 10 patients were treated for a trimalleolar fracture with a multifragmentary transverse fracture of the entire posterior tibial lip, including the posterior colliculus of the medial malleolus. The radiographs of all patients showed a pathognomonic double-contour or flake-fragment sign above the medial malleolus. One patient's posteromedial fracture was not initially recognized and he had a standard lateral fracture repair. A double posterior approach was used in nine patients, with fracture repair proceeding from medial to lateral. Intraoperatively, eight of nine patients had impacted osteochondral fragments at the posteromedial corner of the tibial plafond that blocked anatomic reduction and allowed posteromedial subluxation of the talus. Results: Nine patients had anatomic reconstruction of the posteromedial corner. All fractures healed, and function was normal at one year. One patient had moderate loss of joint space. The patient with the malunited fracture developed symptomatic posteromedial instability of the talus and required an osteotomy of the malunited fragment. He had a good result at 18 months. Conclusions: This unique subtype of trimalleolar fracture has distinct radiological features and implications for the strategy of the operative treatment. If recognized immediately and treated appropriately, the results were excellent. If missed initially, reconstructive osteotomy was possible and led to a good result.
Results of Step-Cut Medial Malleolar Osteotomy
Authors: Thordarson David B. , Kaku Shawn K. 
Published: January 2017

Background: Treatment of certain complex ankle pathology, such as a talar body fracture or osteochondral lesion requiring grafting, can necessitate medial malleolar osteotomy for adequate operative exposure. This paper evaluates the step-cut medial malleolar osteotomy for exposure of the ankle joint. Method: Fourteen patients with intra-articular pathology, including talar body fractures or osteochondral lesions necessitating extensive intra-articular exposure had step-cut malleolar osteotomy. The average age of the patients was 37 (range 20–90) years, and the average followup was 8 months. Results: All 14 patients had an uncomplicated intraoperative course, with excellent exposure of the ankle joint. All patients had prompt healing of the osteotomy by 6 weeks after surgery without loss of reduction. None of the patients had pain at the osteotomy site. Conclusions: Step-cut medial malleolar osteotomy is an excellent, reproducible method for extensive exposure of the talar dome.
Indications for and Technique of First Metatarsophalangeal Joint Arthroscopy
Authors: Debnath U.K. , Hemmady M.V. , Hariharan K. 
Published: January 2017

Background: Arthroscopy of the great toe metatarsophalangeal joint has been used for a variety of indications, ranging from synovitis to osteochondral defects. The purpose of the present study was to define the indications for arthroscopy, assess its efficacy, and demonstrate the limitations of this procedure. Methods: Hallux metatarsophalangeal joint arthroscopy was used in 20 patients (25 feet). Indications included degenerative disease with early osteophytosis, chondromalacia, osteochondral defects, loose bodies, arthrofibrosis, synovitis, gouty arthritis, first metatarsophalangeal joint pain with no obvious findings clinically and radiographically in young adults, and intra-articular fracture of the first metatarsophalangeal joint. All patients had a minimal followup of 2 years and were evaluated clinically and radiographically. Results: Arthroscopic surgery resulted in pain free first metatarsophalangeal joints in 95% (19 of 20 patients). Patients with degenerative disease had a pain-free joint for a minimum of 2 years. The patients with gouty arthritis and intra-articular fracture had good functional outcomes. Arthroscopy also helped in identifying the pathology in painful joints with no obvious radiographic features that included conditions such as ‘meniscoid’ and other impingement lesions. Conclusion: Arthroscopy of the first metatarsophalangeal joint is not suitable for patients with extensive degenerative changes and large osteophytes and those that require cheilectomy or arthrodesis. Arthroscopic management of certain painful hallucal metatarsophalangeal joints is a specialized technique, which if performed for the right indications, gives a favorable outcome with minimal complications.
Superior Retinaculoplasty for Recurrent Dislocation of Peroneal Tendons
Authors: Adachi Nobuo , Fukuhara Kohei , Tanaka Haruyuki , Nakasa Tomoyuki , Ochi Mitsuo 
Published: January 2017

Background: Although dislocation of peroneal tendons is an uncommon injury, if it does occur, daily and sports activities may be restricted because of snapping of the tendons and pain in the posterolateral aspect of the ankle joint. Many operative procedures have been reported for this pathology, including anatomic reattachment of the retinaculum, bone block procedures, tissue-transfer procedures, and groove-deepening. However, no procedure has been established as the “gold standard.” Successful results were reported after anatomic reattachment of the detached superior peroneal retinaculum and periosteum of the fibula. We have modified the procedure to reduce operative invasiveness and introduced a method to determine proper tension when suturing the retinaculum to the fibula. Methods: In our retinaculoplasty, the false pouch was opened through one incision, and the retinaculum was sutured to the fibula while measuring the tension, avoiding too tight or too loose suturing. We performed this procedure in 20 patients with symptomatic dislocation of peroneal tendons in whom conservative treatment had failed. We followed them over 2 years, and clinical results were evaluated. Results: No patient had re-dislocation of the peroneal tendons during the followup period. Fifteen of 18 patients who had been involved in sports activities returned to their previous activities without reducing their activity levels. All patients acquired full range of motion of the ankle joint postoperatively. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores improved significantly ( p value < 0.01) postoperatively. Conclusions: This study demonstrated that the described repair successfully treated patients with symptomatic dislocation of the peroneal tendon and should be considered for this pathology.
Arthroscopic Ankle Arthrodesis: Factors Influencing Union in 39 Consecutive Patients
Authors: Collman David R. , Kaas My Hoa , Schuberth John M. 
Published: January 2017

Background: Arthroscopic ankle arthrodesis is an effective alternative to open techniques with established advantages in select patient populations. The purpose of this study was to evaluate patients who had arthroscopic ankle arthrodesis for end-stage arthritis with minimal to no deformity of the ankle and to report factors influencing union. Methods: Thirty-nine consecutive patients had arthroscopic ankle arthrodesis between 1994 and 2003. Clinical records and radiographs were retrospectively reviewed to evaluate variables that could predispose patients to nonunion. Union outcomes were correlated with etiology of arthritis, ankle deformity, medical comorbidities, and the use of demineralized bone matrix or platelet-rich plasma. Arthroscopic ankle arthrodesis was accomplished with a consistent technique using crossed transmalleolar cannulated screw fixation. Results: Thirty-four of 39 patients (87.2%) achieved radiographic and clinical union. The average time to fusion was 47 (range 37 to 70) days. Poor bone quality and inherent positional ankle deformity were identified as risk factors for nonunion. Patients who smoked, had diabetes mellitus, peripheral neuropathy, or other medical comorbidities attained ankle union in nearly all cases. In obese patients, there was an observed trend towards ankle nonunion (relative risk 5.81, p = 0.049, Fisher's Exact test). The addition of demineralized bone matrix or platelet-rich plasma did not improve the rate of ankle union. Aside from nonunion, 10 patients developed minor complications. Conclusion: Arthroscopic ankle arthrodesis achieves high union rates, facilitates short time to union, and permits rapid patient mobility. Careful patient selection is important for the procedure. Synthetic allograft or platelet-rich plasma did not enhance the fusion rate. Obese patients showed a trend towards nonunion in this series.
Plantarflexion Strength of the Toes: Age and Gender Differences and Evaluation of a Clinical Screening Test
Authors: Menz Hylton B. , Zammit Gerard V. , Munteanu Shannon E. , Scott Genevieve 
Published: January 2017

Background: The toes play an important stabilizing role in weightbearing activities. However, the factors that influence toe plantarflexion strength are poorly understood, and there are no validated measures for assessing toe weakness in the clinical setting. Therefore, the objectives of this study were to determine whether plantarflexion strength of the toes differs according to age and gender and to evaluate the validity of a clinical screening test for assessing toe plantarflexor weakness (the paper grip test). Methods: Plantarflexion strength of the hallux and lesser toes was measured in 40 young participants (20 men and 20 women, mean age 20.8 ± 2.2 years) and 40 older participants (20 men and 20 women, mean age 74.6 ± 5.7 years) using a pressure platform in conjunction with clinical assessment using the paper grip test. Results: Older participants exhibited 32% less plantarflexion strength of the hallux and 27% less plantarflexion strength of the lesser toes compared to younger participants, and women exhibited 42% less hallux plantarflexor strength than men. Gender did not influence lesser toe plantarflexor strength. Participants who failed the paper grip test exhibited significantly reduced plantarflexion strength for both the hallux and lesser toes. The sensitivity and specificity of the paper grip test of the hallux to predict plantarflexor strength less than 2.6 kg was 80% and 79%, respectively, and the sensitivity and specificity of the paper grip test of the lesser toes to predict plantarflexor strength less than 2.2 kg was 75% and 74%, respectively. Conclusions: These findings indicate that aging is associated with reduced plantarflexion strength of the toes. The paper grip test may be a useful screening tool to detect toe weakness in the clinical setting.
Detection of Fibular Torsional Deformities after Surgery for Ankle Fractures with a Novel CT Method
Authors: Vasarhelyi Attila , Lubitz Jessica , Gierer Philip , Gradl Georg , Rösler Klaus , Hopfenmüller Werner , Klaue Kaj , Mittlmeier Thomas W.F. 
Published: January 2017

Background: Substantial fibular torsional deformities were detected after surgery for ankle fractures combined with a lesion of the syndesmotic complex using a novel CT analyzing method. Methods: In a prospective study, 61 patients with ankle fracture dislocations were treated with trans-syndesmotic screw fixation of the distal tibiofibular joint. Postoperative axial CT scans of both lower legs under standardized leg positioning conditions were made and analyzed with three different methods. Method 1 (M1) used proximal and distal CT planes of the lower leg for detection of the fibular torsional angle, method 2 (M2) considered only the angle at the distal tibiofibular joint, and method 3 (M3) measured the angles between the fibular and tibial tangents at the distal tibiofibular joint. Twenty patients with fibular torsional asymmetries of more than 10 degrees were evaluated clinically 6 to 34 months postoperatively with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. Results: Thirty-five of the 61 patients had torsional side-to-side differences of more than 10 degrees. M1 and M2 showed statistically significant differences compared to M3 ( p = 0.001). Validity was controlled by interobserver data, variation coefficients were low for M1 and M2. Clinically, six of 20 patients with torsional differences of more than 10 degrees had excellent results, while seven had good results and seven had moderately functional results. Six of the seven with moderate results had fibular torsional differences of more than 15 degrees, two of the seven patients with good outcomes. Torsional results of M1 and M2 correlated with the AOFAS score ( r = —0.506). Conclusions: Of the 61 ankle fractures with ruptures of the syndesmotic complex, 25% showed torsional side-to-side differences of more than 10 degrees on proximal and distal CT planes. This CT technique correlated with the AOFAS score and could help determine when early operative revision is indicated.
A Study of Vibration Transmission in a Framed Building
Authors: Steel J.A. , Craik R.J.M. , Wilson R. 
Published: January 2017

Sound transmission through large buildings can be studied using Statistical Energy Analysis (SEA). In this study measurements were carried out to investigate sound transmission through a framed building. Sound transmission between columns, beams, walls and floors is investigated. Sound transmission through the building is investigated and measured and predicted results are shown. Difficulties were encountered when modelling large floor slabs. The work demonstrates the application of Statistical Energy Analysis methods to the study of sound transmission in framed buildings and highlights some of the diiffculties.
Determination of The Scattering Parameters of Fittings in Industrial Buildings for Use in Computer Based Factory Noise Prediction Models: Part 1 – Theoretical Background
Authors: Aldi H.A. , Oldham D.J. 
Published: January 2017

In this the first of two companion papers, it is established that the accepted view amongst researchers is that models in which the scatterers of sound in industrial buildings are defined in terms of a mean scattering cross section and absorption coefficient are the most accurate. At the present time there exists no method of determining these parameters. From consideration of the behaviour of sound in a proportionate live room (reverberation chamber) it is shown that the scatterers with a low mean coefficient of absorption the product of mean scattering cross section and absorption coefficient is equal to one quarter of the effective area of absorption of the fitting. The results of computer simulation employing the RAYSCAT model suggest that, although individual values of the two parameters are required as input data, it is actually the product of the two parameters which determines the sound propagation characteristics of a room containing scattering fittings. The results obtained from further simulations suggest that if the equivalent area of absorption of fittings is known, then the sound propagation characteristics of a room containing those fittings can be predicted to a high degree of accuracy by employing an estimated a value of mean absorption coefficient and a value of mean scattering cross section calculated as equal to the effective area of absorption divided by four times the estimated value of the absorption coefficient. In the companion paper which is to follow, the validity of these hypotheses is examined by means of measurements made on acoustic scale models.
Predicted and Measured Low Frequency Response of Small Rooms
Authors: Maluski Sophie , Bougdah Hocine 
Published: January 2017

The sound level difference of party walls at low frequencies [25–200 Hz] has been shown to be strongly dependent on the modal characteristics of the sound fields of the separated rooms. The modal characteristics can be modelled by numerical methods and a Finite Element Method has been selected to model sound transmission between adjacent rooms separated by a party wall. The numerical eigenfrequencies were compared with the theoretical eigenfrequencies to select a mesh model for which the eigenfrequencies are processed within an acceptable error range. As a prelude to the study of sound transmission between dwellings, the simulation of one single room, modelled with the selected mesh model, was validated by predicting the frequency response and comparing values with measured frequency response of a 1:4 scale room model. Results show promising agreement and establish the reliability of the work.