bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modified Biplanar Chevron Osteotomy
Authors: Corte-Real Nuno M. , Moreira Rodrigo M. 
Published: December 2009

Background: The surgical treatment of hallux valgus with an increased distal metatarsal articular angle (DMAA) should include the correction of this angle to maintain a congruent joint. The purpose of this study was to report our results with this procedure. Materials and Methods: From January 2000 until December 2006, 23 feet (13 patients) with an increased DMAA were operated upon by the same surgeon using a biplanar chevron osteotomy. The technique was modified making the plantar cut more horizontal and only removing a wedge from the dorsal cut. Clinical and radiographic evaluation was made after a mean followup of 56 months. The AOFAS score for the hallux was used and angular deformities were measured. The patients had a mean age of 51 years and were all female. Results: A good functional result was achieved with a mean AOFAS score of 87. An improvement of the angular deformities was noted in all patients. The mean hallux valgus angle improved from 28 degrees pre-op to 14 degrees post-op, the intermetatarsal angle from 12 degrees to 7 degrees and the DMAA from 20 degrees to 7 degrees. All patients except one were satisfied with the outcome of the procedure. Minimally symptomatic AVN of the metatarsal head was observed in one foot. Conclusions: We conclude that this procedure is a good choice for the treatment of symptomatic hallux valgus with an increased DMAA, producing a good clinical and radiographic result. Level of Evidence: IV, Retrospective Case Series
Comparison of the Proximal Chevron and Ludloff Osteotomies for the Correction of Hallux Valgus
Authors: Choi Woo Jin , Yoon Han Kook , Yoon Hang Seob , Kim Bom Soo , Lee Jin Woo 
Published: December 2009

Background: Although several studies have described good results of proximal chevron and Ludloff osteotomies, there have been no studies comparing the results of these two techniques at a single institution. Materials and Methods: We consecutively evaluated 46 patients who underwent proximal chevron osteotomies and 52 patients who underwent Ludloff osteotomies. Patients were evaluated by preoperative and postoperative weight bearing radiographs and the American Orthopaedic Foot and Ankle Society (AOFAS) hallux MP score. Results: Both groups had similarly high AOFAS scores and good correction by radiographic parameters. No statistically significant differences were found with respect to correction of hallux valgus angle (HVA) and intermetatarsal angle (IMA) between the two groups. Significant shortening of the first metatarsal was found after Ludloff osteotomy ( p < 0.05). At 6 weeks after surgery, the pain subscore was significantly lower in the proximal chevron group than in the Ludloff group ( p < 0.05). Conclusions: The proximal chevron and Ludloff osteotomies yielded equivalent clinical and radiological results. The Ludloff osteotomy with lag screw fixation is more stable and does not require postoperative hardware removal, although it is technically demanding and has a tendency toward greater shortening of the first metatarsal. Level of Evidence: III, Retrospective Comparative Study
New Radiographic Parameters Assessing Forefoot Abduction in the Adult Acquired Flatfoot Deformity
Authors: Ellis Scott J. , Yu Joseph C. , Williams Benjamin R. , Lee Cheol , Chiu Ya-lin , Deland Jonathan T. 
Published: December 2009

Background: Stage II flatfoot secondary to posterior tibial tendon insufficiency may be subclassified into mild (IIa) and severe (IIb) deformity based on the degree of talonavicular abduction. Current assessment of this abduction is difficult. We hypothesized that two new anteroposterior radiographic parameters, the lateral talonavicular incongruency angle (IA) and incongruency distance (ID) would demonstrate good reliability, correlate with current abduction parameters, and differ in IIb deformity, IIa deformity, and controls. Materials and Methods: Preoperative radiographs for consecutive patients undergoing flatfoot reconstruction were reviewed and subdivided into those with a Stage IIb ( n = 32) or Stage IIa ( n = 8) deformity. A third group of patients without flatfoot served as control ( n = 30). Radiographs were measured blindly by two investigators. Reliability was assessed with intraclass correlation coefficients (ICC), correlation with existing parameters with Pearson coefficients, and comparison between groups with analysis of variance. Results: The mean intrarater and interrater ICC's for the IA (0.88 and 0.81, respectively) were high. The IA correlated well with the coverage angle ( r = 0.86) and uncoverage percent ( r = 0.76). The IA was higher in the IIb versus IIa patients ( p = 0.007) and in the IIb group versus control ( p < 0.001). The ID demonstrated excellent reliability (ICC's of 0.83 and 0.83), but correlated poorly with the two other abduction parameters ( r = −0.59 and −0.49) and failed to differentiate between the three groups ( p = 0.0528). Conclusion: This data suggests that the IA is reliable and may help subclassify Stage II flatfoot deformity. Level of Evidence: III, Retrospective Comparative Study
Risk Factors for Failure of Transmetatarsal Amputation in Diabetic Patients: A Cohort Study
Authors: Younger Alastair SE , Awwad Mohammed A. , Kalla Timothy P. , Vries Gwyneth de 
Published: December 2009

Introduction: This study analysed the factors affecting wound healing of a transmetatarsal amputation (TMA) in patients with diabetes. Materials and Methods: Twenty-one patients who failed a TMA and were revised to transtibial amputation (TTA) within the first year were compared with a matched cohort of 21 successful TMA's. The factors compared included demographics, systemic issues, and local conditions in the foot. Chi-square comparisons were used for group data, and Analysis of Variance (ANOVA) for numeric data. Results: Blood glucose control as measured by HbA1c was the most important single factor predicting the success of TMA. Need for debridement after TMA was also found to be a significant predictor of failure of TMA. There was a trend towards duration of ulcer prior to TMA and smoking being significant. All other variables, including vascular status or renal failure were not significantly different between the two groups. Conclusion: The primary factor determining the success of a TMA was the quality of glucose control. The results of this study can be extrapolated to diabetic patients undergoing other types of surgery, with preoperative diabetic control as measured by HbA1c being an important determinant of the outcome of surgery. As a result of this study we currently do not perform any elective, trauma or emergency surgery on diabetic patients with an HbA1c of over 8 unless the need for surgery is to save life or limb. Level of Evidence: III, Retrospective Comparative Study
Kinematic Analysis of Runners with Achilles Mid-Portion Tendinopathy
Authors: Ryan Michael , Grau Stefan , Krauss Inga , Maiwald Christian , Taunton Jack , Horstmann Thomas 
Published: December 2009

Background: Despite anecdotal evidence linking overpronation to the onset of Achilles tendinopathy (AT), there is little conclusive evidence of a particular movement pattern of the lower extremity associated with this injury. Therefore, the objective of the present study was to observe differences in the kinematic profiles of healthy runners (CON) and runners with mid-portion Achilles tendinopathy (ATG). Materials and Methods: In this cross-sectional analysis, 48 male height and weight matched subjects were invited to participate: 27 with mid-portion Achilles tendon pain and 21 asymptomatic controls. Subjects underwent lower extremity clinical examination, then ran barefoot for 10-trials at a self-selected pace. A 3D motion capture system analysed tri-plane kinematic data for the lower extremity. Results: The ATG displayed significantly greater sub-talar joint eversion displacement during mid-stance of the running gait (13 ± 3 degrees vs. 11 ± 3 degrees; p = 0.04). Trends were observed such that the ATG showed lower peak dorsiflexion velocity (300 ± 39 degrees/s vs. 330 ± 59 degrees/s; p = 0.08) and greater overall frontal plane ankle joint range of motion (45 degrees ± 7 vs. 41 degrees ± 7; p = 0.09). Conclusion: We found an increase in eversion displacement of the sub-talar joint in runners with Achilles mid-portion tendinopathy. Based on the findings from this study, there is evidence that devices used to control sub-talar eversion may be warranted in patients with Achilles mid-portion tendinopathy who demonstrate over-pronation during mid-stance of the running gait. Level of Evidence: III, Comparative Study
Trans-sodium crocetinate enhancing survival and glioma response on magnetic resonance imaging to radiation and temozolomide
Authors: Sheehan Jason , Cifarelli Christopher P. , Dassoulas Kasandra , Olson Claire , Rainey Jessica , Han Shaojie 
Published: December 2009

Object
Glioblastoma (GB) tumors typically exhibit regions of hypoxia. Hypoxic areas within the tumor can make tumor cells less sensitive to chemotherapy and radiation therapy. Trans-sodium crocetinate (TSC) has been shown to transiently increase oxygen to hypoxic brain tumors. The authors examined whether this improvement in intratumor oxygenation translates to a therapeutic advantage when delivering standard adjuvant treatment to GBs.

Methods
The authors used C6 glioma cells to create a hypoxic GB model. The C6 glioma cells were stereotactically injected into the rat brain to create a tumor. Fifteen days later, MR imaging was used to confirm the presence of a glioma. The animals were randomly assigned to 1 of 3 groups: 1) temozolomide alone (350 mg/m2/day for 5 days); 2) temozolomide and radiation therapy (8 Gy); or 3) TSC (100 μg/kg for 5 days), temozolomide, and radiation therapy. Animals were followed through survival studies, and tumor response was assessed on serial MR images obtained at 15-day intervals during a 2-month period.

Results
Mean survival (± SEM) of the temozolomide-alone and the temozolomide/radiotherapy groups was 23.2 ± 0.9 and 29.4 ± 4.4 days, respectively. Mean survival in the TSC/temozolomide/radiotherapy group was 39.8 ± 6 days, a statistically significant improvement compared with either of the other groups (p < 0.05).
Although tumor size was statistically equivalent in all groups at the time of treatment initiation, the addition of TSC to temozolomide and radiotherapy resulted in a statistically significant reduction in the MR imaging–documented mean tumor size at 30 days after tumor implantation. The mean tumor size in the TSC/temozolomide/radiotherapy group was 18.9 ± 6.6 mm2 compared with 42.1 ± 2.7 mm2 in the temozolomide-alone group (p = 0.047) and 35.8 ± 5.1 mm2 in the temozolomide/radiation group (p = 0.004).

Conclusions
In a hypoxic GB model, TSC improves the radiological and clinical effectiveness of temozolomide and radiation therapy. Further investigation of this oxygen diffusion enhancer as a radiosensitizer for hypoxic brain tumors seems warranted.
“In-window” craniotomy and “bridgelike” duraplasty: an alternative to decompressive hemicraniectomy
Authors: Valença Marcelo M. , Martins Carolina , da Silva Joacil Carlos 
Published: December 2009

Object
The object of this study was to propose an alternative procedure to the classic decompressive hemicraniectomy using an “in-window” craniotomy and a “bridgelike” duraplasty.

Methods
The authors performed a large, almost rectangular craniotomy involving the frontal, temporal, and parietal bones and part of the occipital squama in 5 patients. The dura mater is opened and its area is enlarged using a rectangular dural patch of the surgeon's choice in the form of a bridge between the anterior and posterior dural edges. With a vertical cut, the bone flap is divided into 2 similarly sized pieces that function as “window lids.” The outer frontal and occipital sides of the bone are tied to the skull border at 2 points to function as a hinge joint. The angle of the bone cut must be beveled outward (inclination ~ 45° of the bone drill or saw) to allow the bone flap to rest on the adjacent skull and prevent its slippage toward the intracranial cavity.

Results
The above procedures were performed with effective control of intracranial hypertension due to cerebral venous sinus thrombosis, brain trauma, intracerebral hematoma, or malignant cerebral ischemia.

Conclusions
Decompressive surgery, which uses an in-window craniotomy that gradually opens according to the intracranial pressure, is an alternative solution for deploying autologous material. The procedure has the advantage of obviating the need for a second surgical procedure to close the bone defect, and thus preventing the metabolic cerebral impairment associated with the absence of an overlying skull.
Trapping of Active Methylene Intermediates with Alkenes, Indoles or Thiols: Towards Highly Selective Multicomponent Reactions
Authors: Gu Yanlong , Barrault Joël , Jérôme François 
Published: December 2009

AbstractIn this paper, a basic method to access new multicomponent reactions (MCRs) is reported. The mechanism of these MCRs is based on the trapping of methylene intermediates, formed in situ by reaction of formaldehyde with electron‐rich carbons, with alkene, thiol or indole derivatives. According to our strategy, a wide range of valuable skeletons has been obtained in a one‐pot reaction, thus allowing a minimization of waste, cost and labor. The presented methodology exhibits a broad substrate scope and electron‐rich carbons in the α‐position of a hydroxy or carbonyl group were found to be particularly efficient. More generally, this work offers new tools for creating molecular complexity and diversity from one of the simplest organic building blocks, formaldehyde.
Floating‐Harbor syndrome associated with middle ear abnormalities
Authors: Hendrickx Jan‐Jaap , Keymolen Kathelijn , Desprechins Brigitte , Casselman Jan , Gordts Frans 
Published: December 2009

AbstractFloating‐Harbor syndrome is a rare syndrome of unknown etiology, which was first described in 1973. A triad of main features characterizes Floating‐Harbor syndrome: short stature, characteristic face, and an expressive speech delay. We present a patient in whom the hearing thresholds improved insufficiently after placement of grommets. High‐resolution CT scan of the temporal bone showed a prominent soft‐tissue thickening suspected of causing fixation of the malleus, and fusion of the malleus head with the body of the incus. To our knowledge this is the first reported abnormal middle ear anatomy in a patient with Floating‐Harbor syndrome. A conservative treatment with hearing aids was preferred as an initial treatment in favor of a surgical exploration. © 2009 Wiley‐Liss, Inc.
The process of deciding about prophylactic surgery for breast and ovarian cancer: Patient questions, uncertainties, and communication
Authors: Klitzman Robert , Chung Wendy 
Published: December 2009

AbstractMany, women who have, or are at risk for, BRCA, 1/2 mutations or breast cancer decline prophylactic surgery, but questions remain as to how they make and experience these decisions. Our methods consisted of interviewing 32 women for 2 hr each; 19 were tested, 20 were symptomatic. Our results showed that these surgical options forced women to confront questions, involving stresses and uncertainties, regarding: implications of test results, prognoses with and without surgery, and effects of surgery (e.g., on self‐image). Given these dilemmas, many women turned to doctors who then ranged in what and how they communicated about these issues, and how strongly they offered input. Some patients felt disappointed at provider non‐directiveness, while others found providers too directive. Patients turned to family members and friends, who also ranged in how and what they communicated, and whether they agreed with the patient and/or each other. Many women turned to patient communities, but then had to decide how involved to be, and what information to provide or accept. These data suggest that providers and others may need to be more aware of the series of questions, involving stresses and uncertainties, that these women face, and the complex roles providers themselves may play. These data highlight needs for physicians to be able to address these issues flexibly, gauging patient preferences for information and paternalism (vs. autonomy). These data suggest areas for future research: for example, on how providers decide whether, what and how to communicate about these issues, and how these choices shape treatment decisions. © 2009 Wiley‐Liss, Inc.
Fowler syndrome—A clinical, radiological, and pathological study of 14 cases
Authors: Williams Denise , Patel Chirag , Fallet‐Bianco Catherine , Kalyanasundaram Karthik , Yacoubi Mohamed , Déchelotte Pierre , Scott Rosemary , Bazin Anne , Bessières Bettina , Marton Tamas , Cox Phillip 
Published: December 2009

AbstractWe report on 14 fetuses from 10 families with the autosomal recessive syndrome of proliferative vasculopathy and hydranencephaly–hydrocephaly (Fowler syndrome). In four families sibs were affected and in six the parents were consanguineous. Antenatal ultrasonography showed hydrocephaly in all except two fetuses, but hydranencephaly was diagnosed in only one case. Postural abnormalities were seen in 10 fetuses and structural brain abnormalities were suspected in 3. At autopsy the cerebral cortex appeared as a translucent membranous structure (hydranencephaly) in most fetuses. However, in one case, the ventricles were dilated but the cortical mantle was relatively well preserved. Histology of the brain showed the characteristic glomeruloid vascular proliferation of Fowler syndrome in all cases, but with variable extent of involvement of the central nervous system. Dystrophic calcification and necrosis were always present. Extra‐cranial anomalies included micrognathia (10 fetuses), cleft palate (1 fetus), cystic hygroma (2 fetuses), joint contractures (12 fetuses), and pterygia (11 fetuses). The typical proliferative vasculopathy was never observed outside the central nervous system and karyotypes were normal in the 10 fetuses studied. Fowler syndrome should be considered in the differential diagnosis of lethal multiple pterygium syndrome, fetal akinesia, and hydrocephalus in addition to classical hydranencephaly. Autopsy and study of the brain are essential to differentiate autosomal recessive Fowler syndrome from other causes of hydrocephaly and hydranencephaly, which may have a lower recurrence risk. © 2009 Wiley‐Liss, Inc.
Novel cardiac findings in periventricular nodular heterotopia
Authors: Jefferies John L. , Taylor Michael D. , Rossano Joseph , Belmont John W. , Craigen William J. 
Published: December 2009

AbstractPeriventricular nodular heterotopia (PNH) is a set of neuronal migration disorders that occur during fetal development. Neurons in the brain fail to migrate from the lining of the lateral ventricles to the cortex of the brain. When the neurons fail to migrate, ectopic neuronal nodules form. Epilepsy is a common symptom of PNH. The majority of PNH cases appear to be due to mutations in filamin A, an X‐linked gene. Most of the affected individuals are female because affected males typically die in utero. Filamin A anchors integral membrane proteins to the cytoskeleton by binding actin filaments in the cytoplasm. Both animal and human studies indicate that filamin A also plays a role in blood vessel development. In this report, we describe novel cardiac findings in an 18‐month‐old girl with PNH associated with a nonsense mutation in FLNA, including a dysplastic pulmonary valve and clefting of the mitral valve. These findings broaden the range of cardiac anomalies associated with filamin A mutations to include abnormality of the pulmonary valve and clefting of the mitral valve, consistent with a role for filamin A in valve leaflet development. © 2009 Wiley‐Liss, Inc.
Hypospadias in males with intrauterine growth restriction due to placental insufficiency: The placental role in the embryogenesis of male external genitalia
Authors: Yinon Yoav , Kingdom John C.P. , Proctor Leslie K. , Kelly Edmond N. , Salle Joao L. Pippi , Wherrett Diane , Keating Sarah , Nevo Ori , Chitayat David 
Published: December 2009

AbstractOur aim was to define the association between early onset intra‐uterine growth restriction (IUGR) due to placental insufficiency and hypospadias in males. We prospectively studied a cohort of small‐for‐gestational age (SGA) male infants with hypospadias managed by a multidisciplinary team over a 5‐year period. Thirty SGA male infants were diagnosed with hypospadias/abnormal genitalia after birth, and four of them were diagnosed antenatally. Five cases occurred in the smaller pair of discordant IUGR twins, where the larger co‐twin had normal male genitalia. Serial ultrasounds demonstrated features of early‐onset IUGR in all cases at a median gestational age of 21 weeks (range 14–31weeks). Twenty‐one (70%) pregnancies were subsequently complicated by absent/reversed end‐diastolic flow in the umbilical arteries indicating severe IUGR, and 17 (57%) women developed severe pre‐eclampsia. There were 27 (90%) live births at a median gestational age of 31 weeks (range 27–37); 23 (77%) of the neonates had birth weights <3rd centile. All newborns had normal male karyotypes. In 62% (18/29) the hypospadias was severe. A correlation was found between the severity of the IUGR and the severity of hypospadias as significantly more infants with severe hypospadias were less than the 3rd centile compared to the mild–moderate hypospadias group: 94% (17/18) versus 55% (6/11), respectively (P = 0.02). In conclusion, SGA male newborns with hypospadias exhibit a high rate of early‐onset severe IUGR due to placental insufficiency. Early placental development likely influences male external genitalia formation. Careful sonographic evaluation of the genitalia is advised when early‐onset placentally mediated IUGR is found. © 2009 Wiley‐Liss, Inc.
Severe cleidocranial dysplasia and hypophosphatasia in a child with microdeletion of the C‐terminal region of RUNX2
Authors: El‐Gharbawy Areeg H. , Peeden Joseph N. , Lachman Ralph S. , Graham John M. , Moore Stephen R. , Rimoin David L. 
Published: December 2009

AbstractCleidocranial dysplasia (CCD) is a rare autosomal dominant skeletal dysplasia due to mutations causing haploinsufficiency of RUNX2, an osteoblast transcription factor specific for bone and cartilage. The classic form of CCD is characterized by delayed closure of the fontanels, hypoplastic or aplastic clavicles and dental anomalies. Clinical reports suggest that a subset of patients with CCD have skeletal changes which mimic hypophosphatasia (HPP). Mutations in RUNX2 are detected in approximately 65% of cases of CCD, and microdeletions occur in 13%. We present clinical and radiological features in a 6‐year‐old child with severe CCD manifested by absence of the clavicles marked calvarial hypomineralization, osteoporosis and progressive kyphoscoliosis. HPP features included Bowdler spurs, severe osteopenia, and low alkaline phosphatase. Following negative mutation analysis of RUNX2, comparative genomic hybridization (CGH) microarray was performed. The result revealed a microdeletion in RUNX2, disrupting the C‐terminal part of the gene. © 2009 Wiley‐Liss, Inc.