Optimal fixation for the extended trochanteric osteotomy: a pilot study comparing 3 cables vs 2 cables

The extended femoral trochanteric osteotomy allows excellent exposure of the proximal femoral canal, which facilitates resection of the canal's contents during revision total hip arthroplasty. Once the proximal femoral canal has been evacuated and a new femoral component has been placed, the osteotomy should be fixed in proper position to allow healing. The purpose of our study was to compare the fixation of an extended trochanteric osteotomy using 2 vs 3 braided cables with regard to stiffness, peak force, axial displacement, transverse displacement, and angular displacement using an in vitro biomechanical model. Nine paired cadaver femurs were loaded to failure. Movement at the osteotomy site before failure was recorded using a motion analysis system. There was no statistically significant difference between 2 vs 3 cables with regard to stiffness, peak force, or displacement in the 3 planes tested. Peak force and stiffness were both greater in the 3-cable group, whereas angular and transverse displacement were less in the 2-cable construct.     

Navigation with the StealthStation™ in Skull Base Surgery: An Otolaryngological Perspective

The introduction of computer-assisted navigation systems has played a significant role in assuring the integration and consistent intraoperative use of radiological information. We used a frameless stereotactic navigation system to treat 62 patients with a variety of skull base pathologies. The optoelectric appliance uses digital imaging information to locate surgical instruments in the operative area. The aim of this study was to evaluate the clinical accuracy, practicality, and impact of this navigation system on otolaryngological procedures. In conjunction with rigid head fixation and bone-anchored registration markers, the precision of registration was 0.8 mm and the accuracy of clinical measurements was less than 2 mm. With conventional fiducials and flexible head positioning, deviations were as large as 4.5 mm. The additional use of surface registration increased the precision of registration. Preoperative preparations took 15 to 35 minutes, depending on the complexity of the planning. Intraoperative computer support is an important aid to a surgeon's orientation, especially when a patient's anatomy is atypical. Navigation systems will likely improve the quality of surgery and facilitate training.     

Traumatic unilateral avulsion of the anterior superior and inferior iliac spines with anterior dislocation of the hip: a case report

A sixteen-year-old boy involved in a high-speed motor vehicle accident sustained an anterior hip dislocation and avulsion of the anterior ilium extending from the anterior superior iliac spine to the anterior inferior iliac spine. The hip was emergently reduced, and further imaging was obtained to evaluate the bony injury. Computed tomography confirmed the presence of a large displaced bony fragment representing avulsion of the anterior superior and inferior iliac spines and a smaller fragment from the reflected head of the rectus femoris. The patient underwent open reduction and internal fixation of the ilium two days after the initial injury. Postoperatively, he was allowed to bear weight as tolerated with crutches but to avoid active hip flexion. He went on to an uneventful recovery, and at last report (approximately six months after injury), he had returned to full activity. An extensive review of the literature failed to show a similar injury of ipsilateral avulsion of the anterior superior and inferior iliac spines and reflected head of the rectus femoris.     

Effects of hyperbaric oxygen therapy on the rat intestinal mucosa apoptosis caused by ischemia-reperfusion injury

To examine the apoptosis expression in the intestinal mucosa in accordance of different periods of hyperbaric oxygen (HBO) treatment, rats were submitted to 60 min of mesenteric artery and vein ischemia and 60 min of reperfusion occlusion. A group (G-IR) was the control and HBO was applied in the ischemia (GHBO-I), reperfusion (GHBO-R), and ischemia and reperfusion time (GHBO-IR). After 60 min of reperfusion, samples of small bowel were prepared for immunohistochemical expression of caspase-3. The expression of caspase-3 was significantly inferior when HBO was administered in the ischemia (0.16 +/- 0.01) in comparison with the control (0.70 +/- 0.08), but HBO in the further reperfusion (0.84 +/- 0.03) or both ischemia and reperfusion time (0.42 +/- 0.05) was significantly worse. There was a connection between HBO, small bowel I/R injury, and mucosa apoptosis. The favorable effect was obtained when HBO was administered early in the ischemia time.     

Laryngeal mask airway is associated with an increased incidence of adverse respiratory events in children with recent upper respiratory tract infections

BACKGROUND: The laryngeal mask airway (LMA) has been advocated as an alternative technique to tracheal intubation for airway management of children with recent upper respiratory tract infections (URIs). The authors determined the occurrence of adverse respiratory events and identified the associated risk factors to assess the safety of LMA in children. METHODS: During a period of 5 months, parents of children scheduled to undergo general anesthesia with an LMA were asked to fill out a questionnaire regarding their child's medical history and potential symptoms of URI. In addition, all episodes of adverse respiratory events in the perioperative period (laryngospasm, bronchospasm, coughing, airway obstruction, and oxygen desaturation) as well as details of anesthesia management were recorded. RESULTS: Among the 831 children included in the study, 27% presented with a history of a recent URI within the last 2 weeks before anesthesia. The presence of a recent URI doubled the incidence of laryngospasm (odds ratio, 2.6; 95% confidence interval, 1.3-5.0), coughing (odds ratio, 2.7; 95% confidence interval, 1.7-4.3), and oxygen desaturation (odds ratio, 1.9; 95% confidence interval, 1.2-2.8). This incidence was even higher in young children; in those undergoing ear, nose, and throat surgery; and when there were multiple attempts to insert the LMA. CONCLUSION: An LMA used in children with recent URIs was associated with a higher incidence of laryngospasm, cough, and oxygen desaturation compared with healthy children. However, the overall incidence of adverse respiratory events was low, suggesting that if anesthesiologists allow at least a 2-week interval after a URI, they can safely proceed with anesthesia using an LMA.     

Mindfulness‐based program for stress reduction in infertile women: Randomized controlled trial

Infertile women often experience chronic stress, which may have a negative impact on general well‐being and may increase the burden of infertility. In this open‐label, parallel, randomized controlled trial, infertile women aged 18–50 years (median 37 years) were assigned to an 8‐week mindfulness‐based program (MBP) or no intervention. The primary outcome was stress severity measured by the Lipp's Stress Symptoms Inventory (ISSL). Data were analyzed by modified intent‐to‐treat principle, which included all cases available to follow‐up regardless of adherence to the intervention (62 participants from the MBP group and 37 from the control group). The median number of symptoms of chronic stress recorded in the past month decreased from six (interquartile range 2 to 9) before the MBP to two (interquartile range 1 to 4) after the intervention (p < 0.001, repeated measures analysis of variance with Time × Group interaction). Depressive symptoms also decreased after MBP, whereas general well‐being improved (p < 0.01 for both outcomes). Hair cortisol and serum brain‐derived neurotrophic factor (BDNF) did not change significantly between preintervention and postintervention. None of the outcomes changed significantly in the control group. MBP was effective in reducing stress and depressive symptoms while increasing general well‐being in infertile women.     

The impact of a corrective tether on a scoliosis porcine model: a detailed 3D analysis with a 20 weeks follow-up

Purpose

Non-fusion treatment for adolescent idiopathic scoliosis generates interest due to the potential for growth preservation and mobility. Using an established porcine scoliotic model, this study aims to evaluate the global alignment and the morphology of the spine with and without application of a non-fusion corrective tether.

Methods

At 12 weeks of age, 21 immature Yorkshire pigs had an induction of scoliosis. Once a 50° Cobb angle was obtained; animals were placed into one of the following groups: a scoliosis model group (SM, n = 11) where animals were euthanized, tether release group (TR, n = 5) where the inducing tether was removed, and an anterior correction group (AC, n = 5) where the inducing tether was removed and non-fusion corrective tether was applied. TR and AC were observed for a further 20 weeks and then euthanized. Post-mortem CT scans were used to create 3D spinal reconstructions to obtain global and morphologic parameters.

Results

Maximal Cobb angle of the scoliotic deformity was significantly lower for AC (27.9° ± 12.0°) than for the two other groups (TR 52.7° ± 10.0°, SM 48.3° ± 7.6°). AC experienced an increase in kyphosis (24.2° ± 15.9°) compared to TR (7.1° ± 6.4°). Correction in the axial plane was also observed in AC versus TR. Correction of vertebral wedging was found for AC compared to SM and TR in the three apical vertebrae.

Conclusions

3D realignment of scoliotic curves was observed with application of the corrective tether. The correction was the product of both mechanical action and growth modulation. These findings are encouraging for future development of a non-fusion device for the treatment of immature scoliotic curves.     

A Visual-Quantitative Analysis of Fibroblastic Stromagenesis in Breast Cancer Progression

One fundamental difference between normal and transformed cells is the way they interact with their immediate environment. Exploring this difference is crucial for understanding the pathobiology of cancer progression. Benign epithelial tumors are constrained by a surrounding stroma consisting, among other cells, of fibroblasts embedded within fibrillar three-dimensional matrices. However, at a critical point in tumor progression, tumor cells become altered and overcome the barrier, inducing changes in the stroma, which promote, rather than impede, tumor progression. Inherited or acquired genetic aberrations affecting mammary gland epithelia are usually blamed for promoting neoplasia in individuals at high risk for breast cancer. However, in addition to these epithelial aberrations certain individuals possess permissive breast stroma. The occurrence of this permissive stroma results in a predisposition for cancer initiation or progression. Here we review stromagenic stages, experimental 3D systems, and discuss digital imaging analyses suitable for uncovering the mechanisms behind fibroblastic breast stromagenesis.     

Cerebral cortical oxygenation: a pilot study

BACKGROUND: Cerebral hypoxia (cerebral cortical oxygenation [Pbro2] < 20 mm Hg) monitored by direct measurement has been shown in animal and small clinical studies to be associated with poor outcome. We present our preliminary results observing Pbro2 in patients with traumatic brain injury (TBI). METHODS: A prospective observational cohort study was performed. Institutional review board approval was obtained. All patients with TBI who required measurement of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and Pbro2 because of a Glasgow Coma Scale score < 8 were enrolled. Data sets (ICP, CPP, Pbro2, positive end-expiratory pressure (PEEP), Pao2, and Paco2) were recorded during routine manipulation. Episodes of cerebral hypoxia were compared with episodes without. Results are displayed as mean +/- SEM; t test, chi2, and Fisher's exact test were used to answer questions of interest. RESULTS: One hundred eighty-one data sets were abstracted from 20 patients. Thirty-five episodes of regional cerebral hypoxia were identified in 14 patients. Compared with episodes of acceptable cerebral oxygenation, episodes of cerebral hypoxia were noted to be associated with a significantly lower mean Pao2 (144 +/- 14 vs. 165 +/- 8; p < 0.01) and higher mean PEEP (8.8 +/- 0.7 vs. 7.1 +/- 0.3; p < 0.01). Mean ICP and CPP measurements were similar between groups. In a univariate analysis, cerebral hypoxic episodes were associated with Pao2 < or = 100 mm Hg (p < 0.01) and PEEP > 5 cm H2O (p < 0.01), but not ICP > 20 mm Hg, CPP < or = 65 mm Hg, or Pac2 < or = 35 mm Hg. CONCLUSION: Cerebral oxymetry is confirmed safe in the patient with multiple injuries with TBI. Occult cerebral hypoxia is present in the traumatic brain injured patient despite normal traditional measurements of cerebral perfusion. Further research is necessary to determine whether management protocols aimed at the prevention of cerebral cortical hypoxia will affect outcome.