Modified crescentic osteotomy in children

A crescentic osteotomy of the first metatarsal is unstable during the preliminary healing stage. The authors present a modification in the direction of the cut of the osteotomy. This alteration increases stability at the first metatarsal base.     

Inguinal hernia repair in infants less than six months of age.

Previous studies reviewing the morbidity and mortality of infant inguinal hernia surgery have all been done in university hospital settings. From our community-based tertiary hospital, 100 consecutive cases on infants less than six months of age, undergoing inguinal hernia repair, were reviewed. No infants were excluded. Sixty-eight were full term and 32 were premature. A number of different variables were analyzed and none appeared to affect outcome. Infants were followed for three to five years. There were no true complications in any infant in this series, although six infants developed wound erythema that resolved spontaneously. Parents were given a questionnaire to subjectively evaluate the infant before and after surgery with 78% showing improvement.     

Factors associated with work-related injury among hospital employees: a case-control study.

The Central Arkansas Veterans Healthcare System (CAVHS) spends $1 million annually on occupational illnesses and injuries. To address the problem of injuries among hospital employees, a retrospective case-control study was conducted to examine select risk factors for work-related injuries (WRI) among CAVHS employees. Study methods included a review of employee health charts and computer and manual databases from 1997 to 2002 (N = 2,050). The researchers found that WRI increased with age; WRI occurred more often in women than in men; WRI was greater among maintenance and custodial staff compared to direct caregivers, and less among clerical staff; WRI occurred less often in part-time than full-time staff; and WRI increased with increasing body mass index. Developing standards, guidelines, and policies for preplacement screening, preventive measures, training, and education may help to minimize WRI and associated costs.     

Functional overload attenuates plantaris atrophy in tumor-bearing rats

Background  

Late stage cancer malignancies may result in severe skeletal muscle wasting, fatigue and reduced quality of life. Resistance training may attenuate these derangements in cancer patients, but how this hypertrophic response relates to normal muscle adaptations in healthy subjects is unknown. Here, we determined the effect of resistance training on muscle mass and myosin heavy chain (MHC) isoform composition in plantaris muscles from tumor-bearing (TB) rats.     

Gender differences in informal caring

Men have hitherto largely been invisible in research on informal care. This paper examines gender differences in informal caring, focusing on gender differences according to the relationship between the carer and care-recipient and the location of caring. The paper uses secondary analysis of the 1990–91 General Household Survey, which identified over 2700 adults as informal carers. Four per cent of men and women provide care for someone living in the same household. More women than men, 13% compared with 10%, provide care for someone living in another household. Men carers are less involved in care provision than women, providing fewer hours of care each week, and are less likely to be the main carer. However, gender differences are most marked among married carers, apart from those caring for their spouse, and least among unmarried carers. Married men can often rely on their wives to perform caring roles rather than performing them personally. Women carers are more likely to provide personal care than men carers, but the gender difference is least among those caring for their spouse or for disabled children. Cross-sex personal care is performed within the marital relationship and by parents caring for disabled children, but seldom by adult children caring for their parents or in more distant caring relationships. Evidence of cross-sex taboos in giving personal care is largely restricted to care provided in another household. Since the majority of elderly people in need of care are women, such cultural taboos may reinforce the pressure on mid-life women to care for mothers and mothers-in-law.     

Ultrasound biomicroscopy and management of late posterior migration of a ripcord suture after glaucoma drainage implant surgery.

Three years after receiving a Baerveldt tube implant for neovascular glaucoma, a 50-year-old man presented to the Wills Eye Hospital Glaucoma Service with pain and decreased vision in his left eye. On examination, a 4-0 nylon ripcord suture was seen to have migrated posteriorly through the pupil and in front of the intraocular lens. The distal end of the suture was not seen on dilated indirect ophthalmoscopic examination or by standard B-scan ultrasonography. Ultrasound biomicroscopy examination was performed, and the distal end of the suture was found to lie just anterior to the pars plana. Careful removal of the suture was performed intraoperatively through two paracentesis incisions using Kelman forceps. Posterior ripcord migration is a rare complication after glaucoma drainage implant surgery, and ultrasound biomicroscopy imaging may be helpful in determining its proper management.     

Frontal Slab Composite Magnetic Resonance Neurography of the Brachial Plexus: Implications for Infraclavicular Block Approaches

Background: Magnetic resonance neurography (MRN) is an imaging method by which nerves can be selectively highlighted. Using commercial software, the authors explored a variety of approaches to develop a three-dimensional volume-rendered MRN image of the entire brachial plexus and used it to evaluate the accuracy of infraclavicular block approaches.

Methods: With institutional review board approval, MRN of the brachial plexus was performed in 10 volunteer subjects. MRN imaging was performed on a GE 1.5-tesla magnetic resonance scanner (General Electric Healthcare Technologies, Waukesha, WI) using a phased array torso coil. Coronal STIR and T1 oblique sagittal sequences of the brachial plexus were obtained. Multiple software programs were explored for enhanced display and manipulation of the composite magnetic resonance images. The authors developed a frontal slab composite approach that allows single-frame reconstruction of a three-dimensional volume-rendered image of the entire brachial plexus. Automatic segmentation was supplemented by manual segmentation in nearly all cases. For each of three infraclavicular approaches (posteriorly directed needle below midclavicle, infracoracoid, or caudomedial to coracoid), the targeting error was measured as the distance from the MRN plexus midpoint to the approach-targeted site.

Results: Composite frontal slabs (coronal views), which are single-frame three-dimensional volume renderings from image-enhanced two-dimensional frontal view projections of the underlying coronal slices, were created. The targeting errors (mean +/- SD) for the approaches-midclavicle, infracoracoid, caudomedial to coracoid-were 0.43 +/- 0.67, 0.99 +/- 1.22, and 0.65 +/- 1.14 cm, respectively.