bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Spinal Fractures in Ankylosing Spondylitis
Authors: Mathews Michael , Bolesta Michael J. 
Published: August 2014

Ankylosing spondylitis (AS) is a chronic inflammatory spondyloarthropathy with the potential for progressive spinal stiffness that ultimately makes patients susceptible to spinal fractures with traumatic spinal cord injury from even low-energy trauma. Treatment of patients with AS and spinal fractures (AS+FX) is controversial because, although these patients need especially rigorous stabilization, surgery has been associated with an increased risk of complications and persistent neurological deficits. The purpose of this retrospective case series was to profile patients with AS+FX from a 19-year period within the authors’ county hospital system, including differences of neurological status in patients treated operatively vs nonoperatively.
The study group comprised 11 patients with AS+FX (9 men and 2 women; mean age, 63 years [range, 38–91 years]). The authors reviewed available clinical notes and imaging reports. Six patients had posterior operative fixation, and 5 were stabilized nonoperatively. By the time of either discharge or final follow-up, 3 of the patients treated operatively deteriorated neurologically (2 of them preoperatively) and 3 remained stable. Of the patients treated nonoperatively, 3 remained neurologically intact, 1 deteriorated, and 1 recovered completely. The most common complications in all patients were pneumonia and urinary tract infection. Operative and nonoperative management produced acceptable outcomes in most patients. The authors recommend individualized treatment, accounting for patient preferences and comorbidities.
Extra-abdominal Periosteal Desmoid Tumor of the Third Toe
Authors: Saleem Omar , Sayres Stephanie , O’Malley Martin 
Published: August 2014

Extra-abdominal periosteal desmoid tumors are uncommon nonmetastatic tumors of the extremities with a propensity for local recurrence. Lesions in the distal extremities are rare; a majority of extra-abdominal lesions occur in more proximal portions of the upper and lower extremities. This article reports a patient with an extra-abdominal periosteal desmoid tumor in the toe.
A 37-year-old woman had a mass in her left third distal phalanx that was originally noted 3 years prior to presenting to the authors’ institution. She reported the mass expanded during pregnancy. The toe was red and elongated and had expanded to approximately the same size as her great toe. The plantar aspect of the toe was thick and callused, and the toenail was slightly elevated. Marginal excision with retention of the nail was performed without complication. The mass was determined to be an extra-abdominal periosteal desmoid tumor and was successfully removed without recurrence. To date, the patient remains asymptomatic, with no pain and complete sensation in her third toe.
Although extra-abdominal periosteal desmoid tumors have been identified in the extremities, to the authors’ knowledge none have been reported as far distal as the toe. Identifying this lesion in the distal extremity will allow a hasty diagnosis and treatment in future cases of similar presentation. Knowledge of the existence of this type of tumor in the distal extremity may also assist in narrowing differential diagnoses.
Matching Osteochondritis Dissecans Lesions in Identical Twin Brothers
Authors: Richie Lucas B. , Sytsma Mark J. 
Published: August 2014

Osteochondritis dissecans is a disorder of unknown etiology that can result in fragmentation of osteochondral surfaces, most commonly of the knee, shoulder, elbow, and ankle. This may lead to sequelae of pain and an inability to participate in desired activities. Multiple theories exist as to the true cause of the disorder, but none have been fully proven. One such proposed etiology is genetic causation.
Familial cases of osteochondritis dissecans are rare, yet these cases offer support to growing evidence that may support a genetic link. This article describes osteochondritis dissecans lesions of the femoral trochlea in monozygotic (identical) twins. Both twins presented with similar symptoms 1 year apart. Neither twin had any clear inciting trauma. Magnetic resonance imaging revealed osteochondral lesions in similar positions of the lateral trochlear of the same knee in both brothers. Osteochondral autograft transfer and tibial tubercle anteromedialization were performed on both patients. An identical postoperative protocol was followed, and recovery with full return to sport was comparable for the brothers. To the authors’ knowledge, only 1 other case report exists of osteochondritis dissecans lesions in monozygotic twins.
Although debate continues regarding the true etiology of this disorder, cases of identical twins presenting with a similar disease process are highly suggestive of a genetic component and may lead to early identification and treatment of these lesions. Continued research in the area of osteochondritis dissecans and its genetic basis is needed to completely understand this disorder.
Resection of Soft Tissue Tumors Extending Through the Obturator Ring
Authors: Starks Alexandria , Guo Lifei , Abraham John A. 
Published: August 2014

Pelvic soft tissue sarcomas are rare tumors often presenting larger than other soft tissue sarcomas and can extend into the thigh through various anatomic routes. Surgical resection is the main modality of curative treatment. En bloc tumor excision with wide, negative margins may reduce the risk of local recurrence. Soft tissue sarcomas extending through the obturator foramen create unique challenges to operative management.
This case report describes 2 cases of lipomatous lesions that extend through the obturator foramen, presenting as dumbbell-shaped lesions with large intra- and extrapelvis portions. One possible surgical approach performed in both patients is detailed with long-term follow-up. Postoperatively, 1 incidence of infection was reported. Functional outcomes were acceptable, with full restoration of ambulation without assistive devices in both cases and no hernia observed. Oncologic outcomes included locoregional recurrence in 1 patient at 24 months outside the radiation field.
The ideal primary treatment for all localized soft tissue sarcomas, including those extending through the obturator foramen, is resection. However, the unique subgroup of obturator ring soft tissue sarcomas has undefined outcomes and complications. The authors’ goal was to achieve en bloc resection with wide negative margins while preserving ipsilateral limb function. The surgical approach described in this case study offers a description of feasibility and discussion of theoretical and observed complications.
Osteoid Osteoma
Authors: Boscainos Petros J. , Cousins Gerard R. , Kulshreshtha Rajiv , Oliver T. Barry , Papagelopoulos Panayiotis J. 
Published: August 2014

Educational Objectives

As a result of reading this article, physicians should be able to:

1.
Discuss the clinical presentation of and different imaging modality options for suspected osteoid osteomas.

2.
Develop an insight into the histopathology and histochemistry of osteoid osteomas.

3.
Use diagnostic processes in the differential diagnosis of suspected osteoid osteomas.

4.
Apply current treatment depending on the location and accessibility of the lesion.

Osteoid osteoma is the third most common benign bone tumor. The authors describe the clinical presentation, diagnostic investigations, differential diagnosis, histopathology, and treatment options for this condition, including a comprehensive review of the literature. Osteoid osteomas have wide variations in presentation and tend to present in the second decade of life, with pain that is worse at night and is relieved by salicylates. Plain radiographs and computed tomography scans are the mainstay of imaging; however, bone scintigraphy, single-photon emission computed tomography, magnetic resonance imaging, and sonography are also used. Osteoid osteomas consist of a nidus with surrounding sclerotic bone. The differential diagnosis covers a wide range of conditions due to the variable presentation of osteoid osteoma. The natural history is for regression to occur within 6 to 15 years with no treatment; however, this can be reduced to 2 to 3 years with the use of aspirin and non-steroidal anti-inflammatory drugs. Computed tomography–guided percutaneous techniques, including trephine excision, cryoablation, radiofrequency ablation, and laser thermocoagulation, are described.
Comparison of Clinical Results After Pisiformectomy in Patients With Rheumatic Versus Posttraumatic Osteoarthritis
Authors: Lautenbach Martin , Eisenschenk Andreas , Langner Inga , Arntz Ulrike , Millrose Michael 
Published: August 2014

Pisotriquetral osteoarthritis is important to consider in the differential diagnosis of chronic ulnar-sided wrist pain. It can develop following traumatic injury to the pisiform or in rheumatic diseases, such as rheumatoid arthritis or psoriatic arthritis. It has been shown that pisiformectomy can relieve symptoms in cases that have not responded to nonoperative treatment, and the excision does not compromise the function or strength of the wrist. Most studies focus on posttraumatic causes of pisotriquetral osteoarthritis. In the current study, rheumatic causes are also considered and the outcomes are compared.
This retrospective study included 35 patients who underwent pisiformectomy for pisotriquetral osteoarthritis. All patients underwent a thorough diagnostic evaluation to exclude other etiologies for ulnar-sided wrist pain. Radiological examinations including posteroanterior and lateral views of the wrist and a tangential view of the pisotriquetral joint were analyzed. All patients had excellent or very good results after pisiformectomy, with a significant reduction in pain. No significant difference was found in the outcomes for patients with rheumatic vs posttraumatic osteoarthritis.
Patients with rheumatic causes of pisotriquetral osteoarthritis can be successfully treated with pisiformectomy. With respect to idiopathic causes, these patients need a longer postoperative period to gain full pain relief. It is important to consider the possibility of pisotriquetral osteoarthritis after excluding other diagnoses in patients with rheumatic osteoarthritis.
Infection After Primary Total Hip Arthroplasty
Authors: Lindeque Bennie , Hartman Zach , Noshchenko Andriy , Cruse Margaret 
Published: August 2014

Educational Objectives

As a result of reading this article, physicians should be able to:

1.
Understand contemporary postoperative infection rates for primary total hip arthroplasty (THA).

2.
Understand the epidemiology of bacterial species responsible for postoperative primary THA infections.

3.
Review current interventions to decrease the primary THA infection rate.

4.
Assess the volume and quality of data in the current orthopedics literature regarding primary THA infections.

The number of primary total hip arthroplasties (THAs) performed in the United States each year continues to climb, as does the incidence of infectious complications. The changing profile of antibiotic-resistant bacteria has made preventing and treating primary THA infections increasingly complex. The goal of this review was to summarize (1) the published data concerning the risk of surgical site infection (SSI) after primary THA by type of bacteria and (2) the effect of potentially modifying factors.

The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, EMBASE, Web of Science, and PubMed were searched. Studies dated between 2001 and 2011 examining primary THA in adults were included. Meta-analysis of the collected data was performed. The pooled SSI rate was 2.5% (95% confidence interval [Cl], 1.4%–4.4%;
P
<.001; n=28,883). The pooled deep prosthetic joint infection (PJI) rate was 0.9% (95% Cl, 0.4%–2.2%;
P
<.001; n=28,883). The pooled rate of methicillin-resistant
Staphylococcus aureus
SSI was 0.5% (95% Cl, 0.2%–1.5%;
P
<.001; n=26,703). This is approximately 20% of all SSI cases. The pooled rate of intraoperative bacterial wound contamination was 16.9% (95% Cl, 6.6%–36.8%;
P
=.003; n=2180). All these results had significant heterogeneity. The postoperative risk of SSI was significantly associated with intraoperative bacterial surgical wound contamination (pooled rate ratio, 2.5; 95% Cl, 1.4%–4.6%;
P
=.001; n=19,049). [
Orthopedics.
2013; 37(4):257–265.]
Clinical and Optical Intraocular Performance of Rotationally Asymmetric Multifocal IOL Plate-Haptic Design Versus C-Loop Haptic Design
Authors: Alió Jorge L. , Plaza-Puche Ana B. , Javaloy Jaime , Ayala María José , Vega-Estrada Alfredo 
Published: August 2014

PURPOSE:
To compare the visual and intraocular optical quality outcomes with different designs of the refractive rotationally asymmetric multifocal intraocular lens (MFIOL) (Lentis Mplus; Oculentis GmbH, Berlin, Germany) with or without capsular tension ring (CTR) implantation.

METHODS:
One hundred thirty-five consecutive eyes of 78 patients with cataract (ages 36 to 82 years) were divided into three groups: 43 eyes implanted with the C-Loop haptic design without CTR (C-Loop haptic only group); 47 eyes implanted with the C-Loop haptic design with CTR (C-Loop haptic with CTR group); and 45 eyes implanted with the plate-haptic design (plate-haptic group). Visual acuity, contrast sensitivity, defocus curve, and ocular and intraocular optical quality were evaluated at 3 months postoperatively.

RESULTS:

Significant differences in the postoperative sphere were found (
P
= .01), with a more myopic postoperative refraction for the C-Loop haptic only group. No significant differences were detected in photopic and scotopic contrast sensitivity among groups (
P
⩾ .05). Significantly better visual acuities were present in the C-Loop haptic with CTR group for the defocus levels of −2.0, −1.5, −1.0, and −0.50 D (
P
⩽.03). Statistically significant differences among groups were found in total intraocular root mean square (RMS), high-order intraocular RMS, and intraocular coma-like RMS aberrations (
P
⩽.04), with lower values from the plate-haptic group.

CONCLUSIONS:
The plate-haptic design and the C-Loop haptic design with CTR implantation both allow good visual rehabilitation. However, better refractive predictability and intraocular optical quality was obtained with the plate-haptic design without CTR implantation. The plate-haptic design seems to be a better design to support rotational asymmetric MFIOL optics.

[
J Refract Surg.
2013;29(4):252–259.]
Inferior Intrastromal Corneal Ring Segments in Paracentral Keratoconus With No Coincident Topographic and Coma Axis
Authors: Alfonso José F. , Fernández-Vega Cueto Luis , Baamonde Begoña , Merayo-Lloves Jesus , Madrid-Costa David , Montés-Micó Robert 
Published: August 2014

PURPOSE:
To assess the visual and refractive outcomes of implantation of intrastromal corneal ring segments (ICRS) in keratoconic eyes with no coincident topographic and comatic axes.

METHODS:

Forty-one keratoconic eyes of 39 patients with no coincident topographic and comatic axes were implanted inferiorly with a Ferrara-type ICRS (Keraring SI6; Mediphacos Inc., Belo Horizonte, Brazil) of 150° of arc with a thickness of 150, 200, and 250
μ
m. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal coma-like root mean square, and residual refractive errors analyzed using vector analysis were recorded before and 6 months after the ICRS implantation.

RESULTS:

Mean UDVA was 0.76 ± 0.41 logMAR before and 0.53 ± 0.46 logMAR after surgery (
P
= .0006). CDVA was 0.13 ± 0.14 logMAR before and 0.07 ± 0.09 logMAR after surgery (
P
= .0007). Two eyes (4.9%) lost two lines or more of CDVA, 3 eyes (7.32%) lost one line, 16 eyes (39.02%) had no change in CDVA, 9 eyes (21.95%) gained one line, and 11 eyes (26.83%) gained two lines or more of CDVA. The safety index was 1.10. Spherical equivalent was significantly reduced after ICRS implantation (
P
< .001). Corneal coma-like root mean square changed from 0.80 ± 0.53
μ
m before surgery to 0.61 ± 0.59
μ
m after surgery (
P
= .02) for 4.5 mm of pupil size.

CONCLUSIONS:

One Ferrara-type ICRS of 150° of arc with a thickness of 150, 200, or 250
μ
m implanted inferiorly may reduce both astigmatism and corneal coma-like aberrations in keratoconic eyes with no coincident topographic and comatic axes, providing an improvement of UDVA and CDVA values.

[
J Refract Surg.
2013;29(4):266–272.]
Improved Effectiveness of Transepithelial PTK Versus Topography-Guided Ablation for Stromal Irregularities Masked by Epithelial Compensation
Authors: Reinstein Dan Z. , Archer Timothy J. , Gobbe Marine 
Published: August 2014

PURPOSE:
To demonstrate improved effectiveness of transepithelial phototherapeutic keratectomy (PTK) where topography-guided ablation is degraded by epithelial compensation for localized irregularities.

METHODS:
Artemis very high-frequency digital ultrasound (ArcScan Inc., Morrison, CO) scanning was performed on five eyes (four patients) after LASIK in which a truncated nasal flap was created but the ablation was still performed, resulting in irregular astigmatism and double vision. The stromal ablation pattern of a transepithelial PTK ablation was modeled and compared to topography-guided ablation simulations. Artemis-assisted transepithelial PTK procedures were performed in three eyes (two patients).

RESULTS:
In all cases, Artemis very high-frequency digital ultrasound demonstrated a crevice on the stromal surface caused by ablation on the underside of the flap nasally, which had been compensated for by epithelial thickening, thus masking a significant proportion of the stromal surface irregularity from corneal surface topography. The transepithelial PTK ablation pattern appeared logically to reduce the ridge nasal to the crevice, whereas topography-guided ablation patterns demonstrated poor targeting of the stromal ridge. Artemis-assisted transepithelial PTK greatly reduced the stromal irregularity, resulting in smoother epithelium and topography. In one eye, the epithelium had compensated fully for the irregularity and the patient reported 95% subjective improvement. One patient (two eyes) reported little change in visual symptoms despite significant anatomical regularization due to the partial nature of epithelial compensation, demonstrating that multiple procedures may often be required.

CONCLUSION:
Compensatory epithelial remodeling masks stromal irregularities from the corneal surface, meaning that topography-guided (or wavefront-guided) ablations may not provide an adequate treatment option and may potentially worsen the irregularity. The effectiveness of transepithelial PTK will depend on the proportion of epithelial masking due to remodeling, related to the rate of change of curvature of the stromal surface.

[
J Refract Surg.
2013;29(8):526–533.]
Coaxially Sighted Corneal Light Reflex Versus Entrance Pupil Center Centration of Moderate to High Hyperopic Corneal Ablations in Eyes With Small and Large Angle Kappa
Authors: Reinstein Dan Z. , Gobbe Marine , Archer Timothy J. 
Published: August 2014

PURPOSE:
To determine whether centering ablations on the coaxially sighted corneal light reflex (CSCLR) in eyes with large angle kappa leads to poor visual outcomes when compared to patients with eyes with negligible angle kappa that by default would be centered on the entrance pupil. In eyes with no angle kappa, the CSCLR coincides with the entrance pupil center, whereas eyes with large angle kappa possess an offset between the CSCLR and the entrance pupil center.

METHODS:
This study was a retrospective case series of consecutive patients treated by hyperopic LASIK using the MEL80 excimer laser (Carl Zeiss Meditec, Jena, Germany). All ablations were centered on the CSCLR using the standard non-wavefront–guided ablation profile. Angle kappa was classified according to pupil offset defined as the distance in the corneal plane between the entrance pupil center and the corneal vertex. Eyes were divided into two discrete groups according to the pupil offset: small angle kappa for pupil offset of 0.25 mm or less (n = 30) and large angle kappa for pupil offset of 0.55 mm or greater (n = 30). Safety, accuracy, cylinder vector analysis, contrast sensitivity, vertex centered corneal aberrations, entrance pupil centered whole eye aberrometry, and night vision disturbances were compared between the two groups.

RESULTS:
There were no statistically significant differences in safety, accuracy, induced astigmatism, contrast sensitivity, or night vision disturbances between the two groups. There was also no statistically significant difference between groups for vertex centered corneal aberrations; however, as expected, coma was higher in the large angle kappa group for entrance pupil centered aberrometry because the treatment had been centered on the CSCLR rather than the entrance pupil center.

CONCLUSION:
Refractive outcomes of high hyperopic LASIK were not found to be worse for eyes where ablation was centered more than 0.55 mm from the entrance pupil as determined by CSCLR in eyes with large angle kappa. The absence of poor quality visual outcomes in cases, which by entrance pupil centration are considered significantly “decentered,” supports the notion that centration relative to the CSCLR may be preferable. This provides evidence that refractive corneal ablation should not be systematically aligned with the entrance pupil center.

[
J Refract Surg.
2013;29(8):518–525.]
Femtosecond Laser Cataract Incision Morphology and Corneal Higher-Order Aberration Analysis
Authors: Alió Jorge L. , Abdou Ahmed A. , Soria Felipe , Javaloy Jaime , Fernández-Buenaga Roberto , Nagy Zoltán Z. , Filkorn Tamás 
Published: August 2014

PURPOSE:Analysis of the femtosecond laser refractive lens surgery corneal incision configuration and corneal higher-order aberration (HOA) effect from the first postoperative day.METHODS:High-resolution anterior segment optical coherence tomography was used to assess 20 eyes undergoing femtosecond laser refractive lens surgery with 2.2-mm minimal incision. The primary incision (tri-planar) actual length, cord length, surface angle, surface irregularity, and regional pachymetry values and the secondary incision (uni-planar) length, angle, surface irregularity, and pachymetry values were analyzed. Hartmann-Shack aberrometer was used to assess corneal HOAs to correlate the effect. Assessment was done preoperatively and 1 month postoperatively.RESULTS:The actual length, cord length, and surface angle means for the primary incision in the first postoperative day and month were 1.50 ± 0.1 and 1.47 ± 0.2 mm (P= .5), 1.41 ± 0.1 and 1.42 ± 0.2 mm (P= .8), and 27° ± 4° and 23° ± 5° (P= .07), respectively. The length and surface angle for the secondary incision in the first postoperative day and month were 1.17 ± 0.01 and 1.04 ± 0.1 mm (P= .05) and 52° ± 3° and 42° ± 5° (P= .007). The regional pachymetry values for the primary and secondary incisions were significantly increased in the first postoperative day and then significantly decreased after 1 month. All irregularities occurred in the posterior surface (endothelium): 2 cases of posterior gap (first day) and 1 case of posterior retraction (first month). The HOAs had not significantly changed preoperatively and after 1 month.CONCLUSIONS:The femtosecond laser refractive lens surgery incision is stable and does not significantly change the HOA.[J Refract Surg.2013;29(9):590–595.]