Scarf osteotomy for hallux valgus deformity: Radiological outcome,metatarsal length and early complications in 118 feet

BackgroundScarf osteotomy has been widely used to restore axial orientation of the first ray in the treatment of hallux valgus deformity. The aim of the study was to present our radiological outcomes of bunion reconstruction, identify surgical complications in early follow-up, and assess to what extent a shortening of the first metatarsal is present after surgery as a possible cause of postoperative metatarsalgia.MethodsWe enrolled 106 patients (118 feet) and assessed patients’ pre- and postoperative measurements of hallux valgus and intermetatarsal angles on weightbearing X-ray images. Three different methods of measuring metatarsal length were compared and early postoperative complications noted.ResultsHallux valgus angle decreased significantly by an average of 18.7 degrees and the intermetatarsal angle by 7.8 degrees. Using three methods of measuring metatarsal length, all showed significant shortening of the first metatarsal. Mean relative lengthening of the second metatarsal averaged 0.45 mm. The Coughlin method showed the highest interrater reliability (ICC = 0.96).ConclusionsSignificant reduction of the hallux valgus angle and intermetatarsal angle was demonstrated with a low complication rate. There was significant shortening of the first metatarsal. The Coughlin method clearly demonstrated an excellent interrater reliability.Level of evidenceLevel IV.     

Comfortable suture angle with optimized trocar position aids renorrhaphy during retroperitoneal laparoscopic partial nephrectomy

BackgroundThis study investigated a comfortable suture angle (CSA) with optimized trocar position for closing the defect during renorrhaphy in retroperitoneal laparoscopic partial nephrectomy (LPN). The feasibility, usefulness, and safety of achieving the CSA with modified trocar position were determined for different tumor types.MethodsTwo optimized trocar positions were introduced for different tumor types. A suture angle was based on the tumor plane of the superficial parenchyma defect and the line formed by the needle holder. Preliminary surgical simulations determined a CSA that combined the least suture time with the greatest ease of performance. Achieving the CSA was attempted during renorrhaphy of 106 enrolled patients undergoing retroperitoneal LPN. Patients’ characteristics, operative features, and follow-up information were collected and analyzed.ResultsFor 89 (83.96%) patients, a CSA was successfully reached and parenchyma recovered. The remaining 17 patients were successfully sutured, but the attempt to achieve a CSA failed. For the CSA group, the suture, clamping, and overall operative times were significantly less than that of the non-CSA patients. The groups were similar regarding estimated blood loss, positive surgical margin, and rates of glomerular filtration reduction and complications. Univariable analyses determined that tumor location, growth pattern, and R.E.N.A.L. nephrometry score (RNS) may influence the success of this approach. Multivariable analyses indicated that only tumor location and RNS were independent factors affecting successful achievement of the CSA.ConclusionsThrough different kidney position changes, the CSA could be used to ease the suture process. It is feasible and safe to perform a CSA with optimized trocar position during LPN. Tumor location and RNS may influence the approach to get a CSA.     

A rare instance of Wilkie’s syndrome in a young male during the holy month of Ramadan

Introduction and importanceWilkie’s syndrome[SMA(Superior Mesenteric Artery) syndrome or Cast syndrome]) is a unique and rare presentation which may be included in the differential diagnosis especially when a Gastric outlet obstruction is being investigated and there is a history of an associated element of rapid weight loss. The purpose of presenting this case report is its uniqueness given a history of intermittent fasting rather than the usual eating disorders.Case presentationA crescendo worsening of symptoms of intractable vomiting, inability to eat, upper abdominal gas bloating and post meal abdominal pain since one week in a patient during a period of fasting for the first time had been observed.Clinical discussionAfter initial resuscitation, an ultrasound abdomen and an abdominal x ray revealed a distended stomach and a nasogastric tube was immediately introduced to avoid aspiration. A CT scan of the abdomen with contrast revealed the compressed duodenum in the aortomesenteric angle and the diagnosis of SMA syndrome was confirmed. An upper gastrointestinal endoscopy was also done to rule out other causes and it was found to be normal.ConclusionIn an acute presentation, the response to conservative management is remarkable and in the absence of any possible future reoccurrences the surgical options may be avoided. High index of suspicion, appropriate radiological diagnosis and stepwise treatment options may guide the troubled patient towards recovery in this rare presentation. A proper history taking is key in diagnosing such a condition and does not have to be limited to eating disorders, typically.     

Biomechanical assessment with electromyography of post-stroke ankle plantar flexor spasticity

Spasticity has been defined as a motor disorder characterized by a velocity-dependent increase in tonic stretch reflex (muscle tone). Muscle tone consists of mechanical-elastic characteristics, reflex muscle contraction and other elements. The aims of this study were to determine whether to assess spasticity quantitatively, and to characterize biomechanical and electromyographic spasticity assessment parameters. These assessment parameters were described by investigating the correlation between clinical measures and the response to passive sinusoidal movement with consecutive velocity increments. Twenty post-stroke hemiplegic patients and twenty normal healthy volunteers were included in the study. Five consecutive sinusoidal passive movements of the ankle were performed at specific velocities (60, 120, 180, and 240 degrees/ sec). We recorded the peak torque, work, and threshold angle using a computerized isokinetic dynamometer, and simultaneously measured the rectified integrated electromyographic activity. We compared these parameters both between groups and between different velocities. The peak torque, threshold angle, work, and rectified integrated electromyographic activity were significantly higher in the post-stroke spastic group at all angular velocities than in the normal control group. The threshold angle and integrated electromyographic activity increased significantly and linearly as angular velocity increased, but the peak torque and work were not increased in the post-stroke spastic group. Peak torque, work, and threshold angle were significantly correlated to the Modified Ashworth scale, but the integrated electromyographic activity was not. The biomechanical and electromyographic approach may be useful to quantitatively assess spasticity. However, it may also be very important to consider the different characteristics of each biomechanical parameter.     

斗门县农村中老年人群原发闭角性青光眼流行病学调查

【目的】调查 5 0岁以上的中老年人群中的原发闭角性青光眼患病率。【方法】 1997年在广东省斗门县以村为单位 ,通过重组随机整群抽样确定检查对象 ,用ETDRS视力表检查裸眼视力、常戴镜视力和针孔视力 ,Schiotz计测定眼压 ,直接电眼底镜作视神经垂直C/D比的估计 ,手电筒侧照法和vanHerrick法测定前房深度 ,并结合急性发作史、前房角镜和视野检查作出诊断。【结果】在 5 34 2名实检对象 (受检率 92 7% )中 ,青光眼是第 5位致盲眼病。原发闭角性青光眼的患病率为1 0 % ,男性和女性中分别为 0 8%和 1 2 % ,在 5 0～ 5 9、6 0～ 6 9和 70～ 98岁年龄组中分别为 0 4%、0 8%和 1 6 % ,浅前房人群中为 5 9% ,经logistic回归校正混杂作用后 ,年龄和前房深度为独立的危险因素 ,以 5 0岁年龄组和深前房者为基准 ,70～ 98岁年龄组和浅前房者的调整比数比分别为 3 3和 11 3。【结论】原发闭角性青光眼是人群中重要的致盲眼病 ,老年和浅前房者是危险人群。     

三种波长的激光小梁成形术临床疗效比较

目的　对氩激光、倍频Nd：YAG激光、半导体激光小梁成形术的疗效作一前瞻性的评价和比较。方法　随机地将原发性开角型青光眼病人50例84眼分为三个激光组,分别用氩激光、倍频Nd：YAG激光、半导体激光进行小梁成形术,随访三组的有效率。结果　三组各随访期的眼压下降有统计学意义。三组之间的眼压下降数和成功率无差别。结论　三种波长激光都能有效地进行小梁成形术。     

Thermoresponsive Reversible Unimer Micelles of Amphiphilic Fluorinated Copolymers

Amphiphilic fluorinated copolymers PEGMAx-co-FAy and TEGMAx-co-FAy are prepared by activators regenerated by electron transfer atom transfer radical polymerization (ARGET-ATRP). All polymers present a reversible thermoresponsive lower critical solution temperature-type behavior, and a cloud point temperature (T_c) in the range of 30–60 °C strictly dependent on the length of the oxyethylene side chain, the content of the hydrophobic counits, and the concentration of the solution. Combined small angle X-ray scattering (SAXS) and dynamic light scattering measurements are used to study the self-assembly behavior in water, organic solvents (tetrahydrofuran [THF] and dimethylformamide [DMF]), and a fluorinated solvent (hexafluorobenzene [HFB]). SAXS confirms the formation of compact-globular single-chain self-folded unimer micelles in water below T_c, which generally presents small hydrodynamic diameters (D_h ≤ 8 nm) as a result of the folding of the hydrophobic perfluorohexylethyl acrylate counits. The copolymers are also able to form reverse unimer micelle in HFB. The copolymers are not able to self-assemble in unimer micelles in THF or DMF solutions, in which they adopt conventional random coil conformations.     

Pax-1 in the development of the cervico-occipital transitional zone

The Pax-1 gene has been found to play an important role in the development of the vertebral column. The cervico-occipital transitional zone is a specialized region of the vertebral column, and malformations of this region have frequently been described in humans. The exact embryonic border between head and trunk is a matter of controversy. In order to determine a possible role of Pax-1 in the development of the cervico-occipital transitional zone we studied the expression of this gene in a series of quail embryos and murine fetuses with in situ hybridization and immunohistochemistry. Pax-1 is expressed in all somites of the embryo, including the first five occipital ones. During embryonic days 3–5 the gene is down-regulated in the caudal direction within the first five somites, whereas more caudally Pax-1 is strongly expressed in the cells of the perinotochordal tube. In 5-day-old quail embryos, the cartilaginous anlage of the basioccipital bone has developed and there is no more expression of Pax-1 in this region. The fusion of the dens axis with the body of the axis also coincides with switching off of the Pax-1 gene. More caudally, the gene is continuously expressed in the intervertebral discs of murine embryos and therefore seems to be important for the process of resegmentation. Quail embryos do not possess permanent intervertebral discs. Hyper- or hyposegmentation defects may be explained by an over- or under-expression of Pax-1 during development. We also reinvestigated the border between the head and trunk in chick embryos by performing homotopical grafting experiments of the 5^th somite between chick and quail embryos. Grafted quail cells formed mainly the caudal end of the basioccipital bone. They were also located in the cranial half of the ventral atlantic arch, and only a few cells were found in the tip of the dens axis.     

内窥镜辅助下显微神经血管减压术治疗 特发性偏侧面肌痉挛

目的为进一步提高神经血管减压术治疗特发性偏侧面肌痉挛的疗效。方法经乙状窦后小骨窗开颅加用内窥镜辅助显微血管减压术治疗特发性偏侧面肌痉挛３５例。结果术后３４例症状消失,１例症状减轻,３５例随访６个月至３年半,术后面肌抽搐消失者３３例,１例症状减轻,１例１年后复发。结论内窥镜可弥补手术显微镜的不足之处,减少组织损伤和判断错误,提高治疗效果。