bluuebunny/crossref_metadata_2025_split huggingface dataset:
The low contact stress patellofemoral replacement
Authors: Charalambous C. P. , Abiddin Z. , Mills S. P. , Rogers S. , Sutton P. , Parkinson R. 
Published: April 2011

The low contact stress patellofemoral replacement consists of a trochlear component and a modular patellar component which has a metal-backed mobile polyethylene bearing. We present the early results of the use of this prosthesis for established isolated patellofemoral arthritis in 51 consecutive patellofemoral replacements in 35 patients. The mean follow-up was 25 months (5 to 60). The estimated survival rate at three years was 63% (95% confidence interval 47 to 80) with revision as the endpoint and 46% (95% confidence interval 30 to 63) with revision and ongoing moderate or severe pain as the endpoint. The early results of the use of the low contact stress patellofemoral replacement are disappointing with a high rate of revision. We cannot therefore recommend its use.
Neuropathic pain following hip resurfacing due to a transneural suture
Authors: Marchese M. , Sinisi M. , Anand P. , Di Mascio L. , Humphrey J. 
Published: April 2011

A 60-year-old man developed severe neuropathic pain and foot-drop in his left leg following resurfacing arthroplasty of the left hip. The pain was refractory to all analgesics for 16 months. At exploration, a PDS suture was found passing through the sciatic nerve at several points over 6 cm and terminating in a large knot. After release of the suture and neurolysis there was dramatic and rapid improvement of the neuropathic pain and of motor function. This case represents the human equivalent of previously described nerve ligation in an animal model of neuropathic pain. It emphasises that when neuropathic pain is present after an operation, the nerve related to the symptoms must be inspected, and that removal of a suture or irritant may lead to relief of pain, even after many months.
Dropped-head syndrome resulting from injury to the central spinal cord at the upper cervical level
Authors: Rust C. L. , Ching A. C. , Hart R. A. 
Published: April 2011

There are many causes of paraspinal muscle weakness which give rise to the dropped-head syndrome. In the upper cervical spine the central portion of the spinal cord innervates the cervical paraspinal muscles. Dropped-head syndrome resulting from injury to the central spinal cord at this level has not previously been described. We report two patients who were treated acutely for this condition. Both presented with weakness in the upper limbs and paraspinal cervical musculature after a fracture of C2. Despite improvement in the strength of the upper limbs, the paraspinal muscle weakness persisted in both patients. One ultimately underwent cervicothoracic fusion to treat her dropped-head syndrome. While the cause of the dropped-head syndrome cannot be definitively ascribed to the injuries to the spinal cord, this pattern is consistent with the known patho-anatomical mechanisms of both injury to the central spinal cord and dropped-head syndrome.
Comparison of total hip replacement with and without cement in patients younger than 50 years of age
Authors: Kim Y.-H. , Kim J.-S. , Park J.-W. , Joo J.-H. 
Published: April 2011

There have been comparatively few studies of the incidence of osteolysis and the survival of hybrid and cementless total hip replacements (THRs) in patients younger than 50 years of age. We prospectively reviewed 78 patients (109 hips) with a hybrid THR having a mean age of 43.4 years (21 to 50) and 79 patients (110 hips) with a cementless THR with a mean age of 46.8 years (21 to 49). The patients were evaluated clinically using the Harris hip score, the Western Ontario and McMaster Universities (WOMAC) osteoarthritis score and the University of California, Los Angeles (UCLA) activity score. Radiographs and CT scans were assessed for loosening and osteolysis. The mean follow-up was for 18.4 years (16 to 19) in both groups. The mean post-operative Harris hip scores (91 points versus 90 points), the mean WOMAC scores (11 points versus 13 points) and UCLA activity scores (6.9 points versus 7.1 points) were similar in both groups. The revision rates of the acetabular component (13% versus 16%) and the femoral component (3% versus 4%), and the survival of the acetabular component (87% versus 84%) and the femoral component (97% versus 96%) were similar in both groups. Although the long-term fixation of the acetabular metallic shell and the cemented and cementless femoral components was outstanding, wear and peri-acetabular osteolysis constitute the major challenges of THR in young patients.
Outcome following surgical treatment for regional metastases from cutaneous cancers of the head and neck in patients aged 80 and over
Authors: Khandavilli Sunil D , Lloyd Christopher J , Jones Huw B 
Published: April 2011

INTRODUCTION Population demographics and disease epidemiology is resulting in more elderly patients presenting with regional metastases from cutaneous malignancy of the head and neck region. Surgery remains the most appropriate primary treatment option. PATIENTS AND METHODS We analysed consecutive patients aged 80 and over who developed regional metastases from cutaneous cancers of head and neck and underwent a neck dissection over a two-and-a-half-year period. Data were obtained from the cancer database and patients’ notes. A Kaplan-Meier survival graph was constructed. RESULTS Our study demonstrated a low postoperative morbidity but one patient died from medical complications with in the first 30 days post surgery. The median survival time following surgery is nearly two years. CONCLUSIONS We continue to advocate primary surgery for cutaneous metastatic malignancy from the head and neck area but patients need multidisciplinary team discussions, thorough assessment and counselling.
Hospital mortality under surgical care
Authors: Aziz O , Fink D , Hobbs L L , Williams G , Holme TC 
Published: April 2011

INTRODUCTION The ‘hospital standardised mortality ratio’ (HSMR) has been used in England since 1999 to measure NHS hospital performance. Large variations in reported HSMR between English hospitals have recently led to heavy criticism of their use as a surrogate measure of hospital performance. This paper aims to review the mortality data for a consultant general surgeon contributed by his NHS trust over a 3-year period as part of the trust's HSMR calculation and evaluate the accuracy of coding the diagnoses and covariates for case mix adjustment. SUBJECTS AND METHODS The Dr Foster Intelligence database was interrogated to extract the NHS trust's HSMR benchmark data on inpatient mortality for the surgeon from 1 April 2006 to 31 March 2009 and compared to the hospital notes. RESULTS 30 patients were identified of whom 12 had no evidence of being managed by the surgeon. This represents a potential 40% inaccuracy rate in designating consultant responsibility. The remaining 18 patients could be separated into ‘operative’ (11 patients) and ‘non-operative’ (7 patients) groups. Only 27% in the operative group and 43% of the non-operative mortality group respectively had a Charlson co-morbidity index recorded despite 94% of the cases having significant co-morbidities CONCLUSIONS Highlighting crude and inaccurate clinician-specific mortality data when only 1-5% of deaths under surgical care may be associated with avoidable adverse events seems potentially irresponsible.
One hand is better than two: conversion from pure laparoscopic to the hand-assisted approach during difficult nephrectomy
Authors: Mahesan Nishanthan , Choudhury Sirazum M , Khan M Shamim , Murphy Declan G , Dasgupta Prokar 
Published: April 2011

INTRODUCTION The incidence of conversion from a laparoscopic to an open approach during nephrectomy is reported at 6-8%. 1 Conversion to an open procedure may be necessary to control haemorrhage or allow progress in dissection but the well established benefits of minimally invasive surgery (MIS) are obviously lost. Hand-assisted laparoscopy (HAL) also offers the benefits to the patient of MIS. We have used HAL to convert from the pure laparoscopic approach during difficult nephrectomies, rather than converting to traditional open surgery. MATERIALS AND METHODS A review of our prospective database was carried out to identify any conversions from the pure laparoscopic approach during nephrectomy or nephroureterectomy for benign or malignant disease. RESULTS A total of 87 laparoscopic nephrectomies (LNs) were identified over a 3-year period. There were five conversions to the HAL approach (5.7%) and no conversions to open surgery. The reason for conversion was failure to progress in all five cases. Operative times averaged 190 minutes with blood loss of 180ml. Histology revealed xanthogranulomatous pyelonephritis in four cases and renal cell carcinoma in one case. The median postoperative stay was 4 days. CONCLUSIONS Conversion to HAL during LN maintains the benefits of MIS in difficult nephrectomy and should be considered prior to converting to open surgery.
Endoscopic anatomy of the ulnar nerve: a useful adjunct to teaching anatomy
Authors: Matteucci Paolo , Lagopoulos Menos , Southern Stephen 
Published: April 2011

INTRODUCTION There has been a shift away from gross anatomy teaching and hands-on cadaveric dissection. This has been replaced by a variety of teaching modalities including problem-based learning, models and prosections, and computer-assisted learning. We aim to pilot a technique of endoscopic visualisation of upper limb anatomy, to produce a video that can be incorporated into anatomy teaching and to assess the video qualitatively as an adjunct to anatomy teaching. MATERIALS AND METHODS A single, previously undissected, formalin preserved cadaver was used and views were obtained of the left arm. The video was shown to 10 surgical trainees who were then asked to complete appraisal forms anonymously. RESULTS The endoscopic views were thought to be useful and helped the trainees to appreciate the in situ anatomy and potential sites of nerve compression. 70% of respondents would recommend the system to others. CONCLUSIONS We feel this represents another method to help in the understanding of a complex area of anatomy in a way that is unique to endoscopy.
Parotid cancer treatment with surgery followed by radiotherapy in Oxford over 15 years
Authors: Shah Ketan , Javed Faisal , Alcock Chris , Shah Ketan A , Pretorius Pieter , Milford Chris A 
Published: April 2011

INTRODUCTION Primary parotid malignancies represent a rare diagnosis, making high-quality comparative research unfeasible. There is little UK-based evidence to guide practice. A review was therefore undertaken of a large series of patients treated by a multidisciplinary team in a National Health Service tertiary referral centre. PATIENTS AND METHODS Retrospective patient record review at the John Radcliffe Hospital in Oxford identified 401 patients who had undergone parotidectomy between 1995 and 2010, of whom 50 subjects were given a definitive diagnosis of primary parotid malignancy, treated with surgery and postoperative radiotherapy. Case notes, histology and imaging were reviewed by the study team. RESULTS The median follow up for the cohort was 60 months (range: 1-108 months). Facial nerve function was preserved in all patients undergoing partial or total conservative parotidectomy. Although histology showed microscopically close or positive margins in 82% of cases, all patients underwent postoperative radiotherapy and locoregional recurrence was identified in only two (4%) patients. CONCLUSIONS The data presented demonstrate a reasonable and practical multidisciplinary approach to a complex management problem. Facial nerve sparing surgery and postoperative radiotherapy result in good control of locoregional disease.
Laparo-endoscopic resection for extensive and inaccessible colorectal polyps: a feasible and safe procedure
Authors: Wood JJ , Lord AC , Wheeler JMD , Borley NR 
Published: April 2011

INTRODUCTION Polypectomy at colonoscopy may be difficult or dangerous. In such instances colonic resection may be indicated. Novel combined laparoscopic-endoscopic procedures have the potential to allow safe extensive extramucosal resection, thus avoiding resection. Laparoscopic colon mobilisation provides a more favourable orientation for endoscopic mucosal resection and facilitates identification of possible perforation sites with immediate laparoscopic repair or resection if necessary. This study aimed to assess the efficacy and safety of laparo-endoscopic resection (LER) of colonic polyps. PATIENTS AND METHODS Data were collected prospectively on consecutive patients undergoing LER. The mode of presentation, referral pattern, lesion site and size, hospital stay, procedural details, complications, histology and further treatment were recorded. RESULTS A total of 13 patients underwent attempted LER (16 polyps in total) and this was completed for 10, with a median hospital stay of 2 days. Five polyps were removed whole and eight piecemeal. Excision was clinically complete in all cases. Three procedures were converted to colonic resection. One lesion appeared malignant, indicating a conversion to laparoscopic right hemicolectomy. Two polyps were not amenable to LER and resection was performed. One patient underwent subsequent colonic resection based on the histological findings. There were no perforations or serious complications. CONCLUSIONS LER is a safe and effective treatment for large and inaccessible colonic polyps that would otherwise be treated by colonic resection.
The value of intraoperative ultrasound and preoperative imaging, individually and in combination, in liver resection for metastatic colorectal cancer
Authors: Lordan Jeffrey T , Stenson Katherine M , Karanjia Nariman D 
Published: April 2011

INTRODUCTION Liver resection is proved to offer potential long-term survival for colorectal liver metastases (CRLM). Accurate radiological assessment is vital to enable an appropriate surgical approach. The role of intraoperative ultrasound (IOUS) has been controversial. This study was designed to analyse the accuracy of IOUS compared with that of preoperative imaging (POI) in these patients. MATERIALS AND METHODS A prospective analysis of 51 consecutive patients who underwent liver resection for CRLM was undertaken. The accuracy of POI and IOUS were correlated and compared with histopathological analysis. Statistical analyses included t-tests, to compare continuous variables, and chi-square and Fisher’s exact tests to compare categorical variables. p<0.05 was considered significant RESULTS POI correlated with histology in 35 patients (68.6%). The sensitivity and specificity were 82.4% and 86.3% respectively. IOUS correlated with histology in 31 (60.8%) patients. The sensitivity and specificity were 84.3% and 76.5% respectively. There was no difference in accuracy between modalities. The accuracy of POI combined with IOUS correlated with histology in 40 patients (78.4%). The sensitivity and specificity were 88.2% and 84.3% respectively. The accuracy of combined modalities was significantly greater than IOUS or POI alone. CONCLUSIONS POI combined with IOUS may significantly increase the diagnostic accuracy of patients undergoing liver resection for CRLM.
Clinic-based nerve conduction studies reduce time to surgery and are cost effective: a comparison with formal electrophysiological testing
Authors: Bourke Henry E , Read Jeremy , Kampa Rebecca , Hearnden Anthony , Davey Paul A 
Published: April 2011

INTRODUCTION Carpal tunnel syndrome is the most common compression neuropathy affecting the upper limb. Clinical diagnosis is not always clear and electrophysiological testing can be indicated when considering a patient for decompression surgery. The downside of electrophysiological testing is cost and increased time to surgery. Newer methods of performing nerve conduction studies in clinic have become available. MATERIALS AND METHODS We investigated the use of a clinic-based, handheld, non-invasive electrophysiological device (NC-stat®) in 71 patients with suspected carpal tunnel syndrome presenting to our hand clinic in a district general hospital. We compared this to a similar cohort of 71 age-matched patients also presenting to our unit in whom formal nerve conduction studies were performed at a local neurophysiology unit. Our outcome measures were time from presentation to carpal tunnel decompression, the cost of each pathway and the practicalities of using the device in a busy hand unit. RESULTS AND CONCLUSIONS The NC-stat® proved to be a successful device when compared with referring patients out for more formal nerve conduction studies, shortening the time from presentation to surgery from 198 days to 102 days (p<0.0001). It was also cost effective with a calculated saving to the hospital of more than £70 per patient. The device is easy to use and acceptable to patients and no adverse effects were noted.
Long-term clinical outcome following lower limb arterial angioplasty
Authors: Morris-Stiff G , Moawad M , Appleton N , Davies G , Hicks E , Davies C , Lewis MH 
Published: April 2011

INTRODUCTION The aim of this study was to determine the clinical outcome of lower limb arterial angioplasty in a busy district general hospital practice. PATIENTS AND METHODS All angioplasties performed from January 1999 to December 2004 were identified and data collected included cardiovascular risk factors, indications for and complications of angioplasty, limb salvage and patient survival rates, and clinically significant re-stenoses. RESULTS 471 interventions were performed in 385 patients (231 men, 154 women). The median age was 67.9 years (range: 39-93 years). Indications for angioplasty were critical ischaemia (n=247, 52%) and lifestyle-limiting intermittent claudication (n=224, 48%). Stenotic lesions accounted for 378 (80%) cases and occlusion for 93 (20%). Radiological success was obtained in 417 (88.5%), improving to 93.6% if only those in whom access was achieved were included. Post-angioplasty complications were observed in 42/471 (9.1%) of interventions. The actual patient survival at 1,2, and 3 years was 87.4%, 85.1% and 83.2% respectively. Indication for angioplasty and the number of lesions present were identified as risk factors for outcome on multivariate analysis. The cumulative post-angioplasty patency rates at 1, 2 and 3 years were 86.0%, 83.1% and 81.6% respectively. The only factor associated with patency was the mode of presentation. CONCLUSIONS Angioplasty for lower limb peripheral vascular disease can be performed safely and efficaciously with a high technical success rate and a low complication rate. The patient survival and post-angioplasty patency data reflect the progressive and multi-site nature of the underlying disease process.
Control Strategies for an Inline Cooling Device in Hot Strip Processing of Innovative Steel Materials
Authors: Rieger Thomas , Bülters Oliver , Bian Ing. Jian 
Published: April 2011

Abstract
Heat treatment of steel is used to adjust different microstructures and mechanical properties. The Quenching and Partitioning (Q&P) process or cyclic annealing for grain refinement lead to increased strength and ductility. Both approaches demand a strict temperature control and a close strip temperature tracking. A control strategy for optimal properties is developed. Herefore a one-stand laboratory scale hot rolling process line was equipped with a water cooling section. A detailed temperature control during the cooling process was established accounting for strip thickness and velocity, set point temperatures, and amount of water cooling. While industrial set points and parameters of closed-loop controllers are often empirical, the presented control system and strategies are investigated by MatLab-Simulink. The improved material properties were evaluated in annealing tests. The control system for the cooling track reduces the temperature gradient within the strip to 12 K. The simulation of the cooling track gives an optimal set point. As a prerequisite for a controlled design of time-temperature-cycles, it can be calculated for various process parameters. Grain sizes &lt;5 μm are achieved by cyclic annealing and accompanied by increased strength and ductility. The Q&P treatment produces tempered martensite and retained austenite with improved mechanical properties.
Evaluation of a Handwipe Disclosing Method for Lead
Authors: Ashley Kevin , Wise Tamara J. , Esswein Eric J. 
Published: April 2011

Abstract
A qualitative chemical screening method for lead in wipe samples was evaluated for its utility in detecting the presence of lead in collected dust; preliminary evaluation of the performance of the method is reported here. In evaluating the method on pure lead compounds, the observed intensity of the characteristic color change due to the presence of lead was generally consistent with the relative solubilities of the tested compounds. Some pure (non-lead) metal compounds (e.g., those of Ag, Ba, Bi, Ca, Cd, Hg, and Sr) were found to give false positive results. Several representative lead-containing reference materials were also tested, and the qualitative test results differed for different materials. For materials collected on wipes, the method was found to be effective for detecting lead in several sample matrices commonly found in occupational settings. The technique was also applied on-site on dermal samples collected at field locations.
Influencing Factors of Heat Transfer Coefficient in Air and Gas Quenching
Authors: Xiao Bowang , Wang Gang , Sisson Richard D. , Rong Yiming 
Published: April 2011

Abstract
Cooling rates of work pieces in heat treating processes heavily depend on the interfacial heat transfer coefficient (HTC) between work pieces and quenchants. Because the HTC plays an important role in the resulted distortion, residual stress, and mechanical property distributions, understanding how the HTC varies with respect to various influencing factors is of importance for an optimal quenching process. In this paper, the influencing factors such as air/gas velocity, pressure, temperature, gas mixture and part orientation, air/gas temperature, air humidity, surface roughness, oxide, and material to the variation of HTC are studied experimentally by using the Center for Heat Treating Excellence quenching system and theoretically by using empirical equations.
Simulation of Austenitization Processes in Fe–C Steels by Coupled Cellular Automaton and Finite Difference Methods
Authors: Roósz András , Karacs Gábor 
Published: April 2011

Abstract
The aim of the simulation was to calculate the austenitization processes in plain carbon steels with different carbon concentrations. As the first step of simulation, an initial structure was generated where the diameters of pearlite colonies, the thickness and orientation of cementite lamellae, and the thickness of pro-eutectoid ferrite or even secondary cementite were changed. By this method, similar structures to the real ones were obtained. To solve the nucleation problem, a free enthalpy model was used, which makes difference between the places of nuclei. The diffusion equation (Fick II.) in case of the grain growth of austenite was solved by the Finite Differential Method. Nuclei can be formed at the boundary of pearlite colonies, at the boundary of the pro-eutectoid ferrite and cementite, or rarely at the boundary of cementite and ferrite lamellae too. The grain growth model calculates the carbon diffusion through both ferrite and austenite phases. The simulation runs as a coupled Cellular Automaton and Finite Difference Methods.