Extensor tendon ruptures in rheumatoid wrists

European Journal of Orthopaedic Surgery & Traumatology - Rheumatoid arthritis is a chronic inflammatory disease. The associated involvement of hands and tendons is over 90% and impairs overall...     

Improvements in Back and Leg Pain After Minimally Invasive Lumbar Decompression

HSS Journal ® - Few studies have quantified clinical improvement following minimally invasive lumbar decompression based on predominant back pain or leg pain. To quantify improvement in...     

Flexions- und Extensionsosteotomien der proximalen Tibia

Background

Isolated deviations in flexion and extension of the leg axis are rare. These deviations can be corrected if necessary by osteotomy and the range of motion (ROM) of the knee joint can be optimized. In addition to correction in the frontal plane, the tibial slope (i.e. inclination of the surface of the tibial joint) can also be influenced by osteotomy and therefore osteotomy can also be utilized to optimize the biomechanical stability of the knee joint.

Method

Careful planning taking all three spatial planes and torsion into consideration is the foundation of a successful operation. A controlled surgical technique based on careful planning and some basic principles allows the alteration of the three dimensional alignment of the tibia.     

Surgical delivery of drug releasing poly(lactic-co-glycolic acid)/poly(ethylene glycol) paste with in vivo effects against glioblastoma

Introduction

The median survival of patients with glioblastoma multiforme (astrocytoma grade 4) remains less than 18 months despite radical surgery, radiotherapy and systemic chemotherapy. Surgical implantation of chemotherapy eluting wafers into the resection cavity has been shown to improve length of survival but the current licensed therapy has several drawbacks. This paper investigates in vivo efficacy of a novel drug eluting paste in glioblastoma.

Methods

Poly(lactic-co-glycolic acid)/poly(ethylene glycol) (PLGA/PEG) self-sintering paste was loaded with the chemotherapeutic agent etoposide and delivered surgically into partially resected tumours in a flank murine glioblastoma xenograft model.

Results

Surgical delivery of the paste was successful and practical, with no toxicity or surgical morbidity to the animals. The paste was retained in the tumour cavity, and preliminary results suggest a useful antitumour and antiangiogenic effect, particularly at higher doses. Bioluminescent imaging was not affected significantly by the presence of the paste in the tumour.

Conclusions

Chemotherapy loaded PLGA/PEG paste seems to be a promising technology capable of delivering active drugs into partially resected tumours. The preliminary results of this study suggest efficacy with no toxicity and will lead to larger scale efficacy studies in orthotopic glioblastoma models.     

Incidence and risk factors for perioperative visual loss after spinal fusion

Background contextPerioperative visual loss (POVL) is a rare but devastating complication that may follow spinal surgeries. The incidence of POVL after spinal fusion is not well characterized during the past decade.PurposeA population-based database was analyzed to characterize the incidence and risk factors for POVL associated with spinal fusion surgery on a national level.Study designThis study consisted of a retrospective database analysis.Patient sampleA total of 541,485 patients from the Nationwide Inpatient Sample (NIS) database were included in the study.Outcome measuresStudy outcome measures included incidence of POVL, length of stay (LOS), in-hospital costs, mortality, and POVL risk factors.MethodsData from the NIS were obtained from 2002 to 2009. Patients undergoing spinal fusion for degenerative pathologies were identified. Patient demographics, comorbidities, LOS, costs, and mortality were assessed. Statistical analyses were conducted using an independent t test for discrete variables and the chi-square test for categorical data. Binomial logistic regression was used to identify independent predictors of POVL. A p value of less than or equal to .001 was used to denote statistical significance. No funds were received by any of the authors for production of this study.ResultsA total of 541,485 spinal fusions were identified in the United States from 2002 to 2009. The overall incidence of POVL was 1.9 events per 10,000 cases. Of patients who had POVL, 56.2% underwent surgery for a diagnosis of spinal deformity. Patients with POVL were significantly younger on average compared with unaffected patients (37.6 years vs. 52.4 years; p<.001). Length of stay and hospital costs doubled for patients with POVL (p<.001). Logistic regression analysis demonstrated that independent predictors of visual loss were deformity surgery (odds ratio [OR]=6.1), diabetes mellitus with end organ damage (OR=13.1), and paralysis (OR=6.0, p<.001).ConclusionsOur findings demonstrated an overall POVL incidence of 1.9 events per 10,000 spinal fusions. Patients undergoing thoracic fusion for deformity correction accounted for the majority of cases of POVL. Despite being a rare complication after spinal fusion, POVL is an adverse event that may not be entirely preventable. Patients undergoing long-segment fusions for deformity and those with certain risk factors should be counseled regarding the risks of POVL.     

Quantitative Validation of the n-Butanol Sniffin’ Sticks Threshold Pens

Odorant pens are used by medical practitioners and researchers to assess olfactory dysfunction. Despite their routine use, there are currently no data on the gas-phase odorant concentrations released from the pen tips or whether these concentrations scale linearly with the aqueous-phase concentrations inside the pens. The commercially available Sniffin’ Sticks odor threshold test containing n-butanol was chosen for evaluation. The gas-phase concentration of n-butanol at the tip of each pen was measured directly in a new set of pens via proton-transfer-reaction mass spectrometry (PTR-MS). Measurements were additionally made on the same pens after 6 months and two older pen sets, namely a 3-year-old (used) and 4-year-old (new) set. Furthermore, application-related tests were made to determine the performance of the pens during routine use and under stress. These data demonstrate that the gas-phase n-butanol concentrations of the threshold pens are linear over the entire set, both for brand-new pens and 6 months later; this reflects the expected performance that was previously only assumed. Furthermore, the application–simulation tests demonstrated a good performance of the pens when used according to their intended protocol. Measurements of the older pen sets suggest that storage conditions are more critical than usage for pen stability. The present findings confirm that the n-butanol odorant pens are an appropriate tool for threshold testing, provided they are stored and handled correctly.