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Sample records for aluviales distales evidencias

  1. Transformaciones edaficas y diageneticas de los depositos aluviales distales del mioceno de la cuenca de Madrid, area de Paracuellos de Jarama

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    Alonso-Zarza, A. Mª

    2003-08-01

    Full Text Available The distal aluvial fan and the palustrine deposits of the Paracuellos de Jarama area display a variety of specific pedogenic and diagenetic features. The processes affecting these sediments were controlled by: the sedimentary environment, the lithology and initia1 texture of the sediments and by the pedogenic-diagenetic environment in which the transformations occurred. Thus, in the distal alluvial areas (PEL profile the first processes were the formation of thin carbonate laminae and sepiolite, further, these deposits were silicified and later, a spheroidal dolomite is formed on the opaline chert. In lacustnne environments (UPC profile, drying and root activity led to the formation of palustrine carbonates that were silicified, and the initial texture and structure were preserved. The silicification consisted on a pseudomorphic replacement that produced mainly opal whereas quartz was formed mostly by cementation and ageing of previous opal. In both environments, when the silicification occurs on sepiolite, or micrite with sepiolite, atypical microfibrous opal is produced. This replacement can lead to the release of Mg, favounng a later formation of dolomite on the opaline chert, with evidence of bacteria1 activity. Al1 these processes occurred in a shallow phreatic or even vadose environment.Los depósitos distales de los abanicos aluviales arcósicos y también los carbonatos palustres del área de Paracuellos de Jarama presentan rasgos muy específicos debidos a los procesos edáficos y diagenéticos que han sufrido. Los procesos que han afectado a estos sedimentos, y su intensidad, estuvieron controlados por: el ambiente sedimentario, la litología y textura/estructura inicial del material y también por el ambiente pedogénico- diagenético superficial en el que se han desarrollado las transformaciones. Así, en las lutitas de las zonas distales de los abanicos (perfil PEL se forman inicialmente láminas de carbonato edáfico y sepiolita

  2. Sedimentología y petrología de los abanicos aluviales y facies adyacentes en el Neogeno de Paracuellos de Jarama (Madrid

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    Alonso, M.

    1986-06-01

    Full Text Available Lateral and vertical variations of middle Miocene lithofacies (Lower and Intermediate Units of the Miocene of the Madrid Basin have been analyzed in the Paracuellos de Jarama area, near Madrid. A complete transition from medial to distal alluvial fan facies and palustrinelshaltow 1acustrine deposits can be observed. This sedimentary evolution is inferred from the detailed sedimentological. analysis carried out in each of the previously defined lithostratigraphic units: a1 Green shale and dolomite Unit, a2 Brown clays, arkosic and carbonate Unit; these two units are linked together into a Lower Group. b Coarse Arkosic Unit (Upper Group. Facies relationsbips within the Lower Group show a lateral change pattern between alluvial fan deposits, and palustrine deposits. Also the former ones gradually prograde over the palustrine deposits, as deduced from vertical evolution in the southernmost parts of the area. Upper Group represents a sudden progradation of the alluvial fan systems, that extensively overlie the distal facies observed in the Lower Group.
    Wide development of calcretes, sepiolite deposits, and nodular chert is an outstanding feature in the most distal parts of the alluvial fan bodies. They are studied in some detail provided the scarcity of well described examples of facies relationships in the kinds of deposits.

    Se estudia en este trabajo la variación lateral y vertical de las litofacies del Mioceno medio (Unidades Inferior e Intermedia en el área de Paracuellos de Jarama, próxima a Madrid, quedando representada en este área una transición completa entre depósitos de facies medias de abenícos aluviales y depósitos de ámbitos palustres. Estas conclusiones se extraen a partir del análisis sedimentológico realizado en cada una de las unidades previamente definidas: a Unidad de arcillas verdes y carbonatos y Unidad de arcillas pardas, arcillas y carbonatos en el Conjunto Inferior; b Unidad de

  3. Análisis geomorfológico de abanicos aluviales y procesos de desbordamiento en el litoral de Valencia

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    Carmona González, Pilar

    1995-01-01

    Se estudian formas y procesos de desbordamiento en pequeños abanicos aluviales en la llanura litoral de Valencia (Mediterráneo). Los abanicos presentan diferentes morfologías en algunos casos se trata de conos progradantes y en otros dos conos superpuestos o solapados; los diferentes niveles pueden corresponder a niveles morfogenéticos cuaternarios pleistocenos y holocenos. Los canales desbordan frecuentemente en el tránsito del cono pleistoceno al holoceno, la evacuación de las crecidas está...

  4. Medicina basada en la evidencia.

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    José Félix Patiño Restrepo

    1999-08-01

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    El concepto de Medicina Basada en la Evidencia fue descrito en la Universidad de McMaster en el Canadá, como una nueva manera de enseñar y de practicar medicina. Pero fue en la Universidad de Oxford donde se hicieron los primeros planteamientos por el epidemiólogo Archie Cochrane, quien afirmó la necesidad de disponer de revisiones sistemáticas de los estudios prospectivos y randomizados en el campo de la atención medica. La Cochrane Collaboration, la Cochrane Network y la Cochrane Library constituyen una formidable organización internacional sin ánimo de lucro destinada a proveer información sistematizada sobre resultados de estudios prospectivos y controlados como fundamento para una atención de la salud de alta calidad.

    La medicina basada en la evidencia integra la mejor evidencia científica disponible con la experiencia y la habilidad clínica, con el conocimiento de la fisiopatología y con las preferencias de los pacientes, para una toma de decisiones fundamentada en datos e información cuya veracidad y exactitud estén rigurosamente comprobados, o sea una práctica médica basada en los resultados de investigación científica de la mejor calidad. La mejor evidencia científica surge de ensayos prospectivos y rigurosamente controlados, los estudios clínicos randomizados* (ECR, que también se conocen como estudios clínicos controlados (ECC.

    El concepto de medicina basada en la evidencia ha llevado al desarrollo de guías de práctica clínica, cuyo objetivo es objetivo es la estandarización de conductas a fin de minimizar variaciones en los patrones de la práctica médica, reducir la mala calidad de la atención, controlar diferencias geográficas en los patrones del ejercicio profesional y racionalizar costos. La Asociación Médica Americana prefiere la denominación “parámetros de práctica clínica”.

    El concepto de medicina basada en la evidencia fue descrito en forma clásica en la

  5. Cursos virtuales de medicina basada en evidencias

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    Diego Urrunaga-Pastor

    2016-12-01

    Full Text Available La medicina basada en evidencias (MBE es definida como el uso consciente, explícito y juicioso de la mejor evidencia científica dis­ponible para la toma de decisiones sobre los pacientes…

  6. Enfermeria basada en la evidencia

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    Ediltrudis Ramos De La Cruz

    2013-12-01

    Full Text Available El profesional de enfermeria en el siglo xxi enfrenta el reto de mantenerse actualizado acorde con los avances de la ciencia y la tecnologia, produciendo impacto en su cuidado como integrante fundamental del equipo interdisciplinario de salud. Para realizar un buen desempeño el profesional de enfermeria requiere de una formacion especial que lo prepare para asumir el establecimiento de programas de mejoramiento de la calidad de la atencion de salud, la integracion del equipo interdisciplinario de salud, los cambios en la seguridad social, las necesida des del mercado laboral y la sistematizacion entre otros. De la misma forma que desempañarse en este siglo exige de una formación agil y dinamica que le permita adaptarse a los cambios que se generan en el mundo, y proporcionar un cuidado respaldado no solo por las vivencias y experiencias, sino por la evidencia cientifica facilmente obtenida, generalizada y comparada gracias a la globalización de la informacion. Es un deber del profesional de enfermeria estar a la vanguardia de los conocimientos y avances cientificos, obtenidos de la informatica biomedica, adquiriendo informacion y planeando estrategias que fortalezcan el cuerpo de conocimientos del cuidado y eviten que la enfermeria sea considerada solo como un oficio. El profesional de enfermeria en todas sus areas de desempeño debe estar en capacidad de identificar problemas reales y potenciales que afecten a la persona, familia y comunidad respaldados por resultados de estudios válidos y confiables.

  7. Análisis sedimentológico de la Cuenca estefaniense de Tineoo (Asturias. Ejemplo de depósitos de carbón en abanicos aluviales

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    Santos García, J. A.

    1991-04-01

    septentrional, dando lugar a los depósitos de la U. Conglomerática. El relleno de la cuenca, se asimila con un modelo de abanicos aluviales en una cuenca tectónicamente activa, en la que los depósitos de carbón se relacionan con las facies más distales y las etapas de mayor tranquilidad, caracterizándose la existencia de un abanico principal y otros coalescentes de menor entidad.

  8. Los depósitos aluviales del paleógeno basal en el sector suroriental de la Cuenca del Duero (provincia de Segovia: evolución y minerales de la arcilla característicos

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    Garzón, M. G.

    1989-04-01

    Sequence», dominated by arid or semiarid alluvial fans. For this reason, this episode presents an important development of duricrusts and palygorskite is the characteristic clay mineral, probably related with the edafic processes found in the frequent calcrete profiles appearing in these units.En este trabajo se estudian las facies detríticas que constituyen el ciclo prearcósico y la base del ciclo arcósico (de edad paleógena del borde suroriental de la cuenca del Duero. La cartografía geológica y la correlación litológica realizadas han permitido diferenciar cuatro unidades litoestratigráficas que, asimismo, presentan distintas asociaciones de minerales de la arcilla: unidad T.1.1., compuesta por arcillas y arenas cuarzosas, en la que la asociación de minerales de la arcilla es illita + caolinita; unidad T.1.2., de arenas cuarzosas con paleosuelos ferruginosos y esmectita corno mineral de la arcilla característico; unidad T.2.1., de conglomerados polimícticos, arenas arcósicas y arcillas, con frecuentes niveles de calcreta y palygorskita como mineral de la arcilla característico; unidad T.2.2., compuesta por arenas arcósicas, con niveles de encostramiento similares a los de la unidad anterior y esmectita e illita como minerales de la arcilla principales. Las dos primeras unidades son transicionales y presentan una relación genética, correspondiendo a una «Primera Secuencia Deposicional», que es granocreciente y representa una evolución progradante desde un sistema braided distal (T.1.1. a un sistema braided proximal (T.1.2., correspondientes a abanicos aluviales húmedos. Las unidades T.2.1. y T.2.2. forman una «Segunda Secuencia Deposicional», granodecreciente a gran escala, y refleja la transición desde partes proximales (T.2.l. a medias (T.2.2. de abanicos aluviales áridos a semiáridos. A partir del estudio mineralógico y sedimentológico puede co

  9. Medicina basada en la evidencia (MBE: Ventajas

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    L.M. Junquera

    2003-10-01

    Full Text Available La Medicina basada en la Evidencia (MBE se define como un proceso cuyo objetivo es la selección de los mejores argumentos científicos para la resolución de los problemas que la práctica médica cotidiana plantea. Filosóficamente es un nuevo paradigma (verificacionista, que se ha extendido a todas las profesiones sanitarias (Cirugía Basada en la Evidencia, Odontología Basada en la Evidencia, etc., soportado por los avances tecnológicos. Aunque sus ventajas son evidentes, también se han reconocido limitaciones, especialmente en lo concerniente a la práctica quirúrgica. En el presente trabajo se revisan los fundamentos y principales ventajas de la MBE.Evidence Based Medicine (EBM is defined as a process whose objective is the selection of the best scientific arguments for the resolution of problems in the medical practice. Phylosophically, it is a new paradigm that has been extended to all the sanitary professions (Evidence Based Surgery, Evidence Based Dentistry, etc., sustained by the technological advances. Although their advantages are evident, also there have been recognized limitations, specially concerning the surgical practice. At the present work the bases and the main advantages of the EBM are checked.

  10. Error de inclinación paleomagnética en materiales aluviales del Oligoceno superior del sector Suroriental de la Cuenca del Ebro (Región Surpirenaica, NE de España)

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    Barberà i Bota, Xavier; Cabrera, Lluís; Parés, Josep María

    1997-01-01

    [ES] En el sector suroriental de la Cuenca del Ebro, la inclinación paleomagnética obtenida en las sucesiones aluviales oligocenas es considerablemente menor que la esperable, si se considera la paleolatitud de referencia calculada para esa región durante el Oligoceno. Este error de inclinación puede deberse a diversos factores, como el control hidrodinámica de las partículas magnéticas en el medio deposicional, la compactación diferencial del sedimento durante el enterramiento, o bi...

  11. CARACTERIZACIÓN QUÍMICA Y CLASIFICACIÓN TAXONÓMICA DE ALGUNOS SUELOS CULTIVADOS CON BANANO EN LAS LLANURAS ALUVIALES DEL CARIBE DE COSTA RICA

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    Fulvio Arias

    2010-01-01

    Full Text Available Se realizó la caracterización morfológica, química y la clasificación taxonómica de algunos suelos cultivados con banano en las 11 cuencas hidrográficas que confluyen en las llanuras aluviales de la Vertiente Caribe de Costa Rica. Se identificaron 2 sectores con suelos que tienen propiedades morfológicas, químicas, y taxonómicas diferentes. En una zona, se encontraron principalmente Inceptisoles formados a partir de materiales fluvio-volcánicos con propiedades ándicas (Andic Eutrudepts, Aquandic Endoaquepts, Inceptisoles dístricos (Fluventic Dystrudepts y Andisoles (Typic Hapludands; caracterizados por presentar la mayoría buen drenaje, texturas medias (franco arenosa, franca, franca limosa, una suma de bases entre 10 y 19 cmol.l–1, una CIC entre 13 y 28 cmol.l–1 y carga permanente en la arcillas. En la otra zona, se encontraron principalmente Inceptisoles formados a partir de aluviones de origen sedimentario depositados por inundaciones frecuentes (Fluventic Endoaquepts, Dystric Fluventic Eutrudepts, Fluvaquentic Eutrudepts, Fluvaquentic Endoaquepts, con una suma de bases entre 18 y 46 cmol.l–1, una CIC entre 19 y 46 cmol.l–1, sin propiedades ándicas, texturas finas y moderadamente finas (franco arcillosa, franco arcillosa limosa, arcillosa, arcillosa limosa y con problemas de drenajes en algunos casos (Endoaquepts, Epiaquepts, Fluvaquentic. Geográficamente, estas zonas fueron separadas por la subcuenca formada por los ríos Vueltas-Silencio-Parismina, de forma que hacia el noroeste se encuentran suelos con influencia volcánica y fertilidad media, y hacia el sureste suelos sin influencia volcánica y de fertilidad alta.

  12. Pictorial essay: Distal colostography

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    Rahalkar Mukund

    2010-01-01

    Full Text Available Distal colostography (DC, also called distal colography or loopography, is an important step in the reparative management of anorectal malformations (ARMs with imperforate anus, Hirschsprung′s disease (occasionally and colonic atresia (rarely in children and obstructive disorders of the distal colon (colitis with stricture, carcinoma or complicated diverticulosis in adults. It serves to identify/confirm the type of ARM, presence/absence of fistulae, leakage from anastomoses, or patency of the distal colon. We present a pictorial essay of DC in a variety of cases.

  13. Distal digital replantation.

    Science.gov (United States)

    Jazayeri, Leila; Klausner, Jill Q; Chang, James

    2013-11-01

    Hand surgeons have been hesitant to perform distal digital replantation because of the technical challenges and the perception of a high cost-to-benefit ratio. Recent studies, however, have shown high survival rates and excellent functional and aesthetic results, providing renewed enthusiasm for distal replantation. The authors reviewed the literature and summarize key points regarding the surgical treatment, perioperative care, and outcomes of distal digital replantation. They describe specific techniques and considerations for surgical repair in each of four distal zones as described by Sebastin and Chung. Zone 1A replantation involves an artery-only anastomosis of a longitudinal pulp artery. Venous anastomosis first becomes possible in zone 1B. Zone 1C involves periarticular amputations where arthrodesis of the distal interphalangeal joint is usually indicated. Repair of the artery, vein, and nerve is technically optimal in zone 1D, where venous anastomosis should be performed. Overall, survival rates for distal digital replantation are similar to those reported for more proximal replantation. The literature reports good outcomes regarding nail salvage, fingertip sensibility, and range of motion, with restoration of length and aesthetic appearance. Distal replantation performed at institutions that specialize in microsurgery and specifically tailored to the level of injury is associated with good survival, function, and patient satisfaction and superior aesthetic outcome. More prospective data are needed to evaluate the cost of treatment, psychological outcomes, and functional outcomes of distal replantation compared with revision amputation.

  14. Teorías e hipótesis de régimen aplicadas al estudio de ajuste dinámico de los cauces aluviales

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    Conesa García, Carmelo

    2003-06-01

    Full Text Available Geomorphic approaches to describe and explain the equilibrium alluvial river channel form, and another approache porpuses to stable «regime» channel design, have relied on simple equations relating channel dimensions to sediment grain-size, gradient and discharge. These equations are either empirical «hydraulic geometry» equations, obtained from regression analysis of the main variables sampled in natural rivers, or «rational» regime equations derived from physical theory of hydraulics and sediment transport. In this work several theories and hypothesis on the river regime are shown in order to explain the dynamic adjustments of channels in connection with environmental changes: i theory of unit stream power, ii minimum energy dissipation rate , iii dispersive-force model, iv concepts of boundary shear stress and critical bank shear, v other regime relationships. Finally, the last part is devoted to the application of the regime theories in arid and semi-arid environments, by considering it a complex aspect, of great interest in the hydro-morphologic context and until the moment little studied.

    Las aproximaciones geomórficas para describir y explicar la forma de equilibrio de un cauce fluvial y los métodos propuestos para el diseño de cauces de «régimen » estable han contado siempre con ecuaciones simples que relacionan las dimensiones del cauce con el tipo de sedimento, pendiente y caudal. Estas ecuaciones son ecuaciones empíricas de «geometría hidráulica», obtenidas a partir del análisis de regresión de variables relevantes muestreadas en cursos de agua naturales o ecuaciones «racionales » de régimen derivadas a partir de la teoría física sobre hidráulica y transporte de sedimentos. En este trabajo se muestran diferentes teorías e hipótesis de régimen para explicar el ajuste dinámico de los cauces aluviales en relación con los cambios ambientales: i teoría de energía por unidad de corriente, ii tasa m

  15. Archibald Cochrane: evidencia, efectividad y toma de decisiones en salud

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    Arantxa Fátima Hortiales González

    2017-09-01

    Full Text Available Actualmente, la Medicina Basada en Evidencia tiene un papel fundamental en la toma de decisiones médicas, ya que intenta, a través de los métodos de la ciencia, justificar las diferentes alternativas que se le pueden ofrecer a un paciente. Para entender la evolución histórica de esta forma de practicar la medicina, es necesario revisar la contribución de uno de los principales participantes en este movimiento cultural: Archibald Leman Cochrane, quien ayudó a definir el marco teórico que ha permitido incorporar la ciencia a la práctica de la medicina. Su papel, al insistir en la necesidad de integrar la evidencia científica y conjuntarla con la experiencia clínica, constituyó un elemento fundamental y decisivo en el desarrollo de una nueva disciplina, la Medicina Basada en Evidencia.

  16. Evidencia de la gimnasia abdominal hipopresiva en incontinencia urinaria

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    Coscarón Molano, Alazne

    2013-01-01

    Objetivo: Mostrar la evidencia del uso de la GAH en la reeducación perineal del empleo del entrenamiento muscular del suelo pélvico cuya evidencia científica se ha demostrado con estudios a lo largo de los años. Métodos: Revisión sistemática de la literatura publicada desde el año 2007 hasta el momento sobre la gimnasia abdominal hipopresiva en las disfunciones pélvicas. Se buscó en la base de datos Pubmed, Sciencedirect y en revistas y libros electrónicos mediante la universidad, también ...

  17. Giant distal humeral geode

    International Nuclear Information System (INIS)

    Maher, M.M.; Kennedy, J.; Hynes, D.; Murray, J.G.; O'Connell, D.

    2000-01-01

    We describe the imaging features of a giant geode of the distal humerus in a patient with rheumatoid arthritis, which presented initially as a pathological fracture. The value of magnetic resonance imaging in establishing this diagnosis is emphasized. (orig.)

  18. Distal driving of molar by smart distal-propeller appliance

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    U H Vijayashree

    2018-01-01

    Full Text Available In recent years, maxillary molar distalization with noncompliance mechanics has been an increasingly popular method for the resolution of Class II malocclusion. This communication describes one particular molar distalizing appliance, the Smart distal-propeller appliance which is simple, inexpensive, easily fabricated that can be used for unilateral or bilateral molar distalization.

  19. Distal renal tubular acidosis

    Science.gov (United States)

    ... the body's immune system mistakenly attacks healthy tissue Wilson disease , an inherited disorder in which there is too much copper in the body's tissues Use of certain medicines, such as amphotericin B, lithium, and analgesics Symptoms Symptoms of distal renal tubular acidosis include any ...

  20. Distal finger replantation.

    Science.gov (United States)

    Scheker, Luis R; Becker, Giles W

    2011-03-01

    Reconstruction of the fingertip distal to the flexor tendon insertion by replantation remains controversial and technically challenging, but the anatomy of the fingertip has been well described and provides help in surgical planning. The open-book surgical technique is described with potential complications and is illustrated with clinical cases. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  1. Distal biceps tendon rupture.

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    Savvidou, Olga D; Papagelopoulos, Panayiotis J; Mavrogenis, Andreas F; Partsinevelos, Antonios A; Karadimas, Evangelos J; Korres, Demetrios S

    2004-09-01

    The authors report a rupture of the distal tendon of biceps brachii in a 42-year-old athlete. Magnetic resonance imaging confirmed the injury. Early surgical repair was performed by reinsertion of the tendon on the radial tuberosity according to modified Boyd-Anderson technique. Indomethacin was administered prophylactically. No complications were noted. At the latest follow-up, the patient had full elbow range of motion and participated successfully in athletic activities and job.

  2. Distal Radius Hemiarthroplasty.

    Science.gov (United States)

    Adams, Brian D; Lawler, Ericka A; Kuhl, Taften L

    2016-08-01

    Due to a higher risk for implant loosening, particularly of the distal component, patients with physically demanding lifestyles are infrequently considered for total wrist arthroplasty (TWA). A distal radius hemiarthroplasty may obviate the need for the strict restrictions recommended for patients treated by TWA, thus providing another surgical option for active patients with severe wrist arthritis, especially those with articular degeneration of the lunate facet of the radius, capitate head, or combination of both, who are not typically candidates for traditional motion-preserving procedures. Eight fresh-frozen cadaver limbs (age range, 43-82 years) with no history of rheumatoid arthritis or upper extremity trauma were used. Radiodense markers were inserted in the radius and hand. Posteroanterior (PA) fluoroscopic images with the wrist in neutral, radial deviation, and ulnar deviation, and lateral images with the wrist in neutral, flexion, and extension were obtained for each specimen before implantation, after distal radius hemiarthroplasty, and after combined hemiarthroplasty and PRC. On the PA images, the capitate remained within 1.42 and 2.21 mm of its native radial-ulnar position following hemiarthroplasty and hemiarthroplasty with PRC, respectively. Lateral images showed the capitate remained within 1.06 mm of its native dorsal-volar position following hemiarthroplasty and within 4.69 mm following hemiarthroplasty with PRC. Following hemiarthroplasty, capitate alignment changed 2.33 and 2.59 mm compared with its native longitudinal alignment on PA and lateral films, respectively. These changes did not reach statistical significance. As expected, significant shortening in longitudinal alignment was seen on both PA and lateral films for hemiarthroplasty with PRC. A distal radius implant hemiarthroplasty with or without a PRC provides good static alignment of the wrist in a cadaver model and thus supports the concept as potential treatment alternatives

  3. Las asociaciones de ostrácodos en secuencias aluviales como indicadores de cambios ambientales holocenos (Bardenas Reales de Navarra, Cuenca del Ebro, NE Península Ibérica

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    Martínez-García, B.

    2015-12-01

    Full Text Available In this paper, the ostracod assemblages identified in three alluvial units preserved in Bardenas Reales de Navarra (Ebro Basin, NE Iberian Peninsula have been studied, with the aim of reconstructing the palaeoenvironmental evolution of this area during the late Holocene. The most common ostracod species in the studied samples are Ilyocypris bradyi Sars and Paralimnocythere aff. psammophila (Flössner, accompanied by Pseudocandona albicans (Brady. Variations in their relative abundance along these alluvial units allow us to characterize internal changes in the depositional environment. Thus, the unit deposited between 4763±87 and 2848±55 years cal. BP is dominated by I. bradyi, indicating the presence of small streams with running water developed probably in fluvial flood plains. Nevertheless, from 2848±55 to 836±65 years cal. BP Paralimnocythere aff. psammophila is the dominant species, representing the establishment of an ephemeral and stagnant aquatic environment, mainly related with more arid climatic conditions (Medieval Warm Period. Finally, the ostracod assemblage identified in Recent times (191±97 to 127±82 years cal. BP is mainly dominated by I. bradyi, which indicates the presence of running waters. This later assemblage probably defines the influence of cold and wet climatic phase (Little Ice Age during Recent times in this area. The palaeoenvironmental evolution identified from the late Holocene according to ostracod assemblages in Bardenas Reales de Navarra shows good correlation with rapid climatic changes deduced from other continental records of the NE Iberian Peninsula.En este trabajo se estudian las asociaciones de ostrácodos identificadas en tres unidades aluviales preservadas en Bardenas Reales de Navarra (Cuenca del Ebro, NE Península Ibérica, para reconstruir la evolución paleoambiental de esta área durante el Holoceno final. Las especies de ostrácodos más comunes en las muestras estudiadas son Ilyocypris bradyi

  4. Enfermería basada en la evidencia. La investigación y el cuidado

    OpenAIRE

    Lopez-Dicastillo, O. (Olga)

    2010-01-01

    En esta presentación se abordan conceptos relacionados con los atributos del rol avanzado relativos a la investigación y la práctica basada en la evidencia (PBE), se definen los conceptos relacionados con la enfermería basada en la evidencia (EBE) y se plantea brevemente sugerencias finales sobre cómo promover la PBE.

  5. Distal corporoplasty for distal cylinders extrusion after penile prosthesis implantation.

    Science.gov (United States)

    Carrino, Maurizio; Chiancone, Francesco; Battaglia, Gaetano; Pucci, Luigi; Fedelini, Paolo

    2017-02-03

    Distal extrusion of cylinders is a potential complication of the penile prosthesis implantation. Several methods have been proposed for repairing a distal penile erosion. We present our preliminary experience in "Distal corporoplasty" technique. We enrolled 18 consecutive patients whose underwent a distal corporoplasty with simultaneous reimplantation of an "AMS 700 inflatable penile prosthesis (LGX)" from January 2013 to November 2015 at our hospital. All procedures were performed by a single surgical team. Intraoperative and postoperative complications have been classified and reported according to Satava6 and Clavien-Dindo (CD) system.7 Mean values with standard deviations (±SD) were computed and reported for all items. Mean age of the patients was 53.61 (±11.90) years. Mean body max index (BMI) was 24.22 (±2.51). Mean operative time was 85.2 (±13.1) minutes. Blood losses were minimal. No intraoperative complications are reported according to Satava classification. Four out of 18 patients (22.22%) experienced postoperative complications according to CD system. All patients had sexual intercourse for the first time postsurgery after a mean of 59.11 ± 2.08 days. Mean follow-up was 22.11 (±9.95). Distal extrusion of cylinders is a potential complication of the penile prosthesis implantation. Distal corporoplasty was first described by Mulcahy. He reported a series of 14 patients with a follow-up of about 2 years with optimal functional outcomes. Moreover, distal corporoplasty resulted in shorter operative time, better function, less pain, and fewer recurrences than Gortex windsock repair.10 In our experience, distal corporoplasty is a simple and safe procedure in the treatment of distal cylinders extrusion when the prosthetic material is not exposed to the exterior.

  6. Distal esophageal spasm.

    Science.gov (United States)

    Roman, Sabine; Kahrilas, Peter J

    2015-07-01

    Distal esophageal spasm (DES) is a rare esophageal motility disorder associated with dysphagia and chest pain. In 2011, the diagnosis of DES was refined based on the occurrence of premature (rather than rapid) contractions by high-resolution manometry. New therapeutic options have also been recently proposed. Thus, a review on DES incorporating publications since 2012 is timely because of these revisions in definition and management. DES remains a heterogeneous clinical disorder. Its pathophysiology is still debated and DES might be related to achalasia. Alternatively, it might be secondary to medications, especially opiates. Endoscopic ultrasound might be informative diagnostically by demonstrating muscularis propria hypertrophy and thickening. Botulinum toxin injection in the esophageal body has been shown superior to placebo to relieve symptoms associated with DES. Finally, per oral endoscopic myotomy is a promising therapeutic approach, but may be less effective in DES than in achalasia. The diagnosis of DES should lead to a systematic search for medication that might promote the occurrence of esophageal dysmotility. Endoscopic treatment of DES (botulinum toxin injection or per oral endoscopic myotomy) should be further evaluated in controlled studies using current diagnostic criteria by high-resolution manometry.

  7. EVIDENCIA ULTRAESTRUCTURAL DEL NUCLÉOLO DE Entamoeba histolytica

    Directory of Open Access Journals (Sweden)

    Citlali Vázquez-Echeverría

    2009-01-01

    Full Text Available Aunque la estructura celular de Entamoeba histolytica se conoce con detalle, no se ha descrito la presencia de material nucleolar con el microscopio electrónico. En este trabajo utilizamos técnicas citoquímicas para microscopía de luz y electrónica para evidenciar la presencia del nucléolo en trofozoitos de esta amiba. Con la técnica de azul de toluidina para RNA y la técnica de impregnación argéntica para organizador nucleolar, se observa contraste de material intranuclear periférico. Con el microscopio electrónico, un material similar de naturaleza fibro-granular se contrasta también con las técnicas para ribonucleoproteínas y para organizador nucleolar. Una zona similar es negativa cuando se aplican técnicas para DNA. Estos resultados muestran evidencia ultraestructural de la presencia de un nucléolo periférico y anular en el núcleo de E. histolytica. Se sugiere que este organelo intranuclear es un caracter general de los eucariontes.

  8. Cuestionario de claustrofobia: evidencias de su validez y fiabilidad

    Directory of Open Access Journals (Sweden)

    Valdiney V. Gouveia

    2008-01-01

    Full Text Available El objetivo de este estudio fue adaptar el Cuestionario de Claustrofobia al contexto brasileño. Se procuró conocer su estructura factorial y fiabilidad, comprobar la adecuación de los modelos uni y bifactoriales, reunir evidencias de su validez convergente y verificar si sus puntuaciones varían según el género de los sujetos. Participaron 224 estudiantes universitarios, la mayoría mujeres (75.3% y solteras (78.5%, con un promedio de edad de 24.2 años. Éstos cumplimentaron el Cuestionario de Claustrofobia y el Cuestionario de Salud General, además de cinco preguntas demográficas. Como teóricamente esperado, el modelo bifactorial fue más adecuado que el unifactorial, y la aflicción psicológica se correlacionó positivamente con el factor general y los específicos de claustrofobia. Las mujeres presentaron mayor puntuación en claustrofobia de lo que hicieron los varones, independiente del factor considerado (asfixia o restricción. De este estudio se concluyó que el Cuestionario de Claustrofobia presenta parámetros psicométricos aceptables, coherentes con aquellos observados previamente.

  9. Nueva evidencia sobre la Statistical Anxiety Scale (SAS

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    Amparo Oliver

    2014-01-01

    Full Text Available Las asignaturas relacionadas con la estadística suelen tener problemas de rendimiento académico. La ansiedad se relaciona de forma negativa con el rendimiento y en particular, la ansiedad estadística puede ser un constructo clave en la mejora de la enseñanza de esta materia y afines. La Statistical Anxiety Scale (Vigil-Colet, Lorenzo-Seva y Condon, 2008 se creó con la pretensión de ser útil para predecir el rendimiento académico en estadística. Se fundamenta en tres dimensiones de ansiedad referidas a tres aspectos específicos: respecto al examen, cuando se pide ayuda en la comprensión de estadística y en el proceso de interpretación de resultados. Esta estructura de tres factores fue hallada en un primer momento por los autores de la escala y en una primera validación corroborada en estudiantes italianos y españoles. El presente estudio pretende añadir nueva evidencia sobre la fiabilidad y validez de la escala, empleando en el estudio de fiabilidad técnicas estadísticas robustas, y ampliando el estudio de la validez respecto a su principal criterio, el rendimiento académico, ya que no puede ser considerado sinónimo de autoeficacia.

  10. Reverse Distal Transverse Palmar Arch in Distal Digital Replantation.

    Science.gov (United States)

    Wei, Ching-Yueh; Orozco, Oscar; Vinagre, Gustavo; Shafarenko, Mark

    2017-11-01

    Refinements in microsurgery have made distal finger replantation an established technique with high success rates and good functional and aesthetic outcomes. However, it still represents a technically demanding procedure due to the small vessel caliber and frequent lack of vessel length, requiring the use of interpositional venous grafts in some instances. We describe a new technique for anastomosis in fingertip replantation, whereby the need for venous grafts is eliminated. Applying the reverse distal transverse palmar arch technique, 11 cases of distal digital replantation were performed between January 2011 and July 2016. The described procedure was used for arterial anastomosis in 10 cases and arteriovenous shunting for venous drainage in 1 case. A retrospective case review was conducted. The technical description and clinical outcome evaluations are presented. Ten of the 11 replanted digits survived, corresponding to an overall success rate of 91%. One replant failed due to venous insufficiency. Blood transfusions were not required for any of the patients. Follow-up (range, 1.5-5 months) revealed near-normal range of motion and good aesthetic results. All of the replanted digits developed protective sensation. The average length of hospital admission was 5 days. All patients were satisfied with the results and were able to return to their previous work. The use of the reverse distal transverse palmar arch is a novel and reliable technique in distal digital replantation when an increase in vessel length is required, allowing for a tension-free arterial repair without the need for vein grafts.

  11. Dark humic alluvial paleosols in Central and Southern Mexico: Micromorphological indicators of Late Pleistocene megafauna habitats Paleosuelos aluviales con humus oscuro en el Centro y Sur de México: indicadores micromorfológicos de los hábitats de la megafauna del Pleistoceno tardío Paleosolos aluviais com húmus escuro no Centro e Sul do México: indicadores micromorfológicos dos habitats da megafauna do Pleistocénico tardio

    Directory of Open Access Journals (Sweden)

    Rosa E. Tovar

    2013-11-01

    formas de megafauna, hoy extinta. Sin embargo, los ecosistemas que habitaron y determinados nichos ecológicos que ocupaban son poco conocidos. Los hallazgos más numerosos de la megafauna del Pleistoceno han sido en depósitos aluviales, los cuales son registros paleoecológicos importantes que representan una excelente oportunidad para ser estudiados. Los paleosuelos aluviales regularmente son poco desarrollados, sin embargo, el análisis micromorfológico proporciona información relevante sobre el grado de desarrollo del suelo a una microescala, permitiendo discriminar entre los procesos edafogenéticos y sedimentarios; ayudando con ello a la identificación de la configuración del medio ambiente en el que se formaron. Nosotros analizamos la micromofología de seis unidades edafogenéticas en las secuencias de Santa Cruz Nuevo y Axamilpa, en el sur de Puebla y Huexoyucan, en el estado de Tlaxcala. Estas edafosecuencias corresponden a la segunda mitad de la etapa isotópica marina 3 (MIS3, etapa isotópica marina 2 MIS2 y al Holoceno Temprano. Todas las unidades estudiadas se caracterizan por una fuerte pigmentación con humus oscuro. El análisis micromorfológico de los paleosuelos de MIS3 revela condiciones acuáticas con evidencias de biota de agua dulce, como también microlaminaciones de precipitación de carbonatos hidrogénicos y procesos redoximórficos. Los paleosuelos oscuros de MIS2 y el Holoceno Temprano muestran fuerte agregación coprogénica, intemperismo y pocos rasgos gleycos, presentando fuertes diferencias con los suelos modernos. Los suelos modernos se formaron en condiciones aireadas, con un mejor drenaje que excluyen los procesos redoximórficos. Llegamos a la conclusión de que las unidades de paleosuelos del Pleistoceno de color oscuro son indicativos de diferentes paleopaisajes: humedales pantanosos en la MIS3 y praderas húmedas desde MIS2 hasta el Holoceno Temprano. Los ecosistemas pantanosos podrían representar un importante h

  12. Traumatic Distal Ulnar Artery Thrombosis

    Directory of Open Access Journals (Sweden)

    Ahmet A. Karaarslan

    2014-01-01

    Full Text Available This paper is about a posttraumatic distal ulnar artery thrombosis case that has occurred after a single blunt trauma. The ulnar artery thrombosis because of chronic trauma is a frequent condition (hypothenar hammer syndrome but an ulnar artery thrombosis because of a single direct blunt trauma is rare. Our patient who has been affected by a single blunt trauma to his hand and developed ulnar artery thrombosis has been treated by resection of the thrombosed ulnar artery segment. This report shows that a single blunt trauma can cause distal ulnar artery thrombosis in the hand and it can be treated merely by thrombosed segment resection in suitable cases.

  13. El Portafolio de evidencias como una modalidad de titulación en las escuelas normales

    Directory of Open Access Journals (Sweden)

    Laura Irene Dino-Morales

    2017-10-01

    Full Text Available El propósito de la presente investigación documental fue reflexionar sobre la importancia y uso del portafolio de evidencias como una modalidad de titulación en las escuelas normales; esto implica que el futuro docente reflexione y analice su formación y desarrollo de competencias profesionales, vinculándolas con su práctica docente. La metodología empleada consistió en un análisis documental, así como el empleo de la cartografía conceptual para guiar el trabajo a realizar. Los resultados obtenidos permitieron identificar la noción del portafolio de evidencias desde el enfoque socioformativo como un proceso que articula la didáctica con la evaluación y se enfoca en el desarrollo del talento a partir del mejoramiento continuo de las evidencias. Se pudieron determinar los siguientes ejes en la metodología del portafolio: selección de las competencias, determinación de las evidencias, sistematización de las evidencias, evaluación, reflexión y análisis, socialización y titulación. Se sugiere validar la metodología propuesta desde la socioformación y desarrollar una rúbrica analítica que posibilite valorar los portafolios de los estudiantes como modalidad de titulación en las escuelas normales.

  14. Evidencias del cambio climático en Ecuador

    Directory of Open Access Journals (Sweden)

    1998-01-01

    necesidad de evaluar si los cambios globales se manifiestan en Ecuador, y si los escenarios planteados para los estudios de cambio climático tienen una base coherente. El estudio ha sido llevado en 15 estaciones meteorológicas localizadas en las regiones litoral e interandina. Se consideraron los siguientes parámetros: Precipitación, Temperatura Media, Temperatura Máxima, y Temperatura Mínima. Con el fin de cuantificar de alguna manera el “Cambio”, se conceptualizó a éste como la diferencia entre los valores inicial y final de la línea de tendencia. Los resultados obtenidos confirman las tendencias crecientes de la temperatura media anual, con mayor intensidad en la región interandina. Criterios definitivos sobre tendencias en la precipitación no se plantean, aunque las evidencias señalan un “no incremento”. De filtrarse el evento “ENSO”, la señal podría intensificarse en la región costanera especialmente. Las incertidumbres encontradas en la investigación no impiden reconocer la existencia de un “cambio”, sea cual fuere su causa. CLIMATE CHANGE EVIDENCE IN ECUADOR. It is evident nowadays that modern and future climate is and will be the result of a climatic variability and of climate changes. The Intergovernmental Panel of Experts on Climate Change (IPCC in its Second Evaluation Report (1995 points out that even though available scientific uncertainties in evaluating, there exist signals of a noticeable influence of human activity over the climate. The research done is the response basically to the need of evaluating if global change manifests itself in Ecuador and if the presented scenarios to study Climate Change are coherent. The study was done over 15 meteorological stations located in the coastal region and the highlands. Parameter used was: Precipitation, Mean Temperature, Maximum Temperature, and Minimum Temperature. In order to somehow qualify the “Change”, this was conceptualized as the difference between the initial and final values from

  15. Estrategias de género en negociación salarial: evidencia experimental

    OpenAIRE

    Greppi, Catrihel

    2016-01-01

    La evidencia observacional sobre brechas de género en el mercado laboral es abundante. Sin embargo, existe menos consenso sobre los mecanismos causales detrás de estas diferencias. Mientras que parte de la evidencia apunta a la existencia de discriminación por parte de los empleadores (el lado de la demanda), otra parte se enfoca en cuestiones de comportamiento y preferencias de los trabajadores (el lado de la oferta). En este trabajo, nos preguntamos si los trabajadores internalizan el géner...

  16. Práctica basada en evidencia en estudiantes de enfermería colombianos

    OpenAIRE

    María del Pilar Ureña-Molina; Isabel María López-Medina; Pedro Luis Pancorbo-Hidalgo

    2017-01-01

    Objetivo. Determinar el nivel de competencias sobre Práctica Basada en Evidencia en estudiantes de un programa de Enfermería de Colombia. Materiales y métodos. Mediante un diseño cuantitativo, descriptivo y correlacional, el estudio se desarrolló en 2 fases. La primera fase consistió en la adaptación cultural y validación de contenido del cuestionario de Competencias en Práctica Basada en la Evidencia (CACH-PBE) al contexto Colombiano; este instrumento valora tres factores: Actitudes, Habilid...

  17. ¿Fue Baalbek el templo de Heliogábalo?: Nuevas evidencias

    Directory of Open Access Journals (Sweden)

    Alberto González García

    2013-05-01

    Full Text Available Hace algunos años, Warwick Ball propuso que el Templo de Elagabal de Emesa, jamás encontrado, debe identificarse con el complejo de templos de Baalbek. Más recientemente, Gary Young ha pretendido mostrar la endeblez de las evidencias con que apoyó tal aserto, así como la falsedad de algunas de sus suposiciones. Tratamos de refutar a Young y demostrar que las evidencias textuales, arqueológicas y epigráficas en realidad apoyan la tesis de Ball, añadiendo algunas nuevas pruebas.

  18. RESULT OF PRE-CONTOURED DISTAL RADIUS INDIAN LOCKING PLATES IN DISTAL RADIUS FRACTURE

    OpenAIRE

    Shaleen; Baljit; Aditya; Parminder; Simarpreet S

    2014-01-01

    BACKGROUND: Fractures of the distal radius are common, open reduction and internal fixation using an interlocking plate system has gained popularity for the treatment of dorsally displaced distal radius fractures. The aim of the study was to assess how adequately distal radial fracture reduction was reproduced and maintained with the pre-contoured distal radius Indian locking plates and to evaluate the functional and radiological results of treating unstable distal radius ...

  19. Spleen-preserving distal pancreatectomy in trauma.

    Science.gov (United States)

    Schellenberg, Morgan; Inaba, Kenji; Cheng, Vincent; Bardes, James M; Lam, Lydia; Benjamin, Elizabeth; Matsushima, Kazuhide; Demetriades, Demetrios

    2018-01-01

    Traumatic injuries to the distal pancreas are infrequent. Universally accepted recommendations about the need for routine splenectomy with distal pancreatectomy do not exist. The aims of this study were to compare outcomes after distal pancreatectomy and splenectomy versus spleen-preserving distal pancreatectomy, and to define the appropriate patient population for splenic preservation. All patients who underwent distal pancreatectomy (January 1, 2007, to December 31, 2014) were identified from the National Trauma Data Bank. Patients with concomitant splenic injury and those who underwent partial splenectomy were excluded. Demographics, clinical data, procedures, and outcomes were collected. Study groups were defined by surgical procedure: distal pancreatectomy and splenectomy versus spleen-preserving distal pancreatectomy. Baseline characteristics between groups were compared with univariate analysis. Multivariate analysis was performed with logistic and linear regression to examine differences in outcomes. Over the 8-year study period, 2,223 patients underwent distal pancreatectomy. After excluding 1,381 patients with concomitant splenic injury (62%) and 8 (pancreatectomy and splenectomy, those who underwent spleen-preserving distal pancreatectomy were younger (p pancreatectomy (p = 0.017). Complications, mortality, and intensive care unit LOS were not significantly different. In young patients after blunt trauma who are not severely injured, a spleen-preserving distal pancreatectomy should be considered to allow for conservation of splenic function and a shorter hospital LOS. In all other patients, the surgeon should not hesitate to remove the spleen with the distal pancreas. Therapy, level IV.

  20. Genetics Home Reference: distal hereditary motor neuropathy, type V

    Science.gov (United States)

    ... Distal hereditary motor neuropathy, type V Distal hereditary motor neuropathy, type V Printable PDF Open All Close All Enable ... link) PubMed OMIM (2 links) NEURONOPATHY, DISTAL HEREDITARY MOTOR, TYPE VA NEURONOPATHY, DISTAL HEREDITARY MOTOR, TYPE VB Sources ...

  1. Probióticos, Prebióticos y Salud: Evidencia Científica

    OpenAIRE

    Delgado, Susana; Salazar, Nuria; Sánchez García, Borja; Villar-Tajadura, M. Antonia; Nácher-Vázquez, Montserrat; Olivares, Marta

    2010-01-01

    24 páginas.-- Resúmenes de las ponencias presentadas al II Workshop Científico: Probióticos, prebióticos y salud: evidencia científica, celebrado en Madrid del 16 al 17 de Diciembre de 2010.-- et al.

  2. Síncope y escalas de riesgo ¿Qué evidencia se tiene?

    Directory of Open Access Journals (Sweden)

    Guillermo Mora, MD

    2011-11-01

    Conclusiones: aunque existen varias escalas para la definición de riesgo con el paciente que ingresa por síncope a urgencias, no hay evidencia de que alguna sea superior a otra, tienen poca validez externa y no se han aplicado en nuestro medio.

  3. Medicina basada en la evidencia: una aproximación epistemológica

    Directory of Open Access Journals (Sweden)

    Daniel Eduardo Henao

    2009-03-01

    Full Text Available La propuesta de la medicina basada en la evidencia conjuga la experiencia del clínico con el análisis juicioso de los resultados de investigaciones clínicas de excelente calidad metodológica para la toma de decisiones médicas. Esta propuesta ha sido ampliamente divulgada por los líderes de opinión médica. Sin embargo, contrario al gran número de publicaciones que promueven esta práctica, no se evidencia en la literatura médica un espacio de discusión acerca de las implicaciones epistemológicas que ha tenido la implementación de esta práctica en el acontecer cotidiano del acto médico. La propuesta novedosa de la medicina basada en la evidencia consiste en priorizar las decisiones médicas de acuerdo con la disponibilidad del conocimiento como resultado de los estudios científicos. Presentamos en este ensayo algunas reflexiones sobre la inconveniencia de la importación "ciega" del método científico de las ciencias exactas a la ciencia clínica, que es la principal fuente de evidencia para el médico, además de lo inadecuado de definir los estados de salud y enfermedad como continuos numéricos homogenizados por una escala de medición. Finalmente, proponemos que el reconocimiento del ser humano enfermo como sistema complejo, único e irrepetible, definido a su vez por su devenir y su contexto, nos obliga a reconocer que la propuesta de la medicina basada en la evidencia no es universal ni absoluta. Sólo en la medida en que dichas particularidades se tengan en cuenta, estaremos en capacidad de brindar una atención más idónea a nuestros pacientes.

  4. Evidencia clínica en la lumbalgia crónica

    OpenAIRE

    Cuesta Vargas, Antonio Ignacio; Montes Fuentes, Antonio Jesús

    2007-01-01

    Introducción: Existen pocas guías de práctica clínica basadas en la evidencia en todo el mundo para el manejo de la lumbalgia crónica. Objetivo: realizar una síntesis de la evidencia clínica existente en las intervenciones terapéuticas sobre la lumbalgia crónica y estratificar los resultados hallados. Método: Se ha llevado a cabo una estrategia de búsqueda electrónica sobre las principales bases de datos en lo referente a: Guías de Práctica Clínica, Revisiones Sistemáticas y Ar...

  5. La práctica de la enfermería basada en la evidencia

    OpenAIRE

    Cañón Abuchar, Hilda María; Pontificia Universidad Javeriana

    2011-01-01

    Independiente de la controversia que genera la temática, hablar de evidencia científica en el cuidado de enfermería implica referirse a la producción científica en enfermería y a la aplicación de sus resultados en el desempeño profesional. Es imposible desconocer la contribución que la práctica basada en evidencia ha realizado al auge actual de la investigación y a su papel preponderante en el desarollo y legitimización de las disciplinas. En este artículo se revisan tanto los antecedentes de...

  6. Sexología basada en la evidencia: historia y actualización

    Directory of Open Access Journals (Sweden)

    Mirta Granero

    2015-04-01

    Full Text Available El artículo presenta el estatus de la sexología como ciencia desde sus inicios hasta nuestros días. Señala que la sexología es un área de conocimiento “incómoda” que debe luchar contra los prejuicios, los estereotipos y las costumbres de la sociedad. La sexología clínica (o terapéutica y la sexología educativa se fundamentan en trabajos investigativos que comienzan en el siglo XIX con Freud, von Krafft-Ebing, Albert Moll, Ivan Bloch, Magnus Hirschfeld y Havelock Ellis. Posteriormente, se publican las investigaciones de Kinsey, con las cuales empieza la sexología en sentido moderno. Masters y Johnson fueron pioneros en trabajos experimentales de la sexología. Las obras de Kaplan, Basson, Hite y otros autores presentan trabajos con diverso grado de rigurosidad, pero no se puede afirmar que todas sean investigaciones basadas en la evidencia. El artículo revisa y analiza detalladamente la sexología en la actualidad y señala que el énfasis en la evidencia se encuentra en estado incipiente. Mientras tanto, en el caso de la sexología médica (que trata problemas orgánicos y utiliza procedimientos farmacológicos y fisiológicos existe más énfasis en la evidencia que en el caso de la sexología que trata problemas sin un sustrato orgánico definido. El artículo señala la importancia de la sexología para mejorar la calidad de vida de las personas y enfatiza la necesidad de desarrollar una sexología basada en la evidencia.

  7. Contemporary Management of Primary Distal Urethral Cancer

    NARCIS (Netherlands)

    Traboulsi, S.L.; Witjes, J.A.; Kassouf, W.

    2016-01-01

    Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation

  8. Pisiform malalignment associated with distal radius fractures.

    Science.gov (United States)

    Tajima, Takafumi; Zenke, Yukichi; Yamanaka, Yoshiaki; Menuki, Kunitaka; Sakai, Akinori

    2018-03-01

    The association of scaphoid or other carpal bone fractures with distal radius fractures is frequently reported, whereas few studies have described pisiform malalignment associated with distal radius fractures. The purpose of this study was to investigate the frequency and characteristics of pisiform malalignment associated with distal radius fractures. We performed a retrospective study by reviewing the data of 152 consecutive patients with a mean age of 63 years who were treated surgically for distal radius fractures during a five-year period. We evaluated the pisotriquetral joint via preoperative sagittal computed tomography (CT) and assessed pisiform malalignment. Pisiform malalignment was defined as follows: (1) wide type, joint space ≥4.0 mm; (2) non-parallel type, loss of parallelism of the joint surface of ≥20°; or (3) overriding type, proximal or distal overriding of the pisotriquetral joint ≥2.0 mm. We investigated the relationship between pisiform malalignment and the patterns of distal radius fractures. Pisiform malalignment was assessed using postoperative CT to determine whether it had been reduced. Pisiform malalignment was observed in 48 cases involving 44 patients with a mean age of 58 (17-81) years. The patients included 16, 17, and 15 cases of the wide type, non-parallel type, and overriding type, respectively. Distal radius fractures with dorsal displacement exhibited pisiform malalignment significantly more frequently than those with volar displacement. No significant difference was noted between intra- and extra-articular fractures or between patients with and without distal ulnar fractures. Among the 22 pisiform malalignment cases assessed via postoperative CT, 15 cases were reduced, and 7 cases remained malaligned. The non-parallel type exhibited the lowest reduction rate among the 3 types. Among distal radius fractures, 29% were complicated by pisiform malalignment. Distal radius fractures with dorsal displacement exhibited a

  9. Distal movement of maxillary canines and premolars with sectional mechanics following Distal Jet application to molars.

    Science.gov (United States)

    Bolla, E; Doldo, T; Giorgetti, R

    2004-01-01

    to assess the effectiveness of Distal Jet without simultaneous fixed appliance treatment. twenty subjects with Class II malocclusion who received the Distal Jet appliance to move maxillary molars distally. Subsequently, the canine and premolar distal movements were achieved by the use of.017 x.025 Ni-Ti sectional wires and memory power chain. revealed that Distal Jet is more effective with less anchorage loss when this appliance is used independent of multibracket appliances. this study showed that Distal Jet is an effective and predictable appliance. The distal movements of upper premolars, canines and incisors with sectional wires fabricated from.017 x.025 Ni-Ti were biomechanically very effective, simple in clinical application, and did not require any patient compliance.

  10. Load transfer at the distal ulna following simulated distal radius fracture malalignment.

    Science.gov (United States)

    Ferreira, Louis M; Greeley, Gillian S; Johnson, James A; King, Graham J W

    2015-02-01

    To measure the effects of distal radius malalignment on loading at the distal ulna. Using an adjustable mechanism to simulate angulated and translated malalignments, clinically relevant distal radius deformities were simulated in a cadaveric model. A custom-built load cell was inserted just proximal to the native ulna head to measure the resultant force and torque in the distal ulna. Loads were measured before and after transecting the triangular fibrocartilage complex (TFCC). There was an increase in distal ulna load and torque with increasing dorsal translation and angulation. Combined conditions of angulation and translation increased force and torque in the distal ulna to a greater extent than with either condition in isolation. Transecting the TFCC resulted in a reduction in distal ulna load and torque. A progressive increase in load at the distal ulna was observed with increasing severity of malalignment, which may be an important contributor to residual ulnar wrist pain and dysfunction. However, no clear-cut threshold of malalignment of a dorsally angulated and translated distal radius fracture was identified. These observations suggest that radius deformities cause articular incongruity, which increases TFCC tension and distal radioulnar joint load. Cutting of the TFCC decreased distal ulna loading, likely by releasing the articular constraining effect of the TFCC on the distal radioulnar joint, allowing the radius to rotate more freely with respect to the ulna. Anatomical reduction of a distal radius fracture minimizes the forces in the distal ulna and may reduce residual ulnar wrist pain and dysfunction. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  11. Genetics Home Reference: distal 18q deletion syndrome

    Science.gov (United States)

    ... Health Conditions Distal 18q deletion syndrome Distal 18q deletion syndrome Printable PDF Open All Close All Enable ... view the expand/collapse boxes. Description Distal 18q deletion syndrome is a chromosomal condition that occurs when ...

  12. Villous adenoma of the distal appendix.

    Science.gov (United States)

    Taylor, J V; Thomas, M G; Kelly, S; Sutton, R

    1997-04-01

    Villous adenoma confined to the distal appendix has not been previously reported in conjunction with acute apendicitis. The presence of an adenoma indicates a need for further investigation due to an association with neoplasia elsewhere.

  13. Genetics Home Reference: distal arthrogryposis type 1

    Science.gov (United States)

    ... 1 is a disorder characterized by joint deformities (contractures) that restrict movement in the hands and feet. ... distal arthrogryposis type 1 . However, researchers speculate that contractures may be related to problems with muscle contraction ...

  14. Conceptualizing distal drivers in land use competition

    DEFF Research Database (Denmark)

    Niewhöner, Jörg; Nielsen, Jonas Ø; Gasparri, Gasparri

    2016-01-01

    This introductory chapter explores the notion of ‘distal drivers’ in land use competition. Research has moved beyond proximate causes of land cover and land use change to focus on the underlying drivers of these dynamics. We discuss the framework of telecoupling within human–environment systems...... as a first step to come to terms with the increasingly distal nature of driving forces behind land use practices. We then expand the notion of distal as mainly a measure of Euclidian space to include temporal, social, and institutional dimensions. This understanding of distal widens our analytical scope...... for the analysis of land use competition as a distributed process to consider the role of knowledge and power, technology, and different temporalities within a relational or systemic analysis of practices of land use competition. We conclude by pointing toward the historical and social contingency of land use...

  15. Ensayo clinico para la enfermeria basada en evidencia: un desafio alcanzable

    OpenAIRE

    Medina,Eugenia Urra; Riveros,Edith Rivas; Pailaquilén,René Mauricio Barría

    2011-01-01

    El ensayo clínico aleatorio constituye el diseño de investigación más riguroso para estudios de intervenciones. En este tipo de estudios, el investigador está interesado en determinar si existe una relación causa-efecto entre un tratamiento y el resultado. Para ello debe comparar grupos de individuos que han sido asignados a recibir diferente nivel de exposición a la intervención, y así determinar si existe el efecto. Hoy en día, se reconoce como uno de los mejores estándares de evidencia par...

  16. Evidencias sobre la prevención del cáncer

    OpenAIRE

    D. Salas; R. Peiró

    2013-01-01

    El cáncer es uno de los principales problemas de salud. Engloba a un conjunto de enfermedades que tienen un origen multicausal. Los tumores con mayor impacto en la salud son pulmón, próstata y colorrectal en los hombres y mama y colorrectal en las mujeres. Las mejores estrategias para evitar el cáncer son las basadas en la prevención primaria y en el diagnóstico precoz. Se estima que entre el 80-90% de los canceres son prevenibles. Respecto a la prevención primaria hay fuerte evidencia que no...

  17. Evidencia de la punción seca como tratamiento de los puntos gatillo

    OpenAIRE

    Regaliza Carrera, Rakel

    2013-01-01

    Objetivos: El objetivo principal de esta revisión bibliográfica es determinar la evidencia de la punción seca en el tratamiento de los puntos gatillo miofasciales, y en consecuencia en los síndromes de dolor miofascial, que existe hoy en día. Métodos: Se han realizado diferentes búsquedas en las bases de datos Pubmed, ScienceDirect y PEDRO de las cuales se han extraído 17 artículos. 8 de ellos son revisiones sobre los puntos gatillo miofasciales (PGM) y los síndromes de dolor miofascial (SMF)...

  18. El Portafolio de evidencias como una modalidad de titulación en las escuelas normales

    OpenAIRE

    Laura Irene Dino-Morales; Sergio Tobón

    2017-01-01

    El propósito de la presente investigación documental fue reflexionar sobre la importancia y uso del portafolio de evidencias como una modalidad de titulación en las escuelas normales; esto implica que el futuro docente reflexione y analice su formación y desarrollo de competencias profesionales, vinculándolas con su práctica docente. La metodología empleada consistió en un análisis documental, así como el empleo de la cartografía conceptual para guiar el trabajo a realizar. Los resultados obt...

  19. Dolor lumbar: enfoque basado en la evidencia Low back pain and evidence-based medicine

    Directory of Open Access Journals (Sweden)

    Fabio Alonso Salinas Durán

    2007-04-01

    Full Text Available El dolor lumbar es un motivo muy común de consulta médica; debido a la amplia oferta de opciones terapéuticas, es importante recurrir a los conceptos de la medicina basada en la evidencia para seleccionar las mejores. Las intervenciones que cuentan con evidencias más sólidas en la literatura son: mantenerse activo, hacer ejercicio durante los cuadros subagudo y crónico así como después de la cirugía, los antiinflamatorios no esteroides (AINE y los antidepresivos. Low back pain is a very common reason for consultation in general practice; due to the wide offer of treatment options, it is important, in order to select the best, to resort to the concepts of evidence-based medicine. The interventions that have more solid evidence in the literature are: to keep being active, to prescribe therapeutic exercises during the subacute and chronic periods, as well as after surgery, and to use nonsteroidal antiinflammatories and antidepressants.

  20. METODOLOGÍA PARA REALIZAR ESTUDIOS DE EVIDENCIA MICROBIOLÓGICA EN PLANTAS PROCESADORAS DE ALIMENTOS

    Directory of Open Access Journals (Sweden)

    Eric Wong-Gonz\\u00E1lez

    2008-01-01

    Full Text Available Se diseñó una metodología para realizar estudios de evidencia microbiológica en plantas procesadoras de alimentos. La metodología consta de seis pasos: defi nición del objetivo general del estudio, visita a la planta respectiva, diseño de un plan de muestreo, escogencia de los análisis microbiológicos, recolección de los datos, y análisis y utilización de los resultados y conclusiones. Para cada uno de los pasos se describe su objetivo, fi losofía y procedimientos asociados. La aplicación de esta metodología permite obtener una serie de conclusiones importantes con respecto a evidencia microbiológica, que sirven como base para diseñar e implementar los sistemas HACCP, pues brindan información específi ca y propia del ambiente de proceso donde se realizó el estudio.

  1. Distal biceps rupture: the coil sign.

    Science.gov (United States)

    Austin, Luke; Pepe, Matt; VanBeek, Corinne; Tjoumakaris, Fotios

    2014-06-01

    Delayed repair of the distal biceps brachii tendon can lead to the formation of scar tissue and coiling of the tendon. Dissection of the scar tissue and unraveling of the tendon may allow for anatomic repair to the radial tuberosity. A 50-year-old man had a distal biceps brachii tendon tear with an intact lacertus fibrosis. Surgery was performed 22 days after injury. On inspection, the distal biceps tendon was coiled, encased in scar tissue, and unable to be reduced to the radial tuberosity. Dissection of the scar tissue and unraveling of the tendon provided additional length, allowing anatomic repair. Postoperatively, the patient regained full range of motion and strength and returned to work without restrictions. After a distal biceps brachii tear in which the lacertus fibrosis remains intact, the coiled tendon may become enveloped in a sheath of scar tissue. Dissection of the "pseudosheath" unveils the native tendon and allows reduction to the radial tuberosity. Cadaveric analysis shows that the pseudosheath may conceal 6 cm of coiled tendon. When the lacertus fibrosis remains intact after distal biceps tendon rupture, the tethered tendon stump may coil, become encased in scar tissue, and resemble the native tendon. Failure to identify the native tendon could result in the loss of 6 cm of tendon. Copyright 2014, SLACK Incorporated.

  2. Medicina basada en la evidencia: por qué y cómo llegar a ella

    Directory of Open Access Journals (Sweden)

    Fabián Alberto Jaimes Barragan

    1998-03-01

    Full Text Available Se presentan los principios de la Medicina Basada en la Evidencia (MBE, como una nueva estrategia para el aprendizaje y la práctica de la medicina clínica. Se propone una justificación sobre la base de enriquecer y complementar los paradigmas tradicionales del conocimiento médico, respondiendo a las necesidades actuales del avance científico. Se ofrece una secuencia metodológica que comprende la formulación de preguntas, la búsqueda de la mejor evidencia para responderlas, la apreciación crítica de esa evidencia y la aplicación de loS resultados en los pacientes.

  3. Potassium secretion in mammalian distal colon

    DEFF Research Database (Denmark)

    Sørensen, Mads Vaarby

    2009-01-01

    . This research project is the summary of 3 original papers addressing the functional role of different regulating factors on ion transport in mouse distal colon. The first paper addresses the effect of luminal nucleotides on electrogenic Na+ absorption. The distal colon, like the distal nephron is an aldosterone......2 subunits in mice treated on an aldosterone increasing diet (high K+). Immunolabelling showed BK channel localisation in the luminal membrane which also was up-regulated in animals treated on a high K+ diet. Taken together these results firmly prove that aldosterone-stimulated K+ secretion......-/- mouse, we could functionally isolate the cAMP-activated K+ conductance as the BK channel. In addition we found the cAMP-activated K+ conductance to be further up-regulated by aldosterone. Taken together, these results show cAMP-activated K+ secretion occurs via a regulated specific splice variant...

  4. Osteochondritis of the Distal Tibial Epiphysis

    Directory of Open Access Journals (Sweden)

    Firass EL Hajj

    2012-01-01

    Full Text Available Osteochondritis of the distal tibial epiphysis is a very rare entity. 9 cases have been described in 7 articles and 8 other cases have been mentioned in textbooks. This paper describes the 10th case of osteochondritis of the distal tibial epiphysis and summarizes the clinical and radiological presentations of the 9 other cases. The etiology of this entity is well debated in the literature. We believe that it results from a vascular abnormality in the distal tibial epiphysis associated with a mechanical stress (trauma, excessive overload, etc.. Since it is a self-limited disease, the prognosis is good and the younger the patient is the better the prognosis will be. In general, this entity responds well to conservative treatment.

  5. Diagnostic modalities for distal radioulnar joint.

    Science.gov (United States)

    Jens, S; Luijkx, T; Smithuis, F F; Maas, M

    2017-05-01

    The first imaging modality in patients suspected of distal radioulnar joint pathology should be conventional radiography to exclude or diagnose wrist pathology including osteoarthritis, rheumatoid arthritis, calcium pyrophosphate deposition disease, (healed) fractures, or impaction syndromes. When conventional radiography is inconclusive, high resolution 3 Tesla magnetic resonance imaging is advised. We provide a broad overview of the literature regarding the use of intra-articular contrast both with computed tomography (CTA) or magnetic resonance imaging (MRA). Conventional arthrography and unenhanced computed tomography are not indicated. This article discusses the most useful imaging techniques in terms of clinical indications, patient positioning, technical imaging requirements, and diagnostic performance in patients with suspected distal radioulnar joint pathology. Furthermore, the most prevalent pathologies are discussed, with the focus on imaging characteristics in both stable and unstable distal radioulnar joints.

  6. Evidencia científica en sandblasting y neumopatías

    Directory of Open Access Journals (Sweden)

    Katlhyn Vanessa Camargo García

    Full Text Available Un importante número de estudios publicados recientemente ponen de manifiesto la asociación entre el sandblasting y el desarrollo de silicosis en formas graves. La silicosis es una enfermedad intersticial difusa producida por inhalación mantenida de sílice cristalina. No tiene tratamiento efectivo y su presentación y curso clínico son variables; haciendo la prevención y el diagnostico precoz, dos aspectos fundamentales en su control. Las fuentes de exposición a sílice son muy numerosas y se producen de forma casi exclusiva en el ámbito laboral. El sandblasting consiste en proyectar un chorro de arena contra una superficie con aire comprimido o vapor para limpiar, pulir y mejorar, etc. superficies duras. Los objetivos son: identificar la evidencia científica existente entre sandblasting y el desarrollo de silicosis, si existe relación dosis-respuesta, establecer los factores de riesgos del sandblasting, las condiciones de vulnerabilidad, el papel de los EPI en la prevención de silicosis en estos trabajadores e identificar la comorbilidad. Se ha realizado la búsqueda bibliográfica de artículos publicados entre 2006 y diciembre de 2015 en la siguientes bases de datos: Medline, Scopus, Lilacs, Ibecs y OSH. Se seleccionaron por nivel de evidencia y criterios de inclusión-exclusión un total de 20 artículos. La revisión sistemática de estos artículos parece sugerir una asociación concluyente entre el uso de la técnica de sandblasting y el desarrollo de silicosis en formas agresivas. No obstante el diseño descriptivo y transversal de la mayoría de los artículos seleccionados, invitan a realizar estudios con mejores diseños, para conseguir mayor nivel de evidencia.

  7. La evidencia cualitativa y el cuidado del paciente en diálisis peritoneal

    Directory of Open Access Journals (Sweden)

    Ana Julia Carrillo Algarra

    Full Text Available Introducción: La atención de enfermería como relación entre un sujeto de cuidado y un profesional con capacidad para hacerlo requiere que éste último comprenda las vivencias que la enfermedad y los tratamientos generan en la persona. Objetivo: Establecer interrelación entre las evidencias cualitativas disponibles en la literatura científica cualitativa publicada entre 1997-2014 respecto al cuidado de enfermería a pacientes en Diálisis Peritoneal con las taxonomías enfermeras. Material y Métodos: Estudio cualitativo en el cuál, previa autorización del comité de ética e investigación, se realizó revisión sistemática de estudios cualitativos en tres etapas: 1. Búsqueda en las bases de datos: PubMed, Embase, CUIDEN, CINAHL, Dialnet, Scielo, Biblioteca Virtual en Salud y Web of Science. 2. Evaluación de calidad metodológica por pares independientes utilizando el Critical Appraisal Skills Programme, en español; 3. Síntesis de evidencias cualitativas, que se interrelacionaron con las taxonomías Nursing Diagnoses: definitions and classification, y Nursing Intervention Classification. Resultados: Se incluyeron 19 estudios que permitieron, desde la voz de los sujetos de investigación reportadas por los autores y homologadas con las características definitorias, formular diagnósticos y determinar intervenciones de enfermería enmarcadas en los 13 dominios establecidos por la Nursing Diagnoses: definitions and classification. Algunos resultados y conclusiones en sí mismos son evidencias cualitativas del cuidado que requieren las personas en diálisis peritoneal. Discusión y conclusiones: La diálisis peritoneal interfiere en todos los dominios, afectando al sujeto, su familia y su entorno. En general requiere de educación y apoyo permanente para lograr adherencia.

  8. Distal splenorenal shunt with partial spleen resection

    Directory of Open Access Journals (Sweden)

    Gajin Predrag

    2007-01-01

    Full Text Available Introduction: Hypersplenism is a common complication of portal hypertension. Cytopenia in hypersplenism is predominantly caused by splenomegaly. Distal splenorenal shunt (Warren with partial spleen resection is an original surgical technique that regulates cytopenia by reduction of the enlarged spleen. Objective. The aim of our study was to present the advantages of distal splenorenal shunt (Warren with partial spleen resection comparing morbidity and mortality in a group of patients treated by distal splenorenal shunt with partial spleen resection with a group of patients treated only by a distal splenorenal shunt. Method. From 1995 to 2003, 41 patients with portal hypertension were surgically treated due to hypersplenism and oesophageal varices. The first group consisted of 20 patients (11 male, mean age 42.3 years who were treated by distal splenorenal shunt with partial spleen resection. The second group consisted of 21 patients (13 male, mean age 49.4 years that were treated by distal splenorenal shunt only. All patients underwent endoscopy and assessment of oesophageal varices. The size of the spleen was evaluated by ultrasound, CT or by scintigraphy. Angiography was performed in all patients. The platelet and white blood cell count and haemoglobin level were registered. Postoperatively, we noted blood transfusion, complications and total hospital stay. Follow-up period was 12 months, with first checkup after one month. Results In the first group, only one patient had splenomegaly postoperatively (5%, while in the second group there were 13 patients with splenomegaly (68%. Before surgery, the mean platelet count in the first group was 51.6±18.3x109/l, to 118.6±25.4x109/l postoperatively. The mean platelet count in the second group was 67.6±22.8x109/l, to 87.8±32.1x109/l postoperatively. Concerning postoperative splenomegaly, statistically significant difference was noted between the first and the second group (p<0.05. Comparing the

  9. Management of Malunions of the Distal Radius

    OpenAIRE

    Yaniel Truffin Rodriguez; Osmany Pérez Martínez; Rafael Esmandy Gómez Arregoitía; Indira L. Gómez Gil

    2015-01-01

    Fractures of the distal radius often present with a group of major complications. Of these, malunion is one of the most disabling. Its management through salvage procedures is essential for its correction. The case of a 60-year-old healthy woman of urban origin treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos because of a malunion of the distal end of the left radius as a result of a previous Colles' fracture is presented. The patient complained of severe p...

  10. Contemporary Management of Primary Distal Urethral Cancer.

    Science.gov (United States)

    Traboulsi, Samer L; Witjes, Johannes Alfred; Kassouf, Wassim

    2016-11-01

    Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Comparison of Maxillary Molar Distalization with an Implant-Supported Distal Jet and a Traditional Tooth-Supported Distal Jet Appliance

    Directory of Open Access Journals (Sweden)

    Mauro Cozzani

    2014-01-01

    Full Text Available Aim. To investigate and compare the efficiency of two appliances for molar distalization: the bone-anchored distal screw (DS and the traditional tooth-supported distal jet (DJ for molar distalization and anchorage loss. Methods. Tests (18 subjects were treated with a DS and controls (18 subjects were treated with a DJ. Lateral cephalograms were obtained before and at the end of molar distalization and were analysed. Shapiro Wilk test, unpaired t-test, and Wilcoxon rank-sum test were applied according to values distribution. The α level was fixed at 0.05. Results. Maxillary first molars were successfully distalized into a Class I relationship in all patients. The mean molar distalization and treatment time were similar in both groups. The DS group exhibited a spontaneous distalization (2.1±0.9 mm of the first premolar with control of anchorage loss, distal tipping, extrusion, and skeletal changes. Conclusions. The DS is an adequate compliance-free distalizing appliance that can be used safely for the correction of Class II malocclusions. In comparison to the traditional DJ, the DS enables not only a good rate of molar distalization, but also a spontaneous distalization of the first premolars.

  12. Fracture of the Distal Ulna Metaphysis in the Setting of Distal Radius Fractures.

    Science.gov (United States)

    Paksima, Nader; Khurana, Sonya; Soojian, Michael; Patel, Vipul; Egol, Kenneth

    2017-04-01

    Fracture of the metaphyseal region of the distal ulna is an uncommon injury that has been reported to occur concomitantly with distal radius fracture. We aimed to report the incidence and types of distal ulnar head and neck fractures associated with distal radius fractures and compare outcomes in operatively versus non-operatively treated patients. Over a 5-year period a distal radius fracture registry was maintained at our institution. Eleven of 512 consecutive patients had metaphyseal distal ulna fractures in association with distal radius fractures and at least 1-year follow-up. Baseline radiographs and functional data were obtained, and patients were followed at 1-week, 2-week, 3-week, 6-week, 3-month, 6-month, 1-year, and 2-year intervals. Patients were split into two treatment groups: Group 1 consisted of five non-operatively treated patients, and Group 2 consisted of six operatively treated patients. Four separate fracture patterns were observed: simple transverse or oblique fracture of the ulnar neck just proximal to the ulnar head, fracture of the neck region with concomitant fracture of the tip of the ulnar styloid, simple fracture of the ulnar head, and comminuted fracture of the ulnar head. There were no statistical differences between the two groups with regard to flexion, extension, supination, pronation, and functional outcomes. Ulnar fracture patterns observed did not easily fall into previously described categories, and we have proposed a new classification system. Simple fractures of the ulnar neck or head often do not require operative fixation.

  13. Outcome following distally locked volar plating for distal radius fractures with metadiaphyseal involvement.

    Science.gov (United States)

    Matullo, Kristofer S; Dennison, David G

    2015-06-01

    The surgical treatment of metadiaphyseal distal radius fractures may be difficult due to the associated articular or periarticular extension that limits standard fixation techniques. Longer distal radius volar locking plates allow stable fixation of the distal fragments while providing standard plate fixation in the proximal radius. We hypothesize that this plating technique allows adequate fixation to both the distal radius and metadiaphyseal fragments. The purpose of the study is to describe the outcomes, radiographic parameters, secondary surgeries, and complication rate with this device. A retrospective chart review was conducted on adult patients with a distal radius fracture and metadiaphyseal involvement treated with a volar, distally locked plate. All patients were followed up for radiographic union, with a mean time of 219 days (range 38-575). Fracture patterns, outcomes of range of motion, grip strength, and complications, as well as injury, post open reduction and internal fixation (ORIF), and finally, healed radiographic parameters were recorded. Twenty patients with 21 fractures were included. At union, mean radiographic parameters were the following: volar tilt of 8°, radial inclination of 27°, radial height of 14 mm, and ulnar variance of -1 mm. The mean final range of motion was 52° flexion, 50° extension, 68° pronation, and 66° supination. Complications included one infection and one plate removal. Four patients developed a nonunion requiring secondary procedures. There were no incidents of hardware failure or adhesions requiring tenolysis. Distally locked long volar plating for metadiaphyseal distal radius fractures is a safe and effective treatment option for these complex fracture patterns allowing anatomic restoration of the radial shaft and distal radius.

  14. Práctica basada en evidencia en estudiantes de enfermería colombianos

    Directory of Open Access Journals (Sweden)

    María del Pilar Ureña-Molina

    2017-07-01

    Full Text Available Objetivo. Determinar el nivel de competencias sobre Práctica Basada en Evidencia en estudiantes de un programa de Enfermería de Colombia. Materiales y métodos. Mediante un diseño cuantitativo, descriptivo y correlacional, el estudio se desarrolló en 2 fases. La primera fase consistió en la adaptación cultural y validación de contenido del cuestionario de Competencias en Práctica Basada en la Evidencia (CACH-PBE al contexto Colombiano; este instrumento valora tres factores: Actitudes, Habilidades y Conocimientos. En la segunda fase se aplicó el cuestionario a una muestra de 291 estudiantes del Programa de Enfermería de una Universidad de Cúcuta, Colombia, durante el primer semestre del 2016. Resultados. Se encontró un promedio de edad de 20 años, de género femenino en su mayoría, el 57,4 % de ellos no tenía ninguna formación previa sobre PBE y el 57.1 % la había recibido en metodología de investigación. La puntuación global de competencia en PBE fue de 3,58 sobre un máximo de 5, destacando la dimensión Actitudes hacia la PBE con mayor puntuación y la dimensión Conocimientos con menor; encontrándose diferencias estadísticamente significativas a mayor medida en que los estudiantes se encontraban en un semestre superior. Conclusiones. Los estudiantes obtuvieron un nivel medio en competencias para la PBE, asociándose un impacto positivo de la formación académica recibida, ya que en los últimos semestres se evidenció mayor puntuación con respecto a los primeros.

  15. Intramedullary nailing in distal tibial fracture

    Directory of Open Access Journals (Sweden)

    Damian Arroquy

    2015-11-01

    Methods The inclusion criteria of this study were skeletally mature patients with displaced fractures of the distal tibia treated with intramedullary nail with a minimum follow up of one year. Gustilo III open fractures and type C fractures of the AO classification (complete articular Stroke were excluded. The sample comprised 35 patients remained. The follow-up was 29.2 months. We evaluated the time of consolidation, malunion and complications. The functional results were described according to the AOFAS score. Results Of the 35 patients with fracture of the distal third of the tibia all of them presented fracture healing. The average time to union was 17.2 weeks (range: 11-26. Of the total sample, 5 patients had delayed union, requiring dynamic nail on average at 12 weeks. The malunion was present in 4 (11.4% patients. We found no  difference (p = 0.201 in the time to union between fractures associated with fractures of the fibula treated (13sem or not (17sem. The AOFAS score was 86 points. Conclusion Intramedullary nailing with multiple distal locks like a good alternative treatment for distal tibia fractures AO type A or B, with low complication rate and a high rate of consolidation.

  16. Medical Expulsive Therapy for Distal Ureteral Stones

    NARCIS (Netherlands)

    Tzortzis, Vassilios; Mamoulakis, Charalampos; Rioja, Jorge; Gravas, Stavros; Michel, Martin C.; de La Rosette, Jean J. M. C. H.

    2009-01-01

    Although minimally invasive treatments for ureteral stones are efficacious, they are not free of complications and are associated with high cost. Medical expulsive therapy (MET) has recently emerged as an alternative strategy for the initial management of small distal ureteral stories. A MEDLINE

  17. Endovascular treatment of ruptured distal posterior inferior ...

    African Journals Online (AJOL)

    2014-03-01

    Mar 1, 2014 ... Methods: 11 consecutive patients (7 women, 4 men, mean age of 49.2 years) with ruptured distal PICA aneurysms were studied retrospectively. All had onset of acute intraventricular or cerebellar haemorrhage, and subarachnoid hemorrhage. (SAH). Hunt-Hess (HH) grades were H-H I in 1 patient, H-H II in ...

  18. Urethral mobilization and advancement for distal hypospadias ...

    African Journals Online (AJOL)

    Background/purpose Despite the existence of numerous techniques for the repair of distal penile hypospadias, none of them is completely satisfactory. Advancing the urethra without mobilization for repair of glanular hypospadias has the advantage of avoiding a common problem occurring with other techniques: ...

  19. Double Plating of Distal Fibula Fractures.

    Science.gov (United States)

    Vance, Danica D; Vosseller, J Turner

    2017-12-01

    Distal fibula fractures are common orthopaedic injuries that often require open reduction internal fixation (ORIF) to anatomically reduce the fracture and minimize the risk of posttraumatic arthritis. In certain clinical situations, stouter fixation may be advantageous to decrease the risk of fixation failure. In this study, the authors report on 12 patients who underwent distal fibula ORIF with 2 one-third tubular plates. Twelve consecutive patients who underwent distal fibula ORIF with 2 one-third tubular plates were retrospectively reviewed. Clinical and radiographic outcomes were reviewed, and functional outcomes were obtained using the Foot and Ankle Outcome Score (FAOS). Institutional review board approval was obtained. All 12 fractures healed clinically and radiographically. One patient was lost to follow-up after healing of the fracture. One patient had removal of fibular hardware at 15 months after surgery. Ten patients had no hardware related pain and good ankle function. FAOS scores were obtained at a mean of 25.6 months after surgery and were as follows: pain (87.6, SD = 9.5), activities of daily living (90.4, SD = 14.5), symptoms (93.3, SD = 9.5), sports (89.5, SD = 18.1), and quality of life (57.4, SD = 21.3). Double plating of distal fibula fractures is a viable technique for problem fractures that potentially provides a readily accessible, low-cost alternative to other means of enhancing fixation. Level IV.

  20. Computed tomography diagnosis of distal radioulnar subluxation

    International Nuclear Information System (INIS)

    Wechsler, R.J.; Rifkin, M.D.; Edeiken, J.; Branch, H.M.

    1987-01-01

    Eight patients with suspected diagnosis of distal radioulnar joint (DRUJ) subluxation underwent computed tomographic (CT) scans of the wrist. Five underwent surgery and had DRUJ subluxation or dislocation; CT scans revealed subluxation in four. Three CT criteria for the evaluation of DRUJ subluxation are discussed and compared in this manuscript. (orig.)

  1. Ulnar shortening osteotomy for distal radius malunion.

    Science.gov (United States)

    Kamal, Robin N; Leversedge, Fraser J

    2014-08-01

    Background Malunion is a common complication of distal radius fractures. Ulnar shortening osteotomy (USO) may be an effective treatment for distal radius malunion when appropriate indications are observed. Methods The use of USO for treatment of distal radius fracture malunion is described for older patients (typically patients >50 years) with dorsal or volar tilt less than 20 degrees and no carpal malalignment or intercarpal or distal radioulnar joint (DRUJ) arthritis. Description of Technique Preoperative radiographs are examined to ensure there are no contraindications to ulnar shortening osteotomy. The neutral posteroanterior (PA) radiograph is used to measure ulnar variance and to estimate the amount of ulnar shortening required. An ulnar, mid-sagittal incision is used and the dorsal sensory branch of the ulnar nerve is preserved. An USO-specific plating system with cutting jig is used to create parallel oblique osteotomies to facilitate shortening. Intraoperative fluoroscopy and clinical range of motion are checked to ensure adequate shortening and congruous reduction of the ulnar head within the sigmoid notch. Results Previous outcomes evaluation of USO has demonstrated improvement in functional activities, including average flexion-extension and pronosupination motions, and patient reported outcomes. Conclusion The concept and technique of USO are reviewed for the treatment of distal radius malunion when specific indications are observed. Careful attention to detail related to surgical indications and to surgical technique typically will improve range of motion, pain scores, and patient-reported outcomes and will reduce the inherent risks of the procedure, such as ulnar nonunion or the symptoms related to unrecognized joint arthritis.  Level IV.

  2. Does computer use affect the incidence of distal arm pain?

    DEFF Research Database (Denmark)

    Mikkelsen, Sigurd; Lassen, Christina Funch; Vilstrup, Imogen

    2012-01-01

    To study how objectively recorded mouse and keyboard activity affects distal arm pain among computer workers.......To study how objectively recorded mouse and keyboard activity affects distal arm pain among computer workers....

  3. Distal Fibula Fractures in National Football League Athletes

    OpenAIRE

    Werner, Brian C.; Mack, Christina; Franke, Kristina; Barnes, Ronnie P.; Warren, Russell F.; Rodeo, Scott A.

    2017-01-01

    Background: Despite the frequency of distal fibula fractures in elite athletes and the significant potential impact on the athletes’ season and future careers, little data exist characterizing the epidemiology of these injuries or, more importantly, return to competition. Purpose: To (1) evaluate the incidence of acute distal fibula fractures in National Football League (NFL) athletes, including isolated distal fibula and combined ankle fracture patterns; (2) analyze distal fibula fracture ra...

  4. Distal radioulnar joint: functional anatomy, including pathomechanics.

    Science.gov (United States)

    Haugstvedt, J R; Langer, M F; Berger, R A

    2017-05-01

    The distal radioulnar joint allows the human to rotate the forearm to place the hand in a desired position to perform different tasks, without interfering with the grasping function of the hand. The ulna is the stable part of the forearm around which the radius rotates; the stability of the distal radioulnar joint is provided by the interaction between ligaments, muscles and bones. The stabilizing structures are the triangular fibrocartilage complex, the ulnocarpal ligament complex, the extensor carpi ulnaris tendon and tendon sheath, the pronator quadratus, the interosseous membrane and ligament, the bone itself and the joint capsule. The purpose of this review article is to present and illustrate the current understanding of the functional anatomy and pathomechanics of this joint.

  5. Surgical treatment of distal biceps rupture.

    Science.gov (United States)

    Sutton, Karen M; Dodds, Seth D; Ahmad, Christopher S; Sethi, Paul M

    2010-03-01

    Rupture of the distal biceps tendon accounts for 10% of all biceps brachii ruptures. Injuries typically occur in the dominant elbow of men aged 40 to 49 years during eccentric contraction of the biceps. Degenerative changes, decreased vascularity, and tendon impingement may precede rupture. Although nonsurgical management is an option, healthy, active persons with distal biceps tendon ruptures benefit from early surgical repair, gaining improved strength in forearm supination and, to a lesser degree, elbow flexion. Biomechanical studies have tested the strength and displacement of various repairs; the suspensory cortical button technique exhibits maximum peak load to failure in vitro, and suture anchor and interosseous screw techniques yield the least displacement. Surgical complications include sensory and motor neurapraxia, infection, and heterotopic ossification. Current trends in postoperative rehabilitation include an early return to motion and to activities of daily living.

  6. Fractures of the distal phalanx in the horse

    International Nuclear Information System (INIS)

    Yovich, J.V.

    1989-01-01

    Fractures of the distal phalanx are an important cause of lameness referable to the foot. Depending on the fracture configuration and articular involvement, conservative or surgical treatment may be required. Fractures of the distal phalanx have been divided into six categories based on fracture configuration. Discussion of clinical features, management, and prognosis for horses with distal phalangeal fractures is presented for each fracture type

  7. Carpal alignment in distal radial fractures

    Directory of Open Access Journals (Sweden)

    Jain Pankaj

    2002-05-01

    Full Text Available Abstract Background Carpal malalignment following the malunited distal radial fracture is described to develop as an adaptation to realign the hand to the malunion. It worsens gradually after healing of the fracture due to continued loading of the wrist. It is also reported to develop during the immobilization itself rather than after fracture healing. The present work was aimed to study the natural course and the quantitative assessment of such adaptive carpal realignment following distal radial fracture. Methods In a prospective study, 118 distal radial fractures treated with different modalities were followed-up with serial radiographs for a year for assessment of various radiological parameters. Results Two patterns of carpal malalignment were identified depending upon the effective radio-lunate flexion (ERLF measured on pre-reduction radiographs. The midcarpal malalignment was seen in 98 radial fractures (83% with the lunate following the dorsiflexed fracture fragment and a measured ERLF of less than 25°. The second pattern of radio-carpal malalignment showed the fracture fragment to dorsiflex without taking the lunate with a measured ERLF of more than 25°. The scaphoid did not follow the fracture fragment in both the patterns of malalignment. Conclusion It is better to assess distal radial fractures for any wrist ligamentous injury on the post-reduction film with the restored radial anatomy than on the pre-reduction film since most carpal malalignments get corrected with the reduction of the fracture. Similar carpal malalignment reappear with the redisplacement of the fracture as seen in pre-reduction radiographs and develops during the immobilization rather than as a later compensatory mechanism for the malunion.

  8. Dermoscopic features of distal lateral subungual onychomycosis

    Directory of Open Access Journals (Sweden)

    Thansiha Nargis

    2018-01-01

    Full Text Available Background: Onychomycosis is a very common disease and accounts for upto 50% of the diseases affecting the nail apparatus. Diagnosis of onychomycosis is usually confirmed with the help of a potassium hydroxide (KOH mount and fungal culture. Onychoscopy can be a handy and additional tool for the diagnosis. Aims and Objectives: To determine the dermoscopic findings in distal lateral subungual onychomycosis (DLSO. Materials and Methods: A prospective study of 60 nails with a clinical and mycological diagnosis (KOH with Chicago sky blue positive of DLSO. Dermoscopic examination was performed using a Heine delta 20 plus dermatoscope and the features were recorded. Results: Longitudinal striae and jagged proximal edges seen in all 60 (100% patients. Intermittent spiked pattern was seen in 47 nails (78.3%. Chromonychia and distal irregular termination were noticed in 23 (38.3% and 7 (11.7% nails, respectively. Conclusions: Onychoscopy can be used as an important diagnostic tool while evaluating nail disease, especially in DLSO. Limitations: Small study sample and lack of comparison with other nail diseases that manifests with distal onycholysis.

  9. Miastenia grave distal: relato de caso

    Directory of Open Access Journals (Sweden)

    Scola Rosana Herminia

    2003-01-01

    Full Text Available Relatamos o caso de uma mulher de 30 anos com quadro de fraqueza muscular nos membros inferiores com predomínio distal com início há 7 anos. Na evolução apresentou fraqueza muscular nos membros superiores. O exame físico mostrava nervos cranianos sem alterações, hipotrofia bilateral de quadriceps e interósseos dos pés, redução da força muscular mais intensa em tibiais anteriores e interósseos dorsais dos pés e reflexos tendinosos globalmente hipoativos. Foi realizado teste de estimulação repetitiva que mostrou decremento maior que 10% no nervo fibular e ulnar. A dosagem de anticorpos anti-receptor de acetilcolina foi positiva. Tomografia computadorizada de tórax foi normal. Dosagem de hormônios tireoidianos mostrou evidências laboratoriais de hipertireoidismo, porém sem manifestações clínicas. Foi iniciado tratamento com piridostigmina havendo melhora importante do quadro clínico. A fraqueza distal é um sintoma inicial raro na miastenia grave (MG. Contudo, a MG deve entrar no diagnóstico diferencial de doenças que cursam com fraqueza muscular distal de membros superiores ou inferiores.

  10. Management and treatment of distal ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Andrea Calafiore

    2013-12-01

    Full Text Available Ulcerative colitis (UC is a chronic inflammatory condition that is confined to the colonic mucosa. Its main symptoms include diarrhea, rectal bleeding and abdominal pain. Approximately two-thirds of UC patients have disease confined distal to the splenic flexure, which can be treated effectively with topical therapy. This means the active drug can be delivered directly to the site of inflammation, limiting the systemic absorption and potential side effects. Topical treatment with aminosalicylates is the most effective approach in the treatment of these forms, provided that the formulation reaches the upper margin of the disease. Given this, the suppository formulation is the treatment of choice for proctitis and distal sigmoiditis. Thanks to their proximal spread, enemas, foams and gels represent the treatment of choice for proctosigmoiditis and for distal ulcerative colitis. Oral aminosalicylates are less effective than topical therapies in patients with active disease, while the combination of topical and oral treatment is more effective in patients refractory to topical or oral mono-therapy. Topically administered aminosalicylates play an important role in the maintenance of remission, but the long-term adhesion to therapy is poor. For this reason, the oral formulation is the first-line therapy in the maintenance of remission. Refractory patients can be treated with topical steroids or systemic steroids and TNF-alpha inhibitors in severe forms.

  11. Maxillary molar distalization with the dual-force distalizer supported by mini-implants: a clinical study.

    Science.gov (United States)

    Oberti, Giovanni; Villegas, Carlos; Ealo, Martha; Palacio, John Camilo; Baccetti, Tiziano

    2009-03-01

    The objective of this prospective study was to describe the clinical effects of a bone-supported molar distalizing appliance, the dual-force distalizer. The study group included 16 patients (mean age, 14.3 years) with Class II molar relationships. Study models and lateral cephalograms were taken before and after the distalizing movement to record significant dental and skeletal changes (Wilcoxon test). The average distalization time was 5 months, with a movement rate of 1.2 mm per month; the distalization amounts were 5.9 +/- 1.72 mm at the crown level and 4.4 +/- 1.41 mm at the furcation level. The average molar inclination was 5.6 degrees +/- 3.7 degrees ; this was less than the amount of inclination generated by bone-supported appliances that use single distalizing forces. The correlation between inclination and distalization was not significant, indicating predominantly bodily movement. The teeth anterior to the first molar moved distally also; the second premolars distalized an average of 4.26 mm, and the incisors retruded by 0.53 mm. The dual-force distalizer is a valid alternative distalizing appliance that generates controlled molar distalization with a good rate of movement and no loss of anchorage.

  12. CONGESTIÓN EN EL SERVICIO DE URGENCIA: RESPUESTAS BASADAS EN EVIDENCIAS A PREGUNTAS FRECUENTES

    Directory of Open Access Journals (Sweden)

    RJ Salway, MD

    2017-03-01

    Full Text Available La congestión en las unidades de urgencia constituye un problema en muchos países del mundo, entre los que se incluye Estados Unidos y Chile. La congestión en los servicios de urgencia produce problemas a los pacientes y al personal, además de tiempos de espera cada vez más largos, desvíos de ambulancia cada vez mayores, estadías cada vez más largas, mayor número de errores médicos, mayor mortalidad de los pacientes y una mayor pérdida de recursos a los hospitales debido a pérdidas financieras. Este artículo pretende describir la etiología de la congestión en los servicios de urgencia y las posibles soluciones, a través de un análisis de la evidencia. En último término, la congestión en las salas de urgencia se origina, a su vez, por la aglomeración de pacientes en los hospitales y por ende, la solución a este problema complejo radica tanto en la sala de urgencia como fuera de ella.

  13. Evidencia y neurociencias cognitivas: El caso de la resonancia magnética funcional

    Directory of Open Access Journals (Sweden)

    A. Nicolás Venturelli

    2015-12-01

    Full Text Available La resonancia magnética funcional es una de las técnicas de neuroimagen más difundidas en las neurociencias cognitivas. Su influencia tuvo un rol importante en la configuración del costado experimental de este campo. Frente a esto, consideramos que su estatus como evidencia no sido suficientemente discutido en la literatura filosófica. Aquí nos centramos sobre este punto desde la óptica de la tensión clásica sobre el alcance de los enfoques localizacionistas en neurociencias. Atendemos al modo en que esta tensión se manifiesta hoy. Tomamos en cuenta un número de limitaciones que presenta la resonancia magnética funcional y analizamos el modo en que los investigadores les hacen frente. En función de esto, sostenemos que existe una medida importante en que la técnica puede ser orientada sobre la base de supuestos y consideraciones teóricas generales. Para sustentar nuestras ideas, tomamos algunos ejemplos recientes de abordajes neurocientíficos caracterizados por abordar de manera directa el carácer dinámico de la actividad a gran escala en el cerebro.

  14. Evidencias sobre la prevención del cáncer

    Directory of Open Access Journals (Sweden)

    D. Salas

    2013-10-01

    Full Text Available El cáncer es uno de los principales problemas de salud. Engloba a un conjunto de enfermedades que tienen un origen multicausal. Los tumores con mayor impacto en la salud son pulmón, próstata y colorrectal en los hombres y mama y colorrectal en las mujeres. Las mejores estrategias para evitar el cáncer son las basadas en la prevención primaria y en el diagnóstico precoz. Se estima que entre el 80-90% de los canceres son prevenibles. Respecto a la prevención primaria hay fuerte evidencia que no fumar, realizar ejercicio físico regular, y una dieta rica en frutas y verduras junto con el control de algunos factores de riesgo ambientales y laborales, puede disminuir la incidencia del cáncer. Está recomendado el diagnóstico precoz de cáncer de mama, cuello de útero y de cáncer colorrectal en algunos grupos de población en el contexto de programas organizados con la adecuada garantía de calidad.

  15. ¿Puede el desarrollo financiero promover el desarrollo humano? Evidencia para Venezuela

    Directory of Open Access Journals (Sweden)

    Leonardo Vera

    2013-06-01

    Full Text Available Este estudio presenta evidencia empírica para la economía venezolana(entre los años 1970 y 2009 de la posible relación que existe entre el acceso y uso de los servicios financieros por parte de la población y el grado de desarrollo humano. Usando varias proxis de bancarización, el estudio encuentra resultados robustos que indican que una mayor red de servicios y cobertura de depositantes explica las mejoras reportadas en el índice de desarrollo humano (IDH. El IDH también es impactado positivamente por la evolución que ha tomado el precio real de los hidrocarburos petroleros y el gasto público porhabitante. De esta manera, el análisis se aleja de la muy conocida, pero controvertida relación entre desarrollo financiero y crecimiento económico, cuto cuño explicativo se centra en las ganancias de eficiencia, para concentrarse más bien en la importancia que tienen la masificación de los servicios financieros en el bienestar de la población.

  16. Poder de comprador y de vendedor en el comercio minorista: evidencia de Italia.

    Directory of Open Access Journals (Sweden)

    Monica Giulietti

    2010-05-01

    Full Text Available Este trabajo investiga los efectos de la concentración de mercado upstream y downstream sobre el margen precio-costo de los minoristas usando datos bimestrales durante el período 1989–1992 desagregados por tipo de minorista y producto. Adicionalmente a la concentración horizontal, la diferenciación y los factores de costo, el análisis incluye el poder del comprador entre los determinantes de la rentabilidad de los minoristas, como resultado de la negociación vertical. Usando un modelo de efectos fijos en primeras diferencias, encontramos evidencia de actividad de negociación entre las grandes cadenas y los productores de alimentos. Nuestro análisis de la competencia de precios al nivel minorista también revela una cierta interdependencia en las decisiones de fijación de precios de las organizaciones minoristas más grandes y liderazgo en precios por parte de las grandes tiendas independientes.

  17. Síncope y escalas de riesgo: ¿Qué evidencia se tiene?

    Directory of Open Access Journals (Sweden)

    Guillermo Mora

    Full Text Available Objetivo: hacer una revisión de las escalas de riesgo existentes para predecir eventos adversos relacionados con síncope. Metodología: se realizó una búsqueda de artículos en MEDLINE, EMBASE y Cochrane Database of Systematic Reviews con el uso de las palabras clave relacionadas con reglas de predicción clínica (algoritmos, análisis multivariado, guías de predicción clínica, escalas, modelos logísticos, valoración de riesgo y síncope. Adicionalmente, se buscó literatura con el uso de la estrategia de bola de nieve. Resultados: se encontraron nueve escalas que relacionaron el síncope con predicción de eventos adversos. Se hallaron diferencias en los criterios para definir riesgo, las variables de desenlace, la población estudiada, el uso de una estrategia prospectiva o retrospectiva y el tiempo de seguimiento. Conclusiones: aunque existen varias escalas para la definición de riesgo con el paciente que ingresa por síncope a urgencias, no hay evidencia de que alguna sea superior a otra, tienen poca validez externa y no se han aplicado en nuestro medio.

  18. Evidencia de exposición a Leptospira en perros callejeros de Cali.

    Directory of Open Access Journals (Sweden)

    Ana Lucía Rodríguez

    2004-09-01

    Full Text Available En Cali, y en Colombia en general, se desconoce la epidemiología de la leptospirosis en ambientes urbanos. Además, el papel del perro en el ciclo de transmisión en dichos ambientes no es claro. Para explorar esta situación, realizamos un estudio serológico en Cali a 197 sueros de perros callejeros durante el 2001 y el 2003, utilizando la prueba de microaglutinación (MAT. En la prueba se incluyeron 7 serovares: Icterohaemorrhagiae, Canicola, Gryppotyphosa, Hardjo cepa Hardjobovis, Pomona, Hardjo cepa Hardjoprajitno y Bratislava aportados por el Instituto Colombiano Agropecuario (ICA de Tuluá. La prueba se interpretó como positiva por la presencia de una aglutinación ³50% de las leptospiras, con uno o más serovares, en una dilución del suero ³1:100. Encontramos evidencia de infección en el 41,1% de los perros con, al menos, uno de los serovares. La mayor reactividad fue a Icterohaemorrhagiae con 55,6% del total de los seropositivos. Se presentaron 48,1% de coaglutinaciones. No se registraron reacciones contra los serovares Pomona, Hardjo cepa Hardjoprajitno y Bratislava. Estos hallazgos sugieren que el perro callejero es un posible reservorio de leptospira en Cali y resaltan la necesidad de estudiar la epidemiología de la enfermedad en esta ciudad.

  19. Comercio, empleo y salarios en Colombia: Teoría y evidencia empírica

    Directory of Open Access Journals (Sweden)

    De Lombaerde Philippe

    2002-08-01

    Full Text Available El autor parte de la observación de que el debate academico sobre la apertura en Colombia es un debate demasiado polarizado, y sostiene que se requiere una combinación de teorías y de enfoques para poder analizar el tema, y un mayor enfasis en el análisis empírico. Con base en un análisis de la evidencia disponible hasta el momento, llega a las siguientes conclusiones; ies la combinación de la políticas de apertura, por un lado, y las tendencias en materia de cambio tecnologico y de cambio a nivel de los facotres de producción, por otro que explica el comportamiento de las variables comerciales, laborales y de producción; iiaunque ciertos flujos comerciales responden a la logica de los modelos clasicos y neoclasicos, la aperura en su conjunto no se captan en ellos; iiien cuanto a la formulacion de politicas industriales y comerciales alternativas, deben sustentarse teórica y empíricamente, y deben estar acompañadas por un analisis detallado de los costos y beneficios económicos, y sociales y de los efectos redistributivos; ivno hay duda de que la apertura este relacionada con los efectos adversos en el empleo y los salarios de los 90's.

  20. Diversificación temporal en carteras de inversión: evidencia con emisoras multilatinas

    Directory of Open Access Journals (Sweden)

    Jesús Cuauhtémoc Téllez Gaytán

    2014-06-01

    Full Text Available El presente documento da cuenta de las posibilidades de reducir el riesgo en diferentes horizontes de inversión a partir del principio de diversificación de Markowitz (1952. El estudio se llevó a cabo aplicando el enfoque de la descomposición por multirresolución a través de wavelets, que permite descomponer una serie de tiempo en diferentes escalas de tiempo. Los datos consisten en precios semanales de emisoras Multilatinas mexicanas y brasileras consideradas como las de mayor potencial de crecimiento según ranking 2011 de Americaeconomía. Los resultados demuestran que la estructura de correlación entre las rentabilidades de los índices bursátiles y las rentabilidades de emisoras es cambiante en diferentes escalas de tiempo –lo cual refleja oportunidades de diversificación “temporal”–; lo dicho, en contraste con la correlación global que refleja una fuerte asociación en los movimientos de los precios accionarios y con ello elimina las posibilidades de diversificación. El estudio aporta evidencia adicional a la caracterización descrita por Ramsey y Lampart (2007 respecto de las relaciones entre series económicas debido a la presencia de la escala de tiempo.

  1. Diversificación temporal en carteras de inversión: evidencia con emisoras multilatinas

    Directory of Open Access Journals (Sweden)

    Jesús Cuauhtémoc Téllez Gaytán

    2014-07-01

    Full Text Available El presente documento da cuenta de las posibilidades de reducir el riesgo en diferentes horizontes de inversión a partir del principio de diversificación de Markowitz (1952. El estudio se llevó a cabo aplicando el enfoque de la descomposición por multirresolución a través de wavelets, que permite descomponer una serie de tiempo en diferentes escalas de tiempo. Los datos consisten en precios semanales de emisoras Multilatinas mexicanas y brasileras consideradas como las de mayor potencial de crecimiento según ranking 2011 de Americaeconomía. Los resultados demuestran que la estructura de correlación entre las rentabilidades de los índices bursátiles y las rentabilidades de emisoras es cambiante en diferentes escalas de tiempo –lo cual refleja oportunidades de diversificación “temporal”–; lo dicho, en contraste con la correlación global que refleja una fuerte asociación en los movimientos de los precios accionarios y con ello elimina las posibilidades de diversificación. El estudio aporta evidencia adicional a la caracterización descrita por Ramsey y Lampart (2007 respecto de las relaciones entre series económicas debido a la presencia de la escala de tiempo.

  2. An innovative technique to distalize maxillary molar using microimplant supported rapid molar distalizer

    Directory of Open Access Journals (Sweden)

    Meenu Goel

    2013-01-01

    Full Text Available Introduction: In recent years, enhancements in implants have made their use possible as a mode of absolute anchorage in orthodontic patients. In this paper, the authors have introduced an innovative technique to unilaterally distalize the upper left 1 st molar to obtain an ideal Class I molar relationship from a Class II existing molar relationship with an indigenous designed distalizer. Clinical Innovation: For effective unilateral diatalization of molar, a novel cantilever sliding jig assembly was utilized with coil spring supported by a buccally placed single micro implant. The results showed 3 mm of bodily distalization with 1 mm of intrusion and 2° of distal tipping of upper left 1 st molar in 1.5 months. Discussion: This appliance is relatively easy to insert, well-tolerated, and requires minimal patient cooperation compared to other present techniques of molar distalization. Moreover, it is particularly useful in cases that are Class II on one side and Class I on the other, with a minor midline discrepancy and nominal overjet. Patient acceptance level was reported to be within patients physiological and comfort limits.

  3. Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes.

    Science.gov (United States)

    Lai, Eric C H; Tang, Chung Ngai

    2015-09-01

    Robotic system has been increasingly used in pancreatectomy. However, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal pancreatectomy and conventional laparoscopic distal pancreatectomy. During a 15-year period, 35 patients underwent minimally invasive approach of distal pancreatectomy in our center. Seventeen of these patients had robot-assisted laparoscopic approach, and the remaining 18 had conventional laparoscopic approach. Their operative parameters and perioperative outcomes were analyzed retrospectively in a prospective database. The mean operating time in the robotic group (221.4 min) was significantly longer than that in the laparoscopic group (173.6 min) (P = 0.026). Both robotic and conventional laparoscopic groups presented no significant difference in spleen-preservation rate (52.9% vs. 38.9%) (P = 0.505), operative blood loss (100.3 ml vs. 268.3 ml) (P = 0.29), overall morbidity rate (47.1% vs. 38.9%) (P = 0.73), and post-operative hospital stay (11.4 days vs. 14.2 days) (P = 0.46). Both groups also showed no perioperative mortality. Similar outcomes were observed in robotic distal pancreatectomy and conventional laparoscopic approach. However, robotic approach tended to have the advantages of less blood loss and shorter hospital stay. Further studies are necessary to determine the clinical position of robotic distal pancreatectomy.

  4. Topographic matching of distal radius and proximal fibula articular surface for distal radius osteoarticular reconstruction.

    Science.gov (United States)

    Zhang, H; Chen, S; Wang, Z; Guo, Y; Liu, B; Tong, D

    2016-07-01

    During osteoarticular reconstruction of the distal radius with the proximal fibula, congruity between the two articular surfaces is an important factor in determining the quality of the outcome. In this study, a three-dimensional model and a coordinate transformation algorithm were developed on computed tomography scanning. Articular surface matching was performed and parameters for the optimal position were determined quantitatively. The mean radii of best-fit spheres of the articular surfaces of the distal radius and proximal fibula were compared quantitatively. The radial inclination and volar tilt following reconstruction by an ipsilateral fibula graft, rather than the contralateral, best resembles the values of the native distal radius. Additionally, the ipsilateral fibula graft reconstructed a larger proportion of the distal radius articular surface than did the contralateral. The ipsilateral proximal fibula graft provides a better match for the reconstruction of the distal radius articular surface than the contralateral, and the optimal position for graft placement is quantitatively determined. © The Author(s) 2015.

  5. Distal renal tubular acidosis in recurrent renal stone formers

    DEFF Research Database (Denmark)

    Osther, P J; Hansen, A B; Røhl, H F

    1989-01-01

    (1.1%) had complete distal renal tubular acidosis and 14 (15.5%) incomplete distal renal tubular acidosis. Our results confirm that distal renal tubular acidification defects are associated with a more severe form of stone disease and make distal renal tubular acidosis one of the most frequent...... metabolic disturbances in renal stone formers. Distal renal tubular acidosis (dRTA) was relatively more common in female stone formers and most often found in patients with bilateral stone disease (36%). Since prophylactic treatment in renal stone formers with renal acidification defects is available...

  6. Infección por rickettsia en capibaras (Hydrochoerus hydrochaeris de São Paulo, Brasil: evidencia serológica de infección por Rickettsia bellii y Rickettsia parkeri

    Directory of Open Access Journals (Sweden)

    Richard C. Pacheco

    2007-09-01

    Conclusiones. Este trabajo reporta la primera evidencia de infección natural por R. bellii en vertebrados y, también, la primera evidencia de infección por R. parkeri en capibaras. Se sabe que R. parkeri infecta y produce enfermedad en humanos; sin embargo, no hay evidencia de infección humana por R. bellii.

  7. following Wide Resection of Giant Cell Tumour of Distal Ulna

    Directory of Open Access Journals (Sweden)

    Elango Mariappan

    2013-01-01

    Full Text Available Giant cell tumour of the bone (GCT is a rare locally aggressive primary bone tumour with an incidence of 3% to 5% of all primary bone tumours. The most common location for this tumour is the long bone metaepiphysis especially of the distal femur, proximal tibia, distal radius, and the proximal humerus. Involvement of distal ulna is rare accounting for 0.45% to 3.2%. Considering local aggressive nature and high recurrence, wide resection is the treatment recommended. Instability of ulnar stump and ulnar translation of the carpals are known complications following resection of distal ulna. To overcome these problems, we attempted a newer technique of distal ulna reconstruction using proximal fibula and TFCC reconstruction using palmaris longus tendon following wide resection of giant cell tumour of distal ulna in a 44-year-old male. This technique of distal radioulnar joint reconstruction has excellent functional results with no evidence of recurrence after one-year followup.

  8. The role of hand-assisted laparoscopic distal gastrectomy for distal gastric cancer.

    Science.gov (United States)

    Kim, Y W; Bae, J M; Lee, J H; Ryu, K W; Choi, I J; Kim, C G; Lee, J S; Rho, J Y

    2005-01-01

    The aim of this study was to evaluate the role of hand-assisted distal gastrectomy (HALDG) for gastric cancer. This study prospectively enrolled 16 patients who underwent HALDG for early gastric cancer and matched them individually by sex, age, and body mass index to patients who underwent laparoscopically assisted distal gastrectomy (LADG) or open distal gastrectomy (ODG). Surgical outcomes were compared among the surgical methods. The mean operating time was the longest for the HALDG group, whereas wound size of the HALDG group was intermediate between that of the LADG and the ODG groups. The other surgical outcomes, such as the number of harvested lymph nodes, were not different among the groups. According to the findings, HALDG may not be as beneficial for patients with early gastric cancer as has been previously suggested. However, because of easier hand-eye coordination, HALDG may be an excellent bridge learning technique as a surgeon gains experience in laparoscopic gastrectomy.

  9. Liderando cuidados de Enfermería basados en evidencia a través de procesos sistematizados

    Directory of Open Access Journals (Sweden)

    Doris Grinspun

    2016-11-01

    Full Text Available Los gobiernos de todo el mundo apuntan a mejorar los cuidados de salud, y a optimizar sus resultados a través de iniciativas destinadas a acelerar la integración sistematizada de atención clínica basada en la evidencia. No es sorprendente entonces, que este sea el segundo número de la revista MedUNAB, dedicado a visualizar la transformación sistematizada de la profesión de enfermería a través del uso continuo de evidencia científica en la práctica clínica del día a día.

  10. Enfemería Basada en la Evidencia : Un Pilar Esencial en el Currículo

    OpenAIRE

    Wilson Cañón Montañez; Erika Yurley Durán Niño; Jairo Andrés Hernández Beltrán

    2010-01-01

    Introducción: La enfermería basada en la evidencia se propone como un modelo en el cual se plantean preguntas de investigación procedentes de los problemas cotidianos de la práctica y cuya respuesta se evalúa sistemáticamente a partir de resultados de investigación rigurosa que oriente las mejores decisiones en beneficio del usuario. Materiales y Métodos: Artículo de reflexión sobre un análisis crítico de la literatura acercade la implementación de la enfermería basada en la evidencia en el c...

  11. OUTCOME OF FRACTURE OF INTRAARTICULAR DISTAL FEMUR TREATED WITH DISTAL FEMUR LOCKING COMPRESSION PLATE

    Directory of Open Access Journals (Sweden)

    Swapna Pran Saikia

    2017-10-01

    Full Text Available BACKGROUND The most challenging fractures faced by orthopaedic surgeons are the distal fractures of femur, especially the intraarticular distal femoral fractures. These fractures have been classified according to Orthopaedic Trauma Association (OTA 33-C3. Distal femoral fractures account to 4-7% of all femoral fractures and are less common compared to hip fractures. The aim of the study is to study the functional outcome of fracture of intraarticular distal femur treated with distal femur locking compression plate. MATERIALS AND METHODS This study is a prospective study, which comprised of 30 patients of intraarticular distal femur fracture AO classification 33-C3 who were treated by locking compression plate at Jorhat Medical College and Hospital, Jorhat, Assam. This study was conducted during February 2015 to April 2017. The functional outcome was studied using Neer’s score, outcome of radiology and complication with fracture fixation using LCP. RESULTS Out of 30 patients, 22 were males (73.3% and 8 were females (26.7%. 18 patients had fracture right hand side and 12 patients had left-handed fractures. A 19 years old was the youngest patient and 72 years was the oldest patient. About 70% patients had sustained road traffic accidents and 10% had sustained fall from a height. Four days was the average trauma to operative interval, 22 patients were operated extensile lateral approach and 8 patients were operated by swashbuckler approach. 12 weeks was the average weightbearing duration, 21 weeks was average time for fracture healing. 10 patients had C1 (33.3%, 12 patients had C2 (40% and 8 patients had C3 (26.7% type of fracture according to AO classification. Among 30 patients, 13 patients have shown excellent results, 7 patients have good results, 5 fair results and 5 poor results. Primary bone grafting was done in 4 patients for severely comminuted type C3 fracture. Secondary bone grafting was done in 2 patients who had delayed union at 4

  12. Repair of distal biceps brachii tendon ruptures.

    Science.gov (United States)

    Bell, R H; Wiley, W B; Noble, J S; Kuczynski, D J

    2000-01-01

    This study consisted of 26 male patients with distal biceps tendon ruptures, 2 of whom had bilateral injuries, making the total number of ruptures 28. The average age at injury was 45 years. The treatment groups were the following: 3 were treated without surgery, 4 were repaired with brachialis tenodesis, and 21 were reattached to the radial tuberosity by the 2-incision Boyd-Anderson approach. Patients underwent follow-up a minimum of 14 months after surgery, with the average being 43 months. Outcome was evaluated based on the physical examination, isokinetic testing of strength and endurance of flexion and supination, and radiographic analysis.

  13. Periosteal osteoblastoma of the distal femur

    Energy Technology Data Exchange (ETDEWEB)

    Nakatani, Tetsuya; Yamamoto, Tetsuji; Akisue, Toshihiro; Marui, Takashi; Hitora, Toshiaki; Kawamoto, Teruya; Nagira, Keiko; Yoshiya, Shinichi; Kurosaka, Masahiro [Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe (Japan); Fujita, Ikuo; Matsumoto, Keiji [Department of Orthopaedic Surgery, Hyogo Medical Center for Adults, Akashi, Hyogo (Japan)

    2004-02-01

    Osteoblastomas located on the surface of the cortical bone, so-called periosteal osteoblastomas, are extremely rare. We report on a case of periosteal osteoblastoma arising from the posterior surface of the right distal femur in a 17-year-old man. Roentgenographic, computed tomographic, magnetic resonance imaging, and histologic features of the case are presented. Periosteal osteoblastoma should be radiologically and histologically differentiated from myositis ossificans, avulsive cortical irregularity syndrome, osteoid osteoma, parosteal osteosarcoma, periosteal osteosarcoma, and high-grade surface osteosarcoma. Although periosteal osteoblastoma is rare, this tumor should be included in the differential diagnosis of surface-type bone tumors. (orig.)

  14. Periosteal osteoblastoma of the distal femur

    International Nuclear Information System (INIS)

    Nakatani, Tetsuya; Yamamoto, Tetsuji; Akisue, Toshihiro; Marui, Takashi; Hitora, Toshiaki; Kawamoto, Teruya; Nagira, Keiko; Yoshiya, Shinichi; Kurosaka, Masahiro; Fujita, Ikuo; Matsumoto, Keiji

    2004-01-01

    Osteoblastomas located on the surface of the cortical bone, so-called periosteal osteoblastomas, are extremely rare. We report on a case of periosteal osteoblastoma arising from the posterior surface of the right distal femur in a 17-year-old man. Roentgenographic, computed tomographic, magnetic resonance imaging, and histologic features of the case are presented. Periosteal osteoblastoma should be radiologically and histologically differentiated from myositis ossificans, avulsive cortical irregularity syndrome, osteoid osteoma, parosteal osteosarcoma, periosteal osteosarcoma, and high-grade surface osteosarcoma. Although periosteal osteoblastoma is rare, this tumor should be included in the differential diagnosis of surface-type bone tumors. (orig.)

  15. Mini-implant-supported Molar Distalization

    Directory of Open Access Journals (Sweden)

    Amit Goyal

    2012-01-01

    Full Text Available Temporary anchorage devices popularly called mini-implants or miniscrews are the latest addition to an orthodontist′s armamentarium. The following case report describes the treatment of a 16-year-old girl with a pleasant profile, moderate crowding and Angle′s Class II molar relationship. Maxillary molar distalization was planned and mini-implants were used to preserve the anterior anchorage. After 13 months of treatment, Class I molar and canine relation was achieved bilaterally and there was no anterior proclination. Thus, mini-implants provide a viable option to the clinician to carry out difficult tooth movements without any side effects.

  16. Distal radius fracture after proximal row carpectomy

    OpenAIRE

    Igeta, Yuka; Naito, Kiyohito; Sugiyama, Yoichi; Obata, Hiroyuki; Aritomi, Kentaro; Kaneko, Kazuo; Obayashi, Osamu

    2015-01-01

    Introduction: We encountered a patient with distal radius fracture (DRF) after proximal row carpectomy (PRC). The mechanism of the DRF after PRC is discussed in this report. Presentation of case: The patient was a 73-year-old female who had undergone PRC due to Kienböck disease before. The wrist range of motion was: 45° on dorsiflexion and 20° on flexion. DRF has occurred at 3 years after PRC. The fracture type was extra-articular fracture. Osteosynthesis was performed using a volar lockin...

  17. Prácticas basadas en la evidencia: pasado, presente y futuro

    Directory of Open Access Journals (Sweden)

    Alba Elisabeth Mustaca

    2015-04-01

    Full Text Available Las prácticas basadas en la evidencia (PBE y la subclase de ellas, los tratamientos con apoyo empírico (TAE, si bien su nomenclatura es reciente, tienen antecedentes remotos. Se presentan algunos hitos históricos sobre las PBE (pasado y sus antecedentes más próximos, los resultados de las primeras listas que aparecieron de prácticas psicoterapéuticas con apoyo empírico y su comparación con las últimas, como una manera sencilla de evaluar su desarrollo en la psicología clínica (presente. Finalmente, se presentarán algunas de las limitaciones que se deben superar (futuro. Respecto de las primeras listas de PBE, aumentaron las de fuerte apoyo empírico, se agregaron las subcategorías controvertidas y nocivas, presentan TAE para comorbilidades y algunas recomendaciones específicas para cada TAE en particular. Continúa el predominio de las terapias cognitivas-conductuales como las más válidas. Estos resultados muestran un avance considerable en el estudio sistemático de las PBE. En el futuro deberán incrementarse las PBE para comorbilidades, las investigaciones en otros países, las relaciones entre ciencia básica y tecnológica y disminuir la importante disociación que existe entre la investigación, tanto clínica como básica y la práctica profesional, como la cantidad de programas de psicología basados en escuelas psicológicas y bibliografías obsoletas.

  18. El programa ConRed, una práctica basada en la evidencia

    Directory of Open Access Journals (Sweden)

    Rosario del Rey Alamillo

    2012-10-01

    Full Text Available La vertiginosa incorporación de las TIC a la sociedad y los consecuentes riesgos a los que los menores se enfrentan en Internet y las redes sociales han dejado en evidencia la necesidad de incorporar en el currículum escolar el dominio de los entornos virtuales. En cambio, son escasas las iniciativas en esta dirección y más aún programas rigurosamente evaluados, de modo que sirvan de fundamento para el diseño de las líneas de acción educativa. El programa ConRed está basado en la teoría del comportamiento social normativo y persigue los objetivos de mejorar y reducir problemas como el cyberbullying, la dependencia a Internet y la desajustada percepción del control de la información en las redes sociales, para así potenciar el uso beneficioso de éstas. La evaluación del ConRed se ha desarrollado mediante una metodología cuasi experimental, con un grupo experimental (N=595 y uno cuasi-control (N=298. Del total de los 893 estudiantes, el 45,9% eran chicas y la edad media 13,80 años (DT=1,47. Los resultados positivos de reducción de problemas en el grupo experimental y la ausencia de cambio en el grupo control son muestra de su validez y demuestran que trabajando con toda la comunidad educativa y en colaboración con ella es posible mejorar la calidad de la vida virtual y, por tanto, real de los adolescentes.

  19. Dermal pocketing following distal finger replantation.

    Science.gov (United States)

    Puhaindran, Mark E; Paavilainen, Pasi; Tan, David M K; Peng, Yeong Pin; Lim, Aymeric Y T

    2010-08-01

    Replantation is an ideal technique for reconstruction following fingertip amputation as it provides 'like for like' total reconstruction of the nail complex, bone pulp tissue and skin with no donor-site morbidity. However, fingertips are often not replanted because veins cannot be found or are thought to be too small to repair. Attempts at 'cap-plasty' or pocketing of replanted tips with and without microvascular anastomosis have been done in the past with varying degrees of success. We prospectively followed up a group of patients who underwent digital replantation and dermal pocketing in the palm to evaluate the outcome of this procedure. There were 10 patients with 14 amputated digits (two thumbs, five index, four middle, two ring and one little) who underwent dermal pocketing of the amputated digit following replantation. Among the 14 digits that were treated with dermal pocketing, 11 survived completely, one had partial atrophy and two were completely lost. Complications encountered included finger stiffness (two patients) and infection of the replanted fingertip with osteomyelitis of the distal phalanx (one patient). We believe that this technique can help increase the chance of survival for distal replantation with an acceptable salvage rate of 85% in our series. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. Maxillary molar distalization with first class appliance.

    Science.gov (United States)

    Ramesh, Namitha; Palukunnu, Biswas; Ravindran, Nidhi; Nair, Preeti P

    2014-02-27

    Non-extraction treatment has gained popularity for corrections of mild-to-moderate class II malocclusion over the past few decades. The distalization of maxillary molars is of significant value for treatment of cases with minimal arch discrepancy and mild class II molar relation associated with a normal mandibular arch and acceptable profile. This paper describes our experience with a 16-year-old female patient who reported with irregularly placed upper front teeth and unpleasant smile. The patient was diagnosed to have angles class II malocclusion with moderate maxillary anterior crowding, deep bite of 4 mm on a skeletal class II base with an orthognathic maxilla and retrognathic mandible and normal growth pattern. She presented an ideal profile and so molar distalization was planned with the first-class appliance. Molars were distalised by 8 mm on the right and left quadrants and class I molar relation achieved within 4 months. The space gained was utilised effectively to align the arch and establish a class I molar and canine relation.

  1. Biotin absorption by distal rat intestine

    International Nuclear Information System (INIS)

    Bowman, B.B.; Rosenberg, I.H.

    1987-01-01

    We used the in vivo intestinal loop approach, with short (10-min) and long (3-h) incubations, to examine biotin absorption in proximal jejunum, distal ileum, cecum and proximal colon. In short-term studies, luminal biotin disappearance from rat ileum was about half that observed in the jejunum, whereas absorption by proximal colon was about 12% of that in the jejunum. In 3-h closed-loop studies, the absorption of 1.0 microM biotin varied regionally. Biotin absorption was nearly complete in the small intestine after 3 h; however, only about 15% of the dose had been absorbed in the cecum and 27% in the proximal colon after 3 h. Independent of site of administration, the major fraction of absorbed biotin was recovered in the liver; measurable amounts of radioactive biotin were also present in kidney and plasma. The results support the potential nutritional significance for the rat of biotin synthesized by bacteria in the distal intestine, by demonstrating directly an absorptive capability of mammalian large bowel for this vitamin

  2. Distal radius fracture after proximal row carpectomy.

    Science.gov (United States)

    Igeta, Yuka; Naito, Kiyohito; Sugiyama, Yoichi; Obata, Hiroyuki; Aritomi, Kentaro; Kaneko, Kazuo; Obayashi, Osamu

    2015-01-01

    We encountered a patient with distal radius fracture (DRF) after proximal row carpectomy (PRC). The mechanism of the DRF after PRC is discussed in this report. The patient was a 73-year-old female who had undergone PRC due to Kienböck disease before. The wrist range of motion was: 45° on dorsiflexion and 20° on flexion. DRF has occurred at 3 years after PRC. The fracture type was extra-articular fracture. Osteosynthesis was performed using a volar locking plate. No postoperative complication developed, the Mayo score was excellent at 6 months after surgery, and the daily living activity level recovered to that before injury. Since the wrist range of motion decreased and the lunate fitted into the joint surface after PRC, making the forearm join with the hand like a single structure, pressure may have been loaded on the weak distal end of the radius from the dorsal side, causing volar displacement and fracture. The pressure distribution and range of motion of the radiocarpal joint after PRC are different from those of a normal joint, and the mechanism of fracture also changes due to PRC. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. [Carpal malalignment following distal radius fracture].

    Science.gov (United States)

    Coulet, B; Gauci, M-O; Lazerges, C; Chammas, M

    2016-12-01

    Adaptive carpal malalignment is the consequence of malunion of the distal radius. Since the radial metaphysis and capitate have to be aligned, any disorientation of the radial epiphysis will force the proximal carpal row to adapt, as it is the only mobile element. There are two types of adaptation depending where the compensative occurs: (1) midcarpal - leading to flexion between the lunate and capitate, with the lunate maintaining a normal relationship with the radial epiphysis axis; (2) radiocarpal - combining flexion and dorsal displacement of the lunate relative to the axis of the radial epiphysis, with the midcarpal joint remaining aligned. Clinically, adaptive carpal malalignment is not the first reason for consultation in cases of distal radius malunion. It occurs in cases of moderate deformity with preserved pronation-supination in a young patient who has good mobility. It generates dorsal pain that may be associated with a snapping sensation. The diagnosis requires strict lateral X-ray views. Over time, the wrist becomes stiff but analgesic and is often well tolerated functionally. This type of deformity has not been shown to lead to osteoarthritis. Osteotomy to correct the malunion is the only way to treat adaptive carpal malalignment in active young patients who have a mobile but painful wrist. Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  4. Osteoid osteoma of the distal clavicle

    Directory of Open Access Journals (Sweden)

    Bernardo Barcellos Terra

    Full Text Available ABSTRACT The osteoid osteoma is a bone tumor that accounts for 10% of benign tumors. It was described in 1935 by Jaffe, as a tumor that affects the young adult population, with a predominance of males. This study aims to present a case of late diagnosis of a patient with osteoid osteoma of the distal clavicle region. Female patient, 44 years old, non-professional volleyball player, reported pain in the anterior and superior region of the shoulder girdle, specifically in the acromioclavicular joint, which worsened at night and had been treated for nine months as tendinitis of the rotator cuff and acromioclavicular joint arthritis. After confirming the diagnosis, the patient underwent open surgery with resection of the distal clavicle. At two years of follow-up, the patient presents without local pain. In the radiographic evaluation, coracoclavicular distance is preserved and there are no signs of recurrence. Tumors of the shoulder girdle are rare and are often diagnosed late. A high degree of suspicion for the diagnosis of tumors of the shoulder girdle is needed in order to avoid late diagnosis.

  5. Clinical profile of distal renal tubular acidosis

    Directory of Open Access Journals (Sweden)

    Ratan Jha

    2011-01-01

    Full Text Available To determine the clinical profile and progression of renal dysfunction in distal renal tubular acidosis (dRTA, we retrospectively studied 96 consecutive cases of dRTA diagnosed at our center. Patients with unexplained metabolic bone disease, short stature, hypokalemia, re-current renal stones, chronic obstructive uropathy or any primary autoimmune condition known to cause dRTA were screened. Distal RTA was diagnosed on the basis of systemic metabolic acidosis with urine pH >5.5 and positive urine anion gap. In those patients who had fasting urine pH >5.5 with normal baseline systemic pH and bicarbonate levels (incomplete RTA, acid load test with ammonium chloride was done. A cause of dRTA could be established in 53 (54% patients. Urological defect in children (22/44 and autoimmune disease in adults (11/52 were the commonest causes. Hypokalemic paralysis, proximal muscle weakness and voiding difficulty were the common modes of presentation. Doubling of serum creatinine during the study period was noted in 13 out of 27 patients who had GFR 60 mL/min (P <0.005. In conclusion, urological disorders were the commonest cause of dRTA in children while autoimmune disorders were the commonest asso-ciation in adults. Worse baseline renal function, longer duration of disease and greater frequency of nephrolithiasis/nephrocalcinosis and urological disorders were noted in those who had wor-sening of renal dysfunction during the study period.

  6. Comparison of Jones jig molar distalization appliance with extraoral traction.

    Science.gov (United States)

    Haydar, S; Uner, O

    2000-01-01

    In this study, 20 patients were evaluated. Ten were treated with intraoral distalization followed by fixed appliance therapy, and 10 were treated with extra oral traction followed by fixed appliance therapy. Molar relationship correction was achieved in 2.5 months with intraoral distalization and in 10.7 months with extraoral distalization. A significant anterior movement of the anchorage unit (P <.001) was observed with the intraoral distalization and a significant distal drift of premolars was observed in the headgear group (P <.05). Palatal plane was found to tip downward significantly in the headgear group (P <.05). Total outcome of the 2 methods were discussed evaluating the advantages and disadvantages of the 2 distalization methods.

  7. The Supination-Pronation Test for Distal Biceps Tendon Rupture.

    Science.gov (United States)

    Metzman, Louis S; Tivener, Kristin A

    2015-10-01

    Prompt diagnosis of a distal biceps tendon complete rupture increases the ability to perform a primary repair and to restore motion and strength. When examining an acute injury, it is important to isolate the biceps brachii tendon from the lacertus fibrosus and the brachialis because the examiner may mistakenly miss a distal tendon rupture by not isolating supination and pronation. The supination-pronation test can be performed easily in the acute setting and confirms attachment of the biceps tendon distally to the bicipital tuberosity of the radius. If the distal biceps tendon is intact, there is substantial change in the shape of the biceps as the arm is supinated (the biceps moves proximally), then pronated (the biceps moves distally). Clinically, the supination-pronation test has been found to be a reliable, pain-free test that should be incorporated in the physical examination to evaluate patients for distal biceps injury.

  8. Distal renal tubular acidosis in recurrent renal stone formers

    DEFF Research Database (Denmark)

    Osther, P J; Hansen, A B; Røhl, H F

    1989-01-01

    Renal acidification ability was examined in 90 recurrent renal stone formers, using fasting morning urinary pH levels followed by a short ammonium chloride loading test in subjects with pH levels above 6.0. Fifteen patients (16.6%) revealed a distal renal tubular acidification defect: one patient...... (1.1%) had complete distal renal tubular acidosis and 14 (15.5%) incomplete distal renal tubular acidosis. Our results confirm that distal renal tubular acidification defects are associated with a more severe form of stone disease and make distal renal tubular acidosis one of the most frequent...... metabolic disturbances in renal stone formers. Distal renal tubular acidosis (dRTA) was relatively more common in female stone formers and most often found in patients with bilateral stone disease (36%). Since prophylactic treatment in renal stone formers with renal acidification defects is available...

  9. Aquaporin-4 expression in distal myopathy with rimmed vacuoles

    OpenAIRE

    Hoshi, Akihiko; Yamamoto, Teiji; Kikuchi, Saeko; Soeda, Tomoko; Shimizu, Keiko; Ugawa, Yoshikazu

    2012-01-01

    Abstract Background Distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy is clinically characterized by the early involvement of distal leg muscles. The striking pathological features of the myopathy are muscle fibers with rimmed vacuoles. To date, the role of aquaporin-4 water channel in distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy has not been studied. Case presentation Here, we studied the expression of aquaporin-4 in muscle fibers of a patient...

  10. Refractory rickets caused by mild distal renal tubular acidosis

    OpenAIRE

    Ji-Ho Lee; Joo Hyun Park; Tae-Sun Ha; Heon-Seok Han

    2013-01-01

    Type I (distal) renal tubular acidosis (RTA) is a disorder associated with the failure to excrete hydrogen ions from the distal renal tubule. It is characterized by hyperchloremic metabolic acidosis, an abnormal increase in urine pH, reduced urinary excretion of ammonium and bicarbonate ions, and mild deterioration in renal function. Hypercalciuria is common in distal RTA because of bone resorption, which increases as a buffer against metabolic acidosis. This can result in intractable rickets...

  11. Distal Xq duplication and functional Xq disomy

    Directory of Open Access Journals (Sweden)

    Schluth-Bolard Caroline

    2009-02-01

    Full Text Available Abstract Distal Xq duplications refer to chromosomal disorders resulting from involvement of the long arm of the X chromosome (Xq. Clinical manifestations widely vary depending on the gender of the patient and on the gene content of the duplicated segment. Prevalence of Xq duplications remains unknown. About 40 cases of Xq28 functional disomy due to cytogenetically visible rearrangements, and about 50 cases of cryptic duplications encompassing the MECP2 gene have been reported. The most frequently reported distal duplications involve the Xq28 segment and yield a recognisable phenotype including distinctive facial features (premature closure of the fontanels or ridged metopic suture, broad face with full cheeks, epicanthal folds, large ears, small and open mouth, ear anomalies, pointed nose, abnormal palate and facial hypotonia, major axial hypotonia, severe developmental delay, severe feeding difficulties, abnormal genitalia and proneness to infections. Xq duplications may be caused either by an intrachromosomal duplication or an unbalanced X/Y or X/autosome translocation. In XY males, structural X disomy always results in functional disomy. In females, failure of X chromosome dosage compensation could result from a variety of mechanisms, including an unfavourable pattern of inactivation, a breakpoint separating an X segment from the X-inactivation centre in cis, or a small ring chromosome. The MECP2 gene in Xq28 is the most important dosage-sensitive gene responsible for the abnormal phenotype in duplications of distal Xq. Diagnosis is based on clinical features and is confirmed by CGH array techniques. Differential diagnoses include Prader-Willi syndrome and Alpha thalassaemia-mental retardation, X linked (ATR-X. The recurrence risk is significant if a structural rearrangement is present in one of the parent, the most frequent situation being that of an intrachromosomal duplication inherited from the mother. Prenatal diagnosis is performed by

  12. Refractory rickets caused by mild distal renal tubular acidosis

    Directory of Open Access Journals (Sweden)

    Ji-Ho Lee

    2013-09-01

    Full Text Available Type I (distal renal tubular acidosis (RTA is a disorder associated with the failure to excrete hydrogen ions from the distal renal tubule. It is characterized by hyperchloremic metabolic acidosis, an abnormal increase in urine pH, reduced urinary excretion of ammonium and bicarbonate ions, and mild deterioration in renal function. Hypercalciuria is common in distal RTA because of bone resorption, which increases as a buffer against metabolic acidosis. This can result in intractable rickets. We describe a case of distal RTA with nephrocalcinosis during follow-up of rickets in a patient who presented with clinical manifestations of short stature, failure to thrive, recurrent vomiting, dehydration, and irritability.

  13. Outcome in corrective osteotomy for malunited distal radius fractures.

    Science.gov (United States)

    Samson, Lucjan; Treder, Mariusz; Kolarz, Krzysztof; Lorczyński, Adam

    2007-01-01

    This article reports outcome in osteotomy for malunion of distal radius fractures. We evaluated 12 patients with distal radius malunion (mean age 54), who were treated with corrective osteotomy. Wrist motion and grip strength were evaluated, along with examination of pre and post osteotomy radiographs. The indications for corrections were degree of deformity, limitation of function, pain, and the appearance of the wrist. The radiographic evaluation proved that the restoration of the normal anatomic relationship between the distal radius and ulna leads to significant improvement of the function of the hand, as measured by range of motion and grip strength. Osteotomy of the distal radius in cases of malunion gives favorable outcomes.

  14. Computed tomography diagnosis of distal radioulnar joint subluxation

    International Nuclear Information System (INIS)

    Lu Laijin; Nakamura, Ryogo; Nakao, Etsuhiro; Hidaka, Yasuhiro; Shionoya, Kaori.

    1995-01-01

    Although computed tomography (CT) provides the most reliable diagnostic information about distal radioulnar joint dislocation and subluxation, the method for assessing distal radioulnar joint integrity on CT is controversial. We studied roentgenographic diagnosis and three methods of CT diagnosis in 20 patients with suspected distal radioulnar dislocation or subluxation. Sensitivity was 35% in roentgenographic diagnosis and 70 to 100% in CT diagnosis. Of the three methods of CT diagnosis, Mino's radioulnar line method showed 100% sensitivity to subluxation including dislocation. We believe Mino's method is the most reliable method for the diagnosis of distal radioulnar dislocation in unilateral CT. (author)

  15. Computed tomography diagnosis of distal radioulnar joint subluxation

    Energy Technology Data Exchange (ETDEWEB)

    Lu Laijin [Bethune (N.) Medical Univ., Changchun, JL (China); Nakamura, Ryogo; Nakao, Etsuhiro; Hidaka, Yasuhiro; Shionoya, Kaori

    1995-08-01

    Although computed tomography (CT) provides the most reliable diagnostic information about distal radioulnar joint dislocation and subluxation, the method for assessing distal radioulnar joint integrity on CT is controversial. We studied roentgenographic diagnosis and three methods of CT diagnosis in 20 patients with suspected distal radioulnar dislocation or subluxation. Sensitivity was 35% in roentgenographic diagnosis and 70 to 100% in CT diagnosis. Of the three methods of CT diagnosis, Mino`s radioulnar line method showed 100% sensitivity to subluxation including dislocation. We believe Mino`s method is the most reliable method for the diagnosis of distal radioulnar dislocation in unilateral CT. (author).

  16. Primeras evidencias de arte mueble paleolítico en el sur de Portugal

    Directory of Open Access Journals (Sweden)

    Simón Vallejo, María D.

    2012-06-01

    Full Text Available This paper presents the first evidence for Palaeolithic portable art in Southern Portugal. This include two plaques, dated between 20,500 and 19,500 BP from Solutrean levels from the site of Vale Boi, Western Algarve (Portugal. One of the pieces is a small engraved schist plaque (14,6 × 8,1 mm with abstract lines on one side. The other artefact is an 8 × 5 cm schist plaque. One side is an oxide natural deposit, used to produce dye; the other side has three aurochs and a probable cervid. Stilistic information and the engraving sequence indicate probably production by a single artist. The stylistic characteristics are in full agreement withi those from late Gravettian and early Solutrean art known from Valencia, Andalucia (Spain and the Côa valley (Portugal, thus confirming the absolute AMS dates from the Vale Boi Levels.

    En este trabajo presentamos la primera evidencia de arte mueble paleolítico en el sur de Portugal: dos plaquetas de pizarra procedentes de niveles solutrenses del yacimiento de Vale Boi, zona occidental del Algarve (Portugal. La primera de las piezas es una pequeña placa (14,6 × 8,1 mm que presenta sobre una de sus caras un ideomorfo grabado. La segunda (8 × 5 cm cuenta con una superficie ocupada por óxido de hierro natural de color amarillento, tiene claros indicios de extracción de mineral para producir colorantes. En la superficie opuesta han sido grabados tres uros y una posible cierva. El estilo y secuencia de los grabados apuntan a un solo artista. Las características estilísticas de los zoomorfos concuerdan bien con los rasgos comunes del arte del ciclo Gravetiense final y Solutrense antiguo del País Valenciano, Andalucía y Valle de Côa (Portugal. Esta afinidad sintoniza asimismo con las fechas AMS de los niveles solutrenses de Vale Boi, datados entre ca. 20.500 y 19.500 BP.

  17. Gobierno Corporativo y Calidad de la Información Contable: Evidencia Empírica

    Directory of Open Access Journals (Sweden)

    JUAN MONTERREY MAYORAL

    2008-06-01

    Full Text Available En el presente trabajo analizamos empíricamente los efectos de las actividades de Gobierno Corporativo sobre la calidad del resultado de las compañías cotizadas en el mercado español de capitales. Nuestros resultados han puesto de manifiesto una moderada influencia de las tareas desempeñadas por el grado de actividad del Consejo de Administración, que guarda una relación positiva y significativa con la calidad del resultado, pero no su tamaño y composición. Con relación al Comité de Auditoría, ninguna de las variables ha resultado ser estadísticamente significativa, y con respecto a la participación del equipo directivo en la propiedad de la firma, los resultados obtenidos indican cómo moderados niveles de propiedad gerencial aportan un efecto benéfico sobre la calidad contable, si bien a medida que su participación se eleva el efecto se invierte y se hace adverso. También hemos mostrado cómo la presencia de las familias fundadoras en el capital favorece la calidad contable, sin que hayamos obtenido evidencia de efecto alguno de la participación de tenedores de bloques significativos.This paper presents an empirical analysis of the impact of Corporate Governance practices on the quality of earnings reported by Spanish listed companies. Based on a sample of 136 non-financial firms over the period 2003-2005, we computed abnormal accruals based on Jones (1991 model as a proxy for earnings quality and experimental variables representing size, independence and activeness of the Board of Directors and the Audit Committee, CEO power concentration, board members’ compensation schemes and ownership structure. Our results suggest that earnings quality is slightly positively affected by the nature and intensiveness of the activities carried out by the Board, but has no relationship with its size and composition. None of the variables related to the Audit Committee showed a significant association with earnings quality. As for

  18. Post-transplant distal limb syndrome

    Directory of Open Access Journals (Sweden)

    María Florencia Borghi Torzillo

    2017-02-01

    Full Text Available The post-transplant distal limb syndrome is a not well known entity, with a prevalence of 5% in patients with renal transplant. Its diagnosis is based on clinical symptoms, bone scintigraphy and MRI, it has a benign course and the patient recovers without sequel. We present the case of a 37-year-old male, with medical history of hypertension, Berger's disease in 1999 that required dialysis three times a week for four years (2009-2013 and renal transplant in 2013. The patient consults on January 2014 referring severe pain in both feet, with sudden onset; he remembers the exact date of the beginning of the pain and denies trauma, pain prevents ambulation. The bone scintigraphy shows pathological uptake in both feet with no difference between the two. Although there is no treatment for this disease, it has a benign course

  19. [Comparison of laparoscopic distal pancreatectomy and open distal pancreatectomy in pancreatic ductal adenocarcinoma].

    Science.gov (United States)

    Xu, K; Su, J J; Su, M; Yan, L; Feng, J; Xin, X L; Chen, Y L

    2017-10-23

    Objective: To compare and evaluate the curative effect of laparoscopic distal pancreatectomy(LDP) and traditional open distal pancreatectomy(ODP) in pancreatic ductal adenocarcinoma. Methods: The clinical data of 15 patients treated by LDP and 87 contemporaneous cases treated by ODP from January 2010 to November 2015 was collected, and the curative effect and prognosis of these patients were retrospectively analyzed. Results: The operation time of LDP group was (286.5±48.1) min, significantly longer than that of OPD group(226.6±56.8) min ( P 0.05). In both LDP group and ODP group, none occurred percutaneous drainage, re-admissions, second operation or perioperative death. Conclusions: Compared to ODP, LDP is much safer and more steady in perioperative periodand operation. Patients of pancreatic ductal adenocarcinoma received LDP can acquire more benefit and recovery sooner, and LDP is a safe and effective operative method.

  20. Prácticas psicológicas basadas en la evidencia: beneficios y retos para Latinoamérica

    Directory of Open Access Journals (Sweden)

    Alfonso Martínez-Taboas

    2015-04-01

    Full Text Available Este artículo presenta las características medulares de las prácticas psicológicas basadas en la evidencia (PPBE. Enfatiza en que las PPBE son un movimiento internacional, que se ha integrado al abordaje de la salud por gobiernos y una amplia plétora de organizaciones profesionales. La investigación actualizada apunta al hecho que las PPBE usualmente maximizan resultados positivos en muchas poblaciones. Las PPBE plantean la integración de tres variables al momento de realizar una intervención psicológica: (a la utilización de la mejor evidencia disponible, que provee la Psicología para la toma de decisiones, (b considerar las preferencias y características culturales de la población a la cual se dirige la intervención y (c integrar el peritaje y la experiencia profesional del psicólogo. El artículo evalúa las adaptaciones culturales de diferentes PPBE y presenta evidencia que estas intervenciones producen mejores resultados comparados con intervenciones no adaptados. Revisa asuntos fundamentales como la internacionalización del fenómeno de las PPBE, su aplicabilidad y la efectividad en diferentes escenarios y su adaptabilidad con diferentes etnias y razas. Finalmente, se discuten posibles beneficios y barreras de transportar las PPBE a países latinoamericanos. Se utiliza el ejemplo de Puerto Rico para documentar cómo la Psicología puertorriqueña paulatinamente se ha movido por esta línea.

  1. Cultura y creatividad en la nueva economía urbana: evidencias, discursos y críticas

    OpenAIRE

    Galarraga Ezponda, Auxkin; Luna García, Álvaro; González Durán, Sandra

    2013-01-01

    En la medida en que el papel de los sectores cultural, artístico y creativo en el desarrollo económico y social de las ciudades-región comienza a ser ampliamente reconocido gracias a las progresivas evidencias empíricas recogidas en los últimos años sobre su importante capacidad de dinamismo, innovación y conectividad global, las intervenciones de las diferentes administraciones públicas y agentes privados en este ámbito también han ido en aumento. Una vez que el sector industrial ha declinad...

  2. Evidencia científica y recomendaciones sobre cribado de agudeza visual: revisión bibliográfica

    OpenAIRE

    López Andújar, Eva María; Álvarez-Dardet Díaz, Carlos; Gil González, Diana

    2012-01-01

    Fundamentos: En los ámbitos científico e institucional existe controversia sobre cuándo recomendar la práctica del cribado visual en la población. El objetivo de este trabajo es valorar el nivel de evidencia científica que existe sobre el cribado visual para determinar si las recomendaciones existentes son o no adecuadas. Métodos: Revisión sistemática de artículos científicos consultando las bases de datos MedLine y The Cochranre Library Plus, sin restricción de fecha, en los idiomas español ...

  3. La categorización de los sonidos del inglés: evidencia experimental en fonología

    OpenAIRE

    Mompeán González, José Antonio

    2002-01-01

    "La Categorización de los Sonidos del Inglés: Evidencia Experimental en Fonología" es una tesis de fonología experimental que vincula el estudio de la categorización, y en especial de la categorización de los sonidos de una lengua como el inglés, al estudio de la fonología entendida como ciencia que trata de describir no sólo los patrones estructurales y generalizaciones de la estructura fónica de la lengua sino también como ciencia que trata de describir la visión, conocimiento, procesamient...

  4. La distribución del ingreso en la Argentina : Evidencia, determinantes y políticas

    OpenAIRE

    Gasparini, Leonardo; Marchionni, Mariana; Sosa Escudero, Walter

    2001-01-01

    Este trabajo presenta un análisis abarcativo -aunque no exhaustivo- del problema de la distribución del ingreso en la Argentina. El estudio aporta evidencia empírica novedosa y sistematiza la literatura existente sobre el tema. El carácter abarcativo del trabajo y la necesidad de mantener la extensión del mismo en un nivel razonable, hacen inevitable sacrificar profundidad en el análisis de cada tema. Consecuentemente, el desarrollo del trabajo es documentado con una extensa lista de referenc...

  5. Evidencia científica y recomendaciones sobre cribado de agudeza visual. Revisión bibliográfica

    OpenAIRE

    Eva María López Andújar; Carlos Álvarez-Dardet; Diana Gil-González

    2012-01-01

    Fundamentos: En los ámbitos científico e institucional existe controversia sobre cuándo recomendar la práctica del cribado visual en la población. El objetivo de este trabajo es valorar el nivel de evidencia científica que existe sobre el cribado visual para determinar si las recomendaciones existentes son o no adecuadas. Métodos: Revisión sistemática de artículos científicos consultando las bases de datos MedLine y The Cochranre Library Plus, sin restricción de fecha, en los idiomas español ...

  6. Evidencia científica de la relación entre acoso laboral y depresión

    OpenAIRE

    Víctor Adrián Harasemiuc; Jesús Raúl Díaz Bernal

    2013-01-01

    Introducción: El Acoso laboral es una epidemia silenciosa que no solamente afecta a la motivación y a la productividad de los trabajadores, sino que también, afecta negativamente a su víctimas en aspectos psicosociales siendo la depresión una de sus consecuencias. Objetivos: El objetivo es identificar la evidencia científica conocida sobre la relación existente entre el acoso laboral y la depresión. Metodología: Se formularon una serie de ecuaciones de búsqueda con los términos: Mobbing, Depr...

  7. Prácticas psicológicas basadas en la evidencia: beneficios y retos para Latinoamérica

    OpenAIRE

    Alfonso Martínez-Taboas

    2015-01-01

    Este artículo presenta las características medulares de las prácticas psicológicas basadas en la evidencia (PPBE). Enfatiza en que las PPBE son un movimiento internacional, que se ha integrado al abordaje de la salud por gobiernos y una amplia plétora de organizaciones profesionales. La investigación actualizada apunta al hecho que las PPBE usualmente maximizan resultados positivos en muchas poblaciones. Las PPBE plantean la integración de tres variables al momento de realizar una intervenció...

  8. Evidencias sobre el Impacto en el Rendimiento Académico de los Mandos de Respuesta Interactiva

    OpenAIRE

    Castillo Manzano, José I.; Castro Nuño, Mercedes; López Valpuesta, Lourdes; Sanz Díaz, María Teresa; Yñíguez Ovando, Rocío; Buitrago Esquinas, Eva María (Coordinador); Castro Abancens, Ignacio (Coordinador); Ridao Carlini, María Luisa (Coordinador); Rodríguez Ramos, Asunción (Coordinador)

    2016-01-01

    Un gran número de estudios han abordado el impacto de los mandos de Respuesta Interactiva en el rendimiento académico en todas las etapas de la educación. Aunque no existen evidencias concluyentes sobre su eficacia. Con el fin de arrojar luz sobre esta cuestión, hemos realizado un meta-análisis de estudios en todo el mundo sobre el impacto de los mandos de Respuesta Interactiva sobre el rendimiento académico para evaluar si los resultados académicos de los alumnos que han utili...

  9. Benchmark soils on alluvial, fluvial and fluvio-glacial formations of the upper-Segre valley Suelos de referencia en formaciones aluviales, fluviales y fluvio-glaciales de la cabecera del río Segre Solos de referência em formações aluviais, fluviais e fluvio-glaciais da cabeceira do rio Segre

    Directory of Open Access Journals (Sweden)

    Rosa María Poch Claret

    2013-07-01

    spatial differentiation of soil environments in the profile. One of the implications of this research is the inconsistence of using soil development indices based on morphological indicators when soils are formed on different parent materials and are subjected to different geomorphic dynamics.La cabecera del río Segre, en sus tramos Pirenaicos, ofrece una variedad de formaciones geomorfológicas que permiten estudiar cronosecuencias de suelos. El objetivo de este trabajo es ampliar el conocimiento sobre las principales características y los procesos de formación de algunos suelos desarrollados sobre materiales fluvio-glaciales, aluviales y de terrazas Pleistocenas y Holocenas relacionados con el río Segre, ya sean silícicos o carbonáticos. Ello permitirá identificar los procesos formadores del suelo propios de ambientes mediterráneos, como redistribución de carbonatos, formación y movilización de arcillas y rubefacción, y relacionarlos con el material parental y la edad. Se clasificaron cinco perfiles en materiales con edades desde el Pleistoceno Inferior al Holoceno, de acuerdo con Soil Taxonomy /WRB. El perfil de Montferrer (Palexeralf Cálcico /Calcic Cutanic Luvisol (cromic es un suelo profundo, descarbonatado en parte, con acumulación de carbonato de calcio en profundidad superpuesto a rasgos glaciales. El perfil Torre del Remei (Paleustalf típico /Cutanic Luvisol está desarrollado sobre morrenas silícicas y muestra formación e iluviación de arcilla extrema. Los perfiles de Alp (Haplustalf típico /Cutanic Luvisol y Tartera (Calciustept pétrico /Petric Calcisol son suelos desarrollados sobre abanicos aluviales con una fuente de carbonato de calcio. El primero está descarbonatado, mientras que el último está rubefactado en la parte superior y muestra cemento geopetal de carbonatos con morfología de espeleotemas con superposición de iluviación de arcilla. El perfil más joven (Abellerols, Calciustept típico /Typic Calcisol está descarbonatado

  10. [Retrograde locking nail osteosynthesis of distal femoral fractures with the distal femoral nail (DFN)].

    Science.gov (United States)

    Grass, R; Biewener, A; Rammelt, S; Zwipp, H

    2002-04-01

    Non-operative treatment with immobilization or isometric traction has been abandoned as treatment for fractures of the distal femur at the end of the 1960ies. The technique of open reduction and internal fixation with a condylar plate as suggested by the AO has been the golden standard since the 1970ies. However, anatomic reconstruction of the condylar region with interfragmentary screw fixation and axial realignment of the femur shaft with a plate are challenging procedures especially in the presence of severely compromised soft tissues and put periosteal blood supply at risk. Soft tissue complications, axial malalignment and delayed fracture healing times led to the consideration of alternative techniques, such as intramedullary nailing which has been practiced with success since the 1940ies by Gerhard Küntscher and colleagues for femoral shaft fractures with minimal complication rates and improved results after closed reduction. The era of retrograde femoral nailing began with the systematic approach through the intercondylar notch by Green. This paper reviews the biomechanical properties, indication, technique as well as potential hazards and pitfalls of fracture management with the AO "distal femoral nail" (DFN). With appropriate application this technique is suitable for all fractures of the distal third of the femoral shaft including highly instable bicondylar fractures without damage to the soft tissues and the knee joint.

  11. Urethral advancement procedure in the treatment of primary distal ...

    African Journals Online (AJOL)

    Introduction: Distal hypospadias is the most common genital anomaly, occurring in almost 65% of all hypospadias cases. Although there are several surgical techniques for the treatment of distal hypospadias, it is clear that none can be used to correct all forms of hypospadias. The aim of the study was to evaluate urethral ...

  12. Experience with Quartey's Distal Penile Island Skin Flap ...

    African Journals Online (AJOL)

    Objective: To evaluate our experience with Quartey's distal penile island skin flap urethroplasty in the treatment of urethral stricture in two tertiary hospitals in South Western Nigeria. Patients and Methods: Between June 2002 and May 2005, 18 patients with a mean age of 42.2 years (range: 25 – 75 years) underwent distal ...

  13. Distal radius fractures: what determines the outcome after surgery?

    NARCIS (Netherlands)

    Teunis, T.

    2016-01-01

    This thesis addresses current issues in the outcome of operatively treated distal radius fractures. The general aim was to determine factors associated with adverse events, loss of motion, functional limitations, and opioid use after surgery. Injury In 3D complete articular distal radius fracture

  14. Outcome of ureteroscopy for the management of distal ureteric calculi

    African Journals Online (AJOL)

    Objective: To review our 5 years' experience with ureteroscopy treatment of distal ureteric calculi. Patients and methods: We reviewed the medical records of 136 patients who underwent ureteroscopic procedures for the treatment of distal ureteric calculi from February 2007 to October 2012. Patient and stone characteristics, ...

  15. Clinical relevance of distal biceps insertional and footprint anatomy

    NARCIS (Netherlands)

    van den Bekerom, Michel P J; Kodde, Izaäk F.; Aster, Asir; Bleys, Ronald L A W|info:eu-repo/dai/nl/134440455; Eygendaal, Denise

    2016-01-01

    Purpose: The aim of this review was to present an overview, based on a literature search, of surgical anatomy for distal biceps tendon repairs, based on the current literature. Methods: A narrative review was performed using Pubmed/Medline using key words: Search terms were distal biceps,

  16. Current concepts in fractures of the distal femur.

    Science.gov (United States)

    Link, B-C; Babst, R

    2012-01-01

    This paper describes current treatment strategies of distal femoral fractures as well as their evidence based rationale. The treatment of distal femoral fractures has improved with the evolution of plating and nailing technologies. The commonly selected surgical approaches are outlined and surgical treatment techniques including both internal and external fixation are discussed.

  17. Distal clavicular osteolysis: MR evidence for subchondral fracture

    Energy Technology Data Exchange (ETDEWEB)

    Kassarjian, Ara; Palmer, William E. [Massachusetts General Hospital, Department of Radiology, Division of Musculoskeletal Radiology, Yawkey Center, Boston, MA (United States); Llopis, Eva [Hospital de la Ribera, Department of Radiology, Valencia (Spain)

    2007-01-15

    To investigate the association between distal clavicular osteolysis and subchondral fractures of the distal clavicle at MRI. This study was approved by the hospital human research committee, which waived the need for informed consent. Three radiologists retrospectively analyzed 36 shoulder MR examinations in 36 patients with imaging findings of distal clavicular osteolysis. The presence of a subchondral fracture of the distal clavicle, abnormalities of the acromioclavicular joint, rotator cuff tears and labral tears were assessed by MRI. These cases were then compared with 36 age-matched controls. At MRI, 31 of 36 patients (86%) had a subchondral line within the distal clavicular edema, consistent with a subchondral fracture. Of the 36 patients, 32 (89%) had fluid in the acromioclavicular joint, while 27 of 36 patients (75%) had cysts or erosions in the distal clavicle. There were 13 patients (36%) with associated labral tears, while eight patients (22%) had partial-thickness rotator cuff tears. In the control group one of 36 (3%) had a subchondral line (P<0.05), while ten of 36 (28%) had rotator cuff tears and 13 of 36 (36%) had labral tears. These latter two were not statistically significant between the groups. A distal clavicular subchondral fracture is a common finding in patients with imaging evidence of distal clavicular osteolysis. These subchondral fractures may be responsible for the propensity of findings occurring on the clavicular side of the acromioclavicular joint. (orig.)

  18. Complications of Minimally Invasive Percutaneous Plating for Distal Tibial Fractures

    OpenAIRE

    Muzaffar, Nasir; Bhat, Rafiq; Yasin, Mohammad

    2016-01-01

    Background The management of distal tibia fractures continues to remain a source of controversy and debate. Objectives The aim of this study was to evaluate the various complications of minimally invasive percutaneous plate osteosynthesis (MIPPO) using a locking plate for closed fractures of distal tibia in a retrospective study. Patients and Methods Twenty-five patients with dista...

  19. Distal tibiofibular synostosis in a Nigerian: A case report | Owoeye ...

    African Journals Online (AJOL)

    X-ray of the bones showed an oblique fracture in the distal end of the shaft of fibula which is suggestive of post traumatic tibiofibular synostosis (TFS). Knowledge of distal TFS is important in resolving the puzzle of chronic shin pain of unknown origin and in accurate diagnosis of causes of ankle deformity and malformations.

  20. Outcome of management of distal radius fractures in ...

    African Journals Online (AJOL)

    We tried to highlight that postmenopausal distal radius fractures attributed to osteoporosis, are not given much of consideration when lot of funds and researches are being diverted to osteoporosis and related diseases. Methods: 60 elderly female patients with distal radius fracture were studied for outcome. The primary ...

  1. Distal Oblique Bundle Reinforcement for Treatment of DRUJ Instability

    NARCIS (Netherlands)

    Brink, P.R.G.; Hannemann, P.F.

    2015-01-01

    Background Chronic, dynamic bidirectional instability in the distal radioulnar joint (DRUJ) is diagnosed clinically, based on the patient's complaints and the finding of abnormal laxity in the vicinity of the distal ulna. In cases where malunion is ruled out or treated and there are no signs of

  2. Population-based epidemiology and incidence of distal femur fractures

    DEFF Research Database (Denmark)

    Elsoe, Rasmus; Ceccotti, Adriano Axel; Larsen, Peter

    2018-01-01

    The literature lacks recent epidemiological studies on the incidence, trauma mechanism and fracture classification of distal femur fractures. The aim of the present study was to provide up-to-date information concerning the incidence of distal femur fractures in a large and complete population...

  3. Radiographic study of distal radial physeal closure in thoroughbred horses

    International Nuclear Information System (INIS)

    Vulcano, L.C.; Mamprim, M.J.; Muniz, L.M.R.; Moreira, A.F.; Luna, S.P.L.

    1997-01-01

    Monthly radiography was performed to study distal radial physeal closure in ten male and ten female Throughbred horses. The height, thoracic circumference and metacarpus circumference were also measured, Distal radial physeal closure time was sooner in females than males, and took 701 +/- 37 and 748 +/- 55 days respectively

  4. Proximal and distal muscle fatigue differentially affect movement coordination

    Science.gov (United States)

    Cowley, Jeffrey C.

    2017-01-01

    Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proximal (shoulder flexor) or distal (finger flexor) muscles. Pre/Post changes in trunk, shoulder, elbow, and wrist kinematics were compared to determine how proximal and distal fatigue affected multi-joint movement patterns and variability. Proximal fatigue caused a significant increase (7°, p fatigue caused small but significant changes in trunk angles (2°, p fatigue protocols (p fatigue at either proximal or distal joints. The identified differences between proximal and distal muscle fatigue adaptations could facilitate risk assessment of occupational tasks. PMID:28235005

  5. Clinical relevance of distal biceps insertional and footprint anatomy.

    Science.gov (United States)

    van den Bekerom, Michel P J; Kodde, Izaäk F; Aster, Asir; Bleys, Ronald L A W; Eygendaal, Denise

    2016-07-01

    The aim of this review was to present an overview, based on a literature search, of surgical anatomy for distal biceps tendon repairs, based on the current literature. A narrative review was performed using Pubmed/Medline using key words: Search terms were distal biceps, insertional, and anatomy. Last decade, the interest in both reconstruction techniques, as well as surgical anatomy of the distal biceps tendon, has increased. The insights into various aspects of distal biceps tendon anatomy (two tendons, bicipital tuberosity, lacertus fibrosis, bicipital-radial bursa, posterior interosseous nerve, and lateral antebrachial cutaneous nerve) have evolved significantly in the last years. Thorough knowledge of the anatomy is essential for the surgeon in order to understand the biomechanics of rupture and reconstruction of the distal biceps tendon and to avoid injuries of the nerves. Some tips and tricks are provided, and some pitfalls were described to avoid complications and optimize surgical outcome. IV.

  6. Coordinación de Evidencias, Explicaciones y Objetivos Pragmáticos en la Argumentación

    Directory of Open Access Journals (Sweden)

    CHRISTIAN DAVID GAVIRIA MARTÍNEZ

    2011-01-01

    Full Text Available Este estudio explora los efectos del entrenamiento previo en argumentación y de los objetivos pragmáticos de un diálogo argumentativo en la forma en que las personas evalúan las evidencias y las explicaciones presentadas en él. En este estudio participaron 122 estudiantes universitarios divididos en dos grupos: uno con alto nivel de entrenamiento (n=43, compuesto por estudiantes de quinto semestre en adelante que habían tomado cursos en lógica y ciencia, y otro con bajo entrenamiento (n=79, compuesto por estudiantes de primer año. Los participantes leyeron tres diálogos argumentativos y calificaron la calidad del último argumento presentado en cada uno de ellos. Los resultados mostraron que los participantes en el grupo con alto entrenamiento evaluaban los argumentos de acuerdo con las características pragmáticas del diálogo. En particular, estos participantes evaluaron mejor las evidencias que las explicaciones en las situaciones de desacuerdo.

  7. Governança Corporativa e Evidenciação de Capital Intelectual em Empresas Brasileiras

    Directory of Open Access Journals (Sweden)

    Álvaro Fabiano Pereira de Macedo

    2015-04-01

    Full Text Available O aumento da competitividade levou grandes corporações a buscarem estratégias eficientes de governança corporativa. Este estudo teve como objetivo analisar as relações entre atributos internos de governança corporativa e a evidenciação voluntária do capital intelectual. Metodologicamente se trata de uma pesquisa descritiva do tipo documental. Os dados foram coletados de forma secundária por meio dos Relatórios da Administração e Demonstrativos Financeiros referentes ao exercício social de 2012, de 114 empresas pertencentes ao segmento Novo Mercado da BM&FBOVESPA. A pesquisa analisou os aspectos de governança corporativa abordados por Hidalgo, García-Meca e Martinez (2011 e utilizou como variável dependente o índice de evidenciação de capital intelectual desenvolvido a partir do trabalho de Maçambanni et al (2012. Os testes de Kruskal-Wallis e de Mann-Whitney foram utilizados para verificar as tendências das variáveis dependentes, métricas ou dummies em relação aos quartis da variável independente. Para testar o efeito das variáveis de governança sobre a evidenciação do capital intelectual, utilizou-se a regressão linear múltipla modelada automaticamente pelo SPSS. Os resultados apontam que, entre as oito variáveis testadas, apenas cinco foram inseridas no modelo: concentração de propriedade, tamanho do comitê de auditoria, tamanho do conselho de administração, participação institucional e proporção de membros independentes no conselho. A concentração de propriedade e o tamanho do comitê de auditoria apresentaram resultados significativos em todas as técnicas de análise utilizadas, sendo a concentração de propriedade a variável com maior poder de explicação sobre a evidenciação voluntária do capital intelectual. Já em relação ao tamanho do comitê de auditoria, a relação é direta e o nível de evidenciação aumenta com o aumento do tamanho do comitê. Estes resultados apresentam coer

  8. Ipsilateral olecranon and distal radius fracture: A case report.

    Science.gov (United States)

    Cengiz, Ömer; Polat, Gökhan; Karademir, Gökhan; Kara, Deniz; Erdil, Mehmet

    2015-01-01

    Concomitant ipsilateral olecranon and distal radius fracture are rare injuries. Their clinical presentation is unusual and investigation and management is poorly described. We present a 55-year-old woman patient who fell off sustaining a concomitant distal radius and olecranon fracture in the same extremity. On examination, there was gross swelling of the proximal and distal forearm and no neurovascular deficit. Radiographs confirmed distal radius and olecranon fracture. Patient was treated with open reduction and anatomic locking plate for olecranon and a closed reduction percuteneous K wire fixation with penning fixator for distal radius fracture. After physical therapy program, functional results were good and DASH score was 60. Several different combinations of fracture with dislocation have been described, but, to our knowledge, concurrent ipsilateral olecranon and distal radius fracture has not been reported before. In the literature review there are two similar cases in the English literature. Ipsilateral olecranon and distal radius fracture is a very rare injury due to different trauma mechanisms. However we should keep in mind that there may be adjacent joints and structures for concomitant injuries. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Perfil de competencias del profesional que cumple funciones de monitoreo, evaluación y gestión de evidencias de programas y proyectos de desarrollo: un aporte para las decisiones basadas en evidencias

    Directory of Open Access Journals (Sweden)

    Eva Miranda

    2015-01-01

    Full Text Available Los programas y proyectos de desarrollo que forman parte de las políticas públicas necesitan ser eficientes en la inversión y eficaces en el logro de sus objetivos y resultados. El monitoreo y la evaluación (ME son funciones estratégicas y sistemáticas que buscan generar información confiable y rigurosa acerca del alcance y logros de metas y resultados previamente establecidos en los programas y proyectos de desarrollo. Existen consensos internacionales sobre la necesidad de desarrollar capacidades y profesionalizar el ME, adoptar estándares comunes, y reforzar las estrategias de desarrollo nacional, mejorando el uso de las evaluaciones para retroalimentar las políticas públicas y lograr evidencias que sustenten un desarrollo sostenible con inclusión y equidad. En nuestro país, los programas sociales y diversos programas presupuestales que desarrolla el Estado peruano, así como los programas y proyectos que apoya la cooperación internacional, hacen evidente la demanda de sistemas nacionales de ME capaces de obtener evidencias rigurosas sobre los resultados y que estos se reflejen tanto en la asignación presupuestal, como en la mejora de procesos y estrategias. El perfil de competencias del profesional que cumple funciones de ME es el conjunto de conocimientos, habilidades y actitudes que debe poseer la persona para desempeñar adecuadamente sus funciones. En el presente artículo se identifican las funciones de los profesionales en el área de ME y se propone el perfil de competencias que deben adquirir así como los contenidos de las competencias específicas de ME. Se presenta el perfil de competencias validado como un aporte a la gestión por resultados y decisiones basadas en evidencias para su implementación en procesos de gestión de recursos humanos y sistemas de ME; es una herramienta para ser aplicada prioritariamente en la planificación y dotación, organización del trabajo, el desarrollo de capacidades y la

  10. A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy.

    Science.gov (United States)

    Goh, Brian K P; Chan, Chung Yip; Soh, Hui-Ling; Lee, Ser Yee; Cheow, Peng-Chung; Chow, Pierce K H; Ooi, London L P J; Chung, Alexander Y F

    2017-03-01

    This study aims to compare the early perioperative outcomes of robotic-assisted laparoscopic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP). The clinicopathologic features of 45 consecutive patients who underwent minimally-invasive distal pancreatectomy from 2006 to 2015 were retrospectively reviewed. Thirty-nine patients who met our study criteria were included. Eight patients underwent RDP and 31 had LDP. There were 10 (25.6%) open conversions. Six (15.4%) patients had major (> grade 2) morbidities and there was no in-hospital mortality. There were 14 (35.9%) grade A and 9 (23.1%) grade B pancreatic fistulas. Comparison between RDP and LDP demonstrated no significant difference between the patients' baseline characteristics except there was increased frequency of spleen-preserving pancreatectomies (3 (37.5%) vs 25 (80.6%), P=0.016) and splenic-vessel preservation (5 (62.5%) vs 4 (12.9%), P=0.003) in RDP. Comparison between outcomes demonstrated that RDP was associated with a longer median operation time (452.5 (range, 300-685) vs 245 min (range, 85-430), P=0.001) and increased frequency of the procedure completed purely laparoscopically (8 (100%) vs 18 (58.1%), P=0.025). RDP can be safely adopted and is equivalent to LDP in most perioperative outcomes. It is also associated with a decreased frequency of the need for hand-assistance laparoscopic surgery or open conversion but needed a longer operation time. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  11. Tratamento cirúrgico da tendinite distal da patela Surgical treatment of the distal patellar tendinitis

    Directory of Open Access Journals (Sweden)

    Marco Martins Amatuzzi

    2005-01-01

    Full Text Available A tendinite distal da patela é uma doença que acomete principalmente jovens esportistas e caracteriza-se por dor referida na extremidade distal da patela junto à inserção do ligamento patelar. O tratamento inicial preconizado é sempre conservador com fisioterapia. A grande maioria tem boa resposta a este tipo de conduta, mas em alguns raros casos os sintomas não regridem exigindo uma mudança de conduta. Para este grupo usamos o tratamento cirúrgico com técnica derivada de Trillat que se baseia na utilização de um enxerto de parte do tendão do músculo Grácil implantado dentro do ligamento patelar, inserido intra-ósseo na patela e fixado na tuberosidade anterior da tíbia. Foram operados seis pacientes, sendo que em dois casos a operação foi bilateral, totalizando oito joelhos. O seguimento mínimo foi de três anos, com avaliação final dentro do índice considerado como EXCELENTE, conforme a cotação ARPÉGE, para todos os joelhos.Distal patellar tendinitis is a young athlete's disease characterized by pain at the distal patellar pole, near the patellar ligament insertion. Early treatment recommended is generally conservative, with physical therapy. The great majority of patients present favorable responses to this approach, but, in some cases, the remission of symptoms does not occur, requiring a different approach. For this group, surgical treatment with a technique derived from that of Trillat was used, which is based on the use of a graft removed from a portion of gracillis muscle tendon into patellar ligament, intraosseously inserted in the patella and fixed at the tibial anterior tuberosity. Six patients were operated, bilaterally in two cases, totaling eight knees. The minimum follow-up time was three years, with all knees presenting an EXCELLENT score, according to ARPÉGE evaluation.

  12. Femoral derotation osteotomy in spastic diplegia. Proximal or distal?

    Science.gov (United States)

    Pirpiris, M; Trivett, A; Baker, R; Rodda, J; Nattrass, G R; Graham, H K

    2003-03-01

    We describe the results of a prospective study of 28 children with spastic diplegia and in-toed gait, who had bilateral femoral derotation osteotomies undertaken at either the proximal intertrochanteric or the distal supracondylar level of the femur. Preoperative clinical evaluation and three-dimensional movement analysis determined any additional soft-tissue surgery. Distal osteotomy was faster with significantly lower blood loss than proximal osteotomy. The children in the distal group achieved independent walking earlier than those in the proximal group (6.9 +/- 1.3 v 10.7 +/- 1.7 weeks; p spastic diplegia.

  13. Intra-Articular Osteotomy for Distal Humerus Malunion

    Directory of Open Access Journals (Sweden)

    René K. Marti

    2009-01-01

    Full Text Available Intra-articular osteotomy is considered in the rare case of malunion after a fracture of the distal humerus to restore humeral alignment and gain a functional arc of elbow motion. Traumatic and iatrogenic disruption of the limited blood flow to the distal end of the humerus resulting in avascular necrosis of capitellum or trochlea is a major pitfall of the this technically challenging procedure. Two cases are presented which illustrate the potential problems of intra-articular osteotomy for malunion of the distal humerus.

  14. Adenoma of the distal common bile duct -a case report-

    International Nuclear Information System (INIS)

    Do, Young Soo; Lee, Hyun Gon; Han, Ho Seong; Ko, Gyung Hyuck; Kim, Jae Hyoung; Kim, Hyung Jin; Chung, Sung Hoon

    1991-01-01

    On rare occasions, Obstructive Jaundice may be caused by a benign tumor of the biliary tract. We describe a patient in whom the diagnosis of an adenoma of the distal common bile duct (CBD) was established. The CT showed a soft tissue density mass in the distal CBD and diffuse dilatation of the intrahepatic duct, gall the bladder, and CBD. Endoscopic retrograde cholangiopnacreatography showed an irregularly marginated polypoid mass in the distal CBD. The clinical, radiological, and histological features of this neoplasm are reviewed. The clinical, radiological and histological features of this neoplasm are reviewed

  15. Distal tibial interosseous osteochondroma with impending fracture of fibula ? a case report and review of literature

    OpenAIRE

    Wani, Iftikhar H; Sharma, Siddhartha; Malik, Farid H; Singh, Manjeet; Shiekh, Irfan; Salaria, Abdul Q

    2009-01-01

    Osteochondromas arising from the interosseous border of the distal tibia and involving distal fibula are uncommon. We present a 16 year old young boy with an impending fracture, erosion and weakness of the distal fibula, secondary to an osteochondroma arising from the distal tibia. Early excision of this deforming distal tibial osteochondroma avoided the future risk of pathological fracture of the distal fibula, ankle deformities and syndesmotic complications.

  16. Potassium transport across guinea pig distal colon

    International Nuclear Information System (INIS)

    Rechkemmer, G.; Halm, D.R.; Frizzell, R.A.

    1986-01-01

    Active absorption and secretion of K was studied by measuring bidirectional 42 K fluxes across short-circuited guinea pig distal colon. Tissues were pretreated with mucosal (m) and serosal (s) indomethacin (1 μM) and amiloride (0.1 mM, m) to suppress spontaneous, electrogenic Cl secretion and Na absorption. Under these conditions, the short-circuit current (I/sub sc/) was 0.4 μeq/cm 2 h while electroneutral K absorption was 2.8 μeq/cm 2 h. Epinephrine (5 μM, s) stimulated electrogenic K secretion, reducing net K absorption to 1.3 μeq/cm 2 h. Bumetanide (0.1 mM, s) abolished this K secretion and restored K absorption to control values, suggesting mechanistic similarities between K and Cl secretion. K absorption was inhibited 40% by the gastric H/K ATPase inhibitor, omeprazole (0.1 mM, m), and was abolished by ouabain (0.1 mM, m). Neutral K absorption does not appear to be mediated by an apical membrane Na/K pump since: the effect of mucosal ouabain on K absorption does not require the presence of mucosal or serosal Na, unidirectional Na fluxes are not influenced by mucosal ouabain, and K absorption is not affected when Na absorption is abolished by amiloride. Net K transport is determined by the balance between electroneutral K absorption and electrogenic K secretion. The ouabain sensitivity of K absorption suggests that colonic H/K ATPase differs from its gastric counterpart

  17. Histology of the distal dural ring.

    Science.gov (United States)

    Graffeo, Christopher S; Perry, Avital; Copeland, William R; Raghunathan, Aditya; Link, Michael J

    2017-09-01

    The distal dural ring (DDR) is a conserved intracranial anatomic structure marking the boundary point at which the internal carotid artery (ICA) exits the cavernous sinus (CS) and enters the subarachnoid space. Although the CS has been well described in a range of anatomic studies, to our knowledge no prior study has analyzed the histologic relationship between the ICA and DDR. Correspondingly, our objective was to assess the relationship of the DDR to the ICA and determine whether the DDR can be dissected from the ICA and thus divided, or can only be circumferentially trimmed around the artery. The authors examined ten fresh-frozen, adult cadaveric specimens. A standard frontotemporal craniotomy, orbito-optic osteotomy, and extradural anterior clinoidectomy was performed bilaterally. The cavernous ICA, DDR, and supraclinoid ICA were harvested as an en bloc specimen. Specimens formalin-fixed and paraffin-embedded prior to routine histochemical staining with hematoxylin and eosin and Masson trichrome. In all specimens, marked microscopic investment of the DDR throughout the ICA adventitia was noted. Dural collagen fibers extensively permeated the arterial layers superficial to the muscularis propria, with no evidence of a clear separation between the DDR and arterial adventitia. Histologic analysis suggests that the ICA and DDR are highly interrelated, continuous structures, and therefore attempted intraoperative dissection between these structures may carry an elevated risk of injury to the ICA. We correspondingly recommend careful circumferential trimming of the DDR in lieu of direct dissection in cases requiring mobilization of the clinoidal ICA. Clin. Anat. 30:742-746, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  18. Evidenciaçao contábil de instituições bancárias no Brasil

    Directory of Open Access Journals (Sweden)

    Silvia Marques de Brito e Silva

    2009-08-01

    Full Text Available A contabilidade constitui um sistema integrado de dados com o objetivo maior de oferecer informações sobre a entidade, objeto de contabilização, aos mais diversos interessados, entre os quais se destacam os investidores, os credores e os administradores. Essas informações podem ser de natureza econômica, financeira, física e de produtividade, e devem possibilitar uma adequada avaliação da situação atual do empreendimento, assim como oferecer subsídios para progn6sticos. O instrumental utilizado e composto basicamente por demonstrações contábeis tradicionais e por algumas informações suplementares, geralmente divulgadas em notas explicativas, relatório da administração e parecer dos auditores independentes. Alguns autores entendem que evidenciação é um principio contábil, outros entendem que e um objetivo, mas, nos diversos pronunciamentos, torna-se claro que evidenciação e mais do que um principio, a uma espécie de ligação entre os postulados, os princípios contábeis e os objetivos da contabilidade. E um meio para se atingir os objetivos da contabilidade. Nesse contexto, identificamos uma forte ligação entre disclosure - ou evidenciação - e o objetivo principal da contabilidade: as informações divulgadas devem ser transparentes e úteis ao processo de tomada de decisões. Para se definir o que e útil, faz-se necessário uma constante interação com o usuário da informação contábil, de modo a poder oferecer um produto que atenda as suas necessidades, constantemente alteradas face à dinâmica do próprio mercado e em decorrência do processo de globalização. Com isso, a demanda por demonstrações contábeis, assim como sua grande importância, cresce a uma taxa acelerada, requerendo um dinamismo semelhante na evolução da qualidade da informação fornecida.

  19. Results of preputial reconstruction in 77 boys with distal hypospadias

    NARCIS (Netherlands)

    Klijn, A. J.; Dik, P.; de Jong, T. P.

    2001-01-01

    There is growing interest in preputial reconstruction combined with hypospadias repair. We retrospectively analyzed its results for future developments and patient information. We evaluated 77 boys who underwent distal hypospadias repair combined with preputial reconstruction to determine

  20. Surgical treatment of distal biceps tendon rupture: a case report

    Directory of Open Access Journals (Sweden)

    Cristina N. Cozma

    2017-11-01

    Full Text Available Objectives. Distal biceps tendon rupture affects the functional upperextremity movement, impairing supination and flexion strength. According to age, profession and additional risks treatment might be nonoperative or surgical. Methods. We describe the case of a 43 years old male patient who sustained an injury to his right distal biceps and was diagnosed with acute right distal biceps rupture. Surgical treatment was decided and biceps tendon was reinserted to the radius tuberosity using a combination of a cortical button fixation associated with an interference screw. Results. Postoperative functional result was favorable with no complications and with no movement limitation after one month. Conclusions. When possible, distal biceps tendon repair should be realized surgically because this permits restoring of the muscle strength to near normal levels with no loss of motion. Nerve complications are common; therefore the surgery should be realized by experienced upper extremity surgeons.

  1. Minimally invasive percutaneous plate fixation of distal tibia fractures.

    LENUS (Irish Health Repository)

    Bahari, Syah

    2007-10-01

    We report a series of 42 patients reviewed at a mean of 19.6 months after treatment of distal tibial and pilon fractures using the AO distal tibia locking plate with a minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Mean time to union was 22.4 weeks. All fractures united with acceptable alignment and angulation. Two cases of superficial infection were noted, with one case of deep infection. Mean SF36 score was 85 and mean AOFAS score was 90 at a mean of 19 months follow-up. We report satisfactory outcomes with the use of the AO distal tibia locking plate in treatment of unstable distal tibial fractures. Eighty-nine percent of the patients felt that they were back to their pre injury status and 95% back to their previous employment.

  2. Distal vertebral artery reconstruction when managing vertebrobasilar insufficiency

    OpenAIRE

    D. M. Galaktionov; A. V. Dubovoy; K. S. Ovsyannikov

    2017-01-01

    This article presents a literature review devoted to the reconstruction of the distal vertebral artery and a clinical case of successful surgical treatment of a patient suffering from vertebrobasilar insufficiency caused by occlusion of the vertebral artery in a proximal segment. The external carotid artery-distal vertebral artery bypass was performed by using the radial artery.Received 27 February 2017. Revised 25 July 2017. Accepted 3 August 2017.Funding: The study did not have sponsorship....

  3. Escala de Actitudes hacia Lesbianas y Hombres Homosexuales (ATLG 2. Distribución y evidencias de validez

    Directory of Open Access Journals (Sweden)

    José Moral de la Rubia

    2011-01-01

    Full Text Available Este artículo tiene como objetivos describir la distribución de la Escala de Actitudes hacia Lesbianas y Hombres Homosexuales (ATLG; Herek, 1984 y aportar evidencias de validez. Se levantó una muestra incidental de 356 estudiantes. La distribución de la puntuación total se ajustó a una curva normal. Su correlación con la escala de homofobia (EHF; Moral & Martínez Sulvarán, 2010 fue .76. Mostró la diferencia entre hombres y mujeres, entre personas que se definen heterosexuales y las que se definen no heterosexuales, y dentro de las personas heterosexuales entre las que tienen amigos o allegados homosexuales y las que no; lo que aporta pruebas de validez. Se recomienda su uso en México.

  4. Autonomía Profesional: factor clave para el ejercicio de la Enfermería Basada en la Evidencia

    Directory of Open Access Journals (Sweden)

    Carolina Luengo Martínez

    Full Text Available El artículo presenta la importancia de la autonomía del profesional de Enferme-ría como factor clave para la implementación de la Enfermería Basada en la Evidencia (EBE. Se analiza el papel fundamental que cumple la EBE como herramienta que permite elevar la calidad y seguridad del cuidado, mejorar los resultados y reducir costos. La autonomía profesional es la que posibilita la aplicación de conocimientos generados a través de la investigación, pero ha sido identificada como una de las principales barreras para la implementación de la EBE.

  5. Evidencia y recomendación. ¿Harmonic Ultracision ofrece ventajas en tiroidectomía?

    Directory of Open Access Journals (Sweden)

    José Luis PARDAL-REFOYO

    2016-07-01

    Full Text Available Introducción y objetivo: En un paciente con patología de tiroides [paciente] sometido a tiroidectomía [intervención] la técnica realizada con Harmonic Ultracision® (HU comparada con las técnicas convencionales (ligadura, electrocoagulación mono o bipolar y Ligasure® [comparación] ¿es más segura [resultado]? Material y método: Búsqueda bibliográfica en las bases de datos PubMed, Cochrane Library y Scopus con la estrategia de búsqueda «(((((ultrasonic scalpel OR harmonic AND thyroidectomy AND meta-analysis. Resultados: Nivel de evidencia: La evidencia de la ventaja del uso de HU en tiroidectomía frente a otras técnicas es alta respecto a la eliminación de las suturas, a la facilitación del acceso a espacios más reducidos, la reducción del tiempo quirúrgico, la reducción del sangrado intraoperatorio y postoperatorio, la reducción del hipoparatiroidismo transitorio, la reducción del dolor postoperatorio, la reducción de la estancia hospitalaria y reducción del coste. Conclusiones: Recomendación: La recomendación del uso de HU en tiroidectomía frenta a otras alternativas (cirugía convencional / Ligasure® es débil a favor porque reduce la incidencia de parálisis laríngea y es fuerte a favor debido a que reduce el tiempo operatorio, reduce el sangrado intraoperatorio y postoperatorio, reduce el volumen drenado, reduce la incidencia de hipocalcemia, reduce la estancia hospitalaria y el coste. La recomendación del uso de HU en tiroidectomía es fuerte a favor.

  6. Update on the roles of distal airways in COPD

    Directory of Open Access Journals (Sweden)

    N. Roche

    2011-03-01

    Full Text Available This review is the summary of a workshop on the role of distal airways in chronic obstructive pulmonary disease (COPD, which took place in 2009 in Vence, France. The evidence showing inflammation and remodelling in distal airways and the possible involvement of these in the pathobiology, physiology, clinical manifestations and natural history of COPD were examined. The usefulness and limitations of physiological tests and imaging techniques for assessing distal airways abnormalities were evaluated. Ex vivo studies in isolated lungs and invasive measurements of airway resistance in living individuals have revealed that distal airways represent the main site of airflow limitation in COPD. Structural changes in small conducting airways, including increased wall thickness and obstruction by muco-inflammatory exudates, and emphysema (resulting in premature airway closure, were important determinants of airflow limitation. Infiltration of small conducting airways by phagocytes (macrophages and neutrophils, dendritic cells and T and B lymphocytes increased with airflow limitation. Distal airways abnormalities were associated with patient-related outcomes (e.g. dyspnoea and reduced health-related quality of life and with the natural history of the disease, as reflected by lung function decline and mortality. These data provide a clear rationale for targeting distal airways in COPD.

  7. Aquaporin-4 expression in distal myopathy with rimmed vacuoles.

    Science.gov (United States)

    Hoshi, Akihiko; Yamamoto, Teiji; Kikuchi, Saeko; Soeda, Tomoko; Shimizu, Keiko; Ugawa, Yoshikazu

    2012-04-27

    Distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy is clinically characterized by the early involvement of distal leg muscles. The striking pathological features of the myopathy are muscle fibers with rimmed vacuoles. To date, the role of aquaporin-4 water channel in distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy has not been studied. Here, we studied the expression of aquaporin-4 in muscle fibers of a patient with distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy. Immunohistochemical and immunofluorescence analyses showed that sarcolemmal aquaporin-4 immunoreactivity was reduced in many muscle fibers of the patient. However, the intensity of aquaporin-4 staining was markedly increased at rimmed vacuoles or its surrounding areas and in some muscle fibers. The fast-twitch type 2 fibers were predominantly involved with the strong aquaporin-4-positive rimmed vacuoles and TAR-DNA-binding protein-43 aggregations. Rimmed vacuoles with strong aquaporin-4 expression seen in the distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy patient were not found in control muscles without evidence of neuromuscular disorders and the other disease-controls. Aquaporin-4 might be crucial in determining the survival or degeneration of fast-twitch type 2 fibers in distal myopathy with rimmed vacuoles/hereditary inclusion body myopathy.

  8. Distal biceps brachii tendon rupture resulting in acute compartment syndrome.

    Science.gov (United States)

    Grandizio, Louis C; Suk, Michael; Feltham, Glen T

    2013-11-01

    Distal biceps brachii tendon rupture is an uncommon injury. Compartment syndrome of the upper arm is rarely described in the literature. The diagnosis of upper arm compartment syndrome requires a high index of suspicion, and emergent surgical treatment with fasciotomy in the acute setting is necessary to avoid devastating neurovascular complications. This article reports a case of acute compartment syndrome of the anterior compartment of the upper arm after a complete rupture of the distal biceps brachii tendon. A healthy 45-year-old man presented with increasing arm pain; paresthesia in the lateral antebrachial cutaneous nerve distribution; and a tense, swollen anterior compartment of his upper arm. Side port catheter absolute pressure measurement was 83 mm Hg with a diastolic blood pressure of 92 mm Hg. The patient underwent an emergent fasciotomy and was found to have a complete rupture of his distal biceps brachii tendon. He subsequently underwent distal biceps tendon repair and delayed primary closure of his incision. Postoperatively, his paresthesia improved and he has no neurological deficit. There is a paucity of case reports describing compartment syndrome after rupture of either the proximal or distal end of the biceps brachii tendon, and none of the reports describe compartment syndrome of the upper arm after rupture of the distal biceps tendon. This article highlights an unusual complication of an uncommon injury and reviews diagnostic and treatment principles for the management of acute compartment syndrome of the upper arm. Copyright 2013, SLACK Incorporated.

  9. Endovascular treatment for ruptured distal anterior inferior cerebellar artery aneurysm.

    Science.gov (United States)

    Oh, Jae-Sang; Yoon, Seok-Mann; Shim, Jai-Joon; Bae, Hack-Gun; Yoon, Il-Gyu

    2014-03-01

    A 42-year-old woman presented with Hunt and Hess grade (HHG) III subarachnoid hemorrhage (SAH) caused by a ruptured left distal anterior inferior cerebellar artery (AICA) aneurysm. Computed tomography showed a thin SAH on the cerebellopontine angle cistern, and small vermian intracerebral hemorrhage and intraventricular hemorrhage in the fourth ventricle. Digital subtraction angiography revealed the aneurysm on the postmeatal segment of left distal AICA, a branching point of rostrolateral and caudomedial branch of the left distal AICA. Despite thin caliber, tortuous running course and far distal location, the AICA aneurysm was obliterated successfully with endovascular coils without compromising AICA flow. However, the patient developed left side sensorineural hearing loss postoperatively, in spite of definite patency of distal AICA on the final angiogram. She was discharged home without neurologic sequela except hearing loss and tinnitus. Endovascular treatment of distal AICA aneurysm, beyond the meatal loop, is feasible while preserving the AICA flow. However, because the cochlear hair cell is vulnerable to ischemia, unilateral hearing loss can occur, possibly caused by the temporary occlusion of AICA flow by microcatheter during endovascular treatment.

  10. Endoprosthetic Reconstruction of distal Humerus following Resection of distal Humeral Giant Cell Tumours in Six Patients in Rural India

    Directory of Open Access Journals (Sweden)

    Balasubramanian N

    2017-07-01

    Full Text Available Giant cell tumour is a commonly occurring benign bone tumour in the Indian population. The common sites of involvement in descending order of frequency are distal femur, proximal tibia, distal radius and proximal humerus. The less commonly occurring sites are distal humerus, pelvis and proximal femur. We present six cases of giant cell tumour involving the distal humerus in rural India. After obtaining a tissue diagnosis by Trucut biopsy and classifying using Enneking's classification, we proceeded to perform wide resection followed by endoprosthetic reconstruction using custom mega prosthesis. We present here six patients (M: F: 2: 4 who were managed by us between 2008-2014. They presented to us with pain around the elbow and restriction in range of movements. They were each noted radiographically to have a lytic lesion involving the distal humerus with the likely diagnosis of giant cell tumour. Closed biopsy was done in all of them to obtain a definitive diagnosis. All patients underwent wide resection and reconstruction using distal humerus custom prosthesis. All patients were followed up at 6, 12, 18 and 24 weeks and thereafter six monthly until the last review. They were assessed using the DASH scoring system. All patients were well with no evidence of recurrence with good to fair functional outcome. We conclude that careful pre-operative planning with meticulous soft tissue dissection and good implant metallurgy and design, these tumours can be treated with good long term functional results.

  11. Evidenciação de Subvenção e Assistência Governamentais das Empresas na BM&FBovespa

    Directory of Open Access Journals (Sweden)

    Kelen Benetti, Karen Benetti

    2014-04-01

    Full Text Available A convergência da contabilidade aos padrões internacionais por meio das International Financial Reporting Standards (IFRS trouxe significativas alterações na legislação brasileira. Dentre elas, ocorreram modificações no que tange às subvenções e assistências governamentais (SAGs, com a publicação do Pronunciamento Técnico CPC 07 (2010. Neste contexto, o objetivo deste estudo é verificar o nível de evidenciação das SAGs das empresas que integram os setores da BM&FBovespa em conformidade com o Pronunciamento Técnico CPC 07 (2010. A pesquisa classifica-se como descritiva e documental, com abordagem predominantemente quantitativa com análise de dados por meio de estatística descritiva e entropia informacional. A amostra utilizada é não probabilística e intencional, sendo constituída por 144 empresas listadas em 9 setores. O nível de evidenciação foi obtido por meio da coleta de dados no Balanço Patrimonial e nas Notas Explicativas de cada empresa, referente ao ano de 2010 e, posteriormente, analisado com base nos itens que compõe as variáveis da pesquisa elaborado em consonância com o CPC 07 (2010. Os resultados apontam que, dos itens analisados, os que apresentaram maior evidenciação tratam da evidenciação da política contábil adotada pela entidade para as subvenções governamentais, incluindo os métodos de apresentação e da evidenciação da natureza e dos montantes de SAGs que foram reconhecidos nas demonstrações contábeis da entidade. Verificou-se que ocorreu a evidenciação de subvenções e assistências governamentais, com predomínio nos setores de Consumo Cíclico, Materiais Básicos e Utilidade Pública, porém, as empresas efetuaram a evidenciação de forma satisfatória, e atendendo de forma parcial o Pronunciamento Técnico CPC 07 (2010.

  12. Biomechanical analysis of distal biceps tendon repair methods.

    Science.gov (United States)

    Henry, Jon; Feinblatt, Jeff; Kaeding, Christopher C; Latshaw, James; Litsky, Alan; Sibel, Roman; Stephens, Julie A; Jones, Grant L

    2007-11-01

    The 1-incision and 2-incision techniques are commonly used methods to repair a distal biceps rupture, and they differ in the location of reinsertion of tendon into bone. The native distal biceps brachii tendon inserts on the posterior-ulnar aspect of the bicipital tuberosity, which functions as a cam, increasing the tendon's moment arm during its principal action of forearm supination. Repair of the distal biceps tendon to the anterior aspect of the tuberosity compromises forearm supination due to absence of the bicipital tuberosity's cam effect. Controlled laboratory study. Eleven matched pairs of fresh-frozen cadaveric upper extremities were prepared for repair of the distal biceps tendon using either anterior or posterior reattachment with transosseous suture fixation. Specimens were tested on a materials testing machine with intact distal biceps insertion and after repair. A load cell at the distal radial-ulnar joint measured resultant elbow flexion and forearm supination torque produced by 100-N force applied to the proximal aspect of the tendon. Although there was a trend (P= .104) toward loss of supination torque with the anterior reconstruction method, no significant differences in torque (0.80 vs 0.89 N.m) or flexion force (11.87 vs 12.07 N) were found between the anterior and posterior reconstruction techniques. There is no statistically significant difference in flexion force or supination torque between the anterior and posterior reconstruction techniques. This study supports existing limited clinical data suggesting no functional differences exist between 2 common repair methods. Further biomechanical and clinical investigations directly comparing the results of distal biceps tendon repairs made to the anterior aspect versus the posterior aspect of the tuberosity are necessary to definitely determine if differences exist in resultant elbow flexion and forearm supination functions.

  13. O Impacto da Convergência Contábil na Evidenciação dos Instrumentos Financeiros Derivativos das Empresas Brasileiras

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    Franciele Peixoto

    2012-06-01

    Full Text Available A complexidade e os riscos que envolvem os instrumentos financeiros derivativos e sua adequada evidenciação são de grande importância para mostrar a situação econômico-financeira das empresas que os utilizam. Nesse contexto, este trabalho foi realizado com o objetivo geral de analisar o nível de evidenciação que as empresas brasileiras de capital aberto fornecem em seus relatórios contábeis; mais especificamente, foi analisado o impacto da convergência contábil no citado nível de evidenciação. A amostra envolveu 21 empresas listadas na BM&FBOVESPA, no período de 2005 e 2010, sendo analisadas suas notas explicativas, pois nessas notas constam informações quantitativas e qualitativas a respeito das operações com derivativos. A evidenciação foi mensurada de acordo com o instrumento desenvolvido por Darós e Borba (2005, que possui sete itens. Cada um desses itens foi avaliado com base em uma escala que varia entre as notas de 0, 1 e 2. Foi constatado um considerável aumento na evidenciação dos derivativos, possivelmente, em razão das alterações ocorridas nas normas brasileiras de contabilidade, porém as empresas continuaram não fornecendo, de forma completa, todas as informações requeridas pelo instrumento de coleta de dados utilizado.

  14. ¿Inversionistas o especuladores? evidencia de burbuja especulativa en el mercado accionario Colombia, 2004-2006 ¿Inversionistas o especuladores? evidencia de burbuja especulativa en el mercado accionario Colombia, 2004-2006

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    Diego Alonso Agudelo Rueda

    2006-12-01

    Full Text Available ¿Experimentó el mercado accionario colombiano una burbuja especulativa deprecios en los últimos años? Los resultados del presente estudio así lo señalan, enparticular para el período desde inicios de 2004 hasta el momento de conclusión deeste trabajo, Julio de 2006. Durante dicho lapso, un portafolio que replique el índiceaccionario colombiano tendría un rendimiento proyectado a largo plazo similar alde los TES en pesos a 10 años, sin compensación por el riesgo adicional asumido.Este análisis se basa en una estimación del rendimiento proyectado en el largo plazopara un inversionista colombiano, mediante el modelo de Gordon, y es respaldadopor dos pruebas econométricas. De otro lado, aunque los resultados indican que nohubo sobrevaloración para los inversionistas extranjeros, la evidencia también señalaque la actividad de estos agentes no es suficiente explicación para la formación de laburbuja. Se examinan a continuación argumentos alternativos que se han ofrecidopara explicar racionalmente los dramáticos incrementos en los precios pero queaparecen inconsistentes con la evidencia. En general, los resultados de este estudioconfirman la conclusión de Vélez-Pareja (2000 de que la especulación, y no lainversión a largo plazo, ha predominado en el mercado accionario colombiano.This study provides evidence that part of the spectacular price increase of the Colombian Stock Market in the last five years corresponds to a speculative bubble. Since early 2004, the estimated return for the Colombian stock index in the long term is just 0% to 2% annually over the return of the 10 year-TES (Colombian government bond. This analysis is based on the Gordon model and tolerates reasonable adjustments in the assumptions. Additionally, we examined alternative explanations to the dramatic rise in prices over the last five years, but found them inconsistent with the evidence. On the contrary, we found evidence of speculative

  15. A New Orthodontic Appliance with a Mini Screw for Upper Molar Distalization.

    Science.gov (United States)

    Ozkalayci, Nurhat; Yetmez, Mehmet

    2016-01-01

    The aim of this study is to present a new upper molar distalization appliance called Cise distalizer designed as intraoral device supported with orthodontic mini screw for upper permanent molar distalization. The new appliance consists of eight main components. In order to understand the optimum force level, the appliance under static loading is tested by using strain gage measurement techniques. Results show that one of the open coils produces approximately 300 gr distalization force. Cise distalizer can provide totally 600 gr distalization force. This range of force level is enough for distalization of upper first and second molar teeth.

  16. A New Orthodontic Appliance with a Mini Screw for Upper Molar Distalization

    Directory of Open Access Journals (Sweden)

    Nurhat Ozkalayci

    2016-01-01

    Full Text Available The aim of this study is to present a new upper molar distalization appliance called Cise distalizer designed as intraoral device supported with orthodontic mini screw for upper permanent molar distalization. The new appliance consists of eight main components. In order to understand the optimum force level, the appliance under static loading is tested by using strain gage measurement techniques. Results show that one of the open coils produces approximately 300 gr distalization force. Cise distalizer can provide totally 600 gr distalization force. This range of force level is enough for distalization of upper first and second molar teeth.

  17. Fractures of the distal radius in children: A retrospective evaluation

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    Selma Yazıcı

    2012-06-01

    Full Text Available Objectives: This study designed to evaluate the resultsof treatment, closed reduction and percutaneous wires, ofthe distal radius fractures in children.Materials and methods: A retrospective analysis wascarried out in children aged between 5-15 years who presentedwith a displaced fracture of the distal radius to ourhospital. They were initially treated with closed reductionand cast immobilization. If the fractures redisplaced treatedby percutaneous Kirschner (K- wire with scope undera general anaesthesia.Results: Totally 104 patients, who have distal radius fractureswere treated by closed reduction and immobilizationin a plaster cast. 13 patient who have distal radiusfractures were treated by closed reduction under generalanaesthesia and fixed by percutaneous Kirschner (K-wire. Patients with impaired the alignment of the fracturein late period were usually completely displaced fractures.(n=5, 4,3%, in early period, completely displaced fractures(n=5, 4,3% are superior to partial displaced fractures(n=2, 1,7%.Conclusion: In our study, when children with distal radiusfracture first come, they were treated by closed reductionand immobilization in a plaster cast. We thought that inredisplaced fractures patients were suitable for the closedreduction with percutaneous wire treatment.

  18. Complications of Minimally Invasive Percutaneous Plating for Distal Tibial Fractures.

    Science.gov (United States)

    Muzaffar, Nasir; Bhat, Rafiq; Yasin, Mohammad

    2016-07-01

    The management of distal tibia fractures continues to remain a source of controversy and debate. The aim of this study was to evaluate the various complications of minimally invasive percutaneous plate osteosynthesis (MIPPO) using a locking plate for closed fractures of distal tibia in a retrospective study. Twenty-five patients with distal tibial fractures, treated by minimally invasive percutaneous plate osteosynthesis, were evaluated in a retrospective study. We studied the rate, probable etiological factors and preventive and corrective measures of various complications associated with minimally invasive plating of distal tibia. Mean age of the patients was 41.16 years (range 22 - 65). There were 13 male and 12 female patients. All fractures united at an average duration of 16.8 weeks. There were two cases of superficial and two cases of deep infection, and deep infections required removal of hardware for cure. There were four cases of ankle stiffness, most of them occurring in intra-articular fractures, three cases of palpable implant, three cases of malunion, one case of loss of reduction and one patient required reoperation. The average AO foot and ankle score was 83.6. We found MIPPO using locking plate to be a safe and effective method for the treatment of distal tibial fractures in properly selected patients yet can result in a variety of complications if proper precautions before, during and after surgery are not taken care of.

  19. Recurrent Giant cell tumour in distal Humerus: A Case report

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    Y Bhanu Rekha

    2013-07-01

    Full Text Available Introduction: Giant cell tumour of bone (GCT is a common benign primary bone tumour, seen commonly in the distal Femur, proximal Tibia and distal Radius. Very few cases of GCT are reported in distal humerus. We report an unusual presentation of recurrent Giant cell tumour in a 25 year old male in the medial condyle and epicondyle of left Humerus. Case Report: Patient presented elsewhere with lytic lesion of left elbow three years ago. As it is an uncommon site for tumors, it was misdiagnosed as tuberculous osteomyelitis and was inadequately curetted. Patient presented to us with recurrence of tumor one year after the primary surgery. We did en-bloc resection of the tumour, with judicious removal of partial trochlea. Though reconstruction was planned, it was found to be not necessary as the elbow was stable per-operatively. Patient regained near normal movements of the elbow with no instability. His Mayo Elbow Performance score improved from 30 to 85.There is no recurrence or metastasis of the tumor in the two-year follow-up. Conclusion: Though bone tumors are rare in distal Humerus, biopsy is needed to confirm the diagnosis of any lytic lesion in this region for proper management. Keywords: Recurrent Giant cell tumor, resection of GCT, GCT distal Humerus.

  20. Optimal location of a single distal interlocking screw in intramedullary nailing of distal third femoral shaft fractures.

    Science.gov (United States)

    George, C J; Lindsey, R W; Noble, P C; Alexander, J W; Kamaric, E

    1998-05-01

    This biomechanical study was done to determine the effect of the level of a single distal screw in a static intramedullary (IM) femoral nail on the stability of fixation of a fracture in the distal third of the femur. Fifteen composite fiberglass femora were osteotomized transversely in the distal third of the femur. A Grosse-Kempf nail was implanted into the femurs, which were divided into three groups of five specimens. Single screw distal nail locking was varied distal to the osteotomy site for each group at 2.5, 5.0, and 7.5 centimeters, respectively. All instrumented femurs were mounted on a servohydraulic testing machine and fitted with transducers to measure axial, rotational, and bending displacements. Specimens were cyclically loaded (one hertz) in simultaneous torsion (moment: +/- 10 newton-meters) and axial compression (amplitude: 2,000 newtons) for 500 cycles with a 250-pound abductor force. Data from linear and rotational transducers were sampled at 100 hertz for five cycles before cycling, every 100 cycles of loading, and immediately after cycling. Custom computer software was developed to convert transducer signals into static and dynamic measurements of axial motion (in millimeters), rotation (in degrees), and angulation (in degrees). Osteotomy site dynamic rotation increased significantly in specimens locked at 7.5 centimeters when compared with the 2.5-centimeter group. There was minimal difference between the stability of the 5.0-centimeter and 7.5-centimeter groups. There was no significant change in position at the fracture site before or after cyclic loading with respect to axial shortening, rotation, or bending. Both dynamic axial and angular displacements were also unaffected by screw position. The location of a single distal interlocking screw in static IM nail fixation of distal third femur fractures can significantly affect rotational stability but not axial or angular fixation.

  1. Laparoscopic versus open distal pancreatectomy for pancreatic cancer.

    Science.gov (United States)

    Riviere, Deniece; Gurusamy, Kurinchi Selvan; Kooby, David A; Vollmer, Charles M; Besselink, Marc G H; Davidson, Brian R; van Laarhoven, Cornelis J H M

    2016-04-04

    Surgical resection is currently the only treatment with the potential for long-term survival and cure of pancreatic cancer. Surgical resection is provided as distal pancreatectomy for cancers of the body and tail of the pancreas. It can be performed by laparoscopic or open surgery. In operations on other organs, laparoscopic surgery has been shown to reduce complications and length of hospital stay as compared with open surgery. However, concerns remain about the safety of laparoscopic distal pancreatectomy compared with open distal pancreatectomy in terms of postoperative complications and oncological clearance. To assess the benefits and harms of laparoscopic distal pancreatectomy versus open distal pancreatectomy for people undergoing distal pancreatectomy for pancreatic ductal adenocarcinoma of the body or tail of the pancreas, or both. We used search strategies to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index Expanded and trials registers until June 2015 to identify randomised controlled trials (RCTs) and non-randomised studies. We also searched the reference lists of included trials to identify additional studies. We considered for inclusion in the review RCTs and non-randomised studies comparing laparoscopic versus open distal pancreatectomy in patients with resectable pancreatic cancer, irrespective of language, blinding or publication status.. Two review authors independently identified trials and independently extracted data. We calculated odds ratios (ORs), mean differences (MDs) or hazard ratios (HRs) along with 95% confidence intervals (CIs) using both fixed-effect and random-effects models with RevMan 5 on the basis of intention-to-treat analysis when possible. We found no RCTs on this topic. We included in this review 12 non-randomised studies that compared laparoscopic versus open distal pancreatectomy (1576 participants: 394 underwent laparoscopic distal pancreatectomy and 1182

  2. Evidencias Psicométricas de una Medida Breve de Resiliencia en Adultos Mayores Peruanos no Institucionalizados

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    Tomás Caycho-Rodríguez

    2018-04-01

    Full Text Available La resiliencia es comprendida como el dominio de recursos personales y factores contextuales que permiten un afrontamiento exitoso y el logro de una adaptación positiva ante los diferentes estresores que aparecen a lo largo de la vida, siendo así importante dentro del proceso de envejecimiento saludable y exitoso. En la actualidad se han desarrollado instrumentos breves para la medición de la resiliencia como la escala breve de resiliencia (BRCS - Brief Resilient Coping Scale que evalúa la capacidad de los individuos para hacer frente al estrés de manera adaptativa. En este sentido, el estudio ofrece evidencia de validez y fiabilidad de la BRCS en adultos mayores no institucionalizados peruanos. Se contó con la participación de 236 adultos mayores con una edad promedio de 72.8 años (DT = 6.90 de los cuales el 78.4% eran mujeres y el 21.6% hombres, quienes respondieron la versión en español del BRCS y otras escalas para medir la satisfacción con la vida, humor como afrontamiento y depresión. Mediante el análisis factorial confirmatorio se corrobora la estructura unidimensional de la BRCS. Los coeficientes de consistencia interna alfa de Cronbach y omega indicaron una adecuada fiabilidad de la BRCS. Tanto los índices de ajuste del modelo como los valores de los coeficientes de fiabilidad fueron mejores en comparación con los reportados en la literatura. La BRCS mostró una correlación positiva significativa con la satisfacción con la vida y el humor como afrontamiento (p < .01. Asimismo, se observó una correlación negativa significativa con depresión (p < .01. Los resultados muestran que la BRCS cuenta con evidencias de validez y fiabilidad que avala su empleo como medida breve de la resiliencia en adultos mayores peruanos.

  3. Las organizaciones ¿favorecen o dificultan una práctica enfermera basada en la evidencia?

    Directory of Open Access Journals (Sweden)

    Joan Ernest de Pedro Gómez

    Full Text Available El Artículo pretende desde una mirada crítica reflexionar sobre la posición e influencia de las organizaciones, respecto al desarrollo en la práctica clínica de los cuidados enfermeros. Es mucha la evidencia y son muchas las razones para demandar de las organizaciones, un posicionamiento que favorezca el cambio en los Modelos de Práctica Enfermera (MPE. Dada la influencia que tienen los cuidados en los resultados del proceso clínico (morbi-moratlidad y entendiendo éste como el objetivo de las organizaciones sanitarias, parece lógico intentar que las estructuras organizativas abandonen procesos asistenciales totalmente desfasados, para ofrecer los mejores servicios de salud. Para ello es necesario aplicar los resultados de investigación, tanto en la dotación de enfermeras como en la definición de servicios y cuidados enfermeros. Son las organizaciones las que deben establecer las condiciones para que las Enfermeras actúen en un plano de colaboración con otros profesionales y no de sumisión, posición desde la cual no pueden desarrollar su potencial profesional, el cual resulta necesario para un cambio de la prestación de servicios, adaptando éste a las demandas existentes. Sin la adecuada gestión, encaminada a la utilización del conocimiento enfermero como valor organizacional, será imposible adaptar las necesidades de cuidados a las demandas de servicios. Las organizaciones deben optar por un servicio en el que el MPE permita la inclusión de aquellos resultados de investigación con notables efectos en la calidad de sus procesos, las organizaciones deben asumir la responsabilidad de actuar bajo un modelo, que a todas luces no puede ser otro que el de aplicar en la práctica clínica las evidencias producidas por la investigación.

  4. Evidencia Empírica sobre la Paridad del Poder Adquisitivo en México Evidencia Empírica sobre la Paridad del Poder Adquisitivo en México

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    Lorena Medina

    2012-02-01

    Full Text Available This article describes the application of methods recently developed for testing stationarity in the Mexico/US real exchange rate, while allowing for an unknown number of structural breaks in the long-run level of the series. In our empirical implementation, inference relies on bootstraped critical values. As a result, we present unambiguous empirical evidence on the stationarity of the real exchange rate, thus favoring long-run purchasing power parity. En este artículo se describe la aplicación de métodos recientes para probar la estacionariedad del tipo de cambio real peso/dólar, tomando en cuenta la presencia de un número desconocido de cambios estructurales en el nivel de largo plazo de la serie. En nuestra implementación empírica, la inferencia se basa en valores críticos fundamentados en técnicas de remuestreo. Se presenta evidencia contundente sobre la estacionariedad del tipo de cambio real, apoyando así la hipótesis de la paridad del poder adquisitivo.

  5. [Repair of distal biceps brachii tendon rupture: a case report].

    Science.gov (United States)

    Oztürk, Kahraman; Sahin, Vedat

    2002-01-01

    The rupture of the distal tendon of the biceps brachii muscle is a rarely encountered injury, causing flexion and supination losses. There are literature reports giving good results with the use of two-incision technique that fixes the distal biceps brachii tendon to the radial tuberosity. We used this technique in a 49-year-old male patient who had had left distal tendinous rupture of the biceps brachii muscle caused by lifting heavy weight. Functional evaluation at the end of 16 months with the use of the Cybex 350 test machine showed normal range of motions for flexion and extension in the left elbow. There was a 25 percent loss of strength and 5 percent loss of endurance in flexion, and 11 percent loss of endurance in pronation. No complications were observed and a very good functional result was achieved.

  6. [Proximal and distal rupture of the m. biceps brachii].

    Science.gov (United States)

    Lorbach, O; Kieb, M; Grim, C; Engelhardt, M

    2010-12-01

    Ruptures of the biceps tendon account for a high percentage of tendon ruptures. The aetiology of proximal ruptures of the long head of the biceps tendon is often degenerative and they are frequently associated with lesions of the rotator cuff. The clinical findings are often not specific and long lasting. Distal ruptures of the biceps tendon mostly occur during eccentric contraction of the biceps muscle.Clinical tests, the associated haematoma and a distalisation or proximalisation of the muscle belly in combination with ultrasound or MRI to rule out combined diseases lead to the diagnosis. The possible options include conservative and operative treatment. Tenotomy and tenodesis lead to comparable results in the literature. Therefore, conservative treatment is mostly recommended in proximal ruptures. Operative treatment is preferred in distal ruptures of the biceps tendon in order to achieve an anatomical reconstruction of the muscle function. Chronic ruptures of the distal biceps tendon can be successfully treated with free autografts or allografts.

  7. Surgical Management of Fossa Navicularis and Distal Urethral Strictures.

    Science.gov (United States)

    Daneshvar, Michael; Hughes, Michael; Nikolavsky, Dmitriy

    2018-04-17

    Urethral reconstruction has evolved in the last several decades with the introduction of various techniques including fasciocutaneous skin flaps and buccal mucosal grafts. However, distal urethral strictures have continued to be a reconstructive challenge due to tendency for adverse cosmetic outcomes, risks of glans dehiscence or fistula formation, and stricture recurrence. The surgical options for treatment of distal urethral strictures have changed throughout the years; however, there is no one universally accepted technique for their treatment. The current trend for treatment is shifting away from multi-staged procedures or the use of local skin flaps to single-stage transurethral procedures that utilize buccal mucosa with glans preservation. This chapter will describe the evolution of distal urethral stricture treatments tracking gradual improvements and modifications over time. The different interventions include transurethral approaches, such as dilations and visual urethrotomy, meatotomy, and meatoplasty/urethroplasty techniques including genital skin flaps and single- and double-stage repairs with buccal mucosal grafts.

  8. Giant Cell Tumour of the Distal Ulna: A Rare Presentation

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    Ruben Jaya Kumar

    2011-07-01

    Full Text Available Giant-cell tumour (GCT of bone, a primary yet locally aggressive benign tumour, commonly affects patients between the ages of 20 and 40 years, with the peak incidence occurring in the third decade. Women are affected slightly more than men. The distal end of the ulna is an extremely uncommon site for primary bone tumours in general and giant cell tumours in particular. Wide resection of the distal ulna is the recommended treatment for GCT in such locations. Radio-ulna convergence and dorsal displacement of the ulna stump are known complications following ulna resection proximal to the insertion of the pronator quadratus. This leads to reduction in grip power and forearm rotatory motion. Stabilization of the ulna stump with extensor carpi ulnaris (ECU tendon after wide resection of the tumour has been described in the literature. We report a case of GCT of distal end of ulna treated with wide resection and stabilization with ECU tendon.

  9. Distal mycotic aneurysm of the AICA mimicking intracanalicular acoustic neuroma.

    Science.gov (United States)

    DiMaio, Salvatore; Mohr, Gérard; Dufour, Jean-Jacques; Albrecht, Steffan

    2003-11-01

    Among cases of cerebellopontine angle lesions, vascular lesions involving the internal auditory canal are extremely rare. We report a distal fusiform mycotic pseudoaneurysm of the anterior inferior cerebellar artery (AICA) that simulated an acoustic neuroma on presentation. A 60-year-old woman was investigated for recent onset of acute dizziness. Laboratory and radiographic investigations are presented, as well as the surgical management of the patient and pathological examination of the aneurysm. An exceptionally rare case of distal mycotic intracanalicular pseudoaneurysm of the AICA with intraluminal thrombus and fusiform anatomy is described. In our review of the literature (1966-present), only five other intracanalicular AICA-aneurysms were encountered, none of which were infectious in etiology. The possible pathophysiologic mechanisms of distal AICA-aneurysms are discussed along with the currently available literature.

  10. Fractures of the distal tibia treated with polyaxial locking plating.

    Science.gov (United States)

    Gao, Hong; Zhang, Chang-Qing; Luo, Cong-Feng; Zhou, Zu-Bin; Zeng, Bing-Fang

    2009-03-01

    We evaluated the healing rate, complications, and functional outcomes in 32 adult patients with very short metaphyseal fragments in fractures of the distal tibia treated with a polyaxial locking system. The average distance from the distal extent of the fracture to the tibial plafond was 11 mm. All fractures healed and the average time to union was 14 weeks. Six patients (19%) reported occasional local disturbance over the medial malleolus. There were two cases of postoperative superficial infections and evidence of delayed wound healing. Using the American Orthopaedic Foot and Ankle Society ankle score, the average functional score was 87.3 points (of 100 total possible points). Our results show the polyaxial locking plates, which offer more fixation versatility, may be a reasonable treatment option for distal tibia fractures with very short metaphyseal segments.

  11. Minimally Invasive Distal Pancreatectomy: Review of the English Literature.

    Science.gov (United States)

    Wang, Kai; Fan, Ying

    2017-02-01

    Recently, the superiority of the minimally invasive approach, which results in a better cosmetic result, faster recovery, and shorter length of hospital stay, is a technique that has been progressively recognized as it has developed. And the minimally invasive approach has been applied to distal pancreatectomy (DP), which is a standard method for the treatment of benign, borderline, and part of malignant lesions of the pancreatic body and tail. This article aims to analyze the types, postoperative recovery, and outcomes of laparoscopic distal pancreatectomy (LDP). A systematic search of the scientific literature was performed using PubMed, EMBASE, online journals, and the Internet for all publications on LDP. Articles were selected if the abstract contained patients who underwent LDP for pancreatic diseases. All selected articles were reviewed and analyzed. If there were no contraindications for LDP, this operation is suitable for benign, borderline, or malignant tumors of the pancreatic body and tail, which should try to be performed with preservation of the spleen. LDP is safe and feasible under some conditions to experienced surgeon. Single-incision laparoscopic distal pancreatectomy (S-LDP) and robotic laparoscopic distal pancreatectomy (R-LDP) perioperative outcomes are similar with conventional multi-incision laparoscopic distal pancreatectomy (C-LDP). And the advantages of S-LDP and R-LDP require further exploration. With the application of enhanced recovery program (ERP), length of hospital stay and costs are reduced. LDP is safe and feasible under some conditions. Compared with open distal pancreatectomy, LDP has a lot of advantages; a trend was observed for LDP to replace traditional open surgery. LDP combined with ERP is expected to become standard in the treatment of pancreatic body and tail lesions.

  12. Laparoscopic distal pancreatectomy for adenocarcinoma: safe and reasonable?

    Science.gov (United States)

    Postlewait, Lauren M.

    2015-01-01

    As a result of technological advances during the past two decades, surgeons now use minimally invasive surgery (MIS) approaches to pancreatic resection more frequently, yet the role of these approaches for pancreatic ductal adenocarcinoma resections remains uncertain, given the aggressive nature of this malignancy. Although there are no controlled trials comparing MIS technique to open surgical technique, laparoscopic distal pancreatectomy for pancreatic adenocarcinoma is performed with increasing frequency. Data from retrospective studies suggest that perioperative complication profiles between open and laparoscopic distal pancreatectomy are similar, with perhaps lower blood loss and fewer wound infections in the MIS group. Concerning oncologic outcomes, there appear to be no differences in the rate of achieving negative margins or in the number of lymph nodes (LNs) resected when compared to open surgery. There are limited recurrence and survival data on laparoscopic compared to open distal pancreatectomy for pancreatic adenocarcinoma, but in the few studies that assess long term outcomes, recurrence rates and survival outcomes appear similar. Recent studies show that though laparoscopic distal pancreatectomy entails a greater operative cost, the associated shorter length of hospital stay leads to decreased overall cost compared to open procedures. Multiple new technologies are emerging to improve resection of pancreatic cancer. Robotic pancreatectomy is feasible, but there are limited data on robotic resection of pancreatic adenocarcinoma, and outcomes appear similar to laparoscopic approaches. Additionally fluorescence-guided surgery represents a new technology on the horizon that could improve oncologic outcomes after resection of pancreatic adenocarcinoma, though published data thus far are limited to animal models. Overall, MIS distal pancreatectomy appears to be a safe and reasonable approach to treating selected patients with pancreatic ductal

  13. Locking plates in distal humerus fractures: study of 43 patients

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    Gupta Rakesh Kumar

    2013-08-01

    Full Text Available 【Abstract】Objective: The treatment of multi-fragmentary, intraarticular fractures of the distal humerus is difficult, even in young patients with bone of good quality. Small distal fragment, diminished bone mineral quality and increased trauma-associated joint destruction make stable joint reconstruction more problematic. The anatomically preshaped locking plates allow angular stable fixation for these complex fractures. We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal hu-merus fractures. Methods: Forty-three consecutive patients with ar-ticular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates. Forty patients were available for the final outcome analysis. According to AO/ASIF classification, there were 2 cases of type A2, 4 cases of type A3, 1 case of type B1, 1 case of type B2, 14 cases of type C1, 7 cases of type C2 and 11 cases of type C3. Open reduction with triceps splitting technique was used in all patients. The clinical and radiographic follow-up was performed and outcome measures included pain assessment, range of motion, and Mayo elbow performance score. Results: Forty patients were available for the final outcome analysis. There were 29 males and 11 females with an average age of 38.4 years (18-73 years. Clinical and ra-diological consolidation of the fracture was observed in all cases at an average of 11.6 weeks (9-14 weeks. The average follow-up was 12 months (10-18 months. Using the Mayo elbow performance score the results obtained were graded as excellent or good results in 33 patients (82.5%. One pa-tient had superficial infection, and 4 had myositis ossificans. There were no cases of primary malposition or secondary displacement, implant failure or ulnar neuropathy. Conclusion: Anatomically preshaped distal humerus locking

  14. Current concepts in the treatment of distal radial fractures.

    Science.gov (United States)

    Ruch, David S; Weiland, Andrew J; Wolfe, Scott W; Geissler, William B; Cohen, Mark S; Jupiter, Jesse B

    2004-01-01

    Surgical indications for the treatment of distal radial fractures are evolving. It is important to identify the various articular fragments and their significance to facilitate optimal surgical treatment of these fragments from the standpoint of both internal and external fixation. New techniques in the visualization and stabilization of the articular surface and the treatment of defects in the metaphysis, including the use of cement to buttress the articular surface, have been brought to the forefront. A treatment algorithm for associated injuries to the distal radioulnar joint is also helpful.

  15. Neglected Distal Humeral Epiphyseal Injury - Two Case Reports

    Directory of Open Access Journals (Sweden)

    Dr. Pankaj Kumar

    2008-07-01

    Full Text Available Distal humeral epiphyseal separation is an uncommon injury in children, which can be missed or misdiagnosed at initial presentation. Awareness of this injury and appropriate radiological assessment helps in proper management. Neglected cases because of inappropriate diagnosis can result in cubitus varus deformity. Full range of movements of elbow can be achieved if properly diagnosed and managed. We present two cases of neglected distal humeral epiphyseal injury in children that resulted in cubitus varus deformity in one case. Full range of movements was achieved in both cases after proper management.

  16. Galeazzi fracture with volar dislocation of the distal radioulnar joint.

    Science.gov (United States)

    Kim, Suezie; Ward, James P; Rettig, Michael E

    2012-11-01

    Galeazzi fracture dislocations are fractures of the distal one-third of the radial diaphysis with traumatic disruption of the distal radioulnar joint (DRUJ). This injury results in subluxation or dislocation of the ulnar head. We present a case of a Galeazzi fracture with a volar dislocation of the DRUJ. Open reduction of the DRUJ with Kirschner wire fixation in pronation was necessary to reduce the joint and maintain anatomic alignment. Repair of the triangular fibrocartilage complex was also necessary to maintain stability of the DRUJ.

  17. External Fixation of Unstable Distal Radius Fracture. A Case Report

    OpenAIRE

    Yaniel Truffin Rodríguez; Rafael Esmandy Gámez Arregoitía; Indira L. Gómez Gil; José Julio Requeiro Morejón

    2014-01-01

    Unstable fracture of the distal radius is a common injury. If not properly treated, it can cause major disturbance in the radiocarpal joint and impaired hand function. A case of a 42-year-old patient of rural origin without a history of previous conditions treated at the Gustavo Aldereguía Lima Hospital in Cienfuegos is presented. He suffered a fall on the outstretched hand, which led to an unstable fracture of the left distal radius. Emergency surgery consisting of manual fracture reduction ...

  18. Traumatisk distal humerus-epifysiolyse hos nyfødt

    DEFF Research Database (Denmark)

    Al-Aubaidi, Zaid; Nielsen, Keld Daubjerg

    2010-01-01

    Traumatic distal humerus epiphysiolysis (TDHE) is a rare injury in infants with an incidence of about 1:35,000 births. It is primarily a birth injury, but it is also seen in cases of battered child syndrome. Because of its rare occurrence and the diagnostic difficulties, the lesion may be overloo......Traumatic distal humerus epiphysiolysis (TDHE) is a rare injury in infants with an incidence of about 1:35,000 births. It is primarily a birth injury, but it is also seen in cases of battered child syndrome. Because of its rare occurrence and the diagnostic difficulties, the lesion may...

  19. Osteoblastoma-like osteosarcoma of the distal tibia

    Energy Technology Data Exchange (ETDEWEB)

    Abramovici, Luigia; Steiner, German C. [Department of Pathology and Laboratory Medicine, Hospital for Joint Diseases, New York, NY (United States); Kenan, Samuel [Department of Orthopaedic Oncology Surgery, Hospital for Joint Diseases, New York, NY (United States); Hytiroglou, Prodromos [Aristotle University, Thessaloniki (Greece); Rafii, Mahvash [Department of Radiology, Hospital for Joint Diseases, New York, NY (United States)

    2002-03-01

    We report a case of a 14-year-old boy with an intracompartmental lytic lesion with poorly defined margins in the right distal tibia that was originally treated with curettage and bone grafting. Histologic examination showed an osteoblastic tumor with unusual features, which was found on consultation to be an osteoblastoma-like osteosarcoma, a rare, low-grade variant of osteosarcoma. Subsequently, the patient underwent en bloc resection of the distal tibia, which was replaced with vascularized bone graft and followed by chemotherapy. Two years later, he is alive with lung metastases. (orig.)

  20. Distal vertebral artery reconstruction when managing vertebrobasilar insufficiency

    Directory of Open Access Journals (Sweden)

    D. M. Galaktionov

    2017-11-01

    Full Text Available This article presents a literature review devoted to the reconstruction of the distal vertebral artery and a clinical case of successful surgical treatment of a patient suffering from vertebrobasilar insufficiency caused by occlusion of the vertebral artery in a proximal segment. The external carotid artery-distal vertebral artery bypass was performed by using the radial artery.Received 27 February 2017. Revised 25 July 2017. Accepted 3 August 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest. 

  1. Distal renal tubular acidosis and amelogenesis imperfecta: A rare association

    Directory of Open Access Journals (Sweden)

    P Ravi

    2013-01-01

    Full Text Available Renal tubular acidosis (RTA is characterized by a normal anion gap with hyperchloremic metabolic acidosis. Primary distal RTA (type I is the most common RTA in children. Childhood presentation of distal RTA includes vomiting, failure to thrive, metabolic acidosis, and hypokalemia. Amelogenesis imperfecta (AI represents a condition where the dental enamel and oral tissues are affected in an equal manner resulting in the hypoplastic or hypopigmented teeth. We report a 10-year-old girl, previously asymptomatic presented with the hypokalemic paralysis and on work-up found out to have type I RTA. The discoloration of teeth and enamel was diagnosed as AI.

  2. Imaging of the Proximal and Distal Radioulnar Joints.

    Science.gov (United States)

    Ehman, Eric C; Felmlee, Joel P; Frick, Matthew A

    2015-08-01

    The proximal and distal radioulnar joints form a unique articular arrangement between the radius and ulna, allowing pivot motion of the forearm and positioning the hand in space. Typically imaged in conjunction with the elbow, radiographs, computed tomography (CT), and MR imaging of the proximal radioulnar joint contribute unique diagnostic information. Because dysfunction of the distal radioulnar joint is often a result of instability, dynamic CT protocols stressing the joint in addition to anatomic imaging with radiographs and MR imaging is valuable. Detailed knowledge of the patient's clinical condition and careful selection of imaging protocols will maximize the benefits. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Screening renal stone formers for distal renal tubular acidosis

    DEFF Research Database (Denmark)

    Osther, P J; Hansen, A B; Røhl, H F

    1989-01-01

    A group of 110 consecutive renal stone formers were screened for distal renal tubular acidosis (RTA) using morning fasting urinary pH (mfUpH) levels followed by a short ammonium chloride loading test in patients with levels above 6.0. In 14 patients (12.7%) a renal acidification defect was noted...... RTA in renal stone formers. Regardless of whether the acidification defect is primary or secondary to stone formation, however, all renal stone formers with distal RTA can expect to benefit from prophylactic alkaline therapy and it is recommended that the screening procedure, which is easy to use...

  4. Evidenciação das Informações Ambientais das Empresas do Setor de Energia Elétrica do Brasil

    Directory of Open Access Journals (Sweden)

    Francineide Eleotério Pereira

    2015-08-01

    Full Text Available Nos últimos anos, a questão ambiental ganhou espaço no meio empresarial e tem proporcionado uma maior divulgação das externalidades ecológicas. Nesse sentido, o presente estudo objetiva identificar o nível de evidenciação ambiental nas demonstrações contábeis das empresas do setor de energia elétrica do Brasil, no ano de 2012. Para tanto, foram selecionadas as empresas brasileiras do setor de energia elétrica classificadas como 100 maiores empresas do Brasil de acordo com a Revista Exame. Desse contingente foram encontradas um total de 13 organizações, destas apenas 8 tiveram suas demonstrações divulgadas no site da BM&FBovespa. Assim, foi realizada uma análise das Notas Explicativas e Relatórios da Administração, levando em consideração a NBC-T 15, para identificar o nível de evidenciação ambiental destas empresas, por meio de um critério de classificação que variou entre ótimo, bom, regular e ruim. O software check list Word foi utilizado para realizar a análise de conteúdo. Os resultados evidenciam que as divulgações das informações de natureza ambiental não são identificadas nesses relatórios. As empresas com o nível mais satisfatório (regular, com 36,36% de evidenciação, foram Petrobrás, AES Eletropaulo, Cemig Distribuição e Copel, e as empresas com nível de evidenciação ruim, com 0% de evidenciação, foram Eletrobrás e Ligth Distribuição, denotando que neste segmento empresarial o nível de evidenciação ambiental ainda é frágil e necessita de regulamentação para maior transparência.

  5. A busca das melhores evidências En búsqueda de las mejores evidencias In search of the best evidence

    Directory of Open Access Journals (Sweden)

    Cristina Maria Galvão

    2003-12-01

    Full Text Available A prática baseada em evidências é uma abordagem que envolve a definição de um problema, a busca e avaliação crítica das evidências disponíveis, implementação das evidências na prática e avaliação dos resultados obtidos. Para a implementação desta abordagem, na enfermagem, o enfermeiro necessita saber como obter, interpretar e integrar as evidências oriundas de pesquisas na assistência prestada ao cliente e seu familiares. Fundamentados na literatura apresentamos considerações teóricas acerca da hierarquia das evidências e onde realizar a busca das melhores evidências.La práctica basada en evidencias es un enfoque que involucra la definición de un problema, la búsqueda y la evaluación crítica de las evidencias disponibles, poner en práctica las evidencias y, finalmente, evaluar los resultados obtenidos. Para poner en práctica este tipo de enfoque en el área de la enfermería, el enfermero necesita saber cómo obtener, interpretar e integrar las evidencias procedentes de investigaciones realizadas en la ayuda prestada al cliente y a sus familiares. Fundamentados en la literatura, presentamos en este artículo, las consideraciones teóricas respecto a la jerarquía de las evidencias y dónde poder realizar la búsqueda de las mejores evidencias.Evidence-based practice is an approach involving the definition of a problem, the search for and critical evaluation of available evidence, the implementation of evidence in practice and the evaluation of the results obtained. In order to implement this approach in nursing, nurses must know how to obtain, interpret and integrate evidence stemming from research in the care rendered to patients and their relatives. Based on the literature, this article presents theoretical considerations concerning the hierarchy of evidence and where to search for the best evidence.

  6. Resiliencia en Enfermería: definición, evidencia empírica e intervenciones

    Directory of Open Access Journals (Sweden)

    Óscar Arrogante

    2015-12-01

    Full Text Available La resiliencia (adaptación positiva a la adversidad se encuentra dentro de las competencias enfermeras al relacionarse con tres diagnósticos de la taxonomía NANDA y, además, la investigación enfermera señala que es una característica propia de la Enfermería. Sin embargo, la resiliencia es un concepto novedoso para la mayoría de las enfermeras. El artículo tiene como objetivos definir el concepto de resiliencia, exponer la evidencia empírica encontrada en la investigación enfermera y describir los principales programas e intervenciones para su desarrollo. La resiliencia tiene importantes implicaciones clínicas tanto para el cuidado de pacientes, como para el propio autocuidado de la Enfermería. La resiliencia se puede considerar como una característica esencial e inherente a la Enfermería debido a la exposición continua al sufrimiento humano y a unas condiciones laborales estresantes. Por lo tanto, su entrenamiento debería promoverse desde las universidades hasta los centros sanitarios para mejorar la práctica clínica enfermera.

  7. Diferencias en la recaudación del impuesto predial en la zona fronteriza: evidencia en los municipios de Chihuahua

    Directory of Open Access Journals (Sweden)

    Jorge Ibarra Salazar

    2014-01-01

    Full Text Available Basándonos en el estudio de Ibarra y Sotres (2009, en este artículo aportamos evidencia adicional que relaciona las características de la región frontera norte y el marco institucional con la recaudación del impuesto predial. Estimamos una serie de especificaciones econométricas usando una base de datos de panel para los 67 municipios de Chihuahua correspondiente a 2002-2006. Nuestra hipótesis central es que la dinámica económica y demográfica en la zona fronteriza de Chihuahua ha originado una mayor demanda de servicios e infraestructura en los municipios fronterizos de ese estado, lo que los ha motivado a diferenciar su marco institucional para obtener mayores recursos por concepto de impuesto predial en comparación con los municipios no fronterizos. Esto es posible dado que la reforma constitucional de 1999 al Artículo 115 posibilita a los municipios modificar el marco institucional fiscal para enfrentar sus propias peculiaridades.

  8. La demanda de trabajo: teoría y evidencia empírica para el caso colombiano

    Directory of Open Access Journals (Sweden)

    Jairo Guillermo Isaza Castro

    2004-07-01

    Full Text Available Este documento presenta algunos de los aspectos teóricos más importantes para el análisis de la demanda de trabajo, así como la evidencia empírica disponible para el caso colombiano. En cuanto a los aspectos teóricos, la exposición se centra en la discusión microeonómica concerniente a las propiedades de la demanda de trabajo del empresario maximizador debeneficios que enfrenta un proceso productivo con dos factores: capital y trabajo. Luego se discuten las implicaciones de los procesos de liberalización y reformas estructurales en la demanda de trabajo. La revisión de literatura efectuada para el caso colombiano muestra cómo, en general, los estimativos de elasticidades de la demanda por trabajadores frente al producto y el salario real difieren sustancialmente debido a la diversidad de especificaciones econométricas, la temporalidad de los datos y las fuentes de los mismos.

  9. Propeller Flap for Complex Distal Leg Reconstruction: A Versatile ...

    African Journals Online (AJOL)

    have been described in the axilla, periolecranon, forearm, lower extremity,[1] hand,[6] and trunk.[7] In spite of the versatility of perforator‑based flaps, literature search reveals ... Anatomy of distal leg perforators. Perforators are small diameter vessels that originate from a main pedicle and perforate the fascia or muscle to ...

  10. A traction jig for reduction of distal radial fractures.

    Science.gov (United States)

    Wise, David; Coats, Tim; Persad, Ram

    2004-01-01

    A traction jig is described which facilitates the closed reduction of extra-articular distal radial fractures and which maintains the reduction whilst a plaster cast is applied. The jig is suitable for use by a single operator in an Accident and Emergency department setting.

  11. Comparative distalization effects of Jones jig and pendulum appliances.

    Science.gov (United States)

    Patel, Mayara Paim; Janson, Guilherme; Henriques, José Fernando Castanha; de Almeida, Renato Rodrigues; de Freitas, Marcos Roberto; Pinzan, Arnaldo; de Freitas, Karina Maria Salvatore

    2009-03-01

    In this study, we compared the dentoalveolar changes of Class II patients treated with Jones jig and pendulum appliances. The experimental group comprised 40 Class II malocclusion subjects, divided into 2 groups: group 1 consisted of 20 patients (11 boys, 9 girls) at a mean pretreatment age of 13.17 years, treated with the Jones jig appliance for 0.91 years; group 2 comprised 20 patients (8 boys, 12 girls) at a mean pretreatment age of 13.98 years, treated with the pendulum appliance for 1.18 years. Only active treatment time of molar distalization was evaluated in the predistalization and postdistalization lateral cephalograms. Molar, second premolar, and incisor angular and linear variables were obtained. The intergroup treatment changes in these variables were compared with independent t tests. The maxillary second premolars showed greater mesial tipping and extrusion in the Jones jig group, indicating more anchorage loss during molar distalization with this appliance. The amounts and the monthly rates of molar distalization were similar in both groups. The Jones jig group showed greater mesial tipping and extrusion of the maxillary second premolars. The mean amounts and the monthly rates of first molar distalization were similar in both groups.

  12. Distal skin vasodilation promotes rapid sleep onset in preterm neonates.

    Science.gov (United States)

    Barcat, Lucile; Decima, Pauline; Bodin, Emilie; Delanaud, Stephane; Stephan-Blanchard, Erwan; Leke, Andre; Libert, Jean-Pierre; Tourneux, Pierre; Bach, Veronique

    2017-10-01

    Although sleep is of paramount importance for preterm neonates, care of the latter in a neonatal intensive care unit does not favour sleep. Given that several studies in adults have described a 'vegetative preparedness to sleep' (in which distal skin vasodilation before lights-out promotes rapid sleep onset), we looked at whether or not this process operates in preterm neonates. Sleep propensity was assessed in terms of the duration of a spontaneous episode of wakefulness (W). Skin temperatures at six body sites (the abdomen, pectoral region, eye, hand, thigh and foot) were measured (using infrared thermography) during nocturnal polysomnography in 29 9-day-old preterm neonates (postmenstrual age: 209 ± 9 days). We then determined whether the duration of the W episode depended upon the local skin temperatures measured at the start, during and end of the episode. The W episode was shorter when distal skin temperatures (thigh, hand and foot) and the pectoral temperature were higher at the end of the episode (i.e. at sleep onset). The relationship with the duration of the W episode was not significant for temperatures measured at the start of the W episode. We observed gradual distal vasodilation at the pectoral region, the thigh, hand and foot (i.e. affecting most of the body's skin surface) during W episodes. Our results constitute initial evidence to show that distal vasodilation may have a key role in facilitating sleep onset in very preterm neonates. © 2017 European Sleep Research Society.

  13. Proximal and distal environmental correlates of adolescent obesity.

    Science.gov (United States)

    Nesbit, Kathryn C; Kolobe, Thubi A; Arnold, Sandra H; Sisson, Susan B; Anderson, Michael P

    2014-08-01

    The purpose of this study was to determine how proximal (home) and distal (neighborhood) environmental characteristics interact to influence obesity in early and middle adolescents. This was a descriptive, cross-sectional study using the 2007 National Survey of Children's Health (NCSH). Participants were 39,542 children ages 11 to 17 years. Logistic regressions were used to examine the relationship between adolescent obesity and environmental factors, the relative strength of these factors, and the influence of age and gender. Proximal environmental factors were stronger correlates of adolescent obesity than distal environmental factors. Sedentary behavior related to TV watching time at home was the strongest correlate of adolescent obesity overall (OR 1.13, 95% CI 1.11-1.15). Parks and playgrounds (OR 0.86, 95% CI 0.08-0.92), as well as recreation centers (OR 0.91, 95% CI 0.85-0.97) were significant distal environmental factor correlates. Girls and middle adolescents were at less risk for obesity than boys and early adolescents (OR 0.51, 95% CI 0.68-0.82; OR 0.75, 95% CI 0.68-0.96). The results of this study reveal the importance of proximal environmental characteristics on adolescent obesity relative to distal environmental characteristics. Obesity intervention strategies for adolescents should target sedentary behavior and opportunities for physical activity with a focus on early adolescents and boys.

  14. Surgical management of acute distal biceps tendon rupture ...

    African Journals Online (AJOL)

    Acute distal biceps tendon rupture constitute a rare lesion of biceps injuries, typically, easy to diagnosis after lifting a heavy object. Treatment is controversial, nonoperative for sedentary and elderly patients; surgical for young and active individuals. Many operative techniques are described, they all aim to restore an ...

  15. Evaluation of various filling techniques in distal canals of mandibular ...

    African Journals Online (AJOL)

    Evaluation of various filling techniques in distal canals of mandibular molars instrumented with different single-file nickel-titanium systems. ... Comparisons between groups were applied using Student's t-test or one-way ANOVA for normally distributed data. The Mann-Whitney U-test or Kruskal-Wallis test was used when ...

  16. Distal adding-on phenomenon in Lenke 1A scoliosis

    DEFF Research Database (Denmark)

    Wang, Yu; Hansen, Ebbe Stender; Høy, Kristian

    2011-01-01

    the instrumentation) from the CSVL (the vertical line that bisects proximal sacrum). Five methods for determining LIV were compared in both the adding-on group and no adding-on group. RESULTS: Out of the 278 patients reviewed, 45 met the inclusion criteria; 23 of these met the definition for distal adding...

  17. Distal biceps reconstruction 13 years post-injury.

    Science.gov (United States)

    Burrus, M Tyrrell; Chhabra, A Bobby

    2015-04-01

    Distal biceps tendon ruptures are relatively rare injuries most commonly caused by an eccentric contraction of the biceps brachii. The majority of complete ruptures receive early surgical intervention, however, some patients do present in a delayed fashion. There are many surgical options at this time for acute and chronic injuries, and this case report describes an Achilles allograft reconstruction in a male who sustained a complete tear 13 years prior to presentation. At 12-month follow up, he had regained full function of his dominant extremity as evidence by returning to work with no limitations and by a Disabilities of the Arm, Shoulder, and Hand (DASH) score of zero. We are unaware of a successfully surgically reconstructed distal biceps tendon of this chronicity. As the literature on this subject is sparse, this case report gives credence to the idea that certain patients with a chronic distal biceps rupture should be considered for operative reconstruction and not relegated to continued failed conservative treatment. Discussed are the surgical treatment options and controversies for chronic distal biceps ruptures, and we review various outcome studies using different surgical techniques.

  18. Bilateral ruptures of the distal biceps brachii tendon.

    Science.gov (United States)

    Schneider, Adam; Bennett, J Michael; O'Connor, Daniel P; Mehlhoff, Thomas; Bennett, James B

    2009-01-01

    The purpose of this study was to identify characteristics associated with bilateral ruptures of the distal biceps tendons. We present a retrospective case series of 25 patients who sustained non-simultaneous bilateral distal biceps brachii tendon ruptures that were repaired surgically, with follow-up available on 10 patients. The average age of the patients was 50 years (range 28-76). All patients were male. The mean time from the first tendon rupture to the contralateral tendon rupture was 2.7 years (range 0.5 - 6.3). Follow-up averaged 45 months (range 24-85). Patients with bilateral ruptures tended to be middle-aged men, who commonly participated in weight lifting, manual labor, or sports, and who had higher rates of nicotine (50%) and anabolic steroid use (20%) than the general population. After surgical repair of 9 of 10 patients, patients with bilateral distal biceps tendon ruptures had good to excellent outcomes. With the numbers available, outcomes were not statistically associated with manual labor, past medical history, prescription medications, prior tendon injury, body mass index, current activity in sports, use of nutritional supplements, or anabolic steroid use, although worker's compensation claims approached statistical significance (p = 0.059). Patients who sustained bilateral distal biceps tendon ruptures tended to be middle-aged men with higher rates of nicotine and anabolic steroid use than the general population.

  19. Distal Renal Tubular Acidosis, an Uncommonly diagnosed Cause of ...

    African Journals Online (AJOL)

    Five cases of distal renal tubular acidosis aged between 2½ weeks and 2½ months are described. The presenting features included lethargy, refusal to feed, high density of periodic respiration, vomiting and recurrent episodes of unexplained metabolic acidosis. A constant feature was failure to thrive despite caloric intakes ...

  20. Conservative management of distal leg necrosis in lung transplant recipients.

    Science.gov (United States)

    Aigner, F; Husmann, M; Huber, L C; Benden, C; Schuurmans, M M

    2017-05-01

    Critical limb ischemia (CLI) with distal leg necrosis in lung transplant recipients (LTR) is associated with a high risk for systemic infection and sepsis. Optimal management of CLI has not been defined so far in LTR. In immunocompetent individuals with leg necrosis, surgical amputation would be indicated and standard care. We report on the outcome of four conservatively managed LTR with distal leg necrosis due to peripheral arterial disease (PAD) with medial calcification of the distal limb vessels. Time interval from lung transplantation to CLI ranged from four years (n = 1) to more than a decade (n = 3). In all cases a multimodal therapy with heparin, acetylsalicylic acid, iloprost and antibiotic therapy was performed, in addition to a trial of catheter-based revascularization. Surgical amputation of necrosis was not undertaken due to fear of wound healing difficulties under long-term immunosuppression and impaired tissue perfusion. Intensive wound care and selective debridement were performed. Two patients developed progressive gangrene followed by auto-amputation during a follow-up of 43 and 49 months with continued ambulation and two patients died of unrelated causes 9 and 12 months after diagnosis of CLI. In conclusion, we report a conservative treatment strategy for distal leg necrosis in LTR without surgical amputation and recommend this approach based on our experience. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  1. Propeller Flap for Complex Distal Leg Reconstruction: A Versatile ...

    African Journals Online (AJOL)

    Reverse sural artery fasciocutaneous flap has become a workhorse for the reconstruction of distal leg soft tissue defects. When its use is not feasible, perforator‑based propeller flap offers a better, easier, faster, and cheaper alternative to free flap. We present our experience with two men both aged 34 years who sustained ...

  2. Laparoscopic versus open distal pancreatectomy for pancreatic cancer

    NARCIS (Netherlands)

    Riviere, D.M.; Gurusamy, K.S.; Kooby, D.A.; Vollmer, C.M.; Besselink, M.G.; Davidson, B.R.; Laarhoven, C.J.H.M. van

    2016-01-01

    BACKGROUND: Surgical resection is currently the only treatment with the potential for long-term survival and cure of pancreatic cancer. Surgical resection is provided as distal pancreatectomy for cancers of the body and tail of the pancreas. It can be performed by laparoscopic or open surgery. In

  3. Laparoscopic versus open distal pancreatectomy for pancreatic cancer

    NARCIS (Netherlands)

    Riviere, Deniece; Gurusamy, Kurinchi Selvan; Kooby, David A.; Vollmer, Charles M.; Besselink, Marc G. H.; Davidson, Brian R.; van Laarhoven, Cornelis J. H. M.

    2016-01-01

    Surgical resection is currently the only treatment with the potential for long-term survival and cure of pancreatic cancer. Surgical resection is provided as distal pancreatectomy for cancers of the body and tail of the pancreas. It can be performed by laparoscopic or open surgery. In operations on

  4. Autosomal dominant distal myopathy: Linkage to chromosome 14

    Energy Technology Data Exchange (ETDEWEB)

    Laing, N.G.; Laing, B.A.; Wilton, S.D.; Dorosz, S.; Mastaglia, F.L.; Kakulas, B.A. [Australian Neuromuscular Research Institute, Perth (Australia); Robbins, P.; Meredith, C.; Honeyman, K.; Kozman, H.

    1995-02-01

    We have studied a family segregating a form of autosomal dominant distal myopathy (MIM 160500) and containing nine living affected individuals. The myopathy in this family is closest in clinical phenotype to that first described by Gowers in 1902. A search for linkage was conducted using microsatellite, VNTR, and RFLP markers. In total, 92 markers on all 22 autosomes were run. Positive linkage was obtained with 14 of 15 markers tested on chromosome 14, with little indication of linkage elsewhere in the genome. Maximum two-point LOD scores of 2.60 at recombination fraction .00 were obtained for the markers MYH7 and D14S64 - the family structure precludes a two-point LOD score {ge} 3. Recombinations with D14S72 and D14S49 indicate that this distal myopathy locus, MPD1, should lie between these markers. A multipoint analysis assuming 100% penetrance and using the markers D14S72, D14S50, MYH7, D14S64, D14S54, and D14S49 gave a LOD score of exactly 3 at MYH7. Analysis at a penetrance of 80% gave a LOD score of 2.8 at this marker. This probable localization of a gene for distal myopathy, MPD1, on chromosome 14 should allow other investigators studying distal myopathy families to test this region for linkage in other types of the disease, to confirm linkage or to demonstrate the likely genetic heterogeneity. 24 refs., 3 figs., 1 tab.

  5. Stressfrakturer af distale fibula hos en patient med osteoporose

    DEFF Research Database (Denmark)

    Schwartz, Frederik; Heerfordt, Ida Marie

    2014-01-01

    We report a case of an 81-year-old osteoporotic woman, who suffered stress fractures of the distal fibula on both sides within a two-year period. The risk factors for stress fractures are reviewed and the importance of a high index of suspicion for stress fractures is emphasized. When a stress fr...

  6. Evaluation of Various Filling Techniques in Distal Canals of ...

    African Journals Online (AJOL)

    2017-03-06

    Mar 6, 2017 ... treatment.[10] The percentage of GP-filled areas (PGFAs) has been used as a measure of the quality of the root filling.[7] Therefore, the aim of this study was to compare different filling techniques in the distal canals of lower molars, instrumented by different single-file systems, and the canal area in terms of ...

  7. Non-Vascularised Fibular Grafting After Resection of Distal Femoral ...

    African Journals Online (AJOL)

    Background: Vascularized fibular grafting, allografting, megaprosthesis and allograft-prosthesis composite are suitable limb salvage techniques after resection of ... the initial observation showed such a wide non-vascularized fibular grafting for arthrodesis of the knee after resection of the distal femoral tumours is a feasible ...

  8. Snodgrass repair for distal hypospadias: a review of 75 cases

    African Journals Online (AJOL)

    urologists for distal hypospadias correction. We review our cases to find out whether there was any difference in the rate of urethrocutaneous fistula after the use of single- versus double-layer tubularization, the use of thick versus thin dorsal prepuce subcutaneous flap (DPF), the use of. DPF versus the ventral dartos flap for ...

  9. Urethral advancement procedure in the treatment of primary distal ...

    African Journals Online (AJOL)

    advancement in the repair of primary distal penile hypospadias with regard to feasibility, complication rates .... stones and growth, and any associated congenital anomaly. Meticulous local examination was performed ... with a tourniquet placed on the root of the penis. A submeatal crescent-like incision was performed a few.

  10. Simultaneous bilateral distal biceps tendon repair: case report

    Directory of Open Access Journals (Sweden)

    Thiago Medeiros Storti

    Full Text Available ABSTRACT Simultaneous bilateral rupture of the distal biceps tendon is a rare clinical entity, seldom reported in the literature and with unclear therapeutic setting. The authors report the case of a 39-year-old white man who suffered a simultaneous bilateral rupture while working out. When weightlifting with elbows at 90° of flexion, he suddenly felt pain on the anterior aspect of the arms, coming for evaluation after two days. He presented bulging contour of the biceps muscle belly and ecchymosis in the antecubital fossa, extending distally to the medial aspect of the forearm, as well as a marked decrease of supination strength and pain in active elbow flexion. MRI confirmed the rupture with retraction of the distal biceps bilaterally. The authors opted for performing the tendon repairs simultaneously through the double incision technique and fixation to the bicipital tuberosity with anchors. The patient progressed quite well, with full return to labor and sports activities, being satisfied with the result after two years of surgery. In the literature search, few reports of simultaneous bilateral rupture of the distal biceps were retrieved, with only one treated in the acute phase of injury. Therefore, the authors consider this procedure to be a good option to solve this complex condition.

  11. Neglected distal humeral epiphyseal injury - Two Case Reports ...

    African Journals Online (AJOL)

    We present two cases of neglected distal humeral epiphyseal injury in children that resulted in cubitus varus deformity in one case. Full range of movements was achieved in both cases after proper management. Keywords: Neglected epiphyseal injury; Cubitus varus; Diagnosis; Treatment Internet Journal of Medical Update ...

  12. Unusual migration of ventriculo peritoneal distal catheter into vagina

    Directory of Open Access Journals (Sweden)

    Sghavamedin Tavallaee

    2015-04-01

    Full Text Available VP shunt is one of the most popular methods for ICP reduction and treatment of hydrocephalus. Various complications of this method are not uncommon such as shunt malfunction, infection and unusual migration of distal catheter. I present a case of migration of the peritoneal catheter out of the vagina.

  13. Endoprosthetic replacement of distal femoral tumors in Nigeria: A ...

    African Journals Online (AJOL)

    2015-08-12

    Aug 12, 2015 ... In this observational study, three consecutive patients who were treated for distal femur tumours using endoprosthetic replacement between June 2013 and June 2014 were studied. The patients were within the ages of 28-47 years at the time of surgery. All three patients had modular endoprosthesis ...

  14. Subtrochanteric and Distal Femur Fractures in a Patient with ...

    African Journals Online (AJOL)

    There was an improvement of the preinjury function attributed to the osteotomy of the femoral diaphyseal, which alleviated the anterior thigh discomfort. Keywords: Amputation, Distal femur fracture, Femoral shaft fracture, Femur, Femur fractures, Fracture fixation, Fracture malunion, Fractures, Intramedullary nail, Knee ...

  15. Class II correction prior to orthodontics with the carriere distalizer.

    Science.gov (United States)

    McFarlane, Bruce

    2013-01-01

    Class II correction is a challenge in orthodontics with many existing devices being complex, too compliance-driven, or too prone to breakage. The Carriere Distalizer allows for straightforward Class II correction prior to orthodontics (fixed or clear aligners) at a time when no other mechanics interfere, and compliance is at its best.

  16. An electro-myographic study of the distal porcine ureter

    NARCIS (Netherlands)

    Roshani, H.; Dabhoiwala, N. F.; Dijkhuis, T.; Ongerboer de Visser, B. W.; Kurth, K. H.; Lamers, W. H.

    2000-01-01

    PURPOSE: The accumulation of urine in the renal pelvis causes depolarisation of non-specific muscular pace-maker cells. The wave of depolarisation spreads distally in the ureteric smooth muscle cells via gap junctions. This wave of excitation causes a coordinated peristaltic contraction which

  17. Outcome of management of distal radius fractures in ...

    African Journals Online (AJOL)

    Background and Purpose: Distal radial fractures are common fractures of postmenopausal age group patients. They are often called fractures of osteoporosis. These fractures are considered to be one of the commonest minor injuries to cause major morbidity in the community. A lot of patient who need surgery, fail to afford ...

  18. Genetics Home Reference: CAV3-related distal myopathy

    Science.gov (United States)

    ... gene causes a peculiar form of distal myopathy. Neurology. 2002 Jan 22;58(2):323-5. Erratum in: Neurology 2002 Mar 12;58(5):839. Itoyoma Y [ ... 3 cause four distinct autosomal dominant muscle diseases. Neurology. 2004 Feb 24;62(4):538-43. Review. ...

  19. Spontaneous resolution of splenic infarcts after distal splenorenal ...

    African Journals Online (AJOL)

    Background: In cases of portal hypertension with splenic infarcts, splenectomy with proximal splenorenal shunt has been recommended. We are sharing our experience with distal splenorenal shunt in these cases contrary to the popular belief. Materials and Methods: Splenic infarcts were graded as mild, moderate and ...

  20. Local repair of distal thoracal aortic dissections (Locus minoris resistencia).

    Science.gov (United States)

    Belov, Iu V; Komarov, R N; Stepanenko, A B; Gens, A P; Charchian, E R

    2007-01-01

    The paper presents the method of local repair of distal aortic dissections. Local aortic grafting for surgical correction of type B dissecting aortic aneurysms helped to decrease hospital mortality up to 15.4%, the rate of paraparesis and multiorgan failure - up to 11.5%.

  1. Evaluation of the Jones jig appliance for distal molar movement.

    Science.gov (United States)

    Brickman, C D; Sinha, P K; Nanda, R S

    2000-11-01

    The purpose of this study was to determine the effects of the Jones jig appliance on distal movement of maxillary molars and reciprocal effects on premolars and maxillary incisors. Cephalometric radiographs before and after orthodontic treatment of 72 consecutively treated patients, 46 females and 26 males, were measured to define treatment changes attributed to the Jones jig. Comparative measurements were made on a matched sample of 35 patients (20 females and 15 males) treated with cervical headgear by the same clinician. Both series of patients were treated to correct an Angle Class II molar relationship. The molar correction in the Jones jig patients consisted primarily of molar distal movement. Dental, soft tissue, and skeletal changes were evaluated and compared for significant differences between techniques. The results from the Jones jig sample showed the mean maxillary first molar distal movement was 2.51 mm, with distal tipping of 7.53 degrees. The mean reciprocal mesial movement of the maxillary premolar was 2.0 mm, with mesial tipping of 4.76 degrees. The maxillary first molar extruded 0.14 mm; the maxillary premolar extruded 1.88 mm. The maxillary second molars were also moved distally 2.02 mm and tipped distally 7.89 degrees. The longitudinal assessment (initial to completion of orthodontic treatment) showed significant differences between the Jones jig sample and the cervical headgear sample for lower lip to E-line and SNA. The Jones jig sample showed a mean decrease in lower lip to E-line of 0.25 mm versus 1.20 mm (P jig sample versus 1.20 degrees (P jig sample and cervical headgear sample did not show significant differences of the final position in either linear or angular measurements of the maxillary first molars and corresponding premolar-incisor anchor units. The Jones jig appliance demonstrated treatment results comparable with those of the sample treated with cervical headgear. The Jones jig sample demonstrated effective distal molar

  2. VOLAR LOCKING PLATE OSTEOSYNTHESIS IN DISTAL END RADIUS FRACTURES

    Directory of Open Access Journals (Sweden)

    Gyan Ranjan

    2017-07-01

    Full Text Available BACKGROUND Distal end Radius fractures account for about 20% of all the fracture treated in emergency department of Kosi & Seemanhcal area in Bihar. The majority of osteoporotic fractures occur as a result of fall from standing height on outstretched hand while in young patients, distal end radius fractures are seen secondary to RTA & sports activities. We conducted a study of a small group to evaluate the functional outcome of ORIF & volar locking plate fixation done for distal end radius fractures after one year. MATERIALS AND METHODS Records of 19 men and 41 women aged 17 to 78 years who underwent volar locking plate fixation for distal radial fractures were reviewed. According to AO-Classification of Distal End Radius fractures. 2 Patients had A2 Type of fracture, 3 had A3 Type, both B2 & B3 had 4 cases each, 15 of C1 Type, 21 of C2 type and 11 0f C3 Type. Functional outcome was assessed by using “Demerit point rating system” of Gartland & Werley. In all the patients at their final follow-up visit at 12 months. RESULTS Out of all these 60 patients, 9 cases had 10 complications, 2 cases developed Grade (I Arthritis, 2 cases developed Grade (II arthritis, 1 case developed superficial skin infection with medium nerve compression symptoms, 2 cases developed superficial skin infection which was resolved by continuous dressing on alternate days & 5 cases developed median nerve compression symptoms in which for 2 cases symptoms resolved with time, in rest 3 cases carpal Tunnel Decompression was done. Overall 63.3% result were excellent, 23.3% were good & 13.3% fair outcomes. The residual deformity was 0.70 the subjective score was 1.47 the objective score was 1.70, the total demerit score was as per modification Garland & Werley scoring groups (Mean values was 3.67. In all the cases, stainless steel plate was used. CONCLUSION In distal end radius fractures open reduction and internal fixation with volar locking compression plate followed by

  3. La Hipótesis de la Profecia Autocumplida en la Evaluación de la Evidencia en el Contexto de la Gestión Continuada

    Directory of Open Access Journals (Sweden)

    Andrés Guiral Contreras

    2008-06-01

    Full Text Available Este estudio analiza si el valor otorgado a la evidencia a favor y en contra de la hipótesis de gestión continuada, se ve afectada por las percepciones que los auditores tienen sobre la validez de la hipótesis de la profecía autocumplida. Hemos realizado un experimento en el que una muestra de auditores debe someter a estudio la continuidad de una hipotética empresa, basándose tanto en información financiera como en determinada evidencia tanto a favor como en contra de la continuidad de ésta. Los resultados obtenidos sugieren que los auditores que muestran una fuerte creencia en la validez de la hipótesis de la profecía autocumplida otorgan mayor valor probatorio a la evidencia a favor de la hipótesis de continuidad. Por el contrario, los auditores que no muestran una fuerte creencia en la hipótesis de la profecía autocumplida otorgan un mayor valor probatorio a la evidencia en contra de la continuidad.This paper analyzes whether auditors are affected by the so called “self-fulfilling prophecy effect” (in terms of perceptions when evaluating clients’ going concern status. We designed a laboratory experiment to examine auditors’ attitude to both negative and positive evidence in the case of a fictitious financially distressed client. Our results show that those auditors more sensitive to the self-fulfilling prophecy effect offered a higher tendency to rely on the negative factors. On the other hand, those auditors less worried about the self-fulfilling prophecy effect showed a higher tendency to rely on the positive factors.

  4. Laparoscopic radical nephroureterectomy: dilemma of the distal ureter.

    Science.gov (United States)

    Steinberg, Jordan R; Matin, Surena F

    2004-03-01

    Laparoscopic nephroureterectomy has recently emerged as a safe, minimally invasive approach to upper tract urothelial cancers. The most controversial and challenging feature of laparoscopic nephroureterectomy is the management of the distal ureter. We review the most common methods of managing the distal ureter, with emphasis on contemporary oncologic outcomes, indications, advantages, and disadvantages. There are currently in excess of five different approaches to the lower ureter. These techniques often combine features of endoscopic, laparoscopic, or open management. They include open excision, a transvesical laparoscopic detachment and ligation technique, laparoscopic stapling of the distal ureter and bladder cuff, the "pluck" technique, and ureteral intussusception. Each technique has distinct advantages and disadvantages, differing not only in technical approach, but oncological principles as well. While the existing published data do not overwhelmingly support one approach over the others, the open approach remains one of the most reliable and oncologically sound procedures. The principles of surgical oncology dictate that a complete, en-bloc resection, with avoidance of tumor seeding, remains the preferred treatment of all urothelial cancers. The classical open technique of securing the distal ureter and bladder cuff achieves this principle and has withstood the test of time. Transvesical laparoscopic detachment and ligation is an oncologically valid approach in patients without bladder tumors, but is limited by technical considerations. The laparoscopic stapling technique maintains a closed system but risks leaving behind ureteral and bladder cuff segments. Both transurethral resection of the ureteral orifice (pluck) and intussusception techniques should be approached with caution, as the potential for tumor seeding exists. Additional long-term comparative outcomes are needed to solve the dilemma of the distal ureter.

  5. Distal pancreatectomy and splenectomy: a robotic or LESS approach.

    Science.gov (United States)

    Ryan, Carrie E; Ross, Sharona B; Sukharamwala, Prashant B; Sadowitz, Benjamin D; Wood, Thomas W; Rosemurgy, Alexander S

    2015-01-01

    The role and application of robotic surgery are debated, particularly given the expansion of laparoscopy, especially laparoendoscopic single-site (LESS) surgery. This cohort study was undertaken to delineate differences in outcomes between LESS and robotic distal pancreatectomy and splenectomy. With Institutional Review Board approval, patients undergoing LESS or robotic distal pancreatectomy and splenectomy from September 1, 2012, through December 31, 2014, were prospectively observed, and data were collected. The results are expressed as the median, with the mean ± SD. Thirty-four patients underwent a minimally invasive distal pancreatectomy and splenectomy: 18 with robotic and 16 with LESS surgery. The patients were similar in sex, age, and body mass index. Conversions to open surgery and estimated blood loss were similar. There were two intraoperative complications in the group that underwent the robotic approach. Time spent in the operating room was significantly longer with the robot (297 vs 254 minutes, P = .03), although operative duration (i.e., incision to closure) was not longer (225 vs 190 minutes; P = .15). Of the operations studied, 79% were undertaken for neoplastic processes. Tumor size was 3.5 cm for both approaches; R0 resections were achieved in all patients. Length of stay was similar in the two study groups (5 vs 4 days). There was one 30-day readmission after robotic surgery. Patient outcomes are similar with LESS or robotic distal pancreatectomy and splenectomy. Robotic operations require more time in the operating room. Both are safe and efficacious minimally invasive operations that follow similar oncologic principles for similar tumors, and both should be in the surgeon's armamentarium for distal pancreatectomy and splenectomy.

  6. Instrumentos para determinação do índice de evidenciação de informações contábeis

    Directory of Open Access Journals (Sweden)

    Ilse Maria Beuren

    2015-04-01

    Full Text Available Este estudo descreve as características de instrumentos citados na literatura para apuração do índice de evidenciação de informações contábeis. Pesquisa descritiva foi realizada por meio de análise documental, com abordagem qualitativa. Os resultados focalizam cinco temáticas que exprimem os cuidados necessários ao elaborar uma métrica de mensuração de evidenciação de informações contábeis: público-alvo e definição de informação coercitiva e voluntária; escolha da base de dados; extensão do instrumento de coleta de dados; fatores que interferem na métrica; e testes de confiabilidade. O estudo pode contribuir na identificação de métricas para mensurar a extensão da evidenciação de informações contábeis pelas empresas.

  7. Análise do grau de evidenciação das operações com instrumentos financeiros derivativos pelas companhias brasileiras listadas no Ibovespa

    Directory of Open Access Journals (Sweden)

    Marcelo Augusto Ambrozini

    2014-01-01

    Full Text Available La eviden cia de las operaciones con derivados se ha hecho cada vez más compleja, debido a las particularidades de esos tipos de instrumentos financieros y al ambiente altamente volátil de los mercados financieros. El objetivo de este trabajo es evaluar el grado de observancia de las orientaciones de evidencia de instrumentos financieros derivados emanadas por el CPC 40 (R1 por parte de las compañías abiertas brasileñas con acciones negociadas en la Bolsa de Valores de San Pablo. Por medio de un estudio documental d e análisis de contenido, fueron enumerados puntos para verificación en los informes contables finalizados el 31/12/2013 ,de 45 empresas brasileñas de capital abierto que operaron con derivados. En relación a los estudios recientes que se referían a esta pr oblemática, las evidencias presentadas por este estudio indican que el grado de evidencia de los instrumentos financieros derivados en las demostraciones contables de las empresas brasileñas mostró una mejora considerable después de la introducción de las normas IFRS.

  8. (1965-2002: una síntesis de las hipótesis y la evidencia

    Directory of Open Access Journals (Sweden)

    Daniela González Ollino

    2006-01-01

    Full Text Available En el análisis de las tendencias de la distribución espacial de la población y las corrientes migratorias, tres asuntos se contrastan con la evidencia producida mediante el procesamiento de los microdatos de los tres últimos censos chilenos de población y vivienda (1982, 1992 y 2002. El primero atañe a la concentración de la población chilena en el Área Metropolitana del Gran Santiago (amgs y en la región político administrativa que la contiene (Región Metropolitana o rm; dos hipótesis en pugna se confrontan con los datos: la que sugiere la prevalencia del atractivo migratorio del amgs y la rm, como resultado de su capacidad para seguir liderando el dinamismo económico, y la que plantea un cambio de orientación de los flujos, tras lo cual quedarían el amgs y la rm con saldos negativos por la pérdida que tendrían en el intercambio con las regiones más dinámicas, que serían aquellas mejor ubicadas en la globalización productiva. Los datos sugieren  que efectivamente en la segunda mitad del decenio de 1990 la Región Metropolitana y el amgs mostraron la novedosa condición de zonas de emigración neta, pero que paradójicamente esto no alcanza para revertir el incremento de la concentración de la población nacional en ellas por el efecto combinado de un crecimiento natural sobre la media y una fuerte absorción de inmigrantes internacionales. El segundo asunto refiere a los procesos de convergencia regional y al papel de la migración en ellos, respecto del cual hay varias hipótesis, tanto sobre la existencia de tal proceso en las diferentes dimensiones socioeconómicas, como sobre el efecto de los flujos de migración interna en él.El impacto de la migración sobre los niveles de escolaridad regional se evalúa usando procedimientos novedosos que operan con microdatos censales –y que se presentan para su discusión–; los resultados indican que en los dos últimos periodos censales la migración entre regiones ha

  9. Tratamientos basados en la evidencia para adolescentes con trastornos por consumo de cannabis en el Sistema Público de Salud

    Directory of Open Access Journals (Sweden)

    Sergio Fernández Artamendi

    2014-01-01

    Full Text Available El objetivo de este estudio era describir la implementación de dos programas basados en la evidencia (PBE para adolescentes con trastornos por consumo de cannabis en el Sistema Público de Salud, y sus principales resultados. La Aproximación de Reforzamiento Comunitario para Adolescentes (A-CRA y el Control de Contingencias (MC fueron elegidos como los programas de intervención más eficaces para esta población. Un total de 26 adolescentes participaron en el estudio (91,7% chicos; edad media = 16,5 años en dos centros de carácter ambulatorio en España. Se utilizó un diseño cuasi-experimental, donde un grupo recibió A-CRA y el otro A-CRA+MC. La implementación de ambos programas resultó factible, con resultados clínicos positivos. El A-CRA ofreció buenas tasas de retención (81,3% y abstinencia (68,6%. Los resultados del grupo A-CRA+MC no fueron significativamente mejores que los del A-CRA en retención (100% o abstinencia (75,5%, aunque el limitado tamaño muestral no permite establecer conclusiones firmes. Los problemas asociados al cannabis y la sintomatología depresiva se redujeron durante el tratamiento. Varias limitaciones nos impiden determinar la eficacia clínica del A-CRA en este estudio. El proceso de traslación de los PBE al contexto clínico presentó múltiples dificultades que deben ser abordadas. Se discuten recomendaciones para futuros intentos de implementación de PBE en estos contextos.

  10. Sistemas de comunicación wifi y efectos sobre la salud. El estado de las evidencias actuales

    Directory of Open Access Journals (Sweden)

    Francisco Vargas Marcos

    2012-08-01

    Full Text Available En algunos medios de comunicación se ha informado sobre supuestos riesgos para la salud, especialmente en el ámbito escolar, derivados de la exposición a las radiofrecuencias (RF emitidas por los sistemas de telecomunicación inalámbricos (wifi, en su abreviatura en inglés. Estas noticias han generado demandas de información que las autoridades sanitarias competentes en salud ambiental deben responder de forma transparente, clara, eficaz y basada en el conocimiento científico actual. En este trabajo se describen las principales características técnicas de estos sistemas, las normas que regulan su funcionamiento, los niveles de emisión autorizados y los niveles observados en algunos estudios específicos.Hasta el momento se han realizado muy pocos trabajos específicos de los efectos sobre la salud derivados de la exposición a las RF que emiten estos sistemas. En este trabajo se describen las principales evaluaciones de riesgo y los estudios más relevantes publicados por agencias internacionales especializadas de reconocido prestigio. Se detalla el estado actual del conocimiento sobre los efectos de las RF sobre la salud y las recomendaciones internacionales formuladas sobre la seguridad de estas tecnologías.Se concluye que no hay evidencia consistente hasta la fecha de que la exposición a señales de radiofrecuencia procedentes de wifi, por debajo de los niveles aceptados internacionalmente, tengan efectos adversos para la salud de la población general. No hay razones que justifiquen que los sistemas wifi deban ser retirados de las escuelas o que no deban ser utilizados por otros grupos de la población.

  11. Evidencia científica y recomendaciones sobre cribado de agudeza visual. Revisión bibliográfica

    Directory of Open Access Journals (Sweden)

    Eva María López Andújar

    2012-01-01

    Full Text Available Fundamentos: En los ámbitos científico e institucional existe controversia sobre cuándo recomendar la práctica del cribado visual en la población. El objetivo de este trabajo es valorar el nivel de evidencia científica que existe sobre el cribado visual para determinar si las recomendaciones existentes son o no adecuadas. Métodos: Revisión sistemática de artículos científicos consultando las bases de datos MedLine y The Cochranre Library Plus, sin restricción de fecha, en los idiomas español e inglés. Se incluyó literatura gris mediante búsqueda manual. No se hicieron restricciones respecto al tipo de estudio. Se revisaron los abstracts y en los casos necesarios los artículos completos, teniéndose en cuenta finalmente todos los artículos que incluían recomendaciones sobre cribado de agudeza visual y eliminando el resto. Resultados: Se seleccionaron 6 artículos. La mayoría de las recomendaciones realizadas por las sociedades fueron a través de guías de práctica clínica o artículos de opinión. Respecto a los diseños de los artículos científicos localizados hubo 2 ensayos aleatorios controlados, 3 ensayos no controlados y 1 estudio transversal. Conclusiones: Los estudios sobre adultos no permiten determinar que las recomendaciones realizadas por las sociedades científicas tengan una base científica sólida. En el caso de los niños, los estudios y las sociedades científicas no aclaran cuál es la edad más idónea para realizar cribado visual.

  12. Setscrew distal locking for intramedullary nails: a biomechanical study.

    Science.gov (United States)

    Köse, N; Günal, I; Wang, X; Athanasiou, K A; Agrawal, C M; Mabrey, J D

    2000-08-01

    This biomechanical study was undertaken to examine the effectiveness of setscrew distal locking in a static intramedullary (IM) femoral nail on the stability of fixation of femoral shaft fractures. Fifteen fresh-frozen cadeveric femora were randomly separated into three groups of five bones and transversely sectioned immediately distal to the isthmus. After the insertion of the large-diameter nails, distal locking was obtained by conventional method in the first group. In the second group, set-screw design was used in which two transverse screws penetrated only the lateral cortex of the femur and compressed the nail in the intramedullary canal. No distal locking was used in the third group. All instrumented femurs were mounted on a servohydraulic testing machine and tested in both rotations (20 degrees) and axial compression (amplitude: 1,000 Newton). Loading-versus-displacement data, acquired at a ten-Hertz sampling rate, were calibrated and used to calculate maximum torque, stiffness, and energy capacity to failure. Maximum displacement and axial stiffness also were determined. Mean maximum torque at 10 degrees for each group were 15.3+/-4.8 newton-meters for the interlocking group, 8.5 +/-1.2 newton-meters for the setscrew group, and 3.6+/-2.7 newton-meters for the nonlocked femora. At 20 degrees of rotational displacement, the torque measured 37.4+/-2.6 newton-meters; 15.0+/-4.0 newton-meters; and 5.3+/-3.1 newton-meters, respectively (p 0.05). The setscrew design provided 87 percent of the torsional rigidity of the interlocking group. In the axial compression test, mean maximum shortening was 1.1+/-0.3 millimeters in the interlocking group and 1.4+/-0.6 millimeters in the setscrew group (p > 0.05). The mean stiffness on longitudinal compression provided by the interlocking screws and the setscrews was 918 and 860 newton-meters per millimeter, respectively. The distal setscrew design provides adequate distal fixation of intramedullary nail for patients in the

  13. Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures

    Directory of Open Access Journals (Sweden)

    Ata C. Atalar

    2017-01-01

    Conclusion: Our study showed that both plating systems had similar biomechanical stabilities when anatomic plates with distal locking screws were used in intraarticular distal humerus fractures in artificial humerus models.

  14. Multicentre prospective evaluation of implant-assisted mandibular bilateral distal extension removable partial dentures: patient satisfaction

    NARCIS (Netherlands)

    Wismeijer, D.; Tawse-Smith, A.; Payne, A.G.T.

    2013-01-01

    Objective To compare the levels of patient satisfaction with either conventional mandibular bilateral distal extension partial dentures or those assisted by bilateral distal implants. Materials and methods Forty-eight participants who were dissatisfied with their existing conventional mandibular

  15. Minimally invasive versus open distal pancreatectomy (LEOPARD) : Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    de Rooij, Thijs; van Hilst, Jony; Vogel, Jantien A.; van Santvoort, Hjalmar C.; de Boer, Marieke T.; Boerma, Djamila; van den Boezem, Peter B.; Bonsing, Bert A.; Bosscha, Koop; Coene, Peter-Paul; Daams, Freek; van Dam, Ronald M.; Dijkgraaf, Marcel G.; van Eijck, Casper H.; Festen, Sebastiaan; Gerhards, Michael F.; Koerkamp, Bas Groot; Hagendoorn, Jeroen; van der Harst, Erwin; de Hingh, Ignace H.; Dejong, Cees H.; Kazemier, Geert; Klaase, Joost; de Kleine, Ruben H.; van Laarhoven, Cornelis J.; Lips, Daan J.; Luyer, Misha D.; Molenaar, I. Quintus; Nieuwenhuijs, Vincent B.; Patijn, Gijs A.; Roos, Daphne; Scheepers, Joris J.; van der Schelling, George P.; Steenvoorde, Pascal; Swijnenburg, Rutger-Jan; Wijsman, Jan H.; Abu Hilal, Moh'd; Busch, Olivier R.; Besselink, Marc G.

    2017-01-01

    Background: Observational cohort studies have suggested that minimally invasive distal pancreatectomy (MIDP) is associated with better short-term outcomes compared with open distal pancreatectomy (ODP), such as less intraoperative blood loss, lower morbidity, shorter length of hospital stay, and

  16. Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching.

    Science.gov (United States)

    Nakamura, Masafumi; Wakabayashi, Go; Miyasaka, Yoshihiro; Tanaka, Masao; Morikawa, Takanori; Unno, Michiaki; Tajima, Hiroshi; Kumamoto, Yusuke; Satoi, Sohei; Kwon, Masanori; Toyama, Hirochika; Ku, Yonson; Yoshitomi, Hideyuki; Nara, Satoshi; Shimada, Kazuaki; Yokoyama, Takahide; Miyagawa, Shinichi; Toyama, Yoichi; Yanaga, Katsuhiko; Fujii, Tsutomu; Kodera, Yasuhiro; Tomiyama, Yasuyuki; Miyata, Hiroaki; Takahara, Takeshi; Beppu, Toru; Yamaue, Hiroki; Miyazaki, Masaru; Takada, Tadahiro

    2015-10-01

    Laparoscopic distal pancreatectomy has been shown to be associated with favorable postoperative outcomes using meta-analysis. However, there have been no randomized controlled studies yet. This study aimed to compare laparoscopic and open distal pancreatectomy using propensity score-matching. We retrospectively collected perioperative data of 2,266 patients who underwent distal pancreatectomy in 69 institutes from 2006-2013 in Japan. Among them, 2,010 patients were enrolled in this study and divided into two groups, laparoscopic distal pancreatectomy and open distal pancreatectomy. Perioperative outcomes were compared between the groups using unmatched and propensity matched analysis. After propensity score-matching, laparoscopic distal pancreatectomy was associated with favorable perioperative outcomes compared with open distal pancreatectomy, including higher rate of preservation of spleen and splenic vessels (P pancreatectomy was associated with more favorable perioperative outcomes than open distal pancreatectomy. © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  17. Plate fixation and bone grafting of distal clavicle nonunions: radiologic and functional outcomes

    NARCIS (Netherlands)

    Villa, Jordan C.; van der List, Jelle P.; Gausden, Elizabeth B.; Lorich, Dean G.; Helfet, David L.; Kloen, Peter; Wellman, David S.

    2016-01-01

    The optimal treatment for distal clavicle nonunions remains unknown. Small series have reported outcomes following distal fragment excision and various fixation techniques. We present the clinical, radiographic and functional outcomes after superior plating or double (superior and anteroinferior)

  18. La contribución de la Evidencia Cualitativa al campo del cuidado y la salud comunitaria The contribution of qualitative evidence to care and community health

    Directory of Open Access Journals (Sweden)

    Carmen de la Cuesta Benjumea

    2005-11-01

    Full Text Available Para mostrar la contribución de la evidencia cualitativa a la práctica de la enfermería y la salud comunitaria, se hace necesario primero examinar lo que es evidencia y cual es la relación que hay entre la investigación y la práctica. En este artículo argumento que la evidencia es necesariamente plural, que no se produce en un vacío social o histórico y que para valorar su uso se deben examinar los presupuestos y las expectativas que hay sobre la contribución de la investigación a la práctica. Al valorar su impacto éste se debe contextualizar. La investigación cualitativa está encaminada hacia la producción de un conocimiento válido y relevante y no a la solución de problemas prácticos; produce evidencia cuya relevancia es más bien general y no específica, por tanto su impacto es indirecto. Los criterios de evaluación del movimiento de la práctica basada en la evidencia se han de ampliar y se han de cuestionar los intentos de jerarquizar las evidencias con parámetros exclusivamente positivistas; el trabajo cualitativo es interpretativo y subjetivo y por ello se resiste a una jerarquización en niveles. Respecto a su uso las responsabilidades son compartidas. Mientras que la responsabilidad de los investigadores es hacer que la evidencia sea accesible, potente y evocativa, la de los lectores es valorar su ajuste y relevancia a las situaciones específicas. Uno de los mayores retos a los que nos enfrentamos los profesionales de la salud es al de la validación e incorporación de los hallazgos a la práctica.In order to show the contribution of qualitative evidence to nursing practice and community health, there is a need to examine first what is meant by evidence and the relationship between research and practice. This paper argues that evidence is necessarily plural and that is not produced in a social or historical vacuum. The assumptions and expectations about the contribution of research to practice need also to be

  19. Repair of chronic distal biceps brachii tendon rupture using free autogenous semitendinosus tendon.

    Science.gov (United States)

    Hang, D W; Bach, B R; Bojchuk, J

    1996-02-01

    Distal biceps brachii tendon ruptures occur much less frequently than do their proximal counterparts. Distal tendon ruptures usually are associated with considerable function deficits and may require surgical treatment. Repair of chronic distal biceps brachii ruptures are extremely unusual. A free autogenous semitendinosus tendon graft was used to reconstruct the distal biceps tendon by reattaching the graft to the radial tuberosity via a 2-incision technique in a patient with symptoms and a chronic injury.

  20. Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate: Evaluation of results and complications

    OpenAIRE

    Lakhotia, Devendra; Sharma, Gaurav; Khatri, Kavin; Kumar, G.N. Kiran; Sharma, Vijay; Farooque, Kamran

    2016-01-01

    Purpose Soft tissue healing is of paramount importance in distal tibial fractures for a successful outcome. There is an increasing trend of using anterolateral plate due to an adequate soft tissue cover on anterolateral distal tibia. The aim of this study was to evaluate the results and complications of minimally invasive anterolateral locking plate in distal tibial fractures. Methods This is a retrospective study of 42 patients with distal tibial fractures treated with minimally invasive ant...

  1. Retrograde nailing for distal femur fractures in the elderly

    Directory of Open Access Journals (Sweden)

    Giddie Jasdeep

    2015-01-01

    Full Text Available Introduction: We report the results of treating a series of 56 fractures in 54 elderly patients with a distal femur fracture with a retrograde femoral nail. Methods: Fifty-four of the nails were inserted percutaneously with a closed reduction. After surgery all patients were allowed to weight bear as tolerated. Four fractures were supported in a temporary external splint. Results: The mean age of patients was 80.6 years (range 51–103 years, 52/54 (96% were females. There were no cases of nail related complications and no re-operations were required. One patient was lost to follow up. The 30-day mortality was 5/54 (9.3% and the one year mortality was 17/54 (31.5%. Conclusions: Distal femoral nail fixation provides a good method of fixation allowing immediate mobilisation for this group of patients.

  2. Unravelling intention: distal intentions increase the subjective sense of agency.

    Science.gov (United States)

    Vinding, Mikkel C; Pedersen, Michael N; Overgaard, Morten

    2013-09-01

    Experimental studies investigating the contribution of conscious intention to the generation of a sense of agency for one's own actions tend to rely upon a narrow definition of intention. Often it is operationalized as the conscious sensation of wanting to move right before movement. Existing results and discussion are therefore missing crucial aspects of intentions, namely intention as the conscious sensation of wanting to move in advance of the movement. In the present experiment we used an intentional binding paradigm, in which we distinguished between immediate (proximal) intention, as usually investigated, and longer standing (distal) intention. The results showed that the binding effect was significantly enhanced for distal intentions compared to proximal intentions, indicating that the former leads to stronger sense of agency. Our finding provides empirical support for a crucial distinction between at least two types of intention when addressing the efficacy of conscious intentions. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Pendulum Therapy of Molar Distalization in Mixed Dentition.

    Science.gov (United States)

    Patil, Raju Umaji; Prakash, Amit; Agarwal, Anshu

    2016-01-01

    Early and timely pedo-orthodontic treatment is aimed at eliminating the disturbances of skeletal or dentoalveolar development, to harmonize the stomatognathic system before the full eruption of all permanent teeth. The advantages of pendulum appliance are its minimal dependence on patient's compliance (child cooperation), ease of fabrication, onetime activation and adjustment of the springs if necessary to correct minor transverse and vertical molar positions. This article reports a successful treatment method of class II malocclusion with pendulum appliance in mixed dentition phase. Distalization of maxillary molar was done, followed by guidance of canine impaction orthodontically and other dental correction using 0.022 MBT appliances. Posttreatment results were stable and remarkable. How to cite this article: Patil RU, Prakash A, Agarwal A. Pendulum Therapy of Molar Distalization in Mixed Dentition. Int J Clin Pediatr Dent 2016;9(1):67-73.

  4. A Triplane Fracture of The Distal Femoral Epiphysis. RA Gosselin et ...

    African Journals Online (AJOL)

    user

    2005-12-02

    Dec 2, 2005 ... triplane fracture was described for the distal tibial physis, and is presumed to result from a combination of shear and rotational stresses on the incompletely fused growth plate15,16. Triplane fractures have also been described for other epiphyses: proximal tibia17, distal humerus18, distal radius19, and in ...

  5. Impact of a Nationwide Training Program in Minimally Invasive Distal Pancreatectomy (LAELAPS)

    NARCIS (Netherlands)

    de Rooij, Thijs; van Hilst, Jony; Boerma, Djamila; Bonsing, Bert A.; Daams, Freek; van Dam, Ronald M.; Dijkgraaf, Marcel G.; van Eijck, Casper H.; Festen, Sebastiaan; Gerhards, Michael F.; Koerkamp, Bas Groot; van der Harst, Erwin; de Hingh, Ignace H.; Kazemier, Geert; Klaase, Joost; de Kleine, Ruben H.; van Laarhoven, Cornelis J.; Lips, Daan J.; Luyer, Misha D.; Molenaar, I. Quintus; Patijn, Gijs A.; Roos, Daphne; Scheepers, Joris J.; van der Schelling, George P.; Steenvoorde, Pascal; Vriens, Menno R.; Wijsman, Jan H.; Gouma, Dirk J.; Busch, Olivier R.; Hilal, Mohammed Abu; Besselink, Marc G.; de Boer, Marieke T.

    2016-01-01

    Objective:To study the feasibility and impact of a nationwide training program in minimally invasive distal pancreatectomy (MIDP).Summary of Background Data:Superior outcomes of MIDP compared with open distal pancreatectomy have been reported. In the Netherlands (2005 to 2013) only 10% of distal

  6. Cost-effectiveness of laparoscopic versus open distal pancreatectomy for pancreatic cancer

    NARCIS (Netherlands)

    Gurusamy, Kurinchi Selvan; Riviere, Deniece; van Laarhoven, C. J. H.; Besselink, Marc; Abu-Hilal, Mohammed; Davidson, Brian R.; Morris, Steve

    2017-01-01

    A recent Cochrane review compared laparoscopic versus open distal pancreatectomy for people with for cancers of the body and tail of the pancreas and found that laparoscopic distal pancreatectomy may reduce the length of hospital stay. We compared the cost-effectiveness of laparoscopic distal

  7. Dual-port distal gastrectomy for the early gastric cancer

    OpenAIRE

    Kashiwagi, Hiroyuki; Kumagai, Kenta; Monma, Eiji; Nozue, Mutsumi

    2014-01-01

    Background Although recent trends in laparoscopic procedures have been toward minimizing the number of incisions, four or five ports are normally required to complete laparoscopic gastrectomy because of the complexity of this procedure. Multi-channel ports, such as the SILS port (Covidien, JAPAN), are now available and are crucial for performing single-incision laparoscopic surgery (SILS) or reduced port surgery (RPS). We carried out reduced port distal gastrectomy (RPDG) using a dual-port me...

  8. DISTAL SPLENORENAL VENOUS ANASTOMOSIS IN TREATMENT OF DIABETES MELLITUS

    Directory of Open Access Journals (Sweden)

    T. I. Shraer

    2010-01-01

    Full Text Available We studied the outcomes of the operations for distal splenorenal venous anastomosis of 134 patients with type 1 diabetes mellitus. We have noticed the significant improvement of patient’s general condition due to spasmolytic effect of glucagon, bypassed to blood circulation without coming through liver and also a stabilization of glyce- mia because of a restoration of insulin-glucagon ratio in systemic circulation. The effect of a surgery depends on a stage of microangiopathy and nephrosclerosis. 

  9. Anatomical Measurements of the Distal Clavicle in a Kenyan ...

    African Journals Online (AJOL)

    The superoinferior thickness of the distal end was measured using a vernier caliper. The mean clavicle length was 148.57±12.63mm. The left clavicle was longer (150.4mm) than the right one (146.8mm). Conoid tubercle (CT) and trapezoid tuberosity (TT) were 39.52±5.93mm and 17.96±3.42mm respectively from the lateral ...

  10. Haematoma block in reduction of distal radial fractures

    African Journals Online (AJOL)

    radiale distale déplace'e entre janvier 2000 et mars 2001 avaient la reduction de la fracture sous l'obstruction he'matome tout en utili- sant 10ml de 2% lignocaine. ' H y avait une remise importante de la douleur a la suite d'in- filtration de la lignocaine sous la région de la fracture et un soula- gement important au cours de ...

  11. FUNCTIONAL OUTCOMES AFTER DISTAL BICEPS BRACHII REPAIR: A CASE SERIES.

    Science.gov (United States)

    Redmond, Christine L; Morris, Tim; Otto, Charissa; Zerella, Tanisha; Semmler, John G; Human, Taaibos; Phadnis, Joideep; Bain, Gregory I

    2016-12-01

    To investigate outcomes after surgical repair of distal biceps tendon rupture and the influence of arm dominance on isokinetic flexion and supination results. While relatively uncommon, rupture of the distal biceps tendon can result in significant strength deficits, for which surgical repair is recommended. The purpose of this study was to assess patient reported functional outcomes and muscle performance following surgery. A sample of 23 participants (22 males, 1 female), who had previously undergone surgical repair of the distal biceps tendon, were re-examined at a minimum of one year after surgery. Biodex isokinetic elbow flexion and supination testing was performed to assess strength (as measured by peak torque) and endurance (as measured by total work and work fatigue). The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Mayo Elbow Performance Scale (MEPS) were used to assess participants' subjectively reported functional recovery. At a mean of 7.6 years after surgical repair, there were no differences between the repaired and uninvolved elbows in peak torque ( p  = 0.47) or total work ( p  = 0.60) for flexion or supination. There was also no difference in elbow flexion work fatigue ( p  = 0.22). However, there was significantly less work fatigue in supination, which was likely influenced by arm dominance, as most repairs were to the dominant arm, F (1,22)=5.67, p  = 0.03. The long-term strength of the repaired elbow was similar to the uninvolved elbow after surgery to the distal biceps tendon. Endurance of the repaired elbow was similar in flexion but greater in supination, probably influenced by arm dominance. Retrospective case series. Level 4.

  12. Squamous Cell Carcinoma of the Distal Common Bile Duct

    OpenAIRE

    Jain A; Juneja M; Naik S; Sharma S; Kapoor S; Sewkani A; Varshney S

    2005-01-01

    CONTEXT: Squamous cell carcinoma of the biliary tree is rare. Although few cases of squamous cell carcinoma of the intrahepatic bile-duct and gallbladder have been reported, until today, only four cases of squamous cell carcinoma of the extrahepatic bile duct have been reported in the literature. CASE REPORT: We present a case of squamous cell carcinoma of the distal common bile duct presenting with obstructive jaundice in a 60-year-old male which was successfully managed by a Whipple's pancr...

  13. Characterisation of osseous bodies of the distal phalanx of foals

    International Nuclear Information System (INIS)

    Kaneps, A.J.; O'Brien, T.R.; Redden, R.F.; Stover, S.M.; Pool, R.R.

    1993-01-01

    The distal phalanx and metacarpal physis of both forelimbs of 32 Thoroughbred foals 3-32 weeks of age were radiographed to identify those limbs with osseous bodies at a palmar process (PP) of the distal phalanx. Osseous bodies (ossicles) were identified radiographically in 19% of the foals. Sixteen of the 32 foals were selected for microradiographic and histological evaluation: 6 foals with radiographic evidence of ossicles and 10 foals without. Fourteen ossicles of the PP were observed radiographically. Ossicles were either a triangular bone fragment at the palmar aspect of the distal angle of the PP, or an oblong bone fragment separated from P3 by a radiolucent line extending 1-3 cm from the incisure of the PP to the solar margin. One foal had radiographic evidence of bilateral distal metacarpal physitis. Seventeen of 35 PPs examined microradiographically were considered normal, in that the dorsal and solar cortices were thin with trabecular bone orientated parallel to the cortical surfaces, and there was a depression in the dorsal cortical surface (i.e. parietal sulcus). Abnormal microradiographic findings in the other 18 PPs included a fracture line extending from the dorsal cortical surfaces and trabecular bridging of the fracture gap. The fracture line was often continuous with the parietal sulcus. Microradiographic evidence of a fracture was found in 75% of foals evaluated. Normal histological findings in 16 PPs included thin dorsal and solar cortices with trabeculae orientated parallel to the cortical surfaces, parallel-fibred dense connective tissue attachments of the deep digital flexor tendon to the solar cortical surfaces, and a neurovascular bundle associated with the parietal sulcus

  14. Transosseous-Equivalent Repair for Distal Patellar Tendon Avulsion

    OpenAIRE

    Galos, David K.; Konda, Sanjit R.; Kaplan, Daniel J.; Ryan, William E.; Alaia, Michael J.

    2016-01-01

    Extensor mechanism disruptions are relatively uncommon injuries involving injury to the quadriceps tendon, patella, or patellar tendon. Patellar tendon avulsions from the tibial tubercle in adults are rare; as such, little technical information has been written regarding surgical management of this injury in the adult. Transosseous-equivalent repairs have been described in the management of several types of tendon ruptures, including rotator cuff and distal triceps tendon ruptures, but not pr...

  15. The most preferable method for distal hypospadias surgery: TIPU Technique

    OpenAIRE

    ARSLAN, Mehmet Şerif; KÖKSAL, Ersin; YILDIZ, Turan; ÖZALP, Leyla TEKŞAN; KAYA, Cengiz

    2013-01-01

    The purpose of this study is to demonstrate the efficiency of tubularized incised-plate urethroplasty (TIPU) method and the complication rates with postoperative early periodical urethral dilatations. Hypospadias is one of the most common congenital anomaly in male genital system. Retrospectively 45 case’s records which had distal hypospadias and undergone surgery were studied in Samsun Obstetrics and Gynecology and Children’s Hospital. The ages of the patients, their meatus locations, cordi ...

  16. Hereditary distal spinal muscular atrophy with vocal cord paralysis.

    OpenAIRE

    Young, I D; Harper, P S

    1980-01-01

    A large kindred is described in which an unusual form of spinal muscular atrophy is segregating in an autosomal dominant manner. The disease presents most commonly in the teens with small muscle wasting in the hands, particularly involving median nerve musculature. Subsequently distal muscle wasting and weakness occur in the lower limbs. Vocal cord paralysis is a characteristic and potentially hazardous feature. No previous report of this condition has been found.

  17. Epidemiology of distal forearm fractures in Oslo, Norway.

    Science.gov (United States)

    Lofthus, C M; Frihagen, F; Meyer, H E; Nordsletten, L; Melhuus, K; Falch, J A

    2008-06-01

    The population of Oslo has the highest incidence of hip fracture reported. The present study shows that the overall incidence of distal forearm fractures in Oslo is higher than in other countries and has not changed significantly when comparing the incidence of 1998/99 with 1979. The population of Oslo has the highest incidence of hip fracture reported. The present study reports the incidence of distal forearm fracture in Oslo and the fracture rates of immigrants. Patients aged > or = 20 years resident in Oslo sustaining a distal forearm fracture in a one-year period in 1998/99 were identified using electronic diagnosis registers, patient protocols, and/or X-ray registers of the clinics in Oslo. Medical records were obtained and the diagnosis verified. The age- and sex-specific incidence rates were calculated and compared with those for 1979. Data on immigrant category and country of origin of the patients were obtained. The age-adjusted fracture rates per 10,000 for the age group > or = 50 years were 109.8 and 25.4 in 1998/99 compared with 108.3 and 23.5 in 1979 for women and men, respectively (n.s.). The relative risk of fracture in Asians was 0.72 (95% CI 0.53-1.00) compared with ethnic Norwegians. The overall incidence of distal forearm fractures in Oslo is higher than in other countries and has not changed significantly when comparing the incidence of 1998/99 with 1979. Furthermore, the present data suggest that Asian immigrants in Oslo have a slightly lower fracture risk than ethnic Norwegians.

  18. A new total distal radioulnar joint prosthesis: functional outcome.

    Science.gov (United States)

    Schuurman, Arnold H; Teunis, Teun

    2010-10-01

    To present the evolution of design and the short-term functional outcome of our distal radioulnar joint (DRUJ) prosthesis. This total DRUJ prosthesis differs from others in that it consists of 2 parts and attains bony fixation by its hydroxyapatite coating. Nineteen patients received a DRUJ prosthesis after a failed Darrach procedure (n = 10), Sauvé-Kapandji procedure (n = 7), trauma (n = 1), or DRUJ synovitis (n = 1). Indications for the placement were decreased grip, decreased forearm motion, and pain due to ulnar impingement syndrome and instability of the distal ulna. Seven prostheses were removed, 5 due to loosening, 1 due to continuing pain, and 1 at the request of the patient. The 5 prostheses that loosened were an intermediate prototype no longer in use. In 12 remaining cases, range of motion, grip strength, and pinch strength were measured, and patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Pain was assessed with the visual analog scale (range, 0-10). A paired t-test was performed to assess the significance of the difference between preoperative and postoperative measurements. Statistically significant improvements were seen in forearm pronation, from an average of 79° to 88°; grip strength, from an average of 10 kg to an average of 16 kg; and visual analog scale score, decreased from a mean of 5.3 to a mean of 3.5. The distal ulna was clinically stable in all 12 patients who retained the prosthesis. The intermediate prototype had a high failure rate, 5 out of 5. The early results for the current prosthesis prototype show clinical improvement. Based on these results, we conclude that this prosthesis offers a new treatment option for ulnar instability after distal ulnar resection. Therapeutic IV. Copyright © 2010. Published by Elsevier Inc.

  19. Minimally invasive plate osteosynthesis for distal radius fractures

    Directory of Open Access Journals (Sweden)

    Xu-ming Wei

    2014-01-01

    Full Text Available Background: Fractures of distal radius are common injury in all age groups. Cast treatment with or without close reduction is a viable option. However, the results are often unsatisfactory with restricted function. The open reduction and internal fixation often results in extensive soft tissue dissection and associated high rates of infection and delayed/nonunion. The distractor/external fixator have reported good functional and anatomical results but the incidence of pin traction infection nerve injury and cosmedic deformity are high. We introduced a modified operative technique for minimally invasive plate osteosynthesis (MIPO for distal radial fracture and evaluated the functional outcomes and complications. Materials and Methods: 22 distal radial fractures (10 left, 12 right were treated using the MIPO technique and two small incisions with a palmar locking plate from August 2009 to August 2010. The wrist function was assessed according to Dienst wrist rating system, and postoperative complications were recorded. Results: According to Dienst wrist rating system, 13 patients showed excellent results, 6 cases showed good results and 3 patients had moderate results. No patient had poor results. Thus, the excellent and good rate was 86.4%. One patient had anesthesia in the thenar eminence and this symptom disappeared after 3 months. One patient had delayed healing in the proximal wrist crease. Two patients had mild pain on the ulnar side of the wrist and two patients had limited wrist joint function. Conclusion: The MIPO technique by using two small palmar incisions is safe and effective for treatment of distal radial fractures.

  20. External jig in the placement of distal interlocking screws | Ikem ...

    African Journals Online (AJOL)

    Retrograde (52.2%) was the commonest surgical approach used for femur. The main indication for SIGN interlocking surgery was recent fracture 77.8%. Open reduction 97.8% was the commonest method of reduction used. The mean±SD bone union time was 3.58±0.56 months and range 3-5 months. Distal screw insertion ...

  1. Equine distal limb wounds: new and emerging treatments.

    Science.gov (United States)

    Alford, Christopher G; Caldwell, Fred J; Hanson, Reid

    2012-07-01

    Distal limb wounds occur commonly in horses, and treatment can be frustrating for owners and veterinarians. Caring for these wounds is often very expensive, labor intensive, and prolonged. Many commercial products and clinical techniques have been developed to help treat these wounds. Healing of these wounds depends on many factors. With proper wound evaluation and treatment, affected horses can return to function sooner than in the past.

  2. [Stress fractures of the distal fibula in an osteoporotic woman].

    Science.gov (United States)

    Schwartz, Frederik; Heerfordt, Ida Marie

    2014-08-04

    We report a case of an 81-year-old osteoporotic woman, who suffered stress fractures of the distal fibula on both sides within a two-year period. The risk factors for stress fractures are reviewed and the importance of a high index of suspicion for stress fractures is emphasized. When a stress fracture is suspected it should lead to plain radiography and treatment with protected weight-bearing with crutches or a brace.

  3. Analysis of preoperative antibiotic prophylaxis in stented, distal hypospadias repair.

    Science.gov (United States)

    Smith, Jacob; Patel, Ashay; Zamilpa, Ismael; Bai, Shasha; Alliston, Jeffrey; Canon, Stephen

    2017-04-01

    Surgical site infection [SSI] is a risk for any surgical procedure, including hypospadias repair. Prophylactic antibiotic therapy for patients having surgery is often effective in preventing SSIs, but with increasing rates of antibiotic resistance, this practice has been questioned. The objectives of this study are 1) to assess the incidence of SSIs in patients following stented, distal hypospadias repair and 2) to observe for any potential difference in the incidence of SSIs for patients with and without preoperative antibiotic utilization in this setting. We retrospectively reviewed consecutive patients treated with stented, distal hypospadias repair from 2011 to 2014 by three surgeons and compared two groups: patients who received preoperative antibiotics and patients who did not. Patients with a history of previous hypospadias repair were excluded from the study. Two hundred twenty-four subjects were identified. Group 1 (135) received preoperative antibiotic and Group 2 (89) did not receive preoperative antibiotics. There was no statistically significant difference in SSI prevalence with 0 patients in Group 1 and 1 patient in Group 2 having a SSI. Although prophylactic antibiotics prior to hypospadias repair are most often used by pediatric urologists, this study demonstrates further evidence that antibiotics prior to this procedure do not appear to lower the rate of SSI. This study is limited by its retrospective nature and disparate mean follow up in the two cohorts. Surgical site infection does not appear to be decreased by prophylactic antibiotic therapy before distal hypospadias repair.

  4. Distal biceps brachii tendon anatomy revisited from a surgical perspective.

    Science.gov (United States)

    Fogg, Quentin A; Hess, Benjamin R; Rodgers, K Gary; Ashwood, Neil

    2009-04-01

    The distal biceps brachii tendon is commonly susceptible to traumatic injury. This study aimed to describe the morphology of the distal biceps brachii tendon in relation to the commonly used endobutton repair of tendon rupture. The results suggested that the distal tendon is a series of distinct bands of variable number. These bands are obscured surgically by the tendon sheath. Upon opening this sheath, blunt dissection of the tendon released fibrous connections between the tendon bands. Adjacent bands were variably connected via small oblique bands. The separations between bands were continuous onto the radius. They were therefore considered as separate force-conducting units. This notion is of high relevance to endobutton repairs, as the sutures are typically only passed through the margins of the tendon. Where few connections exist between tendinous bands, this represents a potential weakness, as central bands are therefore free to be pulled proximally. This is of primary concern in the early rehabilitative stages of postoperative care. It may be suggested that sutures that cross the width of the tendon will eliminate the give of central bands, improving postoperative results, reducing revision numbers, and potentially reducing rehabilitation time. (c) 2009 Wiley-Liss, Inc.

  5. Laparoscopic distal pancreatectomy for adenocarcinoma of the pancreas

    Science.gov (United States)

    Björnsson, Bergthor; Sandström, Per

    2014-01-01

    Since the first report on laparoscopic distal pancreatectomy (LDP) appeared in the 1990s, the procedure has been performed increasingly frequently to treat both benign and malignant lesions of the pancreas. Many earlier publications have shown LDP to be a good alternative to open distal pancreatectomy for benign lesions, although this has never been studied in a prospective, randomized manner. The evidence for the use of LDP to treat adenocarcinoma of the pancreas is not as well established. The purpose of this review is to evaluate the current evidence for LDP in cases of pancreatic adenocarcinoma. We conducted a review of English language publications reporting LDP results between 1990 and 2013. All studies reporting results in patients with histologically proven pancreatic adenocarcinoma were included. Thirty-nine publications were found and included in the results for a total of 309 cases of pancreatic adenocarcinoma (potential double publications were not eliminated). Most LDP procedures are performed in selected cases and generally involve smaller tumors than open distal pancreatectomy (ODP) procedures. Some of the papers report unselected cases and include procedures on larger tumors. The number of lymph nodes harvested using LDP is comparable to the number obtained with ODP, as is the frequency of R0 resections. Current data suggest that similar short term oncological results can be obtained using LDP as those obtained using ODP. PMID:25309072

  6. Importance of early audiologic assessment in distal renal tubular acidosis

    Directory of Open Access Journals (Sweden)

    Elizabeth Norgett

    2010-12-01

    Full Text Available Anand P Swayamprakasam1, Elizabeth Stover1, Elizabeth Norgett1, Katherine G Blake-Palmer1, Michael J Cunningham2, Fiona E Karet11Department of Medical Genetics, Cambridge Institute for Medical Research, Cambridge, UK; 2Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USAAbstract: Autosomal recessive distal renal tubular acidosis is usually a severe disease of childhood, often presenting as failure to thrive in infancy. It is often, but not always, accompanied by sensorineural hearing loss, the clinical severity and age of onset of which may be different from the other clinical features. Mutations in either ATP6V1B1 or ATP6V0A4 are the chief causes of primary distal renal tubular acidosis with or without hearing loss, although the loss is often milder in the latter. We describe a kindred with compound heterozygous alterations in ATP6V0A4, where hearing loss was formally diagnosed late in both siblings such that they missed early opportunities for hearing support. This kindred highlights the importance of routine audiologic assessments of all children with distal renal tubular acidosis, irrespective either of age at diagnosis or of which gene is mutated. In addition, when diagnostic genetic testing is undertaken, both genes should be screened irrespective of current hearing status. A strategy for this is outlined.Keywords: sensorineural hearing loss, renal tubular acidosis, recessive, genetics, mutation

  7. Distal femoral complications following antegrade intramedullary nail placement

    Directory of Open Access Journals (Sweden)

    Amanda J. Fantry

    2015-03-01

    Full Text Available While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series reviews complications affecting the distal femur after intramedullary nailing including fracture surrounding a distal femoral interlocking screw (Case #1, nonunion after dynamization with nail penetration into the knee joint (Case #2, and anterior cortical perforation (Case #3. Prevention of intraoperative and postoperative complications surrounding intramedullary nailing requires careful study of the femoral anatomy and nail design specifications (radius of curvature, consideration of the necessity of distal interlocking screws, the need for close radiographic follow-up after nail placement with X-rays of the entire length of the nail, and awareness of possible nail penetration into the knee joint after dynamization.

  8. Distal histidine conformational flexibility in dehaloperoxidase from Amphitrite ornata.

    Science.gov (United States)

    Chen, Zuxu; de Serrano, Vesna; Betts, Laurie; Franzen, Stefan

    2009-01-01

    The enzyme dehaloperoxidase (DHP) from the terebellid polychaete Amphitrite ornata is a heme protein which has a globin fold but can function as both a hemoglobin and a peroxidase. As a peroxidase, DHP is capable of converting 2,4,6-trihalophenols to the corresponding 2,6-dihaloquinones in the presence of hydrogen peroxide. As a hemoglobin, DHP cycles between the oxy and deoxy states as it reversibly binds oxygen for storage. Here, it is reported that the distal histidine, His55, exhibits conformational flexibility in the deoxy form and is consequently observed in two solvent-exposed conformations more than 9.5 A away from the heme. These conformations are analogous to the open conformation of sperm whale myoglobin. The heme iron in deoxy ferrous DHP is five-coordinate and has an out-of-plane displacement of 0.25 A from the heme plane. The observation of five-coordinate heme iron with His55 in a remote solvent-exposed conformation is consistent with the hypothesis that His55 interacts with heme iron ligands through hydrogen bonding in the closed conformation. Since His55 is also displaced by the binding of 4-iodophenol in an internal pocket, these results provide new insight into the correlation between heme iron ligation, molecular binding in the distal pocket and the conformation of the distal histidine in DHP.

  9. Distal histidine conformational flexibility in dehaloperoxidase from Amphitrite ornata

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Zuxu; de Serrano, Vesna; Betts, Laurie; Franzen, Stefan; (NCSU); (UNC)

    2009-01-28

    The enzyme dehaloperoxidase (DHP) from the terebellid polychaete Amphitrite ornata is a heme protein which has a globin fold but can function as both a hemoglobin and a peroxidase. As a peroxidase, DHP is capable of converting 2,4,6-trihalophenols to the corresponding 2,6-dihaloquinones in the presence of hydrogen peroxide. As a hemoglobin, DHP cycles between the oxy and deoxy states as it reversibly binds oxygen for storage. Here, it is reported that the distal histidine, His55, exhibits conformational flexibility in the deoxy form and is consequently observed in two solvent-exposed conformations more than 9.5 {angstrom} away from the heme. These conformations are analogous to the open conformation of sperm whale myoglobin. The heme iron in deoxy ferrous DHP is five-coordinate and has an out-of-plane displacement of 0.25 {angstrom} from the heme plane. The observation of five-coordinate heme iron with His55 in a remote solvent-exposed conformation is consistent with the hypothesis that His55 interacts with heme iron ligands through hydrogen bonding in the closed conformation. Since His55 is also displaced by the binding of 4-iodophenol in an internal pocket, these results provide new insight into the correlation between heme iron ligation, molecular binding in the distal pocket and the conformation of the distal histidine in DHP.

  10. Necessity for fibular fixation associated with distal tibia fractures.

    Science.gov (United States)

    Taylor, Benjamin C; Hartley, Brandi R; Formaini, Nathan; Bramwell, Thomas J

    2015-12-01

    Intramedullary (IM) nailing is a well-accepted treatment for distal third tibia fractures in combination with injury to the fibula. However, the indications for operative stabilisation of the fibula remain controversial. The authors performed a retrospective review on a consecutive series of patients who underwent intramedullary nailing of a non-comminuted distal third tibia fracture with or without fibular fixation at a Level I urban trauma centre. A review of surgical records identified 120 patients who initially were included in this study, while a total of 98 patients who met the inclusion criteria were included in the final analysis. Our results found no difference in the mean value of coronal and sagittal plane alignment in both the immediate post-operative and follow-up time periods. We also saw no statistically significant difference when comparing malalignment between patients treated with or without fibula fixation. There were no deep infections between the two groups. No significant differences were seen between the fibular fixation group and the non-fixation group. Distal screw removal due to prominence or pain was the most common reason for future surgery in both groups. These findings suggest that the addition of fibular fixation does not affect whether or not alignment is maintained in either the immediate post-operative or short-term follow-up period. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Manometric and hormonal changes after distal partial gastrectomy.

    Science.gov (United States)

    Yamashita, Y; Inoue, H; Ohta, K; Yoshida, K; Miyahara, E; Hirai, T; Toge, T; Adrian, T E

    2000-04-01

    Alkaline oesophagitis attributable to duodenal mechanisms may induce oesophageal carcinogenesis in a rat reflux model. To investigate the mechanism of the regurgitation after distal partial gastrectomy. Oesophageal manometry was used in 16 patients before and after distal partial gastrectomy with reconstruction by Bilroth methods. Serum concentrations of four gastrointestinal hormones were measured by radioimmunoassay in 10 gastrectomy patients and nine healthy volunteers before and after a standardized meal. The lower oesophageal sphincter pressure was reduced to 83% after surgery. The amplitude and duration of the peristaltic waves tended to be increased, and the velocity tended to be less after surgery (amplitude 120%, duration 114%, velocity 88%). Interrupted waves appeared more frequently after surgery. The manometric changes in gastrectomized patients are considered to be disadvantageous relative to regurgitation. After surgery, gastrin and pancreatic polypeptide were completely abolished postprandially, whereas cholecystokinin and neurotensin were significantly increased. The hormonal changes should have a suppressive effect on the lower oesophageal sphincter. Both the manometric and the hormonal changes may exacerbate reflux oesophagitis after distal partial gastrectomy.

  12. A novel, new robotic platform for natural orifice distal pancreatectomy.

    Science.gov (United States)

    Thakkar, Shyam; Awad, Michael; Gurram, Krishna C; Tully, Steven; Wright, Cornell; Sanan, Siddharth; Choset, Howie

    2015-06-01

    Laparoendoscopic technology has revolutionized the practice of surgery; however, surgeons have not widely accepted laparoscopic techniques for pancreatic surgeries due to the complexity of the operation. Natural orifice transluminal endoscopic surgery (NOTES) offers a great new potential for pancreatic procedures, with early data showing benefits of reduced visible scarring and the potential for decreased wound infections, hernias, pain, and postoperative complications. However, there are significant limitations to the currently used flexible endoscopy tools, including a diminished visual field, spatial orientation and tissue manipulation issues, and 2-dimensional visual feedback. We have adopted a novel snake-like robot, the minimally invasive cardiac surgery (MICS) robot, which addresses these issues. In the current pilot study, the MICS robot was evaluated for transrectal distal pancreas exploration and resection in 2 nonsurvival porcine models. Abdominal navigation and accessing the pancreas was investigated in the first pig, and based on its success, pancreas resection was studied in pig 2. The MICS robot was successful in accessing and visualizing the right upper, left upper, and left lower quadrants of the abdomen in pig 1 and was able to perform a successful complex NOTES procedure with distal pancreas resection in pig 2, with only minimal laparoscopic retraction assistance. In conclusion, preliminary results showing the MICS robot in natural orifice distal pancreatectomy are positive. Enhancements to optics and instrumentation will help further increase the usability in pancreatic interventions. Future indications may include transgastric NOTES approaches, endoluminal procedures, and single-port applications. © The Author(s) 2014.

  13. Evidencia científica de la relación entre acoso laboral y depresión

    Directory of Open Access Journals (Sweden)

    Víctor Adrián Harasemiuc

    2013-09-01

    Full Text Available Introducción: El Acoso laboral es una epidemia silenciosa que no solamente afecta a la motivación y a la productividad de los trabajadores, sino que también, afecta negativamente a su víctimas en aspectos psicosociales siendo la depresión una de sus consecuencias. Objetivos: El objetivo es identificar la evidencia científica conocida sobre la relación existente entre el acoso laboral y la depresión. Metodología: Se formularon una serie de ecuaciones de búsqueda con los términos: Mobbing, Depression, Workplace Bullying, Harassment, Depresión y Acoso Laboral, que se aplicaron a diferentes bases de datos bibliográficas (IBECS, LILACS, The Cochrane Library Plus, Scielo, WHOLIS, OSH Update, que permitió la identificación de 36 referencias de las cuales 8 cumplieron los criterios de inclusión. En función de los objetivos planteados se extrajo la información respectiva después de su revisión a texto completo. Resultados: La prevalencia de acoso laboral fluctuó entre un 11,9% y un 81% según los países en los que se realizó el estudio. Ser mujer, tener estudios universitarios y la antigüedad o experiencia en el puesto de trabajo son factores que determinaron una mayor vulnerabilidad para sufrir acoso. El perfil del acosador es: ser de sexo masculino y, generalmente, de categoría superior a la víctima; siendo el abuso verbal, el hostigamiento y el aumento de la carga laboral las estrategias de acoso más utilizadas. En todos los estudios se encontró una relación positiva entre el acoso y la depresión. Conclusiones: La revisión realizada, no permite demostrar una relación de causalidad entre el acoso y depresión. La reproducibilidad en los resultados de los estudios evidencian la existencia de una asociación entre acoso y depresión, siendo necesario el promover estudios de diseño longitudinal que puedan demostrar, o no, una asociación causal.

  14. Evidencia científica en medicina: ¿única alternativa? Scientific evidence in medicine: the only alternative?

    Directory of Open Access Journals (Sweden)

    Juan José Sarrado

    2004-06-01

    Full Text Available El presente artículo pretende reflexionar acerca del momento actual de las ciencias médicas, incorporando una discusión crítica respecto de la atomización del conocimiento que el pragmatismo de la evidencia científica puede comportar. Propone integrar las aportaciones de las metodologías cuantitativa y cualitativa de las ciencias de la salud, recurriendo a diseños cualicuantitativos que aborden la complejidad del ser humano y de sus referentes axiológicos y socioculturales. Los autores defienden y argumentan la necesidad de que la investigación en salud contemple 5 dimensiones útiles para la toma de decisiones, abordando el objeto de estudio sin prescindir del sujeto y de sus circunstancias poliédricas y complejas. La medicina ha de considerar ineludiblemente el conocimiento tecnológico y técnico, pero dicha capacitación no debe eludir las necesarias competencias relacionales y comunicacionales. La actualización cientificomédica implica un constante maridaje entre rigor técnico y mejora de vínculos entre las personas implicadas (profesionales de la salud y ciudadanía, con una actitud cuidadosa y afable. La animación comunitaria y el establecimiento paulatino de complicidades se erigen en la base de un modelo sanitario integrador, de raigambre biopsicosocial, tanto teórico como práctico.The present article aims to reflect on the current situation of medical sciences by incorporating a critical discussion of knowledge atomization, which can be a consequence of the pragmatism of scientific evidence. The article proposes to integrate the contributions of quantitative and qualitative methodologies in health sciences, paying attention to qualitative and quantitative designs that take into account the complexity of human beings and their axiological, social, and cultural referents. The authors defend and argue for the need for health research to contemplate five useful dimensions for decision-making, approaching the object of the

  15. Radiation-induced cerebrovasculopathy of the distal middle cerebral artery and distal posterior cerebral artery. Case report

    International Nuclear Information System (INIS)

    Hasegawa, Shu; Hamada, Jun-ichiro; Morioka, Motohiro; Kai, Yutaka; Hashiguchi, Akihito; Ushio, Yukitaka

    2000-01-01

    A 15-year-old girl underwent partial removal of a pituitary adenoma followed by local irradiation of the brain with a total of 70 Gy through two lateral opposing ports. Twenty years later, she experienced frequent transient ischemic attacks with left sensory disturbance. Cerebral angiography revealed stenoses of the right distal middle cerebral artery (MCA) and the right distal posterior cerebral artery without net-like vessels. There was a severe decrease of vasoreactivity in the right hemisphere. Right superficial temporal artery (STA)-MCA anastomosis was performed. Her neurological deficits were resolved and perfusion reserve capacity had markedly improved 6 months later. We recomment STA-MCA anastomosis in such cases. (author)

  16. [Results After Distal Digital Replantation - Is It Worth The Effort?

    Science.gov (United States)

    Braig, David; Thiele, Jan R; Penna, Vincenzo; Stark, G Björn; Eisenhardt, Steffen U

    2017-02-01

    There are only relative indications for distal digital replantation in zones 1 and 2 according to Tamai. In contrast to primary closure for fingertip amputations, replantation is a complex procedure that requires skills in supermicrosurgical techniques, as vessels with diameters between 0.3-0.8 mm are connected. In addition the time spent in hospital and the time off from work are longer. Distal digital replantation is thus only indicated, if the expected functional and aesthetic benefits surmount those of primary closure. We retrospectively analysed all fingertip amputations in zone 1 and 2 according to Tamai between 9/2009 and 7/2014 where we attempted distal digital replantation. The success of replantation, wound healing and functional results were evaluated according to Yamano. We performed 11 distal digital replantations in the study period. There were 6 total amputations, 4 subtotal amputations and 1 avulsion of the digital pulp. Revascularisation with long-term reattachment of the amputated tissues was possible in 8 cases (73%). In 3 cases (27%) secondary amputation closure was necessary. The mean operating time was 3 h 56 min. 6 patients, which had a successful replantation, were available for follow-up examinations after a mean period of 19 months. 5 patients were satisfied with the result and would again prefer replantation over primary amputation closure. 4 patients reported a good function of the replanted digits and did not complain about any limitations in their use. 2 patients complained about restricted function. All patients could return to their previous places of employment and were free of pain. Of the 12 affected digital nerves 11 nerves had a 2-point discrimination (2-PD) of ≤15 mm, 3 of them had a 2-PD between 7 and 10 mm and 4 of them of replanted digits and nail deformities in 2 patients. Distal digital replantation is complex and technically challenging. It leads to high patient satisfaction with only minimal functional

  17. FGF10 maintains distal lung bud epithelium and excessive signaling leads to progenitor state arrest, distalization, and goblet cell metaplasia

    Directory of Open Access Journals (Sweden)

    Kobberup Sune

    2008-01-01

    Full Text Available Abstract Background Interaction with the surrounding mesenchyme is necessary for development of endodermal organs, and Fibroblast growth factors have recently emerged as mesenchymal-expressed morphogens that direct endodermal morphogenesis. The fibroblast growth factor 10 (Fgf10 null mouse is characterized by the absence of lung bud development. Previous studies have shown that this requirement for Fgf10 is due in part to its role as a chemotactic factor during branching morphogenesis. In other endodermal organs Fgf10 also plays a role in regulating differentiation. Results Through gain-of-function analysis, we here find that FGF10 inhibits differentiation of the lung epithelium and promotes distalization of the embryonic lung. Ectopic expression of FGF10 in the lung epithelium caused impaired lung development and perinatal lethality in a transgenic mouse model. Lung lobes were enlarged due to increased interlobular distance and hyperplasia of the airway epithelium. Differentiation of bronchial and alveolar cell lineages was inhibited. The transgenic epithelium consisted predominantly of proliferating progenitor-like cells expressing Pro-surfactant protein C, TTF1, PEA3 and Clusterin similarly to immature distal tip cells. Strikingly, goblet cells developed within this arrested epithelium leading to goblet cell hyperplasia. Conclusion We conclude that FGF10 inhibits terminal differentiation in the embryonic lung and maintains the distal epithelium, and that excessive levels of FGF10 leads to metaplastic differentiation of goblet cells similar to that seen in chronic inflammatory diseases.

  18. Concave distal end of ulna metaphysis alone is not a sign of rickets

    Energy Technology Data Exchange (ETDEWEB)

    Oestreich, Alan E. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, 5031, Cincinnati, OH (United States)

    2015-07-15

    Statements have been made in the literature and in legal testimony that misrepresent the radiographic finding of concave distal end of the ulnar metaphysis. To demonstrate that a concave distal end of the ossified ulna in infancy can be normal. Eighty distal wrists of randomly selected infants in the first year of life with radiographic evidence that ruled out rickets were reviewed. In 16 of the cases (20%), mild or moderate concavity of the distal end of the ulna was seen. An intact metaphyseal collar of distal radius or ulna confirmed the absence of radiographic rickets. The finding of 20% of concave distal ulnas in the first year of life confirms the widely acknowledged statements that concave distal end of the ulna alone is not indicative of rickets. Statements to the contrary are not justified. (orig.)

  19. Medicina basada en la evidencia: Aportes a la práctica médica actual y dificultades para su implementación

    Directory of Open Access Journals (Sweden)

    Germán Málaga Rodríguez

    2009-04-01

    Full Text Available Medicina basada en la evidencia (MBE es actualmente sinónimo de práctica médica moderna e innovadora. Sin embargo, poco se sabe de su real dimensión y principios. Su relación con la investigación y la "evidencia" es entendida como la interpretación de la literatura medica, la realización de mega ensayos clínicos o meta-análisis. MBE implica el uso juicioso de la mejor evidencia disponible, gracias a la evaluación rigurosa de la calidad metodológica de la información científica, así como de su aplicabilidad. La MBE rescata la experiencia y pericia clínica del médico. Adicionalmente, incorpora como tercer elemento fundamental las preferencias y valores de los pacientes acerca del cuidado de su salud. La intersección de estos tres aspectos constituye la esencia de la MBE. La práctica así entendida de la MBE ubica al paciente y sus circunstancias en el centro mismo del acto médico y lo revaloriza como "ciencia y arte". En esta revisión buscamos destacar como la práctica de la MBE guía hacia una toma de decisiones correcta y democrática. Así mismo, se revisa los diversos aportes en la práctica medica actual, las distorsiones creadas alrededor de ella y las limitaciones para su aplicación en nuestra realidad.(Rev Med Hered 2009;20:191-197.

  20. Evidenciação ambiental dos resíduos sólidos de companhias abertas no Brasil potencialmente poluidoras

    Directory of Open Access Journals (Sweden)

    Barbara de Lima Voss

    2013-08-01

    Full Text Available Esta pesquisa tem como motivação a obrigatoriedade das empresas de apresentarem informações ambientais sobre os resíduos sólidos no ano de 2010. Parte da seguinte pergunta de pesquisa: como estão sendo evidenciadas as informações ambientais relativas aos resíduos sólidos das companhias abertas no Brasil potencialmente poluidoras no ano de 2010? Com vista a uma resolução plausível, tem-se como objetivo geral verificar a evidenciação ambiental quanto aos resíduos sólidos das companhias abertas no Brasil potencialmente poluidoras no ano de 2010. Para atingir esse objetivo, são estipulados os seguintes objetivos específicos: (i propor um modelo para identificar itens de evidenciação ambiental dos resíduos sólidos; (ii avaliar o nível da evidenciação ambiental e correlacioná-lo com variáveis financeiras. Para a análise dos dados é construído um modelo de análise da evidenciação ambiental dos resíduos sólidos (Waste-Ede, que compreende a junção das ideias contidas no modelo Environmental Disclosure Evaluation, na política nacional de resíduos sólidos (Lei Federal n. 12.305/2010 e nas diretrizes da Global Reporting Initiative (2006. Os resultados demonstram que a maioria das companhias não publicou o relatório de sustentabilidade. A amostra final não probabilística contemplou 86 companhias. Os resultados limitados a essa amostra revelam que as companhias estão evidenciando informações de resíduos sólidos no nível mercado (conforme modelo, com média de 12,44 pontos, e que há correlação significante em 95% do índice Waste-Ede com as variáveis financeiras: investimentos ambientais, ativo total, patrimônio líquido e receita bruta. Conclui-se que, no ano de 2010, as companhias abertas no Brasil potencialmente poluidoras que fizeram parte do estudo respeitaram, provavelmente, as pressões de seus investidores, uma vez que os reguladores não apresentaram poder de enforcement.

  1. Evidencia disponible sobre la eficacia de las estrategias de prevención de la depresión en atención primaria

    OpenAIRE

    Montón Franco, Carmen

    2006-01-01

    La prevención de la depresión tiene como objetivo reducir la incidencia, prevalencia y recurrencia de esta enfermedad y disminuir el impacto en las personas afectadas, su familia y la sociedad. En medicina basada en la evidencia, el ensayo controlado randomizado está ampliamente aceptado como el ¨gold Standard.Sin embargo, en prevención la investigacióndel ensayo controlado randomizado tiene sus limitaciones y podrían ser considerados otros diseños de investigación como estrategias válidas pa...

  2. Resultados adversos en la procreación en mujeres trabajadoras en la floricultura colombiana: un resumen de la evidencia mediante metanálisis

    Directory of Open Access Journals (Sweden)

    Álvaro Javier Idrovo

    2007-12-01

    Conclusiones. Los análisis sugieren que el trabajo en la floricultura se asocia con una mayor aparición de abortos espontáneos y malformaciones congénitas. Sin embargo, no hay indicios de que estos efectos estén asociados con la exposición a plaguicidas. Otros factores de riesgo que requieren posterior estudio son la actividad física y el calor dentro de los invernaderos, ambos presentes en las empresas floricultoras. La evidencia de los países que han entrado recientemente a la industria, ayudará a dilucidar esta relación.

  3. PROGRAMA ALIMENTARIO MEDITERRANEO EN CHILE (PAM-CHILE): FOMENTO DEL VINO Y OTROS PRODUCTOS ALIMENTARIOS SALUDABLES, ECONOMICAMENTE PRIORITARIOS, MEDIANTE EVIDENCIAS CIENTIFICAS

    OpenAIRE

    LEIGHTON PUGA, FEDERICO

    2008-01-01

    Las recomendaciones sobre consumo de alimentos basadas en sus propiedades saludables son un elemento clave en su comercialización, pero deben basarse en evidencias científicas para evitar abusos con los consumidores. Dichas recomendaciones pueden constituir un valor agregado significativo para muchos productos alimentarios chilenos. Este proyecto surge de la experiencia e información obtenidas en seis años de operación del Proyecto Ciencia, Vino y Salud de la Universidad Católica de Chile, qu...

  4. Evidencia científica del abordaje fisioterapéutico en espondilolistesis lumbar. Revisión bibliográfica

    OpenAIRE

    Montelongo Pérez, Javier Lionel

    2016-01-01

    [ES]El objetivo fue revisar y analizar la evidencia científica de la fisioterapia en la espondilolistesis lumbar Se realizó una búsqueda bibliográfica (últimos 10 años) y se valoró a calidad metodológica con la escala Centre for Evidence-Based Medicine, Oxford. Se analizaron 5 estudios de caso y control, 1 ECA y 1 seminario. Los tratamientos observados fueron el fortalecimiento del “core”; estiramientos, reeducación postural global; reeducación postural global, ejercicios de control motor ...

  5. Nuevas evidencias de restos de mamíferos marinos en el Magdaleniense: los datos de la Cueva de Las Caldas (Asturias, España).

    OpenAIRE

    Corchón-Rodríguez, María Soledad; Álvarez-Fernández, Esteban

    2008-01-01

    En este artículo se estudian, desde el punto de vista tecnológico, los objetos de adorno-colgantes realizados en dientes de mamíferos marinos (foca, cachalote, calderón) procedentes de los niveles del Magdaleniense medio de la Cueva de Las Caldas. También se hace una revisión de otras evidencias arqueológicas de estos animales en contextos arqueológicos y se discuten las relaciones costa-interior de los grupos de cazadores recolectores en el territorio europeo en el Paleolítico.

  6. Nuevas evidencias de restos de mamíferos marinos en el Magdaleniense: los datos de la Cueva de Las Caldas (Asturias, España.

    Directory of Open Access Journals (Sweden)

    Corchón-Rodríguez, María Soledad

    2008-01-01

    Full Text Available En este artículo se estudian, desde el punto de vista tecnológico, los objetos de adorno-colgantes realizados en dientes de mamíferos marinos (foca, cachalote, calderón procedentes de los niveles del Magdaleniense medio de la Cueva de Las Caldas. También se hace una revisión de otras evidencias arqueológicas de estos animales en contextos arqueológicos y se discuten las relaciones costa-interior de los grupos de cazadores recolectores en el territorio europeo en el Paleolítico.

  7. Evidencias sobre la efectividad de la toxina butolínica en el pie equino post-ictus: Revisión sistemática

    OpenAIRE

    Grande Cobo, Sara

    2013-01-01

    RESUMEN: INTRODUCCIÓN: La espasticidad en la extremidad inferior y la deformidad del pie en equino-varo suelen ser las manifestaciones físicas más frecuentes tras un ictus o accidente cerebrovascular (ACV). OBJETIVO: El propósito de esta revisión sistemática es evaluar la existencia de evidencia sobre la seguridad y la eficacia de la toxina botulínica como una de las posibles intervenciones para paliar estos síntomas. MATERIAL Y MÉTODOS: se realizó una búsqueda bibliográfica en...

  8. Revisión bibliográfica de la evidencia empírica de los modelos multifactoriales de valoración de activos financieros.

    Directory of Open Access Journals (Sweden)

    García Boza Juan

    2006-08-01

    Full Text Available En la literatura financiera son diversos los autores que consideran que en la valoración de activos financieros no se debe considerar una única fuente de riesgo, sino que se debe adoptar una perspectiva de riesgo multifactorial, en contra de lo argumentado por el modelo CAPM. El presente artículo revisa la evidencia empírica respecto a la aplicación de modelos multifactoriales de valoración de activos financieros, poniendo de manifiesto los principales resultados que se han obtenido.

  9. Relación entre el consumo de sacarosa y cáncer: una revisión de la evidencia

    OpenAIRE

    Javier Aranceta Bartrina; Carmen Pérez Rodrigo

    2013-01-01

    Objetivos: El objetivo de esta revisión es resumir la evidencia disponible sobre la asociación entre el consumo de azúcar, principalmente sacarosa, y el riesgo de cáncer de distinta localización. Métodos: Se ha realizado una revisión de los principales informes publicados, las revisiones sistemáticas, metanálisis, así como grandes estudios epidemiológicos prospectivos publicados con fecha posterior al 1 de enero de 2007 hasta 31 de diciembre de 2012 sobre la asociación entre el consumo de azú...

  10. Altépetl: evidencia arqueológica de una organización político territorial en la Tlaxcala prehispánica

    OpenAIRE

    García Sánchez, Magdalena Amalia

    2007-01-01

    Los estudiosos de la historia antigua de México, entre los que hay historiadores y etnohistoriadores, han dado cuenta del concepto náhuatl altépetl, que tiene connotaciones territoriales (de a: agua y tepetl: cerro) pero también sociales (poblacionales, simbólicas) en Mesoamérica. Sin embargo, no existe un puente que una los datos históricos con los geográficos y arqueológicos, por lo que hasta ahora altépetl no ha tenido evidencia material que lo confirme. Es objetivo de este trabajo present...

  11. Altépetl: evidencia arqueológica de una organización político territorial en la Tlaxcala prehispánica

    OpenAIRE

    García Sánchez, Magdalena Amalia

    2006-01-01

    Los estudiosos de la historia antigua de México, entre los que hay historiadores y etnohistoriadores, han dado cuenta del concepto náhuatl altépetl, que tiene connotaciones territoriales (de a: agua y tepetl: cerro) pero también sociales (poblacionales, simbólicas) en Mesoamérica. Sin embargo, no existe un puente que una los datos históricos con los geográficos y arqueológicos, por lo que hasta ahora altépetl no ha tenido evidencia material que lo confirme. Es objetivo de este trabajo present...

  12. Los orígenes de la producción de sal: evidencias, funciones y valor en el Neolítico europeo

    OpenAIRE

    Weller, Olivier

    2004-01-01

    A partir de un recorrido sobre los conocimientos actuales a escala europea, el autor trata sobre los orígenes de la producción de la sal durante el Neolítico y el Calcolítico, dedicando una especial atención a los diferentes tipos de evidencias (vertederos cerámicos, estructuras, carbones, útiles mineros ... ), a las técnicas de fabricación y a los sistemas de control de la producción. Una vez analizada la manera cómo estas producciones se sitúan en determinados contextos sociales, se llega a...

  13. Tratamiento del dolor en la artritis reumatoide fundamentado en medicina basada en la evidencia Pain treatment in rheumatoid arthritis and evidence-based medicine

    OpenAIRE

    F. Neira; J. L. Ortega

    2006-01-01

    El objetivo ha sido la elaboración de un documento eminentemente práctico, basado en la evidencia científica disponible de mayor relevancia, que permita a los clínicos adoptar técnicas diagnósticas y medidas terapéuticas eficaces, en la Artritis Reumatoide (AR), adecuadamente fundamentadas. Se ha realizado una búsqueda sistemática en Internet, utilizando el término "rheumatoid arthritis" y "artritis reumatoide", en los diferentes grupos de elaboración y almacenamiento de guías de práctica clí...

  14. La acondroplasia entre las poblaciones antiguas de mesoamérica y sudamérica: Evidencia iconográfica y arqueológica

    OpenAIRE

    Rodríguez, Carlos Armando; Isaza, Carolina; Pachajoa Londoño, Harry Mauricio

    2012-01-01

    Introducción: La acondroplasia es la forma más frecuente de enanismo. Los individuos presentan acortamiento rizomélico de las extremidades, facies característica con prominencia frontal, hipoplasia media de la cara, genu varo, y la mano tridente. Aunque la etiología de esta enfermedad fue reportada en 1994, evidencia de la existencia esta enfermedad se ha encontrado en poblaciones del antiguo Egipto (2500 aC) y ha sido documentada en poblaciones americanas antiguas. Objetivo: Analizar la ...

  15. Los efectos agudos de la contaminación del aire en la salud de la población: evidencias de estudios epidemiológicos

    OpenAIRE

    Rosales-Castillo José Alberto; Torres-Meza Víctor Manuel; Olaiz-Fernández Gustavo; Borja-Aburto Víctor H.

    2001-01-01

    Objetivo. Sintetizar las evidencias de los efectos en la salud de la población por la exposición a contaminación del aire por ozono y partículas suspendidas. Material y métodos. A partir de las principales publicaciones internacionales y mexicanas, publicadas y referidas hasta junio del año 2000, se realizó un metanálisis para resumir los efectos reportados a través del empleo de modelos de efectos aleatorios. Resultados. Los resultados se expresaron como porcentajes de incremento por 10 unid...

  16. Vendaje funcional versus técnicas de vendaje neuromuscular en el tratamiento del esguince del ligamento lateral externo, una comparativa basada en la evidencia de la literatura.

    OpenAIRE

    Martínez Montejo, Verónica

    2014-01-01

    El esguince de tobillo es una de las lesiones musculoesqueléticas más frecuentes, sobre todo en el ámbito deportivo. Existe controversia sobre cual es el mejor tipo de tratamiento funcional en casos de esguinces grado II y III. El objetivo de la presente revisión sistemática es conocer, en base a la evidencia científica disponible, si el tratamiento con vendaje neuromuscular en pacientes con esguince de tobillo grado II o III es más efectivo que el tratamiento con vendaje funcional inelást...

  17. [Surgical treatment for distal rupture of the biceps tendon].

    Science.gov (United States)

    Dojcinovic, S; Maes, R; Hoffmeyer, P; Peter, R

    2004-09-01

    Avulsion of the distal biceps brachii tendon at the elbow is uncommon. We analyzed cases operated in our department in order to define etiological factors and surgical treatment outcome. We reviewed retrospectively eleven patients, ten male patients, average age 43 years (range 37-59) with distal biceps tendon ruptures repaired anatomically with a double-incision technique and one other male patient whose tendon was attached to the brachialis anterior. Nine patients were seen for clinical assessment at least two years after operation. Average follow-up was 7 years (range 1-10). Patient satisfaction was good and all stated they would opt for surgical treatment again. The most common mechanism of injury was heavy weight lifting with the elbow at 90 degrees flexion or excentric loading on a flexed elbow. The dominant limb was injured in all patients. Eight patients had sustained injury during domestic activities and three during sports activities. Clinical diagnosis was the rule. MRI was useful in patients seen late after injury. We found nine cases of avulsion located at the bicipital tuberosity. All subjective results were good. Strength testing of the injured limbs revealed a loss of 30% supination strength and 40% supination endurance for the anatomic reinsertions. For the non-anatomic reinsertion, there was a 50% decrease in strength and 60% decrease in endurance. Clinical follow-up after seven years showed no nerve damage or heterotopic bone formation. Anatomic repair of distal biceps tendon rupture provides consistently good results. Attachment of the brachial tendon to the brachial anterior muscle cannot restore supination force. The two-incision technique with the extensor mass-splitting approach described by Boyd and Anderson lessens the risk of radial nerve plasty. Early anatomic reconstruction can restore more strength and endurance for supination. Attachment of the brachialis muscle must be considered in the event of late reconstruction. Subjective

  18. Fractal analysis of bone architecture at distal radius

    International Nuclear Information System (INIS)

    Tomomitsu, Tatsushi; Mimura, Hiroaki; Murase, Kenya; Sone, Teruki; Fukunaga, Masao

    2005-01-01

    Bone strength depends on bone quality (architecture, turnover, damage accumulation, and mineralization) as well as bone mass. In this study, human bone architecture was analyzed using fractal image analysis, and the clinical relevance of this method was evaluated. The subjects were 12 healthy female controls and 16 female patients suspected of having osteoporosis (age range, 22-70 years; mean age, 49.1 years). High-resolution CT images of the distal radius were acquired and analyzed using a peripheral quantitative computed tomography (pQCT) system. On the same day, bone mineral densities of the lumbar spine (L-BMD), proximal femur (F-BMD), and distal radius (R-BMD) were measured by dual-energy X-ray absorptiometry (DXA). We examined the correlation between the fractal dimension and six bone mass indices. Subjects diagnosed with osteopenia or osteoporosis were divided into two groups (with and without vertebral fracture), and we compared measured values between these two groups. The fractal dimension correlated most closely with L-BMD (r=0.744). The coefficient of correlation between the fractal dimension and L-BMD was very similar to the coefficient of correlation between L-BMD and F-BMD (r=0.783) and the coefficient of correlation between L-BMD and R-BMD (r=0.742). The fractal dimension was the only measured value that differed significantly between both the osteopenic and the osteoporotic subjects with and without vertebral fracture. The present results suggest that the fractal dimension of the distal radius can be reliably used as a bone strength index that reflects bone architecture as well as bone mass. (author)

  19. Medical expulsive treatment of distal ureteral stone using tamsulosin

    International Nuclear Information System (INIS)

    Ahmad, H.; Azim, W.; Akmal, M.; Murtaza, B.

    2015-01-01

    Many minimally invasive interventional techniques as well as expectant treatments exist for the management of lower ureteric calculi. This study was conducted to evaluate the efficacy of tamsulosin as an expulsive pharmacologic therapy for the treatment of distal ureteral stone. Methods: This randomized control trial included 100 patients over 18 years of age with stone Size = 8mm in distal 1/3 of ureter. Patients were randomly assigned into two groups (A and B). Group A Patients were given Capsule Tamsulosin 0.4 mg, 1 daily up to 4 weeks while group B patients were given placebo, 1 Capsule daily up to 4 weeks. The primary endpoint was expulsion rate. A written informed consent was taken from all the patients. Expulsion time, need for analgesics, need for hospitalization and drug side effects were secondary endpoints. Results: A total of 49 patients in group A and 48 patients in group B reported back, therefore 97 out of 100 patients were evaluated. Mean age of the patients was 36.34 years (range 18-57 years). Mean stone size was 5.78 mm (range 4-8 mm) in greatest dimension. A stone expulsion rate of 85.71% (42 patients) was noted in group A and 54.20% (26 patients) in group B. Group A revealed a statistically significant advantage in term of stone expulsion rate (p=0.032). Considering expulsion time in days group A showed statistically significant advantage (p=0.015). Regarding age, sex, stone size and stone lateralization (right/left), there was no significant difference between the group A and B. No drug side effects were noted in both the groups. Conclusion: By using tamsulosin a higher stone expulsion rates can be achieved in a shorter time. More randomized control trials are required to establish tamsulosin as a standard medical expulsive treatment for small distal ureteric calculus. (author)

  20. Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ Implant Arthroplasty

    Directory of Open Access Journals (Sweden)

    Amir Reza Kachooei

    2014-09-01

    Full Text Available Background:  Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna.  The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker prosthesis. Methods: We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months. Also, patients were contacted prospectively by phone in order to  minister the disabilities of the armshoulder and hand (DASH, patient rated wrist evaluation (PRWE, and visual analogue scale (VAS, and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median followup time of 60 months (range: 2 to 102 months.  Results: No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively. Conclusions: Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation.

  1. Outcomes of Distal Femur Fracture Treated with Dynamic Condylar Screw

    International Nuclear Information System (INIS)

    Razaq, M. N. U.; Muhammad, T.; Ahmed, A.; Adeel, M.; Ahmad, S.; Ahmad, S.; Sultan, S.

    2016-01-01

    Background: Implants for open reduction and internal fixation of distal femoral fracture includes angle blade plate, rush nails, enders nail and interlocking nails. But all these devices are technically demanding and less effective in providing inter-fragmentary compression in osteoporotic bones. These problems can be solved with dynamic condylar screw (DCS).The objective of the study was to determine the frequency of different outcomes of distal femoral fracture treated with dynamic condylar screw Methods: This case series study was carried out in the Department of Trauma and Orthopaedics, Ayub Teaching Hospital Abbottabad from 1st October 2014 to August 2015, after approval of the ethical committee of the institution. Data of all patients with distal femoral fractures aged 20-70 years, recruited through emergency, OPD or consultant clinic collected on a proforma. Standard treatment of trauma was given to the patients. Detailed history was taken including the past medical and surgical history. Detailed examination including air-way, breathing and circulation, general physical examination and abdomino-pelvic examination was done in each patient. Investigations including urinalysis, haemoglobin percent, full blood count, X-ray (both AP and lateral view) of the involved femur (including hip and knee) was done. Results: Mean age of the patients was 43.18±14.647 ranging from 20 to 70 years. Mean duration of hospital stay in days was 2.21±1.111 ranging from 1 to 6 days. Patients follow-up assessment after 4 months of surgery for union of femoral fracture treated with dynamic condylar screw was found in 96 (94.1 percent), wound infection was found in 7 (6.9 percent), knee stiffness was found in 21 (20.6 percent) and limb shortening was found in 7 (6.9 percent). Conclusion: Dynamic condylar screw is an easy, scientifically less difficult and satisfying method of treatment for fractures of femur. (author)

  2. Distal radius hemiarthroplasty combined with proximal row carpectomy: case report.

    Science.gov (United States)

    Boyer, Jeffrey S; Adams, Brian

    2010-01-01

    Severe wrist arthritis is most commonly treated by complete wrist arthrodesis, which provides predictable pain relief but the loss of motion may reduce ease of function. In selected patients, motion preserving surgical options, including limited intercarpal fusion, proximal row carpectomy (PRC), and total wrist arthroplasty (TWA) are considered. However, limited fusion and PRC are typically possible only in less severe cases in which there are some articular surfaces showing minimal degeneration that can be retained. TWA is an option for patients who have lower activity demands and specific needs or desires to maintain some wrist motion. Recent utility and decision analysis studies demonstrate that arthroplasty is associated with higher qualify adjusted life year (QALY) than arthrodesis in patients with rheumatoid arthritis. Despite these positive aspects of TWA, the procedure is not as widely accepted as hip, knee, or shoulder arthroplasty. Early implants had problems related to both materials and design, with breakage, loosening and joint imbalance being common complications. Newer generation implants are improved with more predictable early function, less joint imbalance, and rare breakage, but distal component loosening remains a substantial problem. Thus, patients with poor bone stock and those with high activity demands are typically not candidates for TWA, and all patients are advised to restrict activities to reduce the risk of implant loosening. A new motion preserving procedure has recently been used at our institution in selected patients with severe arthritis who do not qualify for TWA but request an alternative to complete wrist fusion. In this procedure, a distal radius implant arthroplasty is combined with a PRC. The distal radius component of a Universal 2 (UNI 2) total wrist arthroplasty system (Integra life Sciences, Plainsboro, NJ) is used. To our knowledge, there have been no previous publications on this technique. We report our first two cases

  3. Acute Aldosterone-mediated Signaling Networks in Distal Convoluted Tubules

    DEFF Research Database (Denmark)

    Cheng, Lei; Wu, Qi; Olesen, Emma T. B.

    2017-01-01

    The kidney distal convoluted tubule (DCT) plays an important role in modulating body sodium balance and blood pressure. Long-term effects of aldosterone to increase sodium reabsorption in the DCT are well described. However, potential effects of aldosterone to acutely modulate DCT function via non...... in abundance following aldosterone treatment. The EGFR, ERK1/2, AKT, GSK3B and P70S6K were predicted to be important pathway nodes based on the quantitative proteomics data using network analysis. Ex vivo studies in isolated mouse cortical tubules demonstrated an increase in phosphorylated (active) NCC...

  4. Distal renal tubular acidosis in a child with HIV infection

    Directory of Open Access Journals (Sweden)

    Preeti Shanbag

    2012-01-01

    Full Text Available Renal tubular acidosis (RTA is not uncommon in HIV-infected children with ad-vanced disease, and has been described mainly due to nephrotoxic anti-retroviral therapy and in association with prophylaxis or treatment of Pneumocystis carinii pneumonia with co-trimoxazole. We describe an 8-year-old boy, newly diagnosed to have HIV infection, who presented with distal RTA. There were no features of chronic RTA in the form of rickets or nephrocalcinosis, making an inherited form unlikely.

  5. Concomitant hypercalcemia and hyperammonemia associated with distal renal tubular acidosis.

    Science.gov (United States)

    Saini, Arun; Karmakar, Swati A; Kannikeswaran, Nirupama

    2012-03-01

    We describe an infant with concomitant hypercalcemia and hyperammonemia associated with nonanion gap metabolic acidosis secondary to distal renal tubular acidosis (dRTA). The levels of both serum calcium and ammonia rapidly normalized with the correction of dehydration and metabolic acidosis. To the best of our knowledge, there has been only one previous case report of concomitant hypercalcemia and hyperammonemia associated with dRTA that has been reported in the literature. We describe the causes and emergent management of hypercalcemia and review the possible mechanisms of this rare association with dRTA.

  6. Proximal and distal adjustments of reaching behavior in preterm infants.

    Science.gov (United States)

    de Toledo, Aline Martins; Soares, Daniele de Almeida; Tudella, Eloisa

    2011-01-01

    The authors aimed to investigate proximal and distal adjustments of reaching behavior and grasping in 5-, 6-, and 7-month-old preterm infants. Nine low-risk preterm and 10 full-term infants participated. Both groups showed the predominance of unimanual reaching, an age-related increase in the frequency of vertical-oriented and open hand movement, and also an increase in successful grasping from 6 to 7 months. The frequency of open hand was higher in the preterm group at 6 months. Intrinsic restrictions imposed by prematurity did not seem to have impaired reaching performance of preterm infants throughout the months of age.

  7. Management of fractures of the distal radius: surgeon's perspective.

    Science.gov (United States)

    Raskin, K B

    1999-01-01

    The new millennium represents a time for expanding our present knowledge of the treatment of distal radius fractures, based on the foundation of information that has been gathered over the past century. Treatment-oriented classifications have replaced the prior generalization applied to all "Colles fractures" and have directed preoperative planning. Newer external fixation frames, improved surgical technique, and superior instrumentation allow for safer reproducible ligamentotaxis. These current concepts of treatment along with a comprehensive therapy plan have provided the basis for enhanced recovery from these challenging injuries.

  8. Congenital deformity of the distal extremities in three dogs

    Directory of Open Access Journals (Sweden)

    F. Di Dona

    2016-11-01

    Full Text Available Congenital limb deformities are very rare conditions and the knowledge about etiology, pathogenesis, clinical presentation and treatment is still poor. Moreover, many defects are still not reported in veterinary literature. This report documents clinical and radiographic findings in three dogs with congenital deformity involving the distal extremities. Case 1 was affected with bilateral aphalangia of the pedes, case 2 presented a combination of brachydactyly and syndactyly, whereas in case 3 a unilateral ectrodactyly was observed. To the authors’ knowledge, brachydactyly, as well as aphalangia, are very uncommon anomalies and have been rarely documented. Moreover, association between syndactyly and brachydactyly has still not been reported.

  9. Medial Column Arthrodesis Using an Anatomic Distal Fibular Locking Plate.

    Science.gov (United States)

    Nasser, Ellianne M; LaPorta, Guido A; Trott, Kasandra

    2015-01-01

    The medial column fusion is performed for a multitude of etiologies, including peritalar subluxation deformity, Charcot arthropathy, trauma, post-traumatic degenerative joint disease, and rheumatoid arthritis. Various surgical techniques have been described for medial column arthrodesis. We describe a new fixation method using an anatomic distal fibular locking plate for medial column arthrodesis. This technique provides a rigid construct in compromised or at risk bone. After a review of the surgical technique, we outline 2 case examples of patients with peritalar subluxation and Charcot arthropathy. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  10. El impacto en el aprendizaje del programa Una Laptop por Niño. La evidencia de Uruguay

    Directory of Open Access Journals (Sweden)

    Gioia de Melo

    2017-01-01

    Full Text Available Antecedentes: En los últimos años muchos países han realizado inversiones sustanciales en los programas Una Laptop por Niño (OLPC, por sus siglas en inglés, en tanto que otros están por implementar este tipo de intervenciones. Este artículo contribuye al estudio del efecto que tienen los programas OLPC en el desempeño de los estudiantes en lectura y matemáticas y, para ello, utiliza un diseño cuasi experimental basado en datos de Uruguay, el primer país en implementar un programa OLPC a escala nacional: el Plan CEIBAL.Métodos: Empleamos una estrategia de diferencias en diferencias (DiD para estimar el impacto del Plan CEIBAL en el desempeño educativo. El análisis explota especialmente el hecho de que el despliegue del programa se basó en criterios geográficos y no en el rendimiento escolar de los estudiantes. Se cuenta con la fecha exacta en que se le entregó la laptop a cada estudiante de la muestra. Ello nos permite hacer una medición continua y sin margen de error del tratamiento con base en el número de días en que cada estudiante ha estado expuesto al Plan CEIBAL al llegar la fecha de seguimiento (normalizado a años. Se controla por las diferencias sistemáticas que se dan potencialmente a lo largo del tiempo respecto a un mejor aprovechamiento escolar entre las escuelas en la capital, Montevideo, y el resto de Uruguay.Resultados: Nuestros resultados sugieren que el programa no tuvo impacto en las calificaciones en lectura y matemáticas. Tampoco encontramos efectos heterogéneos entre alumnos cuyas madres poseen distintos niveles de educación. Al analizar la evidencia descriptiva sobre la frecuencia de uso de la laptop en clase, observamos que su uso diario no está generalizado en todas las escuelas públicas. Además, su principal uso en clase consiste en la búsqueda de información en internet y no en la capacitación mediante ejercicios o prácticas de repetición. Una característica particularmente importante

  11. The effectiveness of pendulum, K-loop, and distal jet distalization techniques in growing children and its effects on anchor unit: A comparative study.

    Science.gov (United States)

    Marure, Pravinkumar S; Patil, Raju Umaji; Reddy, Sumitra; Prakash, Amit; Kshetrimayum, Nillachandra; Shukla, Rajeevkumar

    2016-01-01

    A common strategy to correct Class II malocclusions using a nonextraction protocol in children is to move the maxillary molars distally using molar distalization appliances, which usually derive their anchorage from maxillary premolars, causing mesialization of premolars and protrusion of incisors. To evaluate the skeletal, dental and soft tissue changes produced by three different distalizing appliances, namely, pendulum, K-loop, and distal jet appliances. Sixty-six children of mean age 14.13 years requiring molar distalization were divided into three groups: Group I (pendulum appliance), Group II (K-loop), and Group III (distal jet). Lateral cephalometric films were taken before and after 5 months of molar distalization and following cephalometric parameters were used to assess the effects of maxillary molar distalization, namely, anteroposterior skeletal (SNA/SNB/ANB), vertical skeletal (face height ratio/Frankfort-mandibular plane [FMA]/angle formed between Maxillary plane & Mandibular plane (MM)), interdental (overjet/overbite), maxillary dentoalveolar, and soft tissue parameters. There was no significant age difference between the three groups. In overall treatment changes among the three groups, the Anteroposterior skeletal changes were not statistically significant, vertically FMA angle increased by 1.79° ± 2.25° and overbite reduced by 2.38 ± 1.83 mm. The maxillary first molars were distalized by an average of 4.70 ± 3.01 mm (Upper 6 [U6] to pterygoid vertical [PTV]). The maxillary central incisor labial tipping increased to an average of 1.61 ± 2.73 mm and cant of upper lip increased by 3.40° ± 5.88° are statistically significant (P < 0.05). All three distalization techniques in growing children produced significant effects on anchor unit. There was an increase in FMA angle, significant bite opening, proclination of the maxillary incisors and increase in the cant of the upper lip.

  12. Cost-effectiveness of laparoscopic versus open distal pancreatectomy for pancreatic cancer.

    Science.gov (United States)

    Gurusamy, Kurinchi Selvan; Riviere, Deniece; van Laarhoven, C J H; Besselink, Marc; Abu-Hilal, Mohammed; Davidson, Brian R; Morris, Steve

    2017-01-01

    A recent Cochrane review compared laparoscopic versus open distal pancreatectomy for people with for cancers of the body and tail of the pancreas and found that laparoscopic distal pancreatectomy may reduce the length of hospital stay. We compared the cost-effectiveness of laparoscopic distal pancreatectomy versus open distal pancreatectomy for pancreatic cancer. Model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service. A decision tree model was constructed using probabilities, outcomes and cost data from published sources. A time horizon of 5 years was used. One-way and probabilistic sensitivity analyses were undertaken. The probabilistic sensitivity analysis showed that the incremental net monetary benefit was positive (£3,708.58 (95% confidence intervals (CI) -£9,473.62 to £16,115.69) but the 95% CI includes zero, indicating that there is significant uncertainty about the cost-effectiveness of laparoscopic distal pancreatectomy versus open distal pancreatectomy. The probability laparoscopic distal pancreatectomy was cost-effective compared to open distal pancreatectomy for pancreatic cancer was between 70% and 80% at the willingness-to-pay thresholds generally used in England (£20,000 to £30,000 per QALY gained). Results were sensitive to the survival proportions and the operating time. There is considerable uncertainty about whether laparoscopic distal pancreatectomy is cost-effective compared to open distal pancreatectomy for pancreatic cancer in the NHS setting.

  13. Clinical characteristics of ruptured distal middle cerebral artery aneurysms: Review of the literature.

    Science.gov (United States)

    Tsutsumi, Keiji; Horiuchi, Tetsuyoshi; Nagm, Alhusain; Toba, Yasuyuki; Hongo, Kazuhiro

    2017-06-01

    Middle cerebral artery (MCA) aneurysms usually arise at the primary MCA bifurcation or trifurcation. Distal MCA aneurysms are rarely considered as sources of aneurysmal subarachnoid hemorrhage (SAH). It has been reported that ruptured distal MCA aneurysms are associated with head trauma, neoplastic emboli, arterial dissection, or bacterial infection. We experienced five cases of ruptured distal MCA aneurysms and evaluated their clinical characteristics. Retrospective analysis of aneurysmal SAH at Kobayashi Neurosurgical Neurological Hospital was performed from January, 2004 to December, 2014. Clinical characteristics of ruptured distal MCA aneurysms were analyzed using our database. Among 191 aneurysmal SAH patients, there were five ruptured distal MCA aneurysms. All patients did not have any specific medical problems such as infectious disease, head trauma, or cardiac disorders. The incidence of ruptured distal MCA aneurysm was higher than expected and was equivalent to 9.4% of the total ruptured MCA aneurysms. Strong male predominance (80%) and M2-3 junction aneurysm preponderance (80%) were observed. In addition, there were only two patients (40%) with intracerebral hematoma in our study. We reported five cases of ruptured distal MCA aneurysms. Although ruptured distal MCA aneurysms are thought to be rare as sources of aneurysmal SAH, the incidence of ruptured distal MCA aneurysm was 9.4% of all ruptured MCA aneurysms in our study. Ruptured distal MCA aneurysms should be considered as sources of aneurysmal SAH without intracerebral hematoma. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. La evidencia acerca de la controversia de las vacunas que contienen timerosal y su asociación con el autismo

    Directory of Open Access Journals (Sweden)

    Lisset García-Fernández

    2013-06-01

    Full Text Available La vacunación es una de las medidas de mayor impacto en la salud pública para la reducción de la morbimortalidad infantil. El timerosal es un compuesto orgánico del mercurio utilizado como preservante de los frascos multidosis. Eventualmente, en el Perú, surgen olas de controversia acerca de la seguridad de estas vacunas, asociándolas especialmente con el autismo. Como resultado de estas controversias, se han propuesto, incluso, leyes que prohíben este tipo de vacunas, lo que tendría un importante impacto en los costos y en los aspectos logísticos de la estrategia nacional de vacunación. En este artículo se revisa la literatura sobre las principales controversias acerca de las vacunas que contienen timerosal y su supuesta asociación con el autismo. Se realiza una aproximación histórica sobre estas controversias, se hace una actualización de la evidencia científica disponible al momento, y se revisa la posición de los organismos internacionales más importantes con respecto a este tema. Se concluye que la evidencia científica no apoya la noción que exista una asociación entre el uso del timerosal en las vacunas con los trastornos del espectro autista en niños.

  15. Análisis de evidencia de las investigaciones sobre conciencia y lenguaje 2000-2010: una revisión sistemática

    Directory of Open Access Journals (Sweden)

    Johny Villada Zapata

    2012-01-01

    Full Text Available Debido a la importancia de la teorización de la conciencia y el lenguaje, este estudio retomó 86 artículos académicos sobre estos procesos publicados entre 2000 y 2010. Para el análisis de los artículos se utilizó la clasificación hecha por The Scottish Intercollegiate Guidelines Network (SIGN, que permite identificar el nivel de evidencia y los grados de recomendación de los mismos. La mayoría de las investigaciones alcanzan un nivel descriptivo-correlacional, y se encontraron pocos estudios explicativos. En los estudios sobre el lenguaje,el diseño metodológico es recurrentemente transversal, mientras que los diseños experimentales aparecen con mayor frecuencia en las investigaciones sobre la conciencia. Los artículos sobre la conciencia tienen un nivel mayor de evidencia y grados de recomendación que los del lenguaje, asunto que pone de manifiesto el interés creciente por el estudio de este proceso.

  16. La Biblioteca Médica Nacional de Cuba tiene la primicia: curso Cochrane Library, aprendizaje con estrategias para obtener las mejores evidencias en salud

    Directory of Open Access Journals (Sweden)

    Sonia Santana Arroyo

    2015-10-01

    Full Text Available La Biblioteca Médica Nacional de Cuba ha puesto en marcha un programa de alfabetización informacional para adiestrar a sus usuarios y fomentar en ellos las habilidades necesarias para el uso de bases de datos, así como para fomentar el uso de estrategias de búsquedas bien diseñadas y validadas por los bibliotecarios especialistas en información. En el presente trabajo se describen contenidos y habilidades que se fomentan en el curso “Cochrane Library: La Medicina Basada en Evidencias”, cuyo objetivo es que el usuario domine esta base de datos y el concepto de medicina basada en evidencias para la toma de mejores decisiones en la atención médica. Durante el curso se introduce además el Modelo Big 6, como guía del pensamiento para resolver problemas de información que facilite la búsqueda y la organización de la información médica basada en evidencias. Igualmente, se capacita al estudiante para que diseñe productos informativos, como boletines electrónicos, que le permitan tanto presentar los resultados de búsquedas de información como promover información para el cuidado de la salud en el futuro

  17. Correction of Hallux Valgus Interphalangeus With an Osteotomy of the Distal End of the Proximal Phalanx (Distal Akin Osteotomy).

    Science.gov (United States)

    Vander Griend, Robert

    2017-02-01

    Operative correction of a symptomatic hallux valgus interphalangeus (HVI) deformity is often achieved with an osteotomy at the proximal end of the proximal phalanx (Akin osteotomy). However, the apex of the typical HVI deformity (center of rotation angle) is at the interphalangeal joint of the hallux. This study was done to evaluate the results of performing a medial closing wedge osteotomy at the distal end of the proximal phalanx. Thirty-three patients (33 feet) underwent an osteotomy at the distal end of the proximal phalanx for correction of HVI. All of the patients had other forefoot deformities which were corrected at the same time. Eight of these were revision procedures of prior forefoot operations. The length of follow-up was determined by the associated procedures with a minimum follow-up of 4 months. The preoperative hallux valgus interphalangeus angle averaged 16 degrees of valgus (range 7-32 degrees) and was corrected to an average of 2 degrees of valgus (range 5 degrees valgus to 5 degrees varus). All of the patients were satisfied with the postoperative appearance and function of the first toe. Because of simultaneous correction of numerous other forefoot problems, it was not possible to specifically isolate or evaluate the effects and benefits of this osteotomy using outcomes measures. There was one intraoperative complication resulting in a fracture extending into the adjacent IP joint. Correction of an HVI deformity can be achieved with an osteotomy at the distal end of the proximal phalanx. This was a safe technique with few complications and with good results in terms of both correction and patient satisfaction. Level IV, retrospective case series.

  18. Delayed Fracture Healing in Diabetics with Distal Radius Fractures.

    Science.gov (United States)

    Pscherer, S; Sandmann, G H; Ehnert, S; Nussler, A K; Stöckle, U; Freude, T

    2017-01-01

    PURPOSE OF THE STUDY Diabetics may have an increased fracture risk, depending on disease duration, quality of metabolic adjustment and extent of comorbidities, and on an increased tendency to fall. The aim of this retrospective one-centre study consisted in detecting differences in fracture healing between patients with and without diabetes mellitus. Data of patients with the most common fracture among older patients were analyzed. MATERIAL AND METHODS Classification of distal radius fractures was established according to the AO classification. Inital assessment and followup were made by conventional x-rays with radiological default settings. To evaluate fracture healing, formation of callus and sclerotic border, assessment of the fracture gap, and evidence of consolidation signs were used. RESULTS The authors demonstrated that fracture morphology does not influence fracture healing regarding time span, neither concerning consolidation signs nor in fracture gap behavior. However, tendency for bone remodeling is around 70% lower in investigated diabetics than in non-diabetics, while probability for a successful fracture consolidation is 60% lower. CONCLUSIONS To corroborate the authors hypothesis of delayed fracture healing in patients with diabetes mellitus, prospective studies incorporating influencing factors like duration of metabolic disease, quality of diabetes control, medical diabetes treatment, comorbidities and secondary diseaseas, like chronic nephropathy and osteoporosis, have to be carried out. Key words: diabetes, delayed fracture healing, distal radius fractures, callus formation, blood glucose level, osteoblasts.

  19. Concomitant physeal fractures of the distal femur and proximal tibia

    Energy Technology Data Exchange (ETDEWEB)

    Sferopoulos, N.K. [Aristotle University of Thessaloniki, Department of Pediatric Orthopaedics, Thessaloniki (Greece)

    2005-07-01

    Concomitant physeal fractures of the distal femur and proximal tibia are very rare in children and adolescents. They are included in the classification of the ''floating knee'' injuries. Two cases with this combined injury are reported. They were closed injuries and in both patients the fracture of the proximal tibial epiphyseal plate was nondisplaced. In the first, a six-year-old girl, an early diagnosis was made radiographically. The intra-articular femoral fracture was operatively reduced and fixed. No growth abnormality was encountered 12 years later. The second patient, a 16-year-old boy, was conservatively treated for a displaced fracture-separation of the distal femoral epiphysis. Four weeks later there was physeal widening on both sides of the knee which indicated an associated fracture of the proximal tibial epiphyseal plate. One year after injury there was a varus deformity of the knee that was treated with a corrective osteotomy. Ten years later there is normal alignment of the leg. (orig.)

  20. Intramedullary Venous Drainage System for Distal Fingertip Replantations.

    Science.gov (United States)

    Purisa, Husrev; Ozturk, Muhammed Besir; Kabakas, Fatih; Mersa, Berkan; Ozcelik, Ismail Bulent; Sezer, Ilker

    2017-08-01

    The number of venous anastomoses performed during fingertip replantation is one of the most important factors affecting the success of replantation. However, because vessel diameters decrease in the zone 1 level, vessel anastomoses, especially vein anastomoses, are technically difficult and, thus, cannot be performed in most cases. Alternative venous drainage methods are crucial when any reliable vein repair is not possible. In the literature, so many artery-only replantation techniques have been defined, such as arteriovenous anastomoses, forming an arteriovenous or venocutaneous fistula, manual milking and massage, puncturing, and external bleeding via a fishmouth incision and using a medical leech. It has been shown that, in distal fingertip replantations, the medullary cavity may also be a good way for venous return. In this study, we introduce an alternative intramedullary venous drainage system we developed to facilitate venous drainage in artery-only fingertip replantations. The results of 24 fingertip replantations distal to the nail fold by using this system are presented with a literature review.

  1. Artrite interfalangeana distal séptica em bovinos

    Directory of Open Access Journals (Sweden)

    Juliano Santos Gueretz

    2005-06-01

    Full Text Available Afecções podais são relativamente comuns em bovinos, principalmente em rebanhos leiteiros. São de difícil e oneroso tratamento. Causam claudicação, desconforto, dor e perdas econômicas. Podem ter origem exógena, por evolução de infecções nos dígitos e anexos e por traumas penetrantes.Fatores endógenos, pós mastites e afecções do útero, também podem evoluir para podopatias. Relata-se um caso de infecção na articulação interfalangeana distal numa fêmea bovina, raça charolesa, com três anos de idade, com histórico de claudicação crônica, atendida na Clínica Escola da Universidade Estadual do Centro-Oeste UNICENTRO, apresentando sinais clínicos de artrite interfalangeana distal séptica. As técnicas utilizadas no estabelecimento do diagnóstico e a terapêutica abordada são descritas. O caso serve de alerta para o estabelecimento de estratégias a fim de evitar podopatias em bovinos.

  2. [Proximal and distal ruptures of the biceps brachii tendon].

    Science.gov (United States)

    Klonz, A; Loitz, D; Reilmann, H

    2003-09-01

    Proximal ruptures. Ruptures of the long head of the M. biceps humeri are commonly caused by degenerative changes within the tendon. Non-operative treatment gives good results, the loss of power regarding elbow flexion and supination amounts to only 8-21%. Refixation may be indicated for cosmetic reasons and offers a small but evident improvement of flexion and supination power. Deformity of the slipped muscle can be corrected effectively. Residual complaints after conservative treatment often result from associated subacromial problems. Distal ruptures. Ruptures of the distal tendon should be treated operatively. The loss of power after conservative treatment is evident (30-40% for flexion, >50% for supination). Extra-anatomical tenodesis to the brachialis muscle or anatomical fixation to the radial tuberosity can be applied. Flexion power and cosmesis can be addressed by both techniques. If supination strength is to be restored, the tendon has to be fixed anatomically. Preparation of the tuberosity bears the risk of heterotopic ossification or nerve damage. Mini-open techniques, using only a limited anterior approach, may decrease risks.

  3. Complicated distal femoral epiphyseolysis treated by Ilizarov method: Case report

    Directory of Open Access Journals (Sweden)

    Jovanović Vesna

    2010-01-01

    Full Text Available Introduction Injuries of the distal femur are rare in children; however, they are frequently associated with complications. They are almost always physeal, most frequently Salter-Harris type II epiphyseolysis. The treatment of such injuries is similar in all physeal injuries. It is intended to provide growth plate recovery by gentle reduction and stable fixation thus preventing secondary complications, and also to provide decompression of the segment to solve the compartment syndrome and recover the neurovascular structures. Case Outline A seven-year old boy presented with a right knee injury while sleigh riding. He was admitted three weeks following the injury with distal femoral epiphysiolysis associated with peroneal palsy. A day after admission to our Institute the reduction was performed using the Ilizarov device. Physical therapy was started immediately after surgery, as well as walking with weight bearing on the operated leg. Five months after surgery the patient was anatomically and functionally recovered. Conclusion The presented method is recommended in the treatment of such injuries because of several reasons; reposition is simple and complete, there is no need to open the fracture site, fixation is stable, the growth plate is preserved, there is no need for additional external immobilisation, and physical therapy involving walking with weight bearing on the operated leg may be started immediately after surgery. .

  4. [Distal femoral osteotomy using a lateral opening wedge technique].

    Science.gov (United States)

    Feucht, M J; Mehl, J; Forkel, P; Imhoff, A B; Hinterwimmer, S

    2017-08-01

    To shift the weight-bearing axis of the lower limb medially by opening a lateral-based metaphyseal osteotomy at the distal femur. Femoral-based valgus malalignment and symptomatic lateral unicompartimental osteoarthritis, lateral hyperpression syndrome, cartilage therapy of the lateral compartment, lateral meniscal replacement/transplantation, medial instability with valgus thrust, reconstruction of the medial collateral ligament, patellar instability and/or maltracking. Advanced cartilage damage (>grade 2) or subtotal meniscal loss of the medial compartment, age >65 years (relative), nicotine abuse, body mass index >30, flexion contracture >25°, corrections with a wedge base >10 mm in case of congenital deformities, inflammatory or septic arthritis, severe osteoporosis. Lateral approach to the distal femur; biplanar osteotomy (frontal + axial osteotomy), gradual opening of the osteotomy, osteotomy fixation with a locking plate. Free range of motion. Partial weight bearing with 20 kg for 2 weeks, followed by progressive weight bearing thereafter. Mean improvement of knee scores from 20-30 points and mean 10-year survival rate of 80% in patients with lateral unicompartimental osteoarthritis. Mean complication rate of 9%.

  5. An integer programming model for distal humerus fracture fixation planning.

    Science.gov (United States)

    Maratt, Joseph D; Peaks, Ya-Sin A; Doro, Lisa Case; Karunakar, Madhav A; Hughes, Richard E

    2008-05-01

    To demonstrate the feasibility of an integer programming model to assist in pre-operative planning for open reduction and internal fixation of a distal humerus fracture. We describe an integer programming model based on the objective of maximizing the reward for screws placed while satisfying the requirements for sound internal fixation. The model maximizes the number of bicortical screws placed while avoiding screw collision and favoring screws of greater length that cross multiple fracture planes. The model was tested on three types of total articular fractures of the distal humerus. Solutions were generated using 5, 9, 21 and 33 possible screw orientations per hole. Solutions generated using 33 possible screw orientations per hole and five screw lengths resulted in the most clinically relevant fixation plan and required the calculation of 1,191,975 pairs of screws that resulted in collision. At this level of complexity, the pre-processor took 104 seconds to generate the constraints for the solver, and a solution was generated in under one minute in all three cases. Despite the large size of this problem, it can be solved in a reasonable amount of time, making use of the model practical in pre-surgical planning.

  6. DO PROXIMAL AND DISTAL GASTRIC TUMOURS BEHAVE DIFFERENTLY?

    Science.gov (United States)

    Costa, Laurence Bedin da; Toneto, Marcelo Garcia; Moreira, Luis Fernando

    2016-01-01

    Although the incidence of gastric (adenocarcinoma) cancer has been decreasing over time, it is still one of the most common malignancies worldwide, and proximal tumours tend to have a worse prognosis. To compare surgical outcomes and prognosis between proximal - excluding tumours of the cardia - and distal gastric cancer. Out of 293 cases reviewed - 209 with distal and 69 with proximal gastric cancer - were compared for clinical and pathological features, stage, surgical outcome, mortality and survival. Statistically, there was no significant difference between patients in both groups regarding mortality (p=0.661), adjuvant chemotherapy (p 0.661), and radiation (p=1.000). However, there was significant difference in the degree of lymph node dissection employed (p=0.002) and the number of positive lymph nodes resected (p=0.038) between the two groups. The odds of death at five years for patients who had a D0 dissection was three times greater (odds ratio 2.78; (95%CI 1.33-5.82) than that for patients who had a D2 dissection, while for patients who had a D1 dissection the odds ratio was only 1.41 (95%CI 0.71-2.83) compared to D2-dissected patients. Although no significant differences were found between proximal and distal gastric cancer, the increased risk of death in D0- and D1-dissected patients clearly suggests an important role of radical D2 lymph node dissection in survival. Embora a incidência do câncer gástrico esteja diminuindo nas últimas décadas, ele ainda aparece como uma das neoplasias malignas mais comuns, e tumores proximais tendem a ter pior prognóstico. Comparar os resultados cirúrgicos e o prognóstico entre o câncer gástrico proximal, excluindo os tumores da cárdia e junção esofagogástrica, e o distal. De 293 casos revistos - 209 distais e 69 proximais - foram comparados quanto aos achados clínicos e patológicos, estágio, resultados cirúrgicos, mortalidade e sobrevida. Estatisticamente não houve diferença entre pacientes em ambos

  7. Anatomy of the distal biceps brachii tendon and its clinical relevance.

    Science.gov (United States)

    Kulshreshtha, Rajiv; Singh, Raminder; Sinha, Joydeep; Hall, Susan

    2007-03-01

    Rupture of the distal biceps tendon is a relatively uncommon injury. Different methods have been described for its surgical repair. According to published reports, current surgical techniques result in decreased strength and endurance of upper extremity functions requiring supination and flexion. In our anatomic study of 74 cadaveric elbows, we observed that the distal biceps tendon spirals in a predictable manner and has a complex fiber arrangement. Successful surgical repair of a ruptured distal biceps tendon should be predicated on an understanding of the tendon anatomy, but current surgical techniques do not take into account the salient anatomic features of the distal biceps tendon. To our knowledge, there is no description in the surgical literature of the fiber arrangement of the distal biceps tendon. We provide a basis for developing an anatomically accurate protocol for repairing a distal biceps tendon rupture.

  8. Distal radius reconstruction with vascularized proximal fibular autograft after en-bloc resection of recurrent giant cell tumor

    OpenAIRE

    Yang, Yun-fa; Wang, Jian-wei; Huang, Pin; Xu, Zhong-he

    2016-01-01

    Background Giant cell tumors (GCTs) located in the distal radius are likely to recur, and the treatment of such recurrent tumors is very difficult. Here, we report our clinical experience in distal radius reconstruction with vascularized proximal fibular autografts after en-bloc excision of the entire distal radius in 17 patients with recurrent GCT (RGCT) of the distal radius. Methods All 17 patients with RGCT in distal radius underwent plain radiography and/or magnetic resonance imaging (MRI...

  9. Fracture lines and comminution zones in OTA/AO type 23C3 distal radius fractures: The distal radius map.

    Science.gov (United States)

    Misir, Abdulhamit; Ozturk, Kahraman; Kizkapan, Turan Bilge; Yildiz, Kadir Ilker; Gur, Volkan; Sevencan, Ahmet

    2018-01-01

    This study was designed to define fracture lines and comminution zones in OTA/AO 23C3 distal radius fractures from axial computed tomography (CT) images that would influence surgical planning, development of new classifications, and possible implant designs. Thirty-four consecutive OTA/AO 23C3 fractures treated by a single surgeon between January 2014 and December 2014 were analyzed. For each fracture, maps of the fracture lines and zones of comminution were drawn. Each map was digitized and graphically superimposed to create a compilation of fracture lines and zones of comminution. Based on this compilation, major and minor fracture lines were identified and fracture patterns were defined. All major fracture lines were distributed in the central region of the radius distal articular surface. There is a recurrent fracture pattern with a comminution zone including the scaphoid and lunate fossa; Lister's tubercle; and ulnar, volar, and radial zones. It is important for the practicing surgeon to understand these four main fragments. Knowledge of this constant pattern should influence the development of new classifications and possible implant designs.

  10. Intersphincteric Resection and Coloanal Anastomosis in Treatment of Distal Rectal Cancer

    OpenAIRE

    Cipe, Gokhan; Muslumanoglu, Mahmut; Yardimci, Erkan; Memmi, Naim; Aysan, Erhan

    2012-01-01

    In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed. However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphincter-saving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection. The first aim of this study is to assess the morbidity, mortality, oncological, and functional outcomes ...

  11. Classification of Distal Fingertip Amputation Based on the Arterial System for Replantation

    OpenAIRE

    Park, Hyun Chul; Bahar-Moni, Ahmed Suparno; Cho, Sang Hyun; Kim, Sang Soo; Park, Hyun Sik; Ahn, Sang Cheon

    2012-01-01

    During replantation of distal fingertip amputation, identification of the artery is the most important but time consuming procedure. Depending on the damaged arterial structure, we classified distal fingertip amputations into 4 zones, on the basis of three dimensional concept. Zone 1 injury was defined as damage to the proximal central pulp artery; zone 2 injury, damage to the branch of the central pulp artery; zone 3 injury, damage to the distal central pulp artery; and zone 4 injury, no inj...

  12. OUTCOME OF DISTAL TIBIA FRACTURE BY NAIL OR PLATE (MIPPO)- A COMPARATIVE STUDY

    OpenAIRE

    Madhuchandra R; Chandrashekhar Mudgal; Sandeep; Amol Shivaji Chavan

    2017-01-01

    BACKGROUND Distal tibial fracture often present a challenge to the orthopaedic surgeon. The best option for surgical management of distal tibial fracture is still unclear, whether nail or plate. MATERIALS AND METHODS The study consists of 24 patients of distal tibial fracture treated either with reamed intramedullary nails or locked plating/MIPPO with open reduction method or minimally-invasive techniques. RESULTS 24 patients included in the present study were divided i...

  13. Single Incision Distal Biceps Repair With Hemi-Krackow Suture Technique: Surgical Technique and Early Outcomes

    OpenAIRE

    Goljan, Peter; Patel, Nimit; Stull, Justin D.; Donnelly, Brandon P.; Culp, Randall W.

    2016-01-01

    Background: Many surgical methods exist for distal biceps repair. We present the technique and early outcomes of a series of distal biceps repairs completed with a novel suturing technique utilizing a hemi-Krackow locking stitch at the tendon-bone interface. Methods: A retrospective review was performed of patients who underwent primary distal biceps repair using a single anterior incision with 2 suture anchors utilizing a hemi-Krackow stitch. With both anchors, a locking stitch along the ten...

  14. Radiation-free Insertion of Distal Interlocking Screw in Tibial and Femur Nailing: A Simple Technique

    OpenAIRE

    Soni, Ritesh Kumar; Mehta, Surender Mohan; Awasthi, Bhanu; Singh, Janith Lal; Kumar, Amit; Thakur, Lokesh; Tripathy, Sujit Kumar

    2012-01-01

    Background: Distal interlocking screw insertion in intramedullary nailing of long-bone fracture is a challenging task for orthopedic surgeons. It is difficult particularly when the surgeon is in his learning stage or when image intensifier is not available. We describe a radiation-free technique of distal interlocking screw insertion which is easy and practicable. Materials and Methods: In this technique, a same length nail is placed over the skin (outer nail) and through its distal-most scre...

  15. A method for designing plates in treatments of proximal humeral fracture and distal radial fracture

    OpenAIRE

    Lin Wang; Zhengming Chen; Kunjin He; Wei Xiang

    2016-01-01

    The purpose of this paper was to quickly design fixation plates for fractured proximal humerus and distal radius according to the requirements of surgical treatment. Therefore, a new method to quickly design cloverleaf plate appropriate for proximal humerus and volar plate appropriate for distal radius is put forward. First, three-dimensional (3D) reconstruction models of fractured proximal humerus and distal radius were generated based on deforming mean parametric models of proximal humerus ...

  16. Distal fibular malrotation and lateral ankle contact characteristics.

    Science.gov (United States)

    Stroh, D Alex; DeFontes, Kenneth; Paez, Adrian; Parks, Brent; Guyton, Gregory P

    2017-09-20

    Any amount of malreduction of the syndesmotic joint compared with the uninjured syndesmosis has been associated with an adverse effect on functional outcome. The amount of malrotation that may lead to clinically relevant pressure change in this joint has not been reported. Our purpose was to determine whether small degrees of external and internal malrotation would be associated with statistically significant changes in contact pressure in the tibiofibular and talofibular articulations. Twelve cadaveric ankles were osteotomized above the syndesmosis and instrumented with a rotatable distal fibula plate. Sensors at the distal tibiofibular and talofibular articulations recorded contact pressure and area at neutral position and at 5 and 10° of external and internal malrotation through a full range of ankle motion. Compared with neutral rotation, there was a significant decrease in contact pressure at the talofibular articulation with external rotation of 5° (103±113kPa versus 52±69kPa; P=0.01) and 10° (43±62kPa; P=0.01) in plantarflexion.Contact pressure at the tibiofibular articulation in plantarflexion increased with 10° of internal malrotation compared with neutral rotation (56±30kPa versus 74±38kPa; P=0.05) in plantarflexion. Contact area decreased significantly with plantarflexion and 10° of external rotation and increased significantly in plantarflexion and after cyclic loading with 10° of internal rotation (P≤0.05). Any degree of distal fibular external rotation significantly reduced contact pressure in the talofibular articulation with plantarflexion. A minimal increase in contact pressure was found in the tibiofibular and talofibular joints with plantarflexion and mild internal rotation of 5°, but pressure increased significantly in both articulations with 10° of internal rotation. The findings support clinical findings that subtle degrees of fibular malrotation may be associated with alteration of lateral ankle mechanics. Controlled

  17. [Dual plating fixation for distal fibular comminuted fractures].

    Science.gov (United States)

    Gu, Wenqi; Shi, Zhongmin; Mei, Guohua; Xue, Jianfeng; Zou, Jian

    2014-01-01

    To evaluate the technique and effectiveness of dual plating fixation for distal fibular comminuted fractures. Between November 2010 and November 2011, 16 patients with distal fibular comminuted fractures were treated, including 10 males and 6 females with an average age of 49.8 years (range, 35-65 years). All the patients had closed injury, which was caused by sprain in 9 cases, by traffic accident in 5 cases, and by falling in 2 cases. The average interval from injury to admission was 8 hours (range, 1-48 hours). Routine X-ray and CT scan were taken for confirmation of classification and involvement. According to Weber classification system, 11 cases were rated as type A, and 5 as type B; 5 cases had bimalleolar fractures with medial malleolar fracture, and 2 cases had trimalleolar fractures with posterior and medial malleolar fracture. Open reduction and dual plating fixation were performed after swelling was subsided. The X-ray films were taken during follow-up. The effectiveness was evaluated with visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot and ankle score system at last follow-up. The range of motion (ROM) of the ankle and complications were also been recorded. Delayed healing of incision occurred in 1 patient with diabetes, who was cured after changing dressing; primary healing was obtained in the other patients. Twelve patients were followed up 18 months on average (range, 12-24 months). Radiographic examination demonstrated the mean time of bone healing was 12 weeks (range, 10-14 weeks). No complication of implant failure, malunion, nonunion, or post-traumatic arthritis occurred during follow-up. The AOFAS hindfoot and ankle score was 79.6 +/- 6.5, and the VAS score was 1.3 +/- 1.5. The ROM of the ankle was (70.0 +/- 8.0) degrees of flexion and (84.0 +/- 5.1) degrees of extension. Dual plating fixation for distal fibular comminuted fractures can obtain a rigid stabilization with a low complication incidence

  18. Constructs of health belief and disabling distal upper limb pain.

    Science.gov (United States)

    Whibley, Daniel; MacDonald, Ross; Macfarlane, Gary J; Jones, Gareth T

    2016-10-01

    Musculoskeletal pain in the distal upper limb is common and is a cause of disability and healthcare consultation. At the time of presentation individuals reporting similar pain severities may report different levels of related disability. The biopsychosocial model proposes that health beliefs may help explain this difference. The aim of this cross-sectional study was to identify underlying constructs of health belief in those referred to physiotherapy with pain in the distal upper limb and investigate whether these constructs moderated the relationship between pain severity and extent of disability. Health beliefs were assessed using an instrument included in a questionnaire completed before randomisation to the Arm Pain Trial (ISRCTN79085082). Ordinal responses to statements about health beliefs were used to generate a polychoric correlation matrix. The output from this matrix was then used for Exploratory Factor Analysis to determine underlying constructs. The moderating influence of the identified health belief constructs was then tested using interaction terms in linear regression models. 476 trial participants contributed data, age range 18-85 (mean 48.8, SD 13.7), 54% female. Five health belief constructs were identified: beliefs about hereditary factors, beliefs about movement and pain, beliefs about locus of control, beliefs about the role of lifecourse/lifestyle factors, and beliefs about prognosis. The only health belief construct found to moderate the pain-disability relationship was beliefs about prognosis, with greater pessimism resulting in higher levels of disability at mild-to-moderate levels of pain severity (B -0.17, 95% CI -0.30, -0.036). This exploratory cross-sectional study identified five constructs of health belief from responses to a previously used set of statements investigating fear avoidance and illness beliefs in a clinical population with pain in the distal upper limb. Of these constructs, beliefs about prognosis were found to

  19. Fractures of the bilateral distal radius and scaphoid: a case report

    Directory of Open Access Journals (Sweden)

    Ozkan Korhan

    2008-03-01

    Full Text Available Abstract Introduction Bilateral fractures of the distal radius and scaphoid are extremely rare injuries. Case presentation A patient with bilateral comminuted, displaced distal fractures of the radius and bilateral fractures of the scaphoid was treated via internal fixation of the scaphoid fractures with Herbert screws and internal fixation of the distal radius fractures with locked volar plating. Conclusion Rigid internal fixation of distal radius and scaphoid fractures is mandatory to start early active rehabilitation of the wrist without the need for wrist immobilization with a plaster or external skeletal fixation.

  20. Enfermería basada en la evidencia. Heparina frente a suero fisiológico para mantener la permeabilidad de los catéteres venosos centrales en adultos.

    OpenAIRE

    Matesanz Vázquez, Itziar

    2013-01-01

    Este trabajo tiene como objetivo resolver la pregunta clínica surgida en el contexto de las prácticas hospitalarias, mediante el uso de la enfermería basada en la evidencia (EBE). Tras introducir el concepto de EBE y las etapas que deben estar implicadas, se desarrolla una estrategia de búsqueda con el fin de encontrar la evidencia más reciente para el uso de heparina sódica en el mantenimiento de la permeabilidad de los catéteres venosos centrales en adultos, así como su efectividad frente a...

  1. Morphometric variation in Plio-Pleistocene hominid distal humeri.

    Science.gov (United States)

    Lague, M R; Jungers, W L

    1996-11-01

    The magnitude and meaning of morphological variation among Plio-Pleistocene hominid distal humeri have been recurrent points of disagreement among paleoanthropologists. Some researchers have found noteworthy differences among fossil humeri that they believe merit taxonomic separation, while others question the possibility of accurately sorting these fossils into different species and/or functional groups. Size and shape differences among fossil distal humeri are evaluated here to determine whether the magnitude and patterns of these differences can be observed within large-bodied, living hominoids. Specimens analyzed in this study have been assigned to various taxa (Australopithecus afarensis, A. africanus, A. anamensis, Paranthropus, and early Homo) and include AL 288-1m, AL 288-1s, AL 137-48a, AL 322-1, Gomboré IB 7594, TM 1517, KNM-ER 739, KNM-ER 1504, KMN-KP 271 (Kanapoi), and Stw 431. Five extant hominoid populations are sampled to provide a standard by which to consider differences found between the fossils, including two modern human groups (Native American and African American), one group of Pan troglodytes, and two subspecies of Gorilla gorilla (G.g. beringei, G.g. gorilla). All possible pairwise d values (average Euclidena distances) are calculated within each of the reference populations using an exact randomization procedure. This is done using both raw linear measurements as well as scale-free shape data created as ratios of each measurement to the geometric mean. Differences between each pair of fossil humeri are evaluated by comparing their d values to the distribution of d values found within each of the reference populations. Principal coordinate analysis and an unweighted pair group method with arithmetic averages (UPGMA) cluster analysis are utilized to further assess similarities and differences among the fossils. Finally, canonical variates analysis and discriminant analysis are employed using all hominoid samples in order to control for

  2. [Sialic Acid Replacement Therapy for Distal Myopathy with Rimmed Vacuoles].

    Science.gov (United States)

    Mori-Yoshimura, Madoka; Nishino, Ichizo

    2015-09-01

    Distal myopathy with rimmed vacuoles or GNE myopathy, is an early adult-onset myopathy with slow progression that preferentially affects the tibialis anterior muscle. Severely affected patients show marked limb muscle atrophy together with respiratory dysfunction. The disease is caused by a mutation in the GNE gene that catalyzes two rate-limiting reactions in cytosolic sialic acid synthesis. Oral treatment with sialic acid metabolite prevents muscle atrophy and weakness in a mouse GNE myopathy model and a global Phase III study is currently underway. In addition, a global patient registry of neuromuscular cases is widely accepted as a useful tool to obtain epidemiological data and bolster patient recruitment for further development of this treatment strategy.

  3. Distal anastomotic vein adjunct usage in infrainguinal prosthetic bypasses.

    Science.gov (United States)

    McPhee, James T; Goodney, Philip P; Schanzer, Andres; Shaykevich, Shimon; Belkin, Michael; Menard, Matthew T

    2013-04-01

    Single-segment saphenous vein remains the optimal conduit for infrainguinal revascularization. In its absence, prosthetic conduit may be used. Existing data regarding the significance of anastomotic distal vein adjunct (DVA) usage with prosthetic grafts are based on small series. This is a retrospective cohort analysis derived from the regional Vascular Study Group of New England as well as the Brigham and Women's hospital database. A total of 1018 infrainguinal prosthetic bypass grafts were captured in the dataset from 73 surgeons at 15 participating institutions. Propensity scoring and 3:1 matching was performed to create similar exposure groups for analysis. Outcome measures of interest included: primary patency, freedom from major adverse limb events (MALEs), and amputation free survival at 1 year as a function of vein patch utilization. Time to event data were compared with the log-rank test; multivariable Cox proportional hazard models were used to evaluate the adjusted association between vein cuff usage and the primary end points. DVA was defined as a vein patch, cuff, or boot in any configuration. Of the 1018 bypass operations, 94 (9.2%) had a DVA whereas 924 (90.8%) did not (no DVA). After propensity score matching, 88 DVAs (25%) and 264 no DVAs (75%) were analyzed. On univariate analysis of the matched cohort, the DVA and no DVA groups were similar in terms of mean age (70.0 vs 69.0; P = .55), male sex (58.0% vs 58.3%; P > .99), and preoperative characteristics such as living at home (93.2% vs 94.3%; P = .79) and independent ambulatory status (72.7% vs 75.7%; P = .64). The DVA and no DVA groups had similar rates of major comorbidities such as hypertension chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and dialysis dependence (P > .05 for all). Likewise, they had similar rates of distal origin grafts (13.6% vs 12.5%; P = .85), critical limb ischemia indications (P = .53), and prior arterial bypass (58% vs 47%; P = .08

  4. Amelogenesis imperfecta with distal renal tubular acidosis: A novel syndrome?

    Directory of Open Access Journals (Sweden)

    R A Misgar

    2017-01-01

    Full Text Available Amelogenesis imperfecta (AI is a heterogeneous group of inherited dental enamel defects. It has rarely been reported in association with multiorgan syndromes and metabolic disorders. The metabolic disorders that have been reported in association with AI include hypocalciuria, impaired urinary concentrating ability, and Bartter-like syndrome. In literature, only three cases of AI and distal renal tubular acidosis (dRTA have been described: two cases in adults and a solitary case in the pediatric age group. Here, we report a child with AI presenting with dRTA; to the best of our knowledge, our reported case is the only second such case in pediatric age group. Our case highlights the importance of recognizing the possibility of renal abnormalities in patients with AI as it will affect the long-term prognosis.

  5. [Evaluation of surgical repair of distal biceps tendon ruptures].

    Science.gov (United States)

    Behounek, J; Hrubina, M; Skoták, M; Krumpl, O; Zahálka, M; Dvorák, J; Fucík, M

    2009-02-01

    PURPOSE OF THE STUDY To present the results of surgical repair of ruptures of the distal tendon of the biceps brachii muscle and thus show the adequacy of this treatment. MATERIAL Between 1987 and 2006, 19 patients had surgery for distal biceps tendon rupture. Only one side was affected in each patient. All patients were men between 28 and 69 years (average age, 47.5 years) at the time of injury (surgery). When the patients were evaluated at the end of 2007, 18 patients were included, because one died a year after surgery. METHODS The surgical repair always included a single-incision anatomical reattachment into the radial tuberosity. In 11 patients, a modified Mac Reynolds method with screw and washer fixation was used; in seven patients the insertion was fixed with Mitek anchors and, in one, it was sutured to the adjacent soft tissues. The average follow-up was 7 years (range, 1 to 20.5 years). The patients were evaluated for the cause of injury, their physical activity, age, dominance of the injured arm, surgical procedure and complications. RESULTS In 18 patients surgical repair was done early and, in one, at 16 days after injury. In all of them the tendon was detached from its site of insertion, but never torn. The intra-operative complications included, in one patient, bleeding owing to iatrogenic damage to a branch of the brachial artery, and difficult separation of the tendon due to its previous healed injury in another patient. Early post-operative complications included superficial skin necrosis in one patient and transient neurological deficit of the dorsal brand of the radial nerve and of the lateral cutaneous nerve of the forearm in two and one patient, respectively. The late complications were heterotropic ossification in three patients and screw migration in the one treated by the Mac Reynolds method. Excellent results were recorded in 11 patients (61 %), and good outcomes with a slight restriction of motion or muscle strength not limiting the

  6. Laparoscopic distal pancreatectomy: Up-to-date and literature review

    Science.gov (United States)

    Iacobone, Maurizio; Citton, Marilisa; Nitti, Donato

    2012-01-01

    Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatectomy (LDP) has gained world-wide acceptance because it does not require anastomosis or other reconstruction. To date, English literature reports more than 300 papers focusing on LDP, but only 6% included more than 30 patients. Literature review confirms that LDP is a feasible and safe procedure in patients with benign or low grade malignancies. Decreased blood loss and morbidity, early recovery and shorter hospital stay may be the main advantages. Several concerns still exist for laparoscopic pancreatic adenocarcinoma excision. The individual surgeon determines the technical conduction of LDP, with or without spleen preservation; currently robotic pancreatic surgery has gained diffusion. Additional researches are necessary to determine the best technique to improve the procedure results. PMID:23082049

  7. Hand-arm vibration syndrome with distal brachial artery occlusion

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    Vladyslava Bazylevska

    2017-01-01

    Full Text Available Abstract             Hand-arm vibration syndrome (HAVS is a complex disorder of the peripheral extremities that is associated with occupational or recreational exposure to hand-transmitted vibration. Digital artery occlusion in HAVS is a common finding; however, proximal involvement is less likely.  We present a case of HAVS with the initial presentation of acute limb ischemia and with thrombus burden extending from the distal brachial artery and into the ulnar and radial arteries. To our knowledge, no case of HAVS syndrome of similar severity has been previously described. This case emphasizes the potential dangers of HAVS and the necessity for proper prophylactic interventions at the workplace.

  8. Fernandez osteotomy of radio distal with mal united fracture

    International Nuclear Information System (INIS)

    Garcia Herrera, Alvaro; Bocanegra, Sergio; Suarez, Fabio

    2003-01-01

    We review prospectively our experience in the military hospital in Bogota, Colombia, with the opening-wedge osteotomy for the treatment of a mal united fracture of the distal end of the radius in fifty-six consecutive patients from 1990 to 2002. The indications for operation were pain predominantly in the radio-ulnar joint and functional limitation with grip strength loss. Preoperative radiographs revealed an average ulnar inclination of 14 degrees, an average ulnar variance of four millimeters, and increased dorsal tilt (colles deformity) that averaged 28 degrees. All patients had limited function. The average grip strength was a force of fifteen kilograms compared with a force of thirty-one kilograms in the contralateral hand. Postoperatively, all of the patients had substantial improvement in function, relief of pain and grip strength increased. The functional results were rated as very good in eleven patients, good in thirty-six, fair in nine

  9. Sarcoidosis: radiographic manifestations in the nails and distal phalanges

    International Nuclear Information System (INIS)

    Albers, Brittany K.; Garner, Hillary W.; Sluzevich, Jason C.

    2016-01-01

    Sarcoidosis is a granulomatous disease which can affect multiple organ systems. Clinical and radiologic manifestations depend on the organ system involved and the chronicity of disease. Nail involvement in sarcoidosis is rare, but is clinically relevant as it indicates chronic systemic disease. Nail abnormalities can be identified radiographically, and when seen in patients with known or suspected sarcoidosis, should prompt careful evaluation of the underlying bone for osseous involvement. We describe a case of sarcoidosis with radiographic findings in the nails and distal phalangeal tufts, which were indicative of nail and osseous sarcoid involvement and strongly supported the presence of chronic systemic disease. Although the nail findings resolved clinically and on radiographs after treatment, the osseous findings showed only minimal improvement. To our knowledge, the radiographic findings of nail sarcoidosis have not been previously addressed in the literature. (orig.)

  10. Sarcoidosis: radiographic manifestations in the nails and distal phalanges

    Energy Technology Data Exchange (ETDEWEB)

    Albers, Brittany K.; Garner, Hillary W. [Mayo Clinic, Department of Radiology, Jacksonville, FL (United States); Sluzevich, Jason C. [Mayo Clinic, Department of Dermatology, Jacksonville, FL (United States)

    2016-05-15

    Sarcoidosis is a granulomatous disease which can affect multiple organ systems. Clinical and radiologic manifestations depend on the organ system involved and the chronicity of disease. Nail involvement in sarcoidosis is rare, but is clinically relevant as it indicates chronic systemic disease. Nail abnormalities can be identified radiographically, and when seen in patients with known or suspected sarcoidosis, should prompt careful evaluation of the underlying bone for osseous involvement. We describe a case of sarcoidosis with radiographic findings in the nails and distal phalangeal tufts, which were indicative of nail and osseous sarcoid involvement and strongly supported the presence of chronic systemic disease. Although the nail findings resolved clinically and on radiographs after treatment, the osseous findings showed only minimal improvement. To our knowledge, the radiographic findings of nail sarcoidosis have not been previously addressed in the literature. (orig.)

  11. Criteria for diagnosing distal radioulnar joint subluxation by computed tomography

    International Nuclear Information System (INIS)

    Nakamura, Ryogo; Horii, Emiko; Imaeda, Toshihiko; Nakao, Etsuhiro

    1996-01-01

    Bilateral wrist computed tomography (CT) was performed in 30 patients with suspected unilateral distal radioulnar joint (DRUJ) subluxation to evaluate dynamic DRUJ CT scanning with a straight elbow. Five CT criteria for diagnosing dorsovolar subluxation were examined. Maximum active supination and pronation on a conventional scanning table yielded satisfactory rotation (mean±SD, 119 ±29 ) at the DRUJ, thus permitting a dynamic diagnosis of DRUJ subluxation. The radioulnar line method and the congruity method frequently yielded false positive results compared with bilateral diagnosis and were unreliable. Modifications of these two methods achieved sensitivity and specificity comparable to the epicenter method. We recommend the modified radioulnar line method for diagnosing dorsovolar subluxation using unilateral CT because of its excellent sensitivity and specificity combined with ease of technique. (orig.). With 4 figs., 2 tabs

  12. Criteria for diagnosing distal radioulnar joint subluxation by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Ryogo [Department of Orthopedic Surgery, Branch Hospital of Nagoya University, School of Medicine, 1-1-20 Daikominami, Higashiku, Nagoya 461 (Japan); Horii, Emiko [Department of Orthopedic Surgery, Branch Hospital of Nagoya University, School of Medicine, 1-1-20 Daikominami, Higashiku, Nagoya 461 (Japan); Imaeda, Toshihiko [Department of Orthopedic Surgery, Branch Hospital of Nagoya University, School of Medicine, 1-1-20 Daikominami, Higashiku, Nagoya 461 (Japan); Nakao, Etsuhiro [Department of Orthopedic Surgery, Branch Hospital of Nagoya University, School of Medicine, 1-1-20 Daikominami, Higashiku, Nagoya 461 (Japan)

    1996-10-01

    Bilateral wrist computed tomography (CT) was performed in 30 patients with suspected unilateral distal radioulnar joint (DRUJ) subluxation to evaluate dynamic DRUJ CT scanning with a straight elbow. Five CT criteria for diagnosing dorsovolar subluxation were examined. Maximum active supination and pronation on a conventional scanning table yielded satisfactory rotation (mean{+-}SD, 119 {+-}29 ) at the DRUJ, thus permitting a dynamic diagnosis of DRUJ subluxation. The radioulnar line method and the congruity method frequently yielded false positive results compared with bilateral diagnosis and were unreliable. Modifications of these two methods achieved sensitivity and specificity comparable to the epicenter method. We recommend the modified radioulnar line method for diagnosing dorsovolar subluxation using unilateral CT because of its excellent sensitivity and specificity combined with ease of technique. (orig.). With 4 figs., 2 tabs.

  13. Dating young tephras - a distal solution to proximal controversy

    Science.gov (United States)

    Chen, Xuanyu; Blockley, Simon; Xu, Yigang; Menzies, Martin

    2017-04-01

    In-situ dating of young volcanic rocks (Liu, J.-Q., Müller, S., Wagner, M. and Menzies, M.A., 2016. Clarifying the distal to proximal tephrochronology of the Millennium (B-Tm) eruption, Changbaishan Volcano, northeast China. Quat. Geochronol., 33: 61-75. Ge, Q. and Wu, W., 2011. Climate during the Medieval Climate Anomaly in China. PAGES news, 19: 24-26. Sun, C., Plunkett, G., Liu, J., Zhao, H., Sigl, M., McConnell, J.R., Pilcher, J.R., Vinther, B., Steffensen, J.P. and Hall, V., 2014. Ash from Changbaishan Millennium eruption recorded in Greenland ice: Implications for determining the eruption's timing and impact. Geophys. Res. Lett., 2013GL058642.

  14. Distal Radius Quantitative Ultrasound Measurements and Related Factors

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    Özden Özyemiflçi Taflk›ran

    2011-04-01

    Full Text Available Aim: To investigate the quantitative ultrasound measurements and determine the related demographic, clinical and life style parameters. Material and Methods: A questionnaire including demographic features, systemic diseases, physical activity levels and other risk factors for osteoporosis was completed. Measurements of quantitative ultrasound (QUS were performed. Speed of sound (SOS (m/sec measurements were taken at the distal 1/3 radius of the nondominant extremity. Results: Among 2347 persons whom QUS measurements and questionnaires were completed, those aged 35 years and older and that were not taking antiosteoporotic treatment (N= 1867; 1654 women, 213 men were included for the analysis. Mean age of the participants were 52.1±10.7 years and mean SOS scores were 4142.8±185.8 m/sec. The variables that were statistically significant in either independent samples t test or analysis of variance were put in the linear regression analysis. In women, age, years since menopause and duration of lactation were independent predictors for SOS scores (constant= 4367.9 m/sec, age B: -3.8, ß: -0.197, p: 0.01; years since menopause: B: -3.9, ß: -0.211, p: 0.006; duration of lactation B: -0.4, ß: -0.086, p: 0.037. In men, age and level of education affected SOS scores independently (constant= 4271.3 m/sec, age B: -3.8, ß: -0.277, p: 0.001; level of education: B: 18.8, ß: 0.144, p: 0.036. Conclusion: Increasing age is associated with decrements in speed of sound measured by quantitative ultrasound at distal radius. It is important to give education about preventive measures on bone metabolism, especially during the lactation period. (Turkish Journal of Osteoporosis 2011;17:1-5

  15. Contact mechanics of reverse engineered distal humeral hemiarthroplasty implants.

    Science.gov (United States)

    Willing, Ryan; King, Graham J W; Johnson, James A

    2015-11-26

    Erosion of articular cartilage is a concern following distal humeral hemiarthroplasty, because native cartilage surfaces are placed in contact with stiff metallic implant components, which causes decreases in contact area and increases in contact stresses. Recently, reverse engineered implants have been proposed which are intended to promote more natural contact mechanics by reproducing the native bone or cartilage shape. In this study, finite element modeling is used in order to calculate changes in cartilage contact areas and stresses following distal humeral hemiarthroplasty with commercially available and reverse engineered implant designs. At the ulna, decreases in contact area were -34±3% (p=0.002), -27±1% (pengineered and cartilage reverse engineered designs, respectively. Peak contact stresses increased by 461±57% (p=0.008), 387±127% (p=0.229) and 165±16% (p=0.003). At the radius, decreases in contact area were -21±3% (p=0.013), -13±2% (p0.999), 241±32% (p=0.010) and 61±10% (p=0.021). Between the three different implant designs, the cartilage reverse engineered design yielded the largest contact areas and lowest contact stresses, but was still unable to reproduce the contact mechanics of the native joint. These findings align with a growing body of evidence indicating that although reverse engineered hemiarthroplasty implants can provide small improvements in contact mechanics when compared with commercially available designs, further optimization of shape and material properties is required in order reproduce native joint contact mechanics. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. [Tibiotalocalcaneal arthrodesis using a distally introduced femur nail (DFN)].

    Science.gov (United States)

    Grass, René

    2005-10-01

    Simultaneous arthrodesis of ankle and subtalar joints and, at the same sitting, correction of axial malalignment of hindfoot, treatment of bony defects and of sequelae of circulatory disturbances after multiple previous interventions. Internal stabilization with a short distal femur nail. Restitution of a pain-free weight bearing. Failure of arthrodesis of ankle and subtalar joint causing pain in patients with severely altered bone structures particularly at the level of the talar dome. Malalignment of hind- and/or forefoot after previous arthrodesis of ankle and subtalar joint. Failure of conservative therapy in both above-enumerated conditions. Poor skin or soft-tissue conditions. Reflex sympathetic dystrophy. Acute osteitis/osteomyelitis. Posterolateral approach. Resection of the articular cartilage and the areas of sclerosis of the ankle and of the posterior facet of the subtalar joint. Interposition of bone grafts harvested from the iliac crest. Correction of malalignment of hind- and forefoot. Locked nailing with a short distal femur nail. Fitting of a flexible custom-made arthrodesis boot; weight bearing in boot not exceeding half of body weight until the 8th week. Gait training. After 12 weeks wearing of normal shoes. Radiographs after 6 and 12 weeks. Between February 1, 2002 and September 1, 2003 this technique was performed on 18 feet in 17 patients (three women, 14 men, average age 53 years [38.9-73.7 years]). Average duration of follow-up: 1.2 years (0.6-2.1 years). The goal of surgery was reached in all patients. Subjective assessment: 14 times good, three times satisfactory. Four complications: one loss of nail purchase, one dislocation of locking screw, one breakage of locking bolt, one prolonged bone healing.

  17. Distal tibial fractures: evaluation of different fixation techniques.

    Science.gov (United States)

    Jöstl, Julian; Tiefenböck, Thomas Manfred; Hofbauer, Marcus; Winnisch, Markus; Lang, Nikolaus; Hajdu, Stefan; Sarahrudi, Kambiz

    2017-03-01

    The purpose of this study was the comparison of the most commonly used surgical techniques (external fixation, intramedullary nailing, and plate fixation) for the treatment of distal tibial fractures (AO/OTA classification 42-A, B, C or 43-A, B1). A retrospective cohort study of patients who underwent surgical treatment for distal tibial fractures between 1992 and 2011 was performed. A total of 93 patients (52 male/41 female) met inclusion criteria. Statistically significant differences were found regarding the consolidation time of the intramedullary-nailing (147.32 ± 91.16 days) and the plate-fixation group (135.75 ± 110.75 days) versus the external-fixation group (163.12 ± 96.79 days; P = 0.001; P = 0.01). Significant differences were also observed in the range of motion (ROM) of the ankle joint in the intramedullary-nailing and plate-fixation group versus the ROM in the external-fixation group (P = 0.044; P = 0.025). The overall complication rate was 13/93 (14 %). Out of 66 patients treated with intramedullary nailing, 8 (12 %) suffered from complications. Out of the 15 patients treated with plate and 12 patients with external fixation, 2 (13 %) and 3 (25 %) showed complications, respectively. Our results demonstrate advantages in terms of shorter mobilization time and a better ROM of the ankle joint for intramedullary nailing and plate fixation compared with external fixation. Due to our results, we suggest internal fixation (intramedullary nailing or plate fixation) whenever patient's condition and the local fracture situation allow it.

  18. Repair of the torn distal biceps tendon by endobutton fixation

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    Ravi K Gupta

    2012-01-01

    Full Text Available Background: A number of techniques have been described to reattach the torn distal biceps tendon to the bicipital tuberosity. We report a retrospective analysis of single incision technique using an endobutton fixation in sports persons. Materials and Methods: The present series include nine torn distal biceps tendons in eight patients, fixed anatomically to the radial tuberosity with an endobutton by using a single incision surgical technique; seven patients had suffered the injuries during contact sports. The passage of the endobutton was facilitated by using a blunt tipped pin in order to avoid injury to the posterior interosseous nerve. The patients were evaluated by Disabilities of the Arm, Shoulder and Hand (DASH score and Mayo elbow score. Results: The average age of the patients was 27.35 years (range 21-42 years. Average follow-up was 41.5 months (range 24-102 months. The final average flexion extension arc was 0°-143°, while the average pronation and supination angles were 77° (range 70°-82° and 81° (range 78°-85°, respectively at the last followup. All the patients had a Disabilities of the Arm, Shoulder and Hand (DASH score of 0 and a Mayo elbow score of 100 each. All the seven active sports persons were able to get back to their respective game. There was no nerve injury or any other complication. Conclusions: The surgical procedure used by us is a simple, safe and reproducible technique giving minimal morbidity and better cosmetic results.

  19. Fractures of the distal radius. Current concepts for treatment.

    Science.gov (United States)

    Broos, P L; Fourneau, I A; Stoffelen, D V

    2001-06-01

    The authors review the treatment of fractures of the distal radius, based on their experience and from data in the literature. The choice of a treatment for any given fracture must take into account first of all the stability of the fracture. The best results are achieved in stable fractures. Only minimally displaced distal radius fractures can be treated functionally. However, a plaster cast for one week is indicated for the comfort of the patient. In displaced but stable fractures both closed reduction and percutaneous fixation are indicated. In case of closed reduction, the plaster cast should be applied for 5 to 6 weeks with an above-elbow cast for 3 weeks. Percutaneous fixation gives the best results in extraarticular fractures in younger patients. Because of its simplicity however, it should not be ignored in the elderly osteoporotic patients. In the authors' experience, both techniques were only used for extraarticular fractures. Good and excellent results were found in the closed reduction and plaster cast group in 74% of the patients; the Kapandji technique gave 75% good and excellent results. These results are in line with other findings which show that, for simple fracture types, the Kapandji technique and closed reduction seem to give similar results. External fixation is widely used for intra-articular comminuted fractures. Dynamic external fixation does not show any advantage over static devices. Additional K-wires or bone grafting may be necessary. External fixation gives superior results to plate and screw fixation. Internal fixation should be reserved for fractures with ventral comminution or severe displacement with unacceptable reduction by closed or minimally invasive techniques.

  20. Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin.

    Science.gov (United States)

    Imperatore, Vittorio; Fusco, Ferdinando; Creta, Massimiliano; Di Meo, Sergio; Buonopane, Roberto; Longo, Nicola; Imbimbo, Ciro; Mirone, Vincenzo

    2014-06-30

    To compare the efficacy and safety of tamsulosin and silodosin in the context of medical expulsive therapy (MET) of distal ureteric stones. Observational data were collected retrospectively from patients who received silodosin (N = 50) or tamsulosin (N = 50) as MET from January 2012 to January 2013. Inclusion criteria were: patients aged ≥ 18 years with a single, unilateral, symptomatic, radiopaque ureteric stone of 10 mm or smaller in the largest dimension located between the lower border of the sacroiliac joint and the vesico-ureteric junction. Stone expulsion rate, stone expulsion time, number of pain episodes, need for analgesics use, incidence of side effects were compared. Stone-expulsion rate in the silodosin and in the tamsulosin groups were 88% and 82%, respectively (p not significant). Mean expulsion times were 6.7 and 6.5 days in the silodosin and tamsulosin group, respectively (p not significant). Mean number of pain episodes were 1.6 and 1.7 in the silodosin and tamsulosin group, respectively (p not significant). The mean number of analgesic requirement was 0.84 and 0.9 for the silodosin and tamsulosin group, respectively (p not significant). Overall, incidence of side effects was similar in both groups. Patients taking silodosin experienced an higher incidence of retrograde ejaculation but a lower incidence of side effects related to peripheral vasodilation when compared to patients taking tamsulosin. Subgroup analysis demonstrated significantly lower mean expulsion times and pain episodes in patients with stones ≤ 5 mm in both groups. Tamsulosin and silodosin are equally effective as MET for distal ureteric stones sized 10 mm or smaller. MET with silodosin is associatd with a lower incidence of side effects related to peripheral vasodilation but an higher incidence of retrograde ejaculation when compared to tamsulosin.

  1. Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin

    Directory of Open Access Journals (Sweden)

    Vittorio Imperatore

    2014-06-01

    Full Text Available Objectives: To compare the efficacy and safety of tamsulosin and silodosin in the context of medical expulsive therapy (MET of distal ureteric stones. Patients and methods: Observational data were collected retrospectively from patients who received silodosin (N = 50 or tamsulosin (N = 50 as MET from January 2012 to January 2013. Inclusion criteria were: patients aged ≥ 18 years with a single, unilateral, symptomatic, radiopaque ureteric stone of 10 mm or smaller in the largest dimension located between the lower border of the sacroiliac joint and the vesico-ureteric junction. Stone expulsion rate, stone expulsion time, number of pain episodes, need for analgesics use, incidence of side effects were compared. Results: Stone-expulsion rate in the silodosin and in the tamsulosin groups were 88% and 82%, respectively (p not significant. Mean expulsion times were 6.7 and 6.5 days in the silodosin and tamsulosin group, respectively (p not significant. Mean number of pain episodes were 1.6 and 1.7 in the silodosin and tamsulosin group, respectively (p not significant. The mean number of analgesic requirement was 0.84 and 0.9 for the silodosin and tamsulosin group, respectively (p not significant. Overall, incidence of side effects was similar in both groups. Patients taking silodosin experienced an higher incidence of retrograde ejaculation but a lower incidence of side effects related to peripheral vasodilation when compared to patients taking tamsulosin. Subgroup analysis demonstrated significantly lower mean expulsion times and pain episodes in patients with stones ≤ 5 mm in both groups. Conclusions: Tamsulosin and silodosin are equally effective as MET for distal ureteric stones sized 10 mm or smaller. MET with silodosin is associatd with a lower incidence of side effects related to peripheral vasodilation but an higher incidence of retrograde ejaculation when compared to tamsulosin.

  2. Minimally invasive distal pancreatectomy for PNETs: laparoscopic or robotic approach?

    Science.gov (United States)

    Zhang, Jiaqiang; Jin, Jiabin; Chen, Shi; Gu, Jiangning; Zhu, Yi; Qin, Kai; Zhan, Qian; Cheng, Dongfeng; Chen, Hao; Deng, Xiaxing; Shen, Baiyong; Peng, Chenghong

    2017-05-16

    The most effective and radical treatment for pancreatic neuroendocrine tumors (PNETs) is surgical resection. Minimally invasive surgery has been increasingly used in pancreatectomy. Initial results in robotic distal pancreatectomy (RDP) have been encouraging. Nonetheless, data comparing outcomes of RDP with those of laparoscopic distal pancreatectomy (LDP) in treating PNETs are rare. The aim of this study was to compare the safety and efficacy of RDP and LDP for PNETs. From September 2010 to January 2017, operative parameters and perioperative outcomes in an initial experience with 43 consecutive patients undergoing RDP were collected and compared with those in 31 patients undergoing LDP. Patients undergoing RDP and LDP demonstrated equivalent age, sex, ASA score, tumor location and tumor size. Operating time, length of resected pancreas, postoperative length of hospital stay and rates of conversion to open, pancreatic fistula, transfusion and reoperation were not statistically different. Patients in the RDP group were associated with significantly higher overall (79.1 vs. 48.4 %, P = 0.006) and Kimura spleen preservation rates (72.1 vs. 16.1%, P < 0.001) and had reduced risk of excessive blood loss (50 vs. 200mL, P < 0.001). Oncological outcomes in this series were superior for the RDP group with more lymph node harvest for G2 and G3 PNETs (3.5 vs. 2, P = 0.034). Both RDP and LDP are efficacious and safe methods in treating PNETs located in the body or tail of pancreas. Robotic approach offers advantages with less intraoperative blood loss, higher spleen preservation rate and more lymph node harvest. It may be sensible to choose RDP for patients who fit indications for scheduled spleen preservation.

  3. The morphology of Oreopithecus bambolii pollical distal phalanx.

    Science.gov (United States)

    Almécija, Sergio; Shrewsbury, Marvin; Rook, Lorenzo; Moyà-Solà, Salvador

    2014-04-01

    Oreopithecus bambolii is a Late Miocene ape from Italy, first described in the late 19th century. Its interpretation is still highly controversial, especially in reference to its hand proportions and thumb morphology. In this study, the authors provide detailed descriptions of the available Oreopithecus pollical distal phalanx (PDP) specimens, as well as bivariate and multivariate morphometric analyses in comparison with humans, extant apes, selected anthropoid monkeys, and available Miocene PDP specimens. The multivariate results reveal two opposite poles on the hominoid PDP shape spectrum: on one side, a mediolaterally broad and dorsopalmarly short human PDP, and on the other side, the narrow and "conical" PDP of chimpanzees and orangutans. The authors contend that Oreopithecus exhibits intermediate PDP proportions that are largely primitive for hominoids because it shares morphological similarities with Proconsul. Furthermore, Oreopithecus displays a mediolaterally wide tuft for a hominoid, as well as a palmarly elevated attachment for a long tendon of a flexor muscle that is associated at its proximal edge with a proximal fossa and at its distal edge with an ungual fossa. These nonmetrical traits have been associated in humans with their capability to oppose and contact the proximal pads of the thumb and fingers, that is, pad-to-pad precision grasping. These traits reinforce previous studies that indicate a human-like thumb-to-hand length ratio compatible with pad-to-pad precision grasping in Oreopithecus. Although specific hand use is still unresolved in Oreopithecus, the results suggest enhanced manipulative skills (unrelated to stone tool-making) in this taxon relative to other (extant or fossil) hominoids. Copyright © 2014 Wiley Periodicals, Inc.

  4. [Retrograde intramedullary nailing for periprosthetic fractures of the distal femur].

    Science.gov (United States)

    Biber, R; Bail, H J

    2014-10-01

    Intramedullary stabilization of periprosthetic distal femoral fractures by interlocking nailing. Closed reduction by retrograde nail can be combined with the use of transmedullary support screws (TMS principle of Stedtfeld). Supracondylar fractures above stable knee arthroplasty (Rorabeck types I and II), femoral shaft fractures ipsilateral of stable hip and/or knee arthroplasty, contraindications for antegrade nailing Closed box design of femoral implant, intercondylar distance of the femoral component smaller than nail diameter, more than 40° flexion deficit of the knee, inability to place two bicortical distal interlocking screws. Relative contraindication: insufficient overlap with proximal implants Supine position and knee flexion of approximately 45°. Fluoroscopy should be possible between the knee and hip. Longitudinal skin incision into the pre-existing scar over the patellar tendon which is then split. The nail entry point is located in the intercondylar groove at the deepest point of Blumensaat's line, often predetermined by the femoral arthroplasty component. Reaming is rarely necessary. Transmedullary support screws may correct axial malalignment during nail insertion. Static interlocking in a direction from lateral to medial by the aiming device. Insertion of locking cap. Retrograde nailing normally allows full weight bearing. Range of motion does not need to be restricted. Out of 101 fractures treated between 2000 and 2013 with a Targon RF nail (Aesculap, Tuttlingen, Germany) 10 were periprosthetic, all were classified as Rorabeck type II and of these 6 fractures were metaphyseal and 4 were diaphyseal. In four cases proximal implants were present. The mean operative time for periprosthetic fracture fixation did not significantly differ from that for normal retrograde femoral nailing. There were no postoperative infections, fixation failures or delayed unions. There was one revision for secondary correction of maltorsion.

  5. Distal anterior inferior cerebellar artery syndrome after acoustic neuroma surgery.

    Science.gov (United States)

    Hegarty, Joseph L; Jackler, Robert K; Rigby, Peter L; Pitts, Lawrence H; Cheung, Steven W

    2002-07-01

    To define a clinicopathologic syndrome associated with persistent cerebellar dysfunction after acoustic neuroma (AN) excision. Case series derived from radiographic and clinical chart review. Tertiary referral center. In 12 patients with AN, persistent cerebellar dysfunction developed after AN removal. Each case demonstrated abnormality in the ipsilateral cerebellar peduncle on postoperative magnetic resonance imaging. Cerebellar function and ambulatory status over the first postoperative year. On magnetic resonance imaging scans, the extent of cerebellar peduncle infarcts was variable. It ranged from focal brain injury (2 cm) spanning the full thickness of the peduncle. Peduncular infarcts were associated with large tumor size (average 3.8 cm, range 2.0-5.5 cm diameter). The long-term functional outcomes (>1 yr) varied. Dysmetria was unchanged or improved in over half of the patients (6 of 11 patients). Gait recovered to normal or to preoperative levels in 5 patients. In the 6 patients with persistent impaired mobility, 2 had mild gait disturbance, 3 required regular use of a cane, and 1 has been dependent on a walker. One patient had sustained mild motor weakness. Three of 11 patients remained dependent on others for activities of daily living. Peduncle injury most likely stems from interruption of distal branches of the anterior inferior cerebellar artery (AICA). These small vessels are intimately related to the capsule of the tumor and may supply both the neoplasm and the brain parenchyma. It has long been recognized that interruption of the proximal segment of the AICA results in severe injury to the pons, with devastating neurologic sequelae. A limited AICA syndrome caused by loss of its distal ramifications seems a more plausible explanation for peduncular infarction than either venous insufficiency or direct surgical trauma.

  6. Three-dimensional analysis of osteophyte formation on distal radius following scaphoid nonunion.

    Science.gov (United States)

    Oura, Keiichiro; Moritomo, Hisao; Kataoka, Toshiyuki; Oka, Kunihiro; Murase, Tsuyoshi; Sugamoto, Kazuomi; Yoshikawa, Hideki

    2017-01-01

    The purposes of this study were to quantitatively analyze osteophyte formation of the distal radius following scaphoid nonunion and to investigate how fracture locations relate to osteophyte formation patterns. Three-dimensional surface models of the scaphoid and distal radius were constructed from computed tomographic images of both the wrists of 17 patients' with scaphoid nonunion. The scaphoid nonunions were classified into 3 types according to the location of the fracture line: distal extra-articular (n = 6); distal intra-articular (n = 5); and proximal (n = 6). The osteophyte models of the radius were created by subtracting the mirror image of the contralateral radius model from the affected radius model using a Boolean operation. The osteophyte locations on the radius were divided into 5 areas: styloid process, dorsal scaphoid fossa, volar scaphoid fossa, dorsal lunate fossa, and volar lunate fossa. Osteophyte volumes were compared among the areas and types of nonunion. The presence or absence of dorsal intercalated segment instability (DISI) deformity was also determined. The distal intra-articular type exhibited significantly larger osteophytes in the styloid process than the distal extra-articular type. Furthermore, the proximal type exhibited significantly larger osteophytes in the dorsal scaphoid fossa than the distal extra-articular type. Finally, the distal intra- and extra-articular types were more associated with DISI deformity and tended to have larger osteophytes in the lunate fossa than the proximal type. The pattern of osteophyte formation in the distal radius determined using three-dimensional computed tomography imaging varied among the different types of scaphoid nonunion (distal extra-articular, distal intra-articular, and proximal). The results of this study are clinically useful in determining whether additional resection of osteophytes or radial styloid is necessary or not during the treatment of the scaphoid nonunion. Copyright

  7. Randomized comparison of distal protection versus conventional treatment in primary percutaneous coronary intervention: the drug elution and distal protection in ST-elevation myocardial infarction (DEDICATION) trial

    DEFF Research Database (Denmark)

    Kelbaek, Henning; Terkelsen, Christian J; Helqvist, Steffen

    2008-01-01

    OBJECTIVES: The purpose of this study was to evaluate the use of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in native coronary vessels. BACKGROUND: Embolization of material from the infarct-related lesion during PCI may......: The routine use of distal protection by a filterwire system during primary PCI does not seem to improve microvascular perfusion, limit infarct size, or reduce the occurrence of MACCE....

  8. Manejo post sacrificial del cuerpo humano: evidencias e implicaciones rituales en un entierro del Clásico Terminal en Lagartero, Chiapas

    Directory of Open Access Journals (Sweden)

    Judith Lizbeth Ruiz González

    2016-06-01

    Full Text Available Durante 2011 se llevaron a cabo labores de exploración arqueológica en el sitio de Lagartero, en el estado de Chiapas; se recuperó, en un contexto no funerario, un entierro primario con características particulares. Se identificaron segmentos anatómicos incompletos de un individuo masculino, adulto joven, con marcas de corte distribuidas en varias áreas de los huesos. Se puede considerar que se trata de evidencia del tratamiento post sacrificial del cuerpo humano y el posible aprovechamiento de alguna de sus partes con propósitos rituales o como materia prima para la manufactura de utensilios, herramientas, ornatos u otros objetos. A partir de la concepción maya de lo que es el cuerpo humano se pretende entender el porqué del manejo post sacrificial que se dio al cadáver.

  9. A evidenciação dos fatos contábeis ambientais como forma de cumprimento com as obrigações relativas ao meio ambiente

    OpenAIRE

    Sager, André

    2011-01-01

    Artigo apresentado à Fundação Universidade Federal de Rondônia – UNIR, Campus de Cacoal, como requisito parcial para obtenção do grau de Bacharel em Ciências Contábeis, sob orientação da Profª. Ma. Estela Pitwak Rossoni. Diante das obrigações contábeis da empresa em relação ao meio ambiental, este trabalho, tem por objetivo, verificar a percepção e posicionamento dos contadores, quanto à evidenciação dos fatos ambientais nas demonstrações contábeis. Para tanto, foi realizada pesquisa bibli...

  10. Los impuestos como determinantes de la inversión empresarial. Evidencia empírica en empresas españolas que no cotizan en bolsa

    Directory of Open Access Journals (Sweden)

    Juan Monterrey Mayoral

    2017-07-01

    Full Text Available En este artículo se analiza si el deseo de evitar pagos fiscales futuros, calculados en términos de impuestos diferidos netos que se registran en los balances generales de las empresas, podría erigirse, junto con los factores explicativos documentados en la bibliografía anterior, como un determinante de la inversión empresarial. Nuestro análisis empírico aporta resultados sólidos que dejan constancia de que los pagos fiscales futuros son una motivación adicional para adoptar decisiones de inversión. No obstante, nuestros hallazgos también ponen de manifiesto que, hasta cierto punto, las motivaciones de carácter tributario podrían explicar situaciones de sobreinversión, si bien la evidencia que se ha obtenido de dichos episodios muestra una moderada significación estadística.

  11. Hernioplastia laparoscópica y reparación anterior sin tensión: ¿qué dicen las evidencias?

    Directory of Open Access Journals (Sweden)

    Felipe Jorge Aragón Palmero

    Full Text Available El tratamiento quirúrgico de la hernia inguinal permanece controversial a pesar de los avances experimentados en los últimos 20 años en materia de biomateriales e instrumentación. Las técnicas de reparación laparoscópica forman parte del arsenal quirúrgico, pero su lugar en este tipo de cirugía aún no está bien definido. Con el objetivo de determinar el papel de la reparación abierta por vía anterior a base de prótesis y del abordaje laparoscópico de la hernia inguinal, se revisaron las publicaciones con alto nivel de evidencias, de los últimos 10 años, usando diferentes estrategias de búsqueda en bases de datos disponibles en Infomed.

  12. Economía política y finanzas públicas: teoría, evidencia y resultados de laboratorio

    Directory of Open Access Journals (Sweden)

    Gutiérrez , Javier A.

    2000-12-01

    Full Text Available Este trabajo revisa los modelos teóricos y la evidencia empírica relacionados con la economía política de las finanzas públicas. Destaca los factores político institucionales que influyen en los niveles de deuda pública y de déficit fiscal en países y entidades subnacionales con economías similares y describe las relaciones definidas en el contrato fiscal entre gobernantes y electores recurriendo a la teoría del principalagente. Luego usa métodos de economía experimental y teoría de juegos para evaluar la influencia de estas relaciones sobre la deuda y el déficit fiscal, mediante un experimento de laboratorio en el que los participantes actúan primero como agentes (gobernantes y luego como principales (votantes.

  13. FOTOGRAFÍAS DE AMAS DE LECHE EN BAHÍA. EVIDENCIA VISUAL DE LOS APORTES AFRICANOS A LA FAMILIA ESCLAVISTA EN BRASIL

    Directory of Open Access Journals (Sweden)

    Christianne Silva Vasconcellos

    2011-01-01

    Full Text Available Este artículo presenta un análisis de la producción y el uso de fotografías de personas africanas y afrodescendientes, realizadas en Brasil entre 1840, cuando esta técnica fue introducida al país, y 1920, cuando las primeras fotografías aún estaban en circulación. Desde la evidencia visual, se analizan tres temas recurrentes en el Brasil del siglo XIX: la difusión de teorías del racismo científico europeo a través de la fotografía, la creación de los tipos urbanos en las ciudades esclavistas y las nodrizas (amas de leche como agentes culturales en el seno de la familia colonial en Bahía.

  14. ¿ES ÚTIL EL ANÁLISIS TÉCNICO EN PERIODOS DE CRISIS FINANCIERA? Evidencia para el mercado bursátil latinoamericano

    Directory of Open Access Journals (Sweden)

    Christian Espinosa

    2014-01-01

    Full Text Available En este artículo investigamos si los instrumentos de análisis técnico son útiles en periodos de crisis financieras. Considerando cuatro de los principales índices latinoamericanos —Bovespa (Brasil, IGBLV (Perú, IPC (México e IPSA (Chile— no encontramos Considerando cuatro de los principales índices latinoamericanos —Bovespa (Brasil, IGBLV (Perú, IPC (México e IPSA (Chile— no encontramos evidencia a favor del uso de análisis técnico en periodos de crisis financiera. Las técnicas que otorgan rentabilidades más altas no son las mismas que reportan rendimientos más bajos. En general, los instrumentos de mediano plazo son los que reportan un mayor rendimiento, mientras que los de corto plazo reportan un menor rendimiento.

  15. Fotografías de amas de leche en bahía. Evidencia visual de los aportes Africanos a la familia esclavista en Brasil

    Directory of Open Access Journals (Sweden)

    Christianne Silva Vasconcellos

    2011-10-01

    Full Text Available Este artículo presenta un análisis de la producción y el uso de fotografías de personas africanas y afrodescendientes, realizadas en Brasil entre 1840, cuando esta técnica fue introducida al país, y 1920, cuando las primeras fotografías aún estaban en circulación. Desde la evidencia visual, se analizan tres temas recurrentes en el Brasil del siglo XIX: la difusión de teorías del racismo científico europeo a través de la fotografía, la creación de los tipos urbanos en las ciudades esclavistas y las nodrizas (amas de leche como agentes culturales en el seno de la familia colonial en Bahía.

  16. EFECTOS DE LA DISPERSIÓN RETRIBUTIVA EN LOS RESULTADOS DE LAS EMPRESAS COTIZADAS ESPAÑOLAS: EVIDENCIA SOBRE EL MODELO DEL TORNEO

    Directory of Open Access Journals (Sweden)

    Sánchez Marín, G.

    2010-01-01

    Full Text Available La literatura ha puesto en cuestión si realmente las grandes diferencias retributivas entre directivos están vinculadas con mejores resultados de la organización. En este trabajo, sobre la base de los argumentos de la teoría del torneo, se ha tratado de aportar nuevas evidencias en esta línea, utilizando para ello datos de las 120 empresas españolas que cotizan en Bolsa. Los resultados obtenidos, considerando la forma convexa en las relaciones dispersión-resultados de Brown et al. (2003 y las características del trabajo directivo –alto nivel jerárquico, interdependencia moderada y alta incertidumbre-, indican que existe una relación positiva, aunque moderada por ciertas variables, entre dispersión retributiva y resultados de la empresa.

  17. Efectos de sorpresas económicas en la estructura de tasas de interés. Evidencia para Brasil, Chile y México

    Directory of Open Access Journals (Sweden)

    Luis Ceballos Sanhueza

    2016-01-01

    Full Text Available En este artículo se reporta el impacto de sorpresas económicas y anuncios de política monetaria no convencional en los factores de la estructura de tasas nominales en Brasil, Chile y México. Se evidencia que sorpresas locales de inflación y de política monetaria tienen mayor efecto en la forma de la estructura de tasas, además, se registran efectos asimétricos de dichas sorpresas en la estructura de tasas de las economías analizadas. Por otro lado, sorpresas externas tienen un impacto asimétrico, mientras que el efecto de anuncios de política no convencionales, tanto el Quantitative Easing como el Twist Operation son los anuncios que presentan mayor impacto en la estructura de tasas de interés.

  18. Evidenciação da remuneração variável dos executivos nas maiores empresas brasileiras listadas na BM&FBovespa

    Directory of Open Access Journals (Sweden)

    Ilse Maria Beuren

    2016-01-01

    Full Text Available Este estudo objetiva verificar a evolução da evidenciação da remuneração variável dos executivos nas demonstrações financeiras das maiores empresas brasileiras de capital aberto. Estudo descritivo com abordagem qualitativa foi realizado por meio de análise de conteúdo para identificar a evidenciação da remuneração variável dos executivos nos relatórios da administração, notas explicativas, informações anuais e formulário de referência dos anos de 2008 até 2010. Consideraram-se como referência cinco categorias de análise, que foram elaboradas com base no Código das Melhores Práticas de Governança Corporativa do IBGC e na sessão 13 do anexo 24 (Formulário de Referência da Instrução CVM nº 480/09. Os resultados demonstram que as empresas pesquisadas divulgaram em 2008 aspectos superficiais dos planos de remuneração variável, ou seja, evidenciaram informações relativas aos valores da remuneração variável dos executivos pelo seu montante total, sem detalhes. Após a obrigatoriedade da divulgação do formulário de referência, observou-se um aumento no nível de informações divulgadas pelas empresas pesquisadas. Conclui-se que expostas a mais regras, as empresas tiveram em 2009 e 2010 aumento das informações evidenciadas sobre a remuneração variável dos executivos, primordialmente nos formulários de referência.

  19. Evidenciação de custos ambientais: um estudo multicaso de empresas do segmento de papel e celulose listadas na BM&FBOVESPA

    Directory of Open Access Journals (Sweden)

    Débora Gomes Machado

    2015-05-01

    Full Text Available A busca por empresas socialmente responsáveis e sustentáveis tem aumentado, em decorrência das crescentes mudanças socioculturais e da conscientização sobre a necessidade de diminuir o ritmo de exploração e uso dos recursos naturais,mitigando, assim, os impactos socioambientais. Tal fato tem reflexos no contexto empresarial, na medida em que se percebeaí uma tendência inovadora de buscar conhecer os custos provocados pelos impactos socioambientais que causam, como subsídio para avaliar o desempenhoda organização ou sinalizar a necessidade de aperfeiçoamento.Diante do exposto, o objetivo deste estudo é identificar como as empresaspertencentes ao setor de papel e celulose,listadas na Bolsa de Valores, Mercadorias e Futuros – BM&F Bovespa, têm evidenciado seus custos de cunho ambiental.Realizou-se um estudo multicasocomseis empresas,no período de 2008 e 2009.A pesquisa caracteriza-se como descritiva, documental e qualitativa, e a coleta de dados foi realizada por meio deanálise de conteúdo,nas demonstrações contábeis, nos relatórios de administração e notas explicativas. Os resultados demonstraram que não houve qualquer evidenciação de custos ambientais por parte das empresas estudadas. Foi possível identificar práticas de gestão ambiental, certificações, ações socioambientais, de sustentabilidade, entre outras. Por ser um setor que está sujeito ao rigor da norma ambiental, espera-se que um futuro próximo aponte mudanças na postura das empresas em relação à evidenciação de informações quantitativas dos custos ambientais envolvidos.

  20. Análise e Mapeamento sobre a Avaliação da Evidenciação dos Atos Públicos dos Entes Governamentais

    Directory of Open Access Journals (Sweden)

    Lucas dos Santos Matos

    2015-08-01

    Full Text Available O aumento da demanda da população e dos órgãos fiscalizadores por informações relacionadas à gestão governamental ocasionou a necessidade de melhorar a evidenciação dos relatórios públicos, tanto na abrangência e qualidade da informação quanto na sua transparência. Surge então a necessidade de desenvolver modelos de avaliação da transparência dos atos públicos que contemplem a necessidade dos usuários. Assim, esta pesquisa, de natureza exploratório-descritiva, com abordagem qualitativa e quantitativa, objetiva realizar um mapeamento sobre o tema avaliação da evidenciação dos atos públicos dos entes governamentais a partir da seleção de um rol de artigos internacionais reconhecidos cientificamente e, a partir deste portfólio, realizar uma análise de conteúdo destes artigos, visando à identificação de oportunidades de pesquisas. Dessa forma, foi selecionado o Knowledge Development Process – Constructivist (ProKnow-C como instrumento de intervenção do processo. O resultado foi um conjunto de 14 artigos científicos, publicados entre 2000 e 2013, com reconhecimento e, para estes artigos, evidenciou-se os principais artigos, periódicos, autores e palavras-chave acerca do tema de estudo. A análise de conteúdo possibilitou encontrar destaques e oportunidades para pesquisas futuras. Verificou-se que a literatura trata apenas de modelos de avaliação da transparência pública conforme os critérios definidos por normas e legislações, mas é necessário considerar as necessidades dos usuários.

  1. Evidencias acerca de la validez de constructo de la escala voluntad de trabajo Evidence For The Construct Validity Of The Will To Work Scale

    Directory of Open Access Journals (Sweden)

    Facundo Juan Pablo Abal

    2008-12-01

    Full Text Available La Voluntad de Trabajo (VT describe la tendencia por la cual una persona se aboca a sus obligaciones realizándolas con responsabilidad, automotivación y precisión. Con el objetivo de recabar evidencias acerca de la validez de constructo se administró un cuestionario inicial de 12 ítems que evalúan VT a 1,123 estudiantes de Psicología de la Universidad de Buenos Aires. Mediante el análisis clásico de ítems se obtuvo una escala unidimensional de 10 ítems con un Alfa de Cronbach de .71. Se encontraron correlaciones positivas con las subescalas Perseverancia y Dinamismo del Big Five Questionnaire (BFQ. La correlación con la primera fue moderada y con la segunda fue de magnitud inferior. Estos resultados permitieron profundizar el estudio del constructo y aportaron evidencias para establecer su validez.The Will to Work (WW describes the tendency by which a person devotes himself / herself to his / her duties with responsibility, self-motivation and accuracy. With a view to gathering evidence for the construct validity, an initial 12-item questionnaire to evaluate the WW was administered to 1,123 psychology students of the University of Buenos Aires. Through the classical item analysis, an unidimensional 10-item scale was obtained with a Cronbach's Alpha of .71. Positive correlations were found with the Perseverance and Dynamism subscales of the Big Five Questionnaire (BFQ. The correlation with the former was moderate, whereas the correlation with the latter was lower. These findings allowed for a deeper study of the construct and served as evidence of its validity.

  2. Cuidados del cordón umbilical en el recién nacido: revisión de la evidencia científica

    Directory of Open Access Journals (Sweden)

    M.ª José Díaz Gutiérrez

    2016-03-01

    Full Text Available Objetivos: En este trabajo se realiza una revisión de la evidencia científica sobre las pautas de cuidado de la herida umbilical del recién nacido recomendadas en la actualidad con el objetivo de determinar cuál es el mejor cuidado posible. Metodología: En mayo de 2015 se realizó una revisión, siguiendo los criterios PRISMA, de la literatura científica que se completó con una revisión manual. La herramienta utilizada para la evaluación de los trabajos seleccionados fueron las "Fichas de Lectura Crítica" de OSTEBA del Servicio de Evaluación de Tecnologías Sanitarias del Gobierno Vasco. Resultados: Incluimos en la revisión 9 artículos, de los cuales 5 son revisiones previas y 4 ensayos clínicos aleatorizados y controlados. La mayoría de los trabajos comparan la utilización de un antiséptico para la cura del ombligo (generalmente clorhexidina frente al cuidado seco de la herida. Conclusiones: De acuerdo a la evidencia científica resumida en esta revisión sobre las recomendaciones para la cura del ombligo del recién nacido el método a recomendar será diferente según el país en el que nos encontremos ya sea desarrollado o en vías de desarrollo.

  3. Evidenciação de instrumentos financeiros derivativos nas demonstrações contábeis: uma análise das empresas brasileiras

    Directory of Open Access Journals (Sweden)

    Leandro Luís Darós

    2005-12-01

    Full Text Available Dentro da perspectiva de governança corporativa e de acordo com a Instrução Normativa 235 da Comissão de Valores Mobiliários - CVM, este trabalho apresenta uma pesquisa empírica sobre as formas de evidenciação de instrumentos financeiros derivativos nas Demonstrações Contábeis divulgadas no Brasil. Foram analisadas as Demonstrações Contábeis das vinte maiores empresas brasileiras não financeiras classificadas de acordo com a receita líquida. Como resultado constatou-se que a grande maioria das empresas não atende às determinações da CVM e não evidencia, de forma clara, concisa e objetiva, as informações referentes às suas operações envolvendo instrumentos financeiros derivativos. As principais divergências estão na falta de avaliação dos instrumentos a preços de mercado, ausência de divulgação das políticas de investimento em derivativos e falta de controle do risco de mercado, câmbio e crédito.In the context of financial statement disclosure and in accordance with determinations by the Brazilian Securities and Exchange Commission, this study presents rules and ways to disclose derivatives in financial statements. In the empirical analysis, we examined the financial statements of the twenty biggest public companies arranged by revenue. We verified that many companies do not comply with the Brazilian Securities and Exchange Commission's determinations and do not present a clear, concise and objective disclosure of related financial information. The main problems were related to the lack of evaluation in terms of fair value, lack of dissemination of investment policies in derivatives and quantitative and qualitative control of market, credit and exchange risks.

  4. Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius: interobserver reliability

    NARCIS (Netherlands)

    Gradl, Gertraud; Neuhaus, Valentin; Fuchsberger, Thomas; Guitton, Thierry G.; Prommersberger, Karl-Josef; Ring, David; Wahegaonkar, Abhijeet L.; Shafritz, Adam B.; Garcia, Aida E.; Caputo, Andrew E.; Terrono, Andrew L.; Spoor, Andy B.; Eschler, Anica; Vochteloo, Anne J. H.; Beumer, Annechien; Barquet, Antonio; Kristan, Anze; van der Zwan, Arnard L.; Berner, Arne; Ilyas, Asif; Jubel, Axel; Sutker, Ben; Nolan, Betsy M.; Petrisor, Brad; Cross, Brian J.; Wills, Brian P. D.; Barreto, Camilo J. R.; Fernandes, Carlos H.; Swigart, Carrie; Zalavras, Charalampos; Goldfarb, Charles A.; Cassidy, Charles; Eaton, Charles; Wilson, Chris; Cheng, Christine J.; Wall, Christopher J.; Walsh, Christopher J.; Jones, Christopher M.; Garnavos, Christos; Klostermann, Cyrus; Kirkpatrick, D. Kay; Osei, Daniel A.; Rikli, Daniel A.; Wascher, Daniel C.; Polatsch, Daniel; Silva, Dario Mejia; Nelson, David L.; Kalainov, David M.; Ruchelsman, David; Hoffmann, David Victoria; Weiss, David; Eygendaal, Denise; van Deurzen, Derek F. P.; McKee, Desirae M.; Verbeek, Diederik O. F.; Hanel, Doug; Hutchinson, Douglas T.; Brilej, Drago; Harvey, Edward; Stojkovska Pemovska, Emilija; Calvo, Emilio; Hammerberg, Eric Mark; Hofmeister, Eric P.; Kaplan, F. Thomas D.; Suarez, Fabio; Beeres, Frank J. P.; Walter, Frank L.; Frykman, Gary K.; Pess, Gary M.; Kuzma, Gary R.; Dyer, George S. M.; Thomas, George; Kohut, Georges; Kraan, Gerald A.; DeSilva, Gregory; Della Rocca, Gregory J.; Lob, Guenter; Gadbled, Guillaume; Bamberger, H. Brent; Mc Cutchan, Hal; Goost, Hans; Kreder, Hans J.; Grünwald, Heinz; Broekhuyse, Henry; Kimball, Hervey L.; Durchholz, Holger; van der Heide, Huub; McGraw, Iain; Choueka, Jack; Forigua, Jaime E.; Nappi, James F.; Reid, James G.; Kellam, James; Boler, James M.; Biert, Jan; Fanuele, Jason C.; Tavakolian, Jason D.; Jones, Jedediah; Johnson, Jeff W.; Wolf, Jennifer Moriatis; Murachovsky, Joel; Scheer, Johan H.; Rueger, Johannes M.; Erickson, John M.; McAuliffe, John; Boretto, Jorge G.; Rubio, Jorge; Ortiz, Jose A.; Ribeiro Filho, Jose Eduardo Grandi; Di Giovanni, José Fernando; Izzi, Joseph A.; Conflitti, Joseph M.; Abzug, Joshua M.; Cagnone, Juan Carlos; Adams, Julie; Chivers, Karel; Lee, Kendrick; Eng, Kevin; Malone, Kevin J.; Erol, Konul; Ponsen, Kornelis J.; Kabir, Koroush; Jeray, Kyle; Mica, Ladislav; Brunton, Lance M.; Adolfsson, Lars E.; Weiss, Lawrence; Katolik, Leonid; Paz, Lior; Poelhekke, Lodewijk M. S. J.; Escobar, Luis Felipe Naquira; Campinhos, Luiz Augusto B.; Abdel-Ghany, Mahmoud I.; Richard, Marc J. Richard; Swiontkowski, Marc; Rizzo, Marco; Pirpiris, Marinis; Boyer, Martin; Richardson, Martin; Kastelec, Matej; Turina, Matthias; Soong, Maximillian; Wood, Megan M.; Baskies, Michael; Behrman, Michael; Nancollas, Michael; Prayson, Michael; Quell, Michael; Verhofstad, Michael; Grafe, Michael W.; Kessler, Michael W.; van den Bekerom, Michel P. J.; van de Sande, Michiel A. J.; Mckee, Mike; Patel, Milan M.; Merchant, Milind; Tyllianakis, Minos; Wiegand, Mischa Ralph; Waseem, Mohammad; Parnes, Nata; Wilson, Neil; Elias, Nelson; Shortt, Nicholas L.; Schep, Niels; Semenkin, Oleg M.; Henry, Patrick D. G.; Martineau, Paul A.; Jebson, Peter; Kloen, Peter; Brink, Peter R. G.; Schandelmaier, Peter; Blazar, Philip; Streubel, Philipp N.; Vial, Philippe; Choudhari, Pradeep; Inna, Prashanth; Costanzo, Ralph M.; de Bedout, Ramon; Hauck, Randy; Smith, Raymond Malcolm; Fricker, Renato M.; Omid, Reza; Buckley, Richard; Jenkinson, Richard; Hutchison, Richard L.; GIlbert, Richard S.; Page, Richard S.; Nelissen, Rob; Haverlag, Robert; Wagenmakers, Robert; Pesantez, Rodrigo; Klinefelter, Ryan; Calfee, Ryan P.; Moghtaderi, Sam; Spruijt, Sander; Kakar, Sanjeev; Kaplan, Saul; Duncan, Scott F.; Mitchell, Scott; Rowinski, Sergio; Dodds, Seth; Kennedy, Stephen A.; Westly, Stephen K.; Kronlage, Steve; Beldner, Steven; McCabe, Steven J.; Rhemrev, Steven J.; Gosens, Taco; Baxamusa, Taizoon; Apard, Thomas; Dienstknecht, Thomas; Varecka, Thomas F.; Hughes, Thomas; Mittlmeier, Thomas; Pillukat, Thomas; Wright, Thomas; Havenhill, Timothy G.; Omara, Timothy; Siff, Todd; Giordano, Vincenzo; Hammert, Warren C.; Satora, Wojciech

    2013-01-01

    To evaluate the reliability and accuracy of diagnosis of scapholunate dissociation (SLD) among AO type C (compression articular) fractures of the distal radius. A total of 217 surgeons evaluated 21 sets of radiographs with type C fractures of the distal radius for which the status of the

  5. Distal and Proximal Vision: A Multi-Perspective Research in Sociology of Education

    Science.gov (United States)

    Giancola, Orazio; Viteritti, Assunta

    2014-01-01

    Drawing inspiration from the research conducted in Italian schools involved in the reform process, the article proposes to investigate two visions in the research on Sociology of Education: one distal and the other proximal. The distal vision is offered by quantitative research nowadays supported by extensive public funding and framed as…

  6. Clinical and non-clinical aspects of distal radioulnar joint instability

    NARCIS (Netherlands)

    Wijffels, M.; Brink, P.R.G.; Schipper, I.

    2012-01-01

    Untreated distal radioulnar joint (DRUJ) injuries can give rise to long lasting complaints. Although common, diagnosis and treatment of DRUJ injuries remains a challenge. The articulating anatomy of the distal radius and ulna, among others, enables an extensive range of forearm pronosupination

  7. Free tissue transfer of digital food pads for reconstruction of the distal limb in the dog.

    Science.gov (United States)

    Basher, A W; Fowler, J D; Bowen, C V

    1991-01-01

    Reconstructive procedures used in salvaging distal limb injuries in the dog are reviewed. Techniques employed to resurface the distal weight-bearing surface include local reconstruction using pedicle flap transposition of foot pads. The development of a previously described free microneurovascular digital foot pad flap is reviewed; the experimental results and potential for clinical use of the free flap are discussed.

  8. RNA sequencing of kidney distal tubule cells reveals multiple mediators of chronic aldosterone action

    DEFF Research Database (Denmark)

    Poulsen, Søren Brandt; Limbutara, Kavee; Fenton, Robert Andrew

    2018-01-01

    The renal aldosterone-sensitive distal tubule (ASDT) is crucial for sodium reabsorption and blood pressure regulation. The ASDT consists of the late distal convoluted tubule (DCT2), connecting tubule (CNT) and collecting duct. Due to difficulties in isolating epithelial cells from the ASDT in lar...

  9. Utility of 64-row MDCT in assessment of neonates with congenital EA and distal TEF

    Directory of Open Access Journals (Sweden)

    Hosam El-Deen Galal Mohamed El-Malah

    2015-12-01

    Conclusion: Preoperative MDCT scan with MPVR, 3D TL-VR of 64-row MDCT which is a noninvasive technique could provide more accurate information about the assessment of the origin of the fistula, the distal esophageal pouches and inter-pouch distance in neonates with EA and distal TEF.

  10. Symptom scoring systems to diagnose distal polyneuropathy in diabetes : the Diabetic Neuropathy Symptom score

    NARCIS (Netherlands)

    Meijer, J.W.G.; Smit, A.J.; van Sonderen, E.; Groothoff, J.W.; Eisma, W.H.; Links, T.P.

    2002-01-01

    AIMS: To provide one of the diagnostic categories for distal diabetic polyneuro-pathy,several symptom scoring systems are available, which are often extensive andlack in validation. We validated a new four-item Diabetic Neuropathy Symptom (DNS) scorefor diagnosing distal diabetic polyneuropathy.

  11. Classification and treatment of distal radius fractures: a survey among orthopaedic trauma surgeons and residents

    NARCIS (Netherlands)

    M.A.M. Mulders (Marjolein A. M.); D. Rikli; J.C. Goslings (Carel); N.W.L. Schep (Niels)

    2017-01-01

    textabstractPurpose: Classification, the definition of an acceptable reduction and indications for surgery in distal radius fracturemanagement are still subject of debate. The purpose of this study was to characterise current distal radius fracture management in Europe. Methods: During the European

  12. Cost-effectiveness of laparoscopic versus open distal pancreatectomy for pancreatic cancer

    NARCIS (Netherlands)

    Gurusamy, K.S.; Riviere, D.M.; Laarhoven, C.J.H.M. van; Besselink, M.; Abu-Hilal, M.; Davidson, B.R.; Morris, S.

    2017-01-01

    BACKGROUND: A recent Cochrane review compared laparoscopic versus open distal pancreatectomy for people with for cancers of the body and tail of the pancreas and found that laparoscopic distal pancreatectomy may reduce the length of hospital stay. We compared the cost-effectiveness of laparoscopic

  13. Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant Disease: Review of the Literature

    NARCIS (Netherlands)

    de Rooij, T.; Sitarz, R.; Busch, O. R.; Besselink, M. G.; Abu Hilal, M.

    2015-01-01

    Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. The most obvious benefits of a laparoscopic approach to distal pancreatectomy include earlier recovery and shorter hospital stay. Spleen-preserving

  14. Intra-Operative Amylase Concentration in Peri-Pancreatic Fluid Predicts Pancreatic Fistula After Distal Pancreatectomy

    NARCIS (Netherlands)

    Nahm, C.B.; Reuver, P.R.; Hugh, T.J.; Pearson, A.; Gill, A.J.; Samra, J.S.; Mittal, A.

    2017-01-01

    Post-operative pancreatic fistula (POPF) is a potentially severe complication following distal pancreatectomy. The aim of this study was to assess the predictive value of intra-operative amylase concentration (IOAC) in peri-pancreatic fluid after distal pancreatectomy for the diagnosis of POPF.

  15. Efficiency and safety of percuSurge distal protection device in acute ...

    African Journals Online (AJOL)

    user

    2011-04-25

    Apr 25, 2011 ... myocardial infarction. The long-term effects of the distal protection device are still in controversy. The enhanced myocardial efficacy and recovery by aspiration of liberated debris (EMERALD) trial failed to show the effectiveness of the distal protection device in patients with AMI (Yamada and Topol, 2000).

  16. Thoracic stent grafts with a distal fenestration for the celiac axis

    NARCIS (Netherlands)

    Tielliu, IFJ; Verhoeven, ELG; Zeebregts, CJ; Prins, TR; van den Dungen, JJAM

    2005-01-01

    Descending thoracic aneurysms can be treated with a stent graft provided that there is sufficient proximal and distal aortic neck length above the celiac axis. One of the options for the treatment of thoracic aneurysms with a too short distal neck is described in this report. For this purpose, a

  17. Morphological features of the distal ileum and ceca of the common ...

    African Journals Online (AJOL)

    Following euthanasia, gross and histological techniques were used to investigate the morphology of the distal ileum and ceca of common pigeon. Results: At the ileo-ceco-rectal junction, the tunica muscularis of the distal ileum exhibited a thickened layer of oblique smooth muscle fibers positioned between the middle ...

  18. Transfer of Motor Learning Is More Pronounced in Proximal Compared to Distal Effectors in Upper Extremities

    Directory of Open Access Journals (Sweden)

    Tore K. Aune

    2017-09-01

    Full Text Available The current experiment investigated generalizability of motor learning in proximal versus distal effectors in upper extremities. Twenty-eight participants were divided into three groups: training proximal effectors, training distal effectors, and no training control group (CG. Performance was tested pre- and post-training for specific learning and three learning transfer conditions: (1 bilateral learning transfer between homologous effectors, (2 lateral learning transfer between non-homologous effectors, and (3 bilateral learning transfer between non-homologous effectors. With respect to specific learning, both training groups showed significant, similar improvement for the trained proximal and distal effectors, respectively. In addition, there was significant learning transfer to all three transfer conditions, except for bilateral learning transfer between non-homologous effectors for the distal training group. Interestingly, the proximal training group showed significantly larger learning transfer to other effectors compared to the distal training group. The CG did not show significant improvements from pre- to post-test. These results show that learning is partly effector independent and generalizable to different effectors, even though transfer is suboptimal compared to specific learning. Furthermore, there is a proximal-distal gradient in generalizability, in that learning transfer from trained proximal effectors is larger than from trained distal effectors, which is consistent with neuroanatomical differences in activation of proximal and distal muscles.

  19. New molecular players facilitating Mg(2+) reabsorption in the distal convoluted tubule.

    NARCIS (Netherlands)

    Glaudemans, Bob; Knoers, N.V.A.M.; Hoenderop, J.G.J.; Bindels, R.J.M.

    2010-01-01

    The renal distal convoluted tubule (DCT) has an essential role in maintaining systemic magnesium (Mg(2+)) concentration. The DCT is the final determinant of plasma Mg(2+) levels, as the more distal nephron segments are largely impermeable to Mg(2+). In the past decade, positional candidate

  20. Imaging of the Distal Tibiofibular Syndesmosis: Anatomy in Relation to Radiological Diagnosis

    NARCIS (Netherlands)

    J.J. Hermans (John)

    2011-01-01

    textabstractInjury to the distal tibiofibular syndesmosis can occur after an ankle sprain or after an acute ankle fracture. In an estimated 1-11% of all ankle sprains, injury of the distal tibiofibular syndesmosis occurs which is known as a high ankle sprain. However, depending on the type and

  1. The prevalence of an excessive prepuce and the effects of distal circumcision on premature ejaculation

    Directory of Open Access Journals (Sweden)

    Luigi Gallo

    2017-06-01

    Conclusions: An excessive prepuce is very common in patients affected by PE. Although accepted by only 13% of our patients, distal circumcision was shown to be a very effective surgical treatment for definitive treatment of PE. We therefore recommend assessing patients complaining of lifelong PE for an excessive prepuce and if they have an excessive prepuce to suggest that they undergo distal circumcision.

  2. A new technique in the treatment of distal radius fractures: the Micronail(R)

    NARCIS (Netherlands)

    Geerts, R.W.; Toonen, H.G.; Unen, J.M. van; Vugt, R. van; Werre, A.J.

    2011-01-01

    OBJECTIVES: In 2006, an intramedullar titanium osteosynthesis for the stabilization of distal radius fractures was introduced in The Netherlands: the Micronail(R). The Micronail(R) can be used in approximately 30% of distal radius fracture treatments. This article presents the introduction of this

  3. Increased rates of wound complications with locking plates in distal fibular fractures

    NARCIS (Netherlands)

    Schepers, T.; van Lieshout, E. M. M.; de Vries, M. R.; van der Elst, M.

    2011-01-01

    There is a growing use of locking compression plates in fracture surgery. The current study was undertaken to investigate the wound complication rates of locking versus non-locking plates in distal fibular fractures. During a 6-year study period all consecutive, closed distal fibular fractures

  4. Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach.

    NARCIS (Netherlands)

    Hermans, J.J.; Beumer, A.; Jong, T.A.W. de; Kleinrensink, G.J.

    2010-01-01

    A syndesmosis is defined as a fibrous joint in which two adjacent bones are linked by a strong membrane or ligaments.This definition also applies for the distal tibiofibular syndesmosis, which is a syndesmotic joint formed by two bones and four ligaments. The distal tibia and fibula form the osseous

  5. Clinical outcome after surgical treatment of transitional fractures of the distal tibia in children

    DEFF Research Database (Denmark)

    Strohm, P C; Hauschild, O; Reising, K

    2011-01-01

    PURPOSE OF THE STUDY: Fractures affecting a partially closed physis are described as transitional fractures. The distal tibia is one of the most common locations for transitional fractures second only to the distal radius. Aim of this retrospective study was to evaluate the clinical...... and radiological results after surgical treatment of transitional fractures of the distal tibia. PATIENTS AND METHODS: From May 2003 to March 2009 24 children (median age 14 years) received surgical treatment for transitional fractures of the distal tibia. 89% (21/24) of patients were followed up after 27.5 (range...... in displaced transitional fractures of the distal tibia and will lead to good or excellent mid term results....

  6. Robotic distal locking of intramedullary nailing: Technical description and cadaveric testing.

    Science.gov (United States)

    Panzica, Martin; Suero, Eduardo M; Westphal, Ralf; Citak, Musa; Liodakis, Emmanouil; Hawi, Nael; Petri, Max; Krettek, Christian; Stuebig, Timo

    2017-12-01

    Interlocked intramedullary nailing is the treatment of choice for femoral shaft fractures. However, distal locking is a technically challenging part of the procedure that can result in distal femoral malrotation and high radiation exposure. We have tested a robotic procedure for robotic distal locking based on the computation of a drilling trajectory on two calibrated fluoroscopic images. Twenty distal holes were attempted in ten cadaveric femur specimens. Successful screw hole drilling was achieved at the first attempt in each of the ten specimens (20 drill holes in total). No failures were recorded. The average total number of images needed was 6.5 +/- 3.6. The average computation time was 16.5+/- 16.0 seconds. Robotic distal locking was feasible in this test and can be integrated into a fully robotic intramedullary nailing procedure. Copyright © 2017 John Wiley & Sons, Ltd.

  7. Distal prosody affects learning of novel words in an artificial language.

    Science.gov (United States)

    Morrill, Tuuli H; McAuley, J Devin; Dilley, Laura C; Zdziarska, Patrycja A; Jones, Katherine B; Sanders, Lisa D

    2015-06-01

    The distal prosodic patterning established at the beginning of an utterance has been shown to influence downstream word segmentation and lexical access. In this study, we investigated whether distal prosody also affects word learning in a novel (artificial) language. Listeners were exposed to syllable sequences in which the embedded words were either congruent or incongruent with the distal prosody of a carrier phrase. Local segmentation cues, including the transitional probabilities between syllables, were held constant. During a test phase, listeners rated the items as either words or nonwords. Consistent with the perceptual grouping of syllables being predicted by distal prosody, congruent items were more likely to be judged as words than were incongruent items. The results provide the first evidence that perceptual grouping affects word learning in an unknown language, demonstrating that distal prosodic effects may be independent of lexical or other language-specific knowledge.

  8. Entorno virtual de aprendizaje y resultados académicos: evidencia empírica para la enseñanza de la Contabilidad de Gestión

    Directory of Open Access Journals (Sweden)

    M. Dolores Montagud Mascarell

    2014-07-01

    La evidencia aportada pone de manifiesto que el EVA desarrollado, en combinación con la docencia presencial, además de facilitar el aprendizaje del estudiante aumenta su rendimiento académico y su motivación.

  9. [Distal soft-tissue procedure in hallux valgus deformity].

    Science.gov (United States)

    Arbab, D; Wingenfeld, C; Frank, D; Bouillon, B; König, D P

    2016-04-01

    Distal, lateral soft tissue release to restore mediolateral balance of the first metatarsophalangeal (MTP) joint in hallux valgus deformity. Incision of the adductor hallucis tendon from the fibular sesamoid, the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament. Hallux valgus deformities or recurrent hallux valgus deformities with an incongruent MTP joint. General medical contraindications to surgical interventions. Painful stiffness of the MTP joint, osteonecrosis, congruent joint. Relative contraindications: connective tissue diseases (Marfan syndrome, Ehler-Danlos syndrome). Longitudinal, dorsal incision in the first intermetatarsal web space between the first and second MTP joint. Blunt dissection and identification of the adductor hallucis tendon. Release of the adductor tendon from the fibular sesamoid. Incision of the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament. Postoperative management depends on bony correction. In joint-preserving procedures, dressing for 3 weeks in corrected position. Subsequently hallux valgus orthosis at night and a toe spreader for a further 3 months. Passive mobilization of the first MTP joint. Postoperative weight-bearing according to the osteotomy. A total of 31 patients with isolated hallux valgus deformity underwent surgery with a Chevron and Akin osteotomy and a distal medial and lateral soft tissue balancing. The mean preoperative intermetatarsal (IMA) angle was 12.3° (range 11-15°); the hallux valgus (HV) angle was 28.2° (25-36°). The mean follow-up was 16.4 months (range 12-22 months). The mean postoperative IMA correction ranged between 2 and 7° (mean 5.2°); the mean HV correction was 15.5° (range 9-21°). In all, 29 patients (93%) were satisfied or very satisfied with the postoperative outcome, while 2 patients (7%) were not satisfied due to one delayed wound healing and one recurrent hallux valgus deformity. There were no

  10. [Comparison of Short-Therm Results of Conservative versus Operative Treatment of Distal Ulna Fractures Associated with Distal Radius Fracture Treated by Plate Osteosynthesis].

    Science.gov (United States)

    Meluzinová, P; Kopp, L; Dráč, P; Edelmann, K; Obruba, P

    2017-01-01

    PURPOSE OF THE STUDY The study aims to evaluate and compare the results of conservative and operative treatment of individual types of distal ulna fractures associated with distal radius fracture treated by plate osteosynthesis and to verify the conclusions of the other authors regarding the recommended therapeutic procedures in these fractures. MATERIAL AND METHODS In the period from 08/2013 to 09/2015, a total of 81 patients participated in the prospective randomised study, with the mean follow-up period of 24 months (6-36). All the fractures of distal two thirds of ulnar styloid process were treated conservatively. The patients with the other types of ulnar fractures (fractures of the proximal third of ulnar styloid process, ulnar head fractures, subcapital fractures) were systematically divided into two cohorts, based on which the subsequent (conservative vs. operative) treatment of distal ulna fractures was indicated. The operative treatment of all the types of distal ulna fractures was performed by plate osteosynthesis using LCP Distal Ulna Plate implant so that a uniform method is applied. RESULTS In the post-operative follow-up not a single patient with tip fracture of ulnar styloid process in the cohort showed a posttraumatic instability or disorder of distal radioulnar joint (DRUJ) biomechanics (ROM 96.6% (91-100), MWS 61.3 points (75-100), QDASH 2.9 points (0-6.8)). The patients with a fracture of the proximal third of ulnar styloid process, a fracture of ulnar head and a subcapital fracture, treated operatively, achieved better early radiographic and functional outcome (ROM 95.7% (60-100), MWS 91.2 points (75-100), QDASH 3.5 points (0-11.4)) than patients treated conservatively (ROM 89.6% (64-100), MWS 70.4 points (35-85), QDASH 18.4 points (0-52.3)). DISCUSSION The study confirms the conclusions drawn by the other authors that tip fractures of ulna do not cause posttraumatic DRUJ instability and do not require operative treatment. Conservative

  11. In vivo studies of biotin absorption in distal rat intestine

    International Nuclear Information System (INIS)

    Bowman, B.B.; Rosenberg, I.H.

    1986-01-01

    The authors have extended their previous studies of biotin absorption in rat proximal jejunum (PJ) to examine biotin absorptive capacity of rat ileum (I) and proximal colon (PC) using in vivo intestinal loop technique. Intestinal loops (2.5 cm) were filled with 0.3 ml of solution containing ( 3 H)-biotin and ( 14 C)-inulin in phosphate buffer, pH 6.5. Biotin absorption was determined on the basis of luminal biotin disappearance after correction for inulin recovery and averaged (pmol/loop-10 min; X +/- SEM). In related experiments, 5-cm loops of PJ, distal I (DI), or PC were filled with 0.5 ml of solution of similar composition (1.0 μM biotin). The abdominal cavity was closed and the rats were allowed to recover from anesthesia, then sacrificed 3 hr after injection. Biotin absorption averaged 96.2% (PJ), 93.2% (DI), and 25.8% (PC) of the dose administered. These differences were reflected in the radioactive biotin content of plasma and intestinal loop, kidney, and liver. These data demonstrate significant biotin absorption in rat DI and PC, as required if the intestinal microflora are to be considered as a source of biotin for the host

  12. Neurofibromatosis Type 2 Presenting with Oculomotor Ophthalmoplegia and Distal Myopathy

    Directory of Open Access Journals (Sweden)

    Jessica Mani Penny Tevaraj

    2016-01-01

    Full Text Available Neurofibromatosis type 2 usually presents with bilateral acoustic schwannomas. We highlight the rare presentation of neurofibromatosis initially involving third nerve. A 23-year-old Malay female presented with left eye drooping of the upper lid and limitation of upward movement for 8 years. It was associated with right-sided body weakness, change in voice, and hearing disturbance in the right ear for the past 2 years. On examination, there was mild ptosis and limitation of movement superiorly in the left eye. Both eyes had posterior subcapsular cataract. Fundoscopy showed generalised optic disc swelling in both eyes. She also had palsy of the right vocal cord, as well as the third and eighth nerve. There was wasting of the distal muscles of her right hand, with right-sided decreased muscle power. Pedunculated cutaneous lesions were noted over her body and scalp. MRI revealed bilateral acoustic and trigeminal schwannomas with multiple extra-axial lesions and intradural extramedullary nodules. Patient was diagnosed with neurofibromatosis type 2 and planned for craniotomy and tumour debulking, but she declined treatment. Neurofibromatosis type 2 may uncommonly present with isolated ophthalmoplegia, so a thorough physical examination and a high index of suspicion are required to avoid missing this condition.

  13. Normative data for distal line bisection and baking tray task.

    Science.gov (United States)

    Facchin, Alessio; Beschin, Nicoletta; Pisano, Alessia; Reverberi, Cristina

    2016-09-01

    Line bisection is one of the tests used to diagnose unilateral spatial neglect (USN). Despite its wide application, no procedure or norms were available for the distal variant when the task was performed at distance with a laser pointer. Furthermore, the baking tray task was an ecological test aimed at diagnosing USN in a more natural context. The aim of this study was to collect normative values for these two tests in an Italian population. We recruited a sample of 191 healthy subjects with ages ranging from 20 to 89 years. They performed line bisection with a laser pointer on three different line lengths (1, 1.5, and 2 m) at a distance of 3 m. After this task, the subjects performed the baking tray task and a second repetition of line bisection to test the reliability of measurement. Multiple regression analysis revealed no significant effects of demographic variables on the performance of both tests. Normative cut-off values for the two tests were developed using non-parametric tolerance intervals. The results formed the basis for clinical use of these two tools for assessing lateralized performance of patients with brain injury and for diagnosing USN.

  14. Distal and variably proximal causes: education, obesity, and health.

    Science.gov (United States)

    Schafer, Markus H; Ferraro, Kenneth F

    2011-11-01

    Medical sociologists hold that social conditions generate disparities across a host of health conditions through exposure to a variety of more proximate risk factors. Though distal and proximal causes jointly influence disease, the nature of risk accumulation may differ appreciably by the link of a proximal cause to the outcome in question. This paper employs a representative sample of over 3000 American older adults to examine whether position in the educational gradient amplifies the effect of obesity on two health outcomes. Results indicate that educational inequalities amplify the effect of high body mass index on disability (unstandardized coefficients across education groups range from -.05 [ns] to .26 [p obese adults), but fail to amplify the consequences of severe obesity in the case of C-reactive protein (CRP) levels. Instead, educational gradients in CRP are most pronounced at lower levels of body mass. Sex-specific analyses further clarify these patterns, as the connections between CRP and body mass are particularly strong among women. We conclude that risk accumulation processes differ based on the proximity of causes to the health outcome under examination. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Percutaneous Hallux Valgus Surgery Without Distal Metatarsal Articular Angle Correction.

    Science.gov (United States)

    Crespo Romero, Eusebio; Arcas Ordoño, Alvaro; Peñuela Candel, Raquel; Gómez Gómez, Silvia; Arias Arias, Angel; Gálvez González, Jaime; Crespo Romero, Ricardo

    2017-12-01

    Many factors are considered predictors of recurrence after hallux valgus (HV) surgery, including preoperative distal metatarsal articular angle (DMAA). The restoration of the bone and joint alignment would be more important than realigning the cartilaginous surface of the metatarsal head. Therefore, is DMAA correction essential for a good clinical and radiological results after HV surgery? This study aims to illustrate the results of percutaneous forefoot surgery (PFS) for correction of HV deformity without DMAA correction. A prospective single-center study of 74 patients (89 feet), with mild-to-moderate hallux valgus deformity, who underwent PFS. The mean latest follow-up was 57.3 months. Preoperative median visual analog scale was 7 points and AOFAS scores were 52 points. At the mean latest follow up both scores improved to 0 points and 90 points, respectively. Median HV angle and intermetatarsal angle changed from 30° and 12° preoperatively, to 21° and 11° at mean latest follow-up. Overall, 80% of the patients were satisfied or very satisfied. Recurrence of medial first metatarsal head pain occurred in 12 cases (13.5%). PFS, without DMAA correction, is a valid procedure for surgical correction in patients with HV, despite the slightly worse radiographic results in our study. Level II: Prospective study.

  16. AO Distal Radius Fracture Classification: Global Perspective on Observer Agreement.

    Science.gov (United States)

    Jayakumar, Prakash; Teunis, Teun; Giménez, Beatriz Bravo; Verstreken, Frederik; Di Mascio, Livio; Jupiter, Jesse B

    2017-02-01

    Background  The primary objective of this study was to test interobserver reliability when classifying fractures by consensus by AO types and groups among a large international group of surgeons. Secondarily, we assessed the difference in inter- and intraobserver agreement of the AO classification in relation to geographical location, level of training, and subspecialty. Methods  A randomized set of radiographic and computed tomographic images from a consecutive series of 96 distal radius fractures (DRFs), treated between October 2010 and April 2013, was classified using an electronic web-based portal by an invited group of participants on two occasions. Results  Interobserver reliability was substantial when classifying AO type A fractures but fair and moderate for type B and C fractures, respectively. No difference was observed by location, except for an apparent difference between participants from India and Australia classifying type B fractures. No statistically significant associations were observed comparing interobserver agreement by level of training and no differences were shown comparing subspecialties. Intra-rater reproducibility was "substantial" for fracture types and "fair" for fracture groups with no difference accounting for location, training level, or specialty. Conclusion  Improved definition of reliability and reproducibility of this classification may be achieved using large international groups of raters, empowering decision making on which system to utilize. Level of Evidence  Level III.

  17. [Diagnostic value of CT scan for AO B3 fracture of distal radius].

    Science.gov (United States)

    Li, S L; Wang, M Y; Lu, Y

    2017-08-18

    To determine whether 3-dimentional CT scans is able to effectively improve the detection rate of AO B3 distal radius fractures in clinics. From Jan 2013 to Jan 2014, 30 patients with distal radius fractures were retrospectively enrolled in this study, all the patients directly visited the skeletal trauma emergency department in Beijing Jishuitan Hospital post injury and all of them accepted open reduction and internal fixation of distal radius fractures at last. All the radiographic data including X ray films and 3-dimentional CT scans of these patients were collected. Two independent observers were required to make primary AO classifications for each fracture by X rays at first, then to make final AO classifications by 3-dimentional CT scans. Finally, the detection rates of CT scans and plain films for AO B3 distal radius fractures and B3.3 distal radius fractures were compared, the agreements of the two methods for diagnosing AO B3 and B3.3 fractures were calculated by Cohen's Kappa calculations. All the 30 fractures were confirmed to be AO B3 distal radius fractures intraoperatively, and 10 of them were B3.3 fractures. The results were completely consistent with the results of 3-dimensional CT scans. However, only 80%(24/30) AO B3 distal radius fractures and 60%(6/10) B3.3 distal radius fractures could be diagnosed only by X rays. The detection rate of CT scans was proved to be significantly higher than X rays for diagnosing B3 distal radius fractures(100% vs. 80%,PAO B3 distal radius fracture and B3.3 distal radius fracture (kappa=0). Most importantly, in the study process, two special kinds of B3 distal radius fracture were initially found and described by us. One was named as radial B3 fracture, and the other was named as ulna B3 fracture. 3-dimentional CT scans can effectively improve the detection rate of B3 and B 3.3 distal radius fractures, and also help find two special kinds of B3 fractures.

  18. Reabilitação das fraturas do rádio distal Rehabilitation of distal radius fractures

    Directory of Open Access Journals (Sweden)

    Patrícia Silva Hampe Barbosa

    2009-01-01

    Full Text Available O objetivo deste estudo foi avaliar a evidência do efeito e eleição da conduta terapêutica nas fraturas do rádio distal. A revisão sistemática utilizou as bases de dados PubMed, Lilacs, Pedro, Cochrane, Scielo, OTseeker, sem restrições de período de publicação, com as seguintes palavras chaves: fraturas do rádio, reabilitação, terapia ocupacional, fisioterapia, incluindo línguas inglesa, espanhola, francesa e portuguesa. Os estudos encontrados foram avaliados independentemente pelos dois autores utilizando critérios da escala PEDro. Estudos não experimentais foram incluídos em busca de esclarecimentos sobre a reabilitação. Foram encontrados 22 estudos, sendo 14 ensaios clínicos controlados randomizados (ECRs. Dentre eles, quatro compararam mobilização precoce com tratamento convencional apresentando evidência moderada a favor da primeira; sete confrontaram tratamento baseado em exercícios domiciliares com tratamento em consultório apontando evidência conflitiva (um deles também comprovou eficácia de mobilização acessória passiva; e três analisaram eficácia de procedimentos terapêuticos: campo eletromagnético pulsado, drenagem linfática, ultra-som, indicando evidências limitadas. Os nove estudos não experimentais encontrados não apresentaram informações suficientes sobre os questionamentos desta pesquisa. Observou-se uma tendência dos autores em utilizar os princípios gerais da reabilitação ao elaborar condutas terapêuticas, mas os procedimentos utilizados não estão bem atestados pela literatura.The aim of this study was to assess the evidence regarding the adoption and effectiveness of therapeutic procedures employed for rehabilitation of distal radius fractures. This systematic review used the following databases: PubMed, Lilacs, PEDro, Cochrane, Scielo and OTseeker, without time restrictions. The following keywords were searched for: distal radius fracture, rehabilitation, occupational therapy

  19. Modified distal revascularization with interval ligation procedure for steal syndrome after arteriovenous fistula creation for hemodialysis access

    NARCIS (Netherlands)

    van der Meer, Saskia; Zeebregts, Clark; Tielliu, Ignacc; Verhoeven, Eric; van den Dungen, Jan

    2007-01-01

    Patients diagnosed with steal syndrome after hemodialysis access surgery have a few options for symptom relief while maintaining vascular access. These include fistula lengthening, banding, distal revascularization with interval ligation (DRIL), revision using distal inflow (RUDI) or proximalization

  20. Bucket and straw technique to facilitate passage of a ventriculoperitoneal shunt through the distal tunneling sheath.

    Science.gov (United States)

    Downes, Angela E; Vandergrift, William A; Beckman, Joshua M; Truong, Devon; Tuite, Gerald F

    2014-12-01

    Placement of a ventriculoperitoneal shunt (VPS) is a procedure comprising many small steps. Difficulties and delays can arise when passing the distal shunt tubing down the distal tunneling sheath during surgery. The authors of this report describe a simple technique for quickly passing the distal catheter of a VPS through the tunneler sheath, whereby the sheath is used as a fluid tube to allow the distal catheter to be drawn through the fluid tube under suction pressure. The plastic sheath that surrounds the shunt tunneler device is used as a fluid tube, or "straw," with the proximal aperture submerged into a bucket of sterile irrigation liquid containing the distal catheter. Suction pressure is placed against the distal aperture of the tunneler, and the shunt catheter is quickly drawn through the sheath. No special equipment is required. In time trials, the bucket and straw technique took an average of 0.43 seconds, whereas traditional passage methods took 32.3 seconds. The "bucket and straw" method for passing distal shunt tubing through the tunneler sheath is a technique that increases surgical efficiency and reduces manual contact with shunt hardware.

  1. Cervical vagotomy increased the distal colon distention to urinary bladder inhibitory reflex in male rats.

    Science.gov (United States)

    Kaddumi, Ezidin G

    2016-02-01

    Many studies have demonstrated the convergence of vagal inputs into brainstem centers with inputs from the urinary bladder and colon, as well as the convergence of vagal inputs into other centers controlling the urinary bladder and colon reflexes. However, the effect of the vagal inputs on the interaction between the urinary bladder and other pelvic organs has not been studied. In this study, the effect of bilateral cervical vagotomy on the distal colon to urinary bladder reflex was examined. Changes to cystometry parameters in response to increased distal colon distensions (1, 2, and 3 ml) were tested in urethane-anesthetized male rats with or without bilateral cervical vagotomy. In animals with intact vagus nerves, 1 and 2 ml distal colon distentions had no significant effects on micturition frequency; however, 3 ml distal colon distention significantly decreased the frequency of micturition cycles. Also, 3 ml distal colon distention inhibited micturition cycles in 37.5 % of these animals. On the other hand, following cervical vagotomy, 1 ml distal colon distention was enough to significantly decrease the frequency of micturition cycles and to inhibit the cycles in 75 % of the animals. These results demonstrate the presence of supraspinal inhibitory regulation, via the vagus nerve, over the distal colon to urinary bladder inhibitory reflex.

  2. CT virtual reality in the preoperative workup of malunited distal radius fractures: preliminary results

    International Nuclear Information System (INIS)

    Rieger, Michael; Gruber, Hannes; Jaschke, Werner R.; Gabl, Markus; Mallouhi, Ammar

    2005-01-01

    Our objective was to evaluate the usefulness of CT virtual preoperative planning in the surgical repositioning of malunited distal radius fracture. Eleven patients with malunited distal radius fracture underwent multislice CT of both wrists. A preoperative workup was performed in a virtual reality environment created from the CT data sets. Virtual planning comprised three main procedures, carrying out the virtual osteotomy of the radius, prediction of the final position of the distal radius after osteotomy and computer-assisted manufacturing of a repositioning device, which was later placed at the surgical osteotomy site to reposition objectively the distal radius fragment before fixation with the osteosynthesis. All patients tolerated the surgical procedure well. During surgery, the orthopedic surgeons were not required in any of the cases to alter the position of the distal radius that was determined by the repositioning device. At postoperative follow-up, the anatomic relationship of the distal radius was restored (radial inclination, 21.4 ; volar tilt, 10.3 ; ulnar variance, 0.5 mm). Clinically, a significant improvement of pronation (P=0.012), supination (P=0.01), flexion (P=0.001) and extension (P=0.006) was achieved. Pain decreased from 54 to 7 points. CT virtual reality is a valuable adjunct for the preoperative workup and surgical reposition of malunited distal radius fractures. (orig.)

  3. Dynamics and function of distal regulatory elements during neurogenesis and neuroplasticity

    Science.gov (United States)

    Thakurela, Sudhir; Sahu, Sanjeeb Kumar; Garding, Angela; Tiwari, Vijay K.

    2015-01-01

    Gene regulation in mammals involves a complex interplay between promoters and distal regulatory elements that function in concert to drive precise spatiotemporal gene expression programs. However, the dynamics of the distal gene regulatory landscape and its function in the transcriptional reprogramming that underlies neurogenesis and neuronal activity remain largely unknown. Here, we performed a combinatorial analysis of genome-wide data sets for chromatin accessibility (FAIRE-seq) and the enhancer mark H3K27ac, revealing the highly dynamic nature of distal gene regulation during neurogenesis, which gets progressively restricted to distinct genomic regions as neurons acquire a post-mitotic, terminally differentiated state. We further find that the distal accessible and active regions serve as target sites for distinct transcription factors that function in a stage-specific manner to contribute to the transcriptional program underlying neuronal commitment and maturation. Mature neurons respond to a sustained activity of NMDA receptors by epigenetic reprogramming at a large number of distal regulatory regions as well as dramatic reorganization of super-enhancers. Such massive remodeling of the distal regulatory landscape in turn results in a transcriptome that confers a transient loss of neuronal identity and gain of cellular plasticity. Furthermore, NMDA receptor activity also induces many novel prosurvival genes that function in neuroprotective pathways. Taken together, these findings reveal the dynamics of the distal regulatory landscape during neurogenesis and uncover novel regulatory elements that function in concert with epigenetic mechanisms and transcription factors to generate the transcriptome underlying neuronal development and activity. PMID:26170447

  4. Asymptomatic Flexor Tendon Damages after Volar Locking Plate Fixation of Distal Radius Fractures.

    Science.gov (United States)

    Tokunaga, Susumu; Abe, Yoshihiro

    2017-03-01

    To investigate asymptomatic flexor tendon damages after volar locking plate fixation of distal radius fractures in 32 wrists of 32 patients with distal radius fractures fixed using two plate types. Sixteen patients received the Acu-Loc volar distal radius plate, and the remaining 16 patients received the Aptus distal radius correction plate. The flexor pollicis longus (FPL) tendon and flexor digitorum profundus were evaluated according to intraoperative findings at plate removal. Ultrasonography was used to measure the distance between the FPL tendon and distal edge of the plates (FPL plate distance) before plate removal, the distance between the FPL tendon and distal edge of the radius (FPL radius distance) after plate removal, in the contralateral wrist, and the angle between an extension line of a volar surface line on the proximal FPL tendon and a second volar surface line on the distal FPL tendon (FPL angles). Erosion of the FPL tendon was identified in four wrists, and erosion of the flexor digitorum profundus of the index finger was identified in one wrist. All five cases of wrists with flexor tendon damage had Acu-Loc plates installed. The average FPL angle before plate removal was 15.4° in the wrists with tendon damage, which was statistically significantly larger than the average FPL angle in the wrists without erosion. The type of plate and larger FPL angle on ultrasonography may be the risk factors for flexor tendon damage.

  5. Fishtail deformity - a delayed complication of distal humeral fractures in children

    Energy Technology Data Exchange (ETDEWEB)

    Narayanan, Srikala [Massachusetts General Hospital, Department of Radiology, Division of Pediatric Imaging, Boston, MA (United States); University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States); Shailam, Randheer; Nimkin, Katherine [Massachusetts General Hospital, Department of Radiology, Division of Pediatric Imaging, Boston, MA (United States); Grottkau, Brian E. [Massachusetts General Hospital, Department of Orthopaedics, Pediatric Orthopaedics, Boston, MA (United States)

    2015-06-15

    Concavity in the central portion of the distal humerus is referred to as fishtail deformity. This entity is a rare complication of distal humeral fractures in children. The purpose of this study is to describe imaging features of post-traumatic fishtail deformity and discuss the pathophysiology. We conducted a retrospective analysis of seven cases of fishtail deformity after distal humeral fractures. Seven children ages 7-14 years (five boys, two girls) presented with elbow pain and history of distal humeral fracture. Four of the seven children had limited range of motion. Five children had prior grade 3 supracondylar fracture treated with closed reduction and percutaneous pinning. One child had a medial condylar fracture and another had a lateral condylar fracture; both had been treated with conservative casting. All children had radiographs, five had CT and three had MRI. All children had a concave central defect in the distal humerus. Other imaging features included joint space narrowing with osteophytes and subchondral cystic changes in four children, synovitis in one, hypertrophy or subluxation of the radial head in three and proximal migration of the ulna in two. Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment. (orig.)

  6. Fluoroscopic freehand and electromagnetic-guided targeting system for distal locking screws of humeral intramedullary nail.

    Science.gov (United States)

    Persiani, P; Gurzi, M; Moreschini, O; Di Giacomo, G; Villani, C

    2017-04-01

    The current techniques used to lock distal screws for the nailing of long bone fractures expose the surgeons, radiologists and patients to a hearty dose of ionizing radiation. The Sureshot™ Distal Targeting System is a new technique that, with the same results, allows for shorter surgery times and, consequently, less exposure to radiation. The study was performed on 59 patients (34 males and 25 females) with a simple humerus fracture diagnosis, type 1.2.A according to the AO classification, who were divided into two groups. Group 1 was treated with ante-grade intramedullary nailing with distal locking screws inserted with a freehand technique. Group 2 was treated with the intramedullary nail using the Sureshot™ Distal Targeting System. Two intra-operative time parameters were evaluated in both groups: the time needed for the positioning of the distal locking screws and the time of exposure to ionizing radiations during this procedure. Group 2 showed a lower average distal locking time compared to group 1 (645.48″ vs. 1023.57″) and also a lower average time of exposure to ionizing radiation than in group 1 (4.35″ vs. 28.96″). The Sureshot™ Distal Targeting System has proven to be equally effective when compared to the traditional techniques, with the added benefits of a significant reduction in both surgical time and risk factors related to the exposure to ionizing radiation for all the operating room staff and the patient.

  7. Computer-assisted planning and navigation for corrective distal radius osteotomy, based on pre- and intraoperative imaging

    NARCIS (Netherlands)

    Dobbe, J. G. G.; Strackee, S. D.; Schreurs, A. W.; Jonges, R.; Carelsen, B.; Vroemen, J. C.; Grimbergen, C. A.; Streekstra, G. J.

    2011-01-01

    Malunion after a distal radius fracture is very common and if symptomatic, is treated with a so-called corrective osteotomy. In a traditional distal radius osteotomy, the radius is cut at the fracture site and a wedge is inserted in the osteotomy gap to correct the distal radius pose. The standard

  8. Tibial rotational osteotomy for idiopathic torsion. A comparison of the proximal and distal osteotomy levels.

    Science.gov (United States)

    Krengel, W F; Staheli, L T

    1992-10-01

    A retrospective analysis was done of 52 rotational tibial osteotomies (RTOs) performed on 35 patients with severe idiopathic tibial torsion. Thirty-nine osteotomies were performed at the proximal or midtibial level. Thirteen were performed at the distal tibial level with a technique previously described by one of the authors. Serious complications occurred in five (13%) of the proximal and in none of the distal RTOs. For severe and persisting idiopathic tibial torsion, the authors recommend correction by RTO at the distal level. Proximal level osteotomy is indicated only when a varus or valgus deformity required concurrent correction.

  9. Intersphincteric Resection and Coloanal Anastomosis in Treatment of Distal Rectal Cancer

    Directory of Open Access Journals (Sweden)

    Gokhan Cipe

    2012-01-01

    Full Text Available In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed. However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphincter-saving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection. The first aim of this study is to assess the morbidity, mortality, oncological, and functional outcomes of intersphincteric resection. The second aim is to compare outcomes of patients who underwent intersphincteric resection with the outcomes of patients who underwent abdominoperineal resection.

  10. [Distal tibial fracture--an indication for osteosynthesis with the unreamed intramedullary nail?].

    Science.gov (United States)

    Richter, D; Ostermann, P A; Ekkernkamp, A; Hahn, M P; Muhr, G

    1997-01-01

    In a prospective study, 50 fractures of the distal fifth of the tibia with additional involvement of the ankle joint in 18 patients were stabilized by unreamed nailing. In all, 90% of all fractures healed uneventfully without further surgical intervention after unreamed nailing, the highest ratio of complications (22%) being seen in all patients with distal fractures of the fibula without additional plating (of the fibula). Tibial fractures close to the ankle joint can be managed by unreamed nailing; distal fractures of the fibula should be additionally stabilized by fibular plating.

  11. New Clasp Assembly for Distal Extension Removable Partial Dentures: The Reverse RPA Clasp.

    Science.gov (United States)

    Hakkoum, Mohammad Ayham

    2016-07-01

    Several clasp types are used in distal extension removable partial dentures. In some cases the terminal abutments have only distal retentive undercuts that can be occupied by bar clasps; however, bar clasps may be contraindicated with no suitable alternative. This article presents a reasonable solution by introducing a new clasp design as a modification to the well-known RPA clasp. The design includes a mesial rest, proximal plate, and buccal retentive arm arising from the rest and extending to reach the distal retentive undercut. © 2015 by the American College of Prosthodontists.

  12. Distal humeral physeal injuries in child abuse: MR imaging and ultrasonography findings

    Energy Technology Data Exchange (ETDEWEB)

    Nimkin, K. [Dept. of Radiology, Univ. of Massachusetts, Medical Center, Worcester, MA (United States); Kleinman, P.K. [Dept. of Radiology, Univ. of Massachusetts, Medical Center, Worcester, MA (United States); Teeger, S. [Dept. of Radiology, Univ. of Massachusetts, Medical Center, Worcester, MA (United States); Spevak, M.R. [Dept. of Radiology, Univ. of Massachusetts, Medical Center, Worcester, MA (United States)

    1995-09-01

    Distal humeral physeal injuries, in particular, fracture-separation of the distal humeral epiphysis, can be seen in abused infants. Detection of physeal injury in an infant of toddler may indicate the possibility of unsuspected abuse, particularly when an appropriate history explaining the circumstance of the fracture is lacking. In addition, the extent of injury can be difficult to characterize on plain radiographs. Ultrasonography (US) and MR imaging (MRI) may be of value in diagnosis and may obviate the need for intraoperative arthrography. We present MRI findings in three abused children with distal humeral physeal injuries. Sonographic correlation is also presented in one case. (orig.)

  13. Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases

    Directory of Open Access Journals (Sweden)

    Varun Sharma Tandra

    2015-01-01

    Full Text Available Giant cell tumour (GCT is an uncommon primary bone tumour, and its multicentric presentation is exceedingly rare. We report a case of a 45-year-old female who presented to us with GCT of left distal radius. On the skeletal survey, osteolytic lesion was noted in her right sacral ala. Biopsy confirmed both lesions as GCT. Pulmonary metastasis was also present. Resection-reconstruction arthroplasty for distal radius and thorough curettage and bone grafting of the sacral lesion were done. Multicentric GCT involving distal radius and sacrum with primary sacral involvement is not reported so far to our knowledge.

  14. Valgusdeformitet i anklen som følge af distal fibula-epifysefraktur

    DEFF Research Database (Denmark)

    Al-Aubaidi, Zaid

    2011-01-01

    Ankle fracture with involvement of the growth plate is the second most common paediatric fracture after the distal radius. The most common fracture type according to Salter Harris (SH) is type II of the distal tibia combined with green stick of the fibula. Isolated fracture of the distal fibular...... growth plate is not common and as a rule it does not give any growth arrest. We describe a case of isolated fibular fracture SH type II in a ten year-old girl which ended with symptomatic valgus deformity of the ankle. The patient was operated with good results....

  15. Distal humeral physeal injuries in child abuse: MR imaging and ultrasonography findings

    International Nuclear Information System (INIS)

    Nimkin, K.; Kleinman, P.K.; Teeger, S.; Spevak, M.R.

    1995-01-01

    Distal humeral physeal injuries, in particular, fracture-separation of the distal humeral epiphysis, can be seen in abused infants. Detection of physeal injury in an infant of toddler may indicate the possibility of unsuspected abuse, particularly when an appropriate history explaining the circumstance of the fracture is lacking. In addition, the extent of injury can be difficult to characterize on plain radiographs. Ultrasonography (US) and MR imaging (MRI) may be of value in diagnosis and may obviate the need for intraoperative arthrography. We present MRI findings in three abused children with distal humeral physeal injuries. Sonographic correlation is also presented in one case. (orig.)

  16. Simultaneous ipsilateral fractures of distal and proximal ends of the radius

    OpenAIRE

    El Kadi, Khalid Ibn; Benabid, Mounir; Saliou, Sarr; El Assil, Oussama; Marzouki, Amine; Lahrach, Kamal; Boutayeb, Fawzi

    2017-01-01

    We treated a patient with a rare combination of ipsilateral fractures of the distal and proximal ends of the radius. A man aged 42 years had simultaneous fractures of the distal and proximal ends of the radius (radial neck) following a roadside accident. The distal end fracture of the radius was treated with surgical reduction and T-plate volar fixation, and the undisplaced radial neck fracture was treated by an above elbow splintage for 2 weeks. The elbow mobilization was started at 2 weeks....

  17. OUTCOME OF LOCKING PLATES IN DISTAL TIBIA FRACTURES TREATMENT

    Directory of Open Access Journals (Sweden)

    Lokesh

    2016-05-01

    Full Text Available INTRODUCTION Most of these fractures except intra-articular fractures are treated with interlocking nail. 1,2 These nails are a boon for these fractures. But as the fracture nears to the joint stability the fracture fixation will be compromised due to malreduction and alignment, it leads to increased chances of delayed and nonunion. 3 Locking anatomical plates are evaluated for anatomical and relative stability fixation. Since then most intra and near intra-articular fractures are fixed with these plates with minimally invasive percutaneous plate osteosynthesis method, these plates have given excellent result 4 . But again these plates have some disadvantages 5 . This study is done to see the outcome of locking plates in distal tibia fracture. METHODS This study is done in the Department of Orthopaedics, Bangalore Medical College, Bangalore. This study is done from 2013 to 2015. 30 patients who came to outpatient department were treated with locking plates. All patients above 16 years having distal third tibia fracture are included. All open fractures except type 1 and elderly above 60 years and pathological fractures are excluded in our study. All patients were followed up for initial 5 months, thereafter, once in 3 months, for clinical and radiological evaluation of union status, knee range of motion, ankle range of motion and other complications. Assessment of the patient with functional recovery was done with American Orthopaedic Foot and Ankle Surgery(AOFAS 6 minimum 5 months after injury. RESULTS Majority of the patients are from age group 18-29 years (50%. Average age group was 30 years. Majority of the patients were males 80.6% (25. All fractures were closed fractures except 2 cases which are type 1. There were 12 cases of AO type A, 8 patients were AO type B and 10 patients were type C. Majority of the patients had fracture due to road traffic accidents, 74%. All fractures were united by the end of 20 weeks. There was delayed union in

  18. Recomendaciones para la fotoprotección en la edad pediátrica, una propuesta basada en evidencias científicas

    Directory of Open Access Journals (Sweden)

    Pilar María Acuña Aguilarte

    Full Text Available Introducción: el incremento mundial del cáncer de piel y otras afecciones relacionadas con las radiaciones ultravioletas ha sido reconocido por la Organización Mundial de la Salud, que ha llamado a trazar estrategias de prevención. En el mundo existen diferentes posturas relacionadas con la fotoprotección, y la Organización Mundial de la Salud, entre sus recomendaciones, enfatiza en no exponer a las radiaciones ultravioletas de forma directa a los niños menores de 1 año, pero las recomendaciones varían entre países y organismos internacionales. Objetivo: elaborar recomendaciones basadas en evidencias científicas para la fotoprotección de niños y adolescentes cubanos. Desarrollo: se empleó un diseño cualitativo, con un acercamiento de investigación documental. Se emplearon motores de búsqueda y bases de datos disponibles en la Biblioteca Virtual de Salud, y se buscaron descriptores relacionados con el tema de fotoprotección, publicados en inglés y español entre 2002 y el 2012. Se obtuvieron evidencias científicas sobre el incremento de las radiaciones ultravioletas y su influencia en el ser humano. Se realizaron recomendaciones que fueron evaluadas por un grupo de expertos en el tema. Conclusiones: los puericultores pueden disponer de recomendaciones actualizadas para la fotoprotección de niños y adolescentes sanos cubanos, entre las cuales se incluyen, evitar la exposición directa del recién nacido a las radiaciones solares hasta los 6 meses de vida, clasificar el fototipo cutáneo de cada niño o adolescente y ofrecer indicaciones diferenciadas, así como dirigir la educación en las medidas de fotoprotección a toda la familia y la comunidad.

  19. Distal clavicular osteolysis in adults: association with bench pressing intensity

    Energy Technology Data Exchange (ETDEWEB)

    Nevalainen, Mika T.; Morrison, William B.; Zoga, Adam C.; Roedl, Johannes B. [Sidney Kimmel Medical College at Thomas Jefferson University, Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA (United States); Ciccotti, Michael G. [Sidney Kimmel Medical College at Thomas Jefferson University, Division of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Philadelphia, PA (United States)

    2016-11-15

    To investigate the association between distal clavicular osteolysis (DCO) and bench pressing intensity. From a retrospective review of MRI shoulder reports of individuals between 20 and 40 years of age, 262 male patients with DCO and 227 age-matched male patients without DCO were selected. All patients had completed a bench pressing questionnaire. The patients' bench pressing frequency (times per week), duration (years of bench pressing), bench pressing weight (maximum bench pressing weight with one repetition = 1RM) and the ratio of bench pressing weight to body weight were compared between both groups using Chi-square and Mann-Whitney tests. The results showed that 56 % (146/262) of patients with DCO were high-intensity bench pressers (1RM more than 1.5 times the body weight) compared to 6 % (14/227) in patients without DCO. High-intensity bench pressing was a risk factor for DCO (OR = 19; 95 %CI = 11-35; p < 0.001). Low-intensity bench pressing (1RM less than 1.5 times the body weight) was not a risk factor for DCO (OR = 0.6; 95 % CI = 0.4-0.8). High frequency (>1 x /week) and duration (>5 years) of bench pressing were risk factors. In bench pressers who suffered from DCO, the mean 1RM was 283 lbs (±SD 57) compared to 209 lbs (±SD 60) in bench pressers not affected by DCO (p < 0.001, Mann-Whitney). High-intensity, but not low-intensity bench pressing is a risk factor for DCO. (orig.)

  20. Dual-port distal gastrectomy for the early gastric cancer.

    Science.gov (United States)

    Kashiwagi, Hiroyuki; Kumagai, Kenta; Monma, Eiji; Nozue, Mutsumi

    2015-06-01

    Although recent trends in laparoscopic procedures have been toward minimizing the number of incisions, four or five ports are normally required to complete laparoscopic gastrectomy because of the complexity of this procedure. Multi-channel ports, such as the SILS port (Covidien, JAPAN), are now available and are crucial for performing single-incision laparoscopic surgery (SILS) or reduced port surgery (RPS). We carried out reduced port distal gastrectomy (RPDG) using a dual-port method with a SILS port. Ten patients who were diagnosed as early stage gastric cancer were offered the RPDG. Mean age and body mass index (BMI) were 68.1 and 21.4, respectively. No distant metastasis or regional lymph node swelling was seen in any case. A 5-mm flexible scope (Olympus, JAPAN) and SILS port were used and a nylon ligature with a straight needle, instead of a surgical instrument, was available to raise the gastric wall. The average operative time was 266.9 ± 38.3 min and blood loss was 37.8 ± 56.8 ml. Patients recovered well and experienced no complications after surgery. All patients could tolerate soft meals on the first day after surgery and the average hospital stay was 8.1 days. Past conventional LAG cases were evaluated to compare the short-term outcome and no difference was seen in the mean operative time or operative blood loss. The length of hospital stay after surgery was shorter for the RPDG group than the conventional operation group (p < 0.0001). Interestingly, the trend of serum CRP elevation after surgery was lower in the RPDG group than the conventional LAG group (p = 0.053). Although the benefits of RPS have not been established, this type of surgery may be expected to have some advantages. Cosmetic benefits and shorter hospital stays are clear advantages. Less invasiveness can be expected according to the trend of serum CRP elevation after RPDG.

  1. Pre-Liver Transplant: Tips Versus Distal Splenorenal Shunt

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    Thomas W. Faust

    1997-01-01

    Full Text Available Recurrent variceal bleeding in liver transplant candidates with end-stage liver disease can complicate or even prohibit a subsequent transplant procedure (OLT. Endoscopic sclero-therapy and medical therapy are considered as first-line management with surgical shunts reserved for refractory situations. Surgical shunts can be associated with a high mortality in this population and may complicate subsequent OLT. The transjugular intrahepatic portosystemic shunt (TIPS has been recommended in these patients as a bridge to OLT. This is a new modality that has not been compared with previously established therapies such as the distal splenorenal shunt (DSRS. In this study we report our experience with 35 liver transplant recipients who had a previous TIPS (18 patients or DSRS (17 patients for variceal bleeding. The TIPS group had a significantly larger proportion of critically ill and Child-Pugh C patients. Mean operating time was more prolonged in the DSRS group (P=0.014 but transfusion requirements were similar. Intraoperative portal vein blood flow measurements averaged 2132±725 ml/min in the TIPS group compared with 1120±351ml/min in the DSRS group (P<0.001. Arterial flows were similar. Mean ICU and hospital stays were similar. There were 3 hospital mortalities in the DSRS group and none in the TIPS group (P=0.1. We conclude that TIPS is a valuable tool in the management of recurrent variceal bleeding prior to liver transplantation. Intra0Perative hemodynamic measurements suggest a theoretical advantage with TIPS. In a group of patients with advanced liver disease we report an outcome that is similar to patients treated with DSRS prior to liver transplantation. The role of TIPS in the treatment of nontransplant candidates remains to be clarified.

  2. Beyond race and place: distal sociological determinants of HIV disparities.

    Science.gov (United States)

    Buot, Max-Louis G; Docena, Jeffrey P; Ratemo, Brenda K; Bittner, Matthew J; Burlew, Jacob T; Nuritdinov, Aziz R; Robbins, Jennifer R

    2014-01-01

    Informed behavior change as an HIV prevention tool has yielded unequal successes across populations. Despite decades of HIV education, some individuals remain at high risk. The mainstream media often portrays these risk factors as products of race and national borders; however, a rich body of recent literature proposes a host of complex social factors that influence behavior, including, but not limited to: poverty, income inequality, stigmatizing social institutions and health care access. We examined the relationship between numerous social indicators and HIV incidence across eighty large U.S. cities in 1990 and 2000. During this time, major correlating factors included income inequality, poverty, educational attainment, residential segregation and marriage rates. However, these ecological factors were weighted differentially across risk groups (e.g. heterosexual, intravenous drug use, men who have sex with men (MSM)). Heterosexual risk rose significantly with poor economic indicators, while MSM risk depended more heavily on anti-homosexual stigma (as measured by same-sex marriage laws). HIV incidence among black individuals correlated significantly with numerous economic factors but also with segregation and imbalances in the male:female ratio (often an effect of mass incarceration). Our results support an overall model of HIV ecology where poverty, income inequality and social inequality (in the form of institutionalized racism and anti-homosexual stigma) have over time developed into synergistic drivers of disease transmission in the U.S., inhibiting information-based prevention efforts. The relative weights of these distal factors vary over time and by HIV risk group. Our testable model may be more generally applicable within the U.S. and beyond.

  3. Beyond Race and Place: Distal Sociological Determinants of HIV Disparities

    Science.gov (United States)

    Buot, Max-Louis G.; Bittner, Matthew J.; Burlew, Jacob T.; Nuritdinov, Aziz R.; Robbins, Jennifer R.

    2014-01-01

    Informed behavior change as an HIV prevention tool has yielded unequal successes across populations. Despite decades of HIV education, some individuals remain at high risk. The mainstream media often portrays these risk factors as products of race and national borders; however, a rich body of recent literature proposes a host of complex social factors that influence behavior, including, but not limited to: poverty, income inequality, stigmatizing social institutions and health care access. We examined the relationship between numerous social indicators and HIV incidence across eighty large U.S. cities in 1990 and 2000. During this time, major correlating factors included income inequality, poverty, educational attainment, residential segregation and marriage rates. However, these ecological factors were weighted differentially across risk groups (e.g. heterosexual, intravenous drug use, men who have sex with men (MSM)). Heterosexual risk rose significantly with poor economic indicators, while MSM risk depended more heavily on anti-homosexual stigma (as measured by same-sex marriage laws). HIV incidence among black individuals correlated significantly with numerous economic factors but also with segregation and imbalances in the male:female ratio (often an effect of mass incarceration). Our results support an overall model of HIV ecology where poverty, income inequality and social inequality (in the form of institutionalized racism and anti-homosexual stigma) have over time developed into synergistic drivers of disease transmission in the U.S., inhibiting information-based prevention efforts. The relative weights of these distal factors vary over time and by HIV risk group. Our testable model may be more generally applicable within the U.S. and beyond. PMID:24743728

  4. Beyond race and place: distal sociological determinants of HIV disparities.

    Directory of Open Access Journals (Sweden)

    Max-Louis G Buot

    Full Text Available Informed behavior change as an HIV prevention tool has yielded unequal successes across populations. Despite decades of HIV education, some individuals remain at high risk. The mainstream media often portrays these risk factors as products of race and national borders; however, a rich body of recent literature proposes a host of complex social factors that influence behavior, including, but not limited to: poverty, income inequality, stigmatizing social institutions and health care access. We examined the relationship between numerous social indicators and HIV incidence across eighty large U.S. cities in 1990 and 2000. During this time, major correlating factors included income inequality, poverty, educational attainment, residential segregation and marriage rates. However, these ecological factors were weighted differentially across risk groups (e.g. heterosexual, intravenous drug use, men who have sex with men (MSM. Heterosexual risk rose significantly with poor economic indicators, while MSM risk depended more heavily on anti-homosexual stigma (as measured by same-sex marriage laws. HIV incidence among black individuals correlated significantly with numerous economic factors but also with segregation and imbalances in the male:female ratio (often an effect of mass incarceration. Our results support an overall model of HIV ecology where poverty, income inequality and social inequality (in the form of institutionalized racism and anti-homosexual stigma have over time developed into synergistic drivers of disease transmission in the U.S., inhibiting information-based prevention efforts. The relative weights of these distal factors vary over time and by HIV risk group. Our testable model may be more generally applicable within the U.S. and beyond.

  5. Distal Metatarsal Osteotomy in Hallux Valgus Surgery: Chevron Osteotomy

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    Fatih Dogar

    2016-04-01

    Full Text Available Aim: Hallux valgus is a complex foot deformity resulting from medial deviation of first metatarsal and lateral deviation of toe. Radiographic and functional outcomes of chevron type distal metatarsal osteotomy applied to symptomatic hallux valgus patients with moderate deformity were assessed in the present study. Chevron osteotomy was applied to 27 feet (13 left, 14 right of 22 patients (12 women and 10 men; mean age: 45±16.7 years. Mean follow-up was 15.4± 4.71 months (range, 10%u201324. Material and Method: The average preoperative AOFAS score of 39.1 ± 8.55 (range, 32%u201357 improved (p < 0.0001 to 87.8 ± 4.7 (range, 82%u201397. The average preoperative hallux valgus angle (HVA of 37.4 ± 5.8 (range, 29%u201350 improved (p < 0.0001 to 14.8 ± 3.1 (range, 10%u201320 , and the average preoperative intermetatarsal 1-2 angle (IMA of 13.1 ± 1.5 (range, 11%u201317 improved (p < 0.0001 to 7.1 ± 1.4 (range, 5%u20139 . The average sesamoid position improved from 2.9 ± 0.2 (range, 2-3 preoperatively to 1.2 ± 0.4 (range, 1-2 (p < 0.0001. Toe hypoesthesia was developed in one patient as a complication. At the end of follow-up, patient satisfaction was found to be excellent in 16 feet (59.2% and good in 11 feet (40.8%. Results: The results of the study that chevron osteotomy yields good radiological result, high degree of postoperative patient satisfaction with minimal complications. Chevron ostoetomy is most effective method in the treatment of moderate hallux valgus.

  6. Evolution of minimally invasive distal pancreatectomies at a single institution

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    Brian K P Goh

    2018-01-01

    Full Text Available Introduction: This study aims to study the changing trends and outcomes associated with the adoption of minimally invasive distal pancreatectomy (MIDP at a single centre. Materials and Methods: Retrospective review of sixty consecutive patients who underwent MIDP from September 2006 to November 2016 at a single institution. To study the evolution of MIDP, the study population was divided into three groups consisting of twenty patients (Group I, Group II and Group III. Results: Sixty patients underwent MIDP with 11 (18.3% requiring open conversions. The median operation time was 305 (range: 85–775 min and the median post-operative stay was 6 (range: 3–73 days. Fifteen procedures were spleen-saving pancreatectomies. Major post-operative morbidity (>Grade 2 occurred in 12 (20.0% patients and there was no mortality or reoperations. There were 33 (55.0% pancreatic fistulas, of which 15 (25.0% were Grade B fistulas of which 12 (20.0% required percutaneous drainage. Comparison between the three groups demonstrated a statistically significant increase in the frequency of procedures performed, increase in robotic-assisted procedures and proportion of asymptomatic tumours resected. There also tended to be non-significant decrease in open conversion rates from 25% to 5% between the three groups and increase in tumour size resected from 24 to 40 mm. Conclusion: Comparison between the three groups demonstrated that MIDP was performed with increased frequency. There was a statistically significant increase in the frequency of resections performed for asymptomatic tumours and resections performed through robotic assistance. There was also a non-significant trend towards a decrease in open conversions and increase in the size of tumours resected.

  7. Distal polyneuropathy in an adult Birman cat with toxoplasmosis

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    Lorenzo Mari

    2016-02-01

    Full Text Available Case summary A 6-year-old female spayed Birman cat presented with a history of weight loss, stiff and short-strided gait in the pelvic limbs and reluctance to jump, progressing to non-ambulatory tetraparesis over 6 weeks. Poor body condition, dehydration and generalised muscle wastage were evident on general examination. Neurological examination revealed mildly depressed mental status, non-ambulatory flaccid tetraparesis and severely decreased proprioception and spinal reflexes in all four limbs. The neuroanatomical localisation was to the peripheral nervous system. Haematology, feline immunodeficiency virus/feline leukaemia virus serology, serum biochemistry, including creatine kinase and thyroxine, thoracic radiographs and abdominal ultrasound did not reveal significant abnormalities. Electromyography revealed fibrillation potentials and positive sharp waves in axial and appendicular muscles. Decreased motor conduction velocities and compound muscle action potential amplitudes were detected in ulnar and sciatic–tibial nerves. Residual latency was increased in the sciatic–tibial nerve. Histologically, several intramuscular nerve branches were depleted of myelinated fibres and a few showed mononuclear infiltrations. Toxoplasma gondii serology titres were compatible with active toxoplasmosis. Four days after treatment initiation with oral clindamycin the cat recovered the ability to walk. T gondii serology titres and neurological examination were normal after 11 and 16 weeks, respectively. Clindamycin was discontinued after 16 weeks. One year after presentation the cat showed mild relapse of clinical signs and seroconversion, which again resolved following treatment with clindamycin. Relevance and novel information To our knowledge, this is the first report of distal polyneuropathy associated with toxoplasmosis in a cat. This case suggests the inclusion of toxoplasmosis as a possible differential diagnosis for acquired polyneuropathies in

  8. Distinct subclassification of DRG neurons innervating the distal colon and glans penis/distal urethra based on the electrophysiological current signature.

    Science.gov (United States)

    Rau, Kristofer K; Petruska, Jeffrey C; Cooper, Brian Y; Johnson, Richard D

    2014-09-15

    Spinal sensory neurons innervating visceral and mucocutaneous tissues have unique microanatomic distribution, peripheral modality, and physiological, pharmacological, and biophysical characteristics compared with those neurons that innervate muscle and cutaneous tissues. In previous patch-clamp electrophysiological studies, we have demonstrated that small- and medium-diameter dorsal root ganglion (DRG) neurons can be subclassified on the basis of their patterns of voltage-activated currents (VAC). These VAC-based subclasses were highly consistent in their action potential characteristics, responses to algesic compounds, immunocytochemical expression patterns, and responses to thermal stimuli. For this study, we examined the VAC of neurons retrogradely traced from the distal colon and the glans penis/distal urethra in the adult male rat. The afferent population from the distal colon contained at least two previously characterized cell types observed in somatic tissues (types 5 and 8), as well as four novel cell types (types 15, 16, 17, and 18). In the glans penis/distal urethra, two previously described cell types (types 6 and 8) and three novel cell types (types 7, 14, and 15) were identified. Other characteristics, including action potential profiles, responses to algesic compounds (acetylcholine, capsaicin, ATP, and pH 5.0 solution), and neurochemistry (expression of substance P, CGRP, neurofilament, TRPV1, TRPV2, and isolectin B4 binding) were consistent for each VAC-defined subgroup. With identification of distinct DRG cell types that innervate the distal colon and glans penis/distal urethra, future in vitro studies related to the gastrointestinal and urogenital sensory function in normal as well as abnormal/pathological conditions may be benefitted. Copyright © 2014 the American Physiological Society.

  9. Innovaciones, investigación y evidencias en educación médica: La colaboración EMBE (Educación Médica Basada en la mejor Evidencia Innovations, research and evidences in medical education: The BEME Collaboration (Best Evidence Medical Education

    Directory of Open Access Journals (Sweden)

    Ángel M. Centeno

    2003-03-01

    Full Text Available Aunque la educación ha constituido siempre un componente esencial de la profesión médica, su desarrollo explícito y específico sólo se ha iniciado en las últimas décadas. La investigación en educación médica está todavía en una etapa muy inicial de su desarrollo. Las intervenciones educativas son habitualmente complejas y de carácter cualitativo; resulta, por ello, difícil, aunque indispensable, obtener evidencias científicas que avalen tanto los diversos métodos educativos utilizados como los instrumentos de evaluación que se emplean en los diferentes niveles de la formación médica. A partir de la perspectiva y de las estrategias generadas por las metodologías de la medicina basada en la evidencia, ha surgido recientemente la Colaboración EMBE como una red internacional que tiene como objetivo prioritario recoger y promover el despliegue de la mejor evidencia de la cual se pueda disponer sobre el rigor y la calidad de los actuales y de los nuevos métodos educativos y evaluativos en el ámbito de la profesión médica, a fin de optimizar el uso de la extraordinaria inversión que realiza la sociedad en la formación de los profesionales en atención médica.Although education has ever constituted an essential component of medical profession, its explicit and specific development has only recently started in the last few decades. Research on medical education is still in a very initial stage of development. Educational interventions usually are complex and of a qualitative nature; that’s why it is hard, even though essential, to obtain scientific evidences that underpin the various educational methods as well as the assessment tools which are used at different medical education levels. From the perspective and strategies generated by evidence based medicine methodologies, The BEME Collaboration has recently emerged as an international network whose priority objective is to collect and to promote the best evidence that may

  10. Marcos GRADE de la evidencia a la decisión (EtD: un enfoque sistemático y transparente para tomar decisiones sanitarias bien informadas. 1: Introducción

    Directory of Open Access Journals (Sweden)

    Pablo Alonso-Coello

    2018-03-01

    Full Text Available Los médicos y quienes elaboran guías y políticas a veces pasan por alto criterios importantes, les dan un peso indebido o no usan la mejor evidencia disponible para informar sus juicios. Los sistemas explícitos y transparentes para la toma de decisiones pueden ayudar a garantizar que se consideren todos los criterios importantes, y que las decisiones estén basadas en la mejor evidencia disponible. El grupo de trabajo GRADE ha desarrollado marcos «de la evidencia a la decisión» (EtD para los diferentes tipos de recomendaciones o decisiones. El objetivo de los marcos EtD es ayudar a los paneles a usar la evidencia de una manera estructurada y transparente para informar las decisiones respecto de las recomendaciones clínicas, decisiones de cobertura sanitaria y recomendaciones o decisiones sobre el sistema sanitario o sobre salud pública. Los marcos EtD tienen una estructura común: formulación de una pregunta, evaluación de la evidencia y conclusiones. No obstante, existen diferencias entre los marcos para cada tipo de decisión. Los marcos EtD informan a los usuarios sobre los juicios que se han hecho y la evidencia que los apoya dotando de transparencia la base para las decisiones de los que tienen que tomarlas. Los marcos EtD también facilitan la diseminación de las recomendaciones y permiten a los decisores de otros ámbitos adoptar recomendaciones o decisiones, o adaptarlas a su contexto. El siguiente artículo es una traducción del artículo original publicado en British Medical Journal. Los marcos EtD se utilizan actualmente en el marco del Programa de Guías de Práctica Clínica en el Sistema Nacional de Salud, coordinado por GuíaSalud.

  11. Three distal root canals in mandibular first molar with different canal configurations: Report of two cases and literature review

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    Parul Bansal

    2015-01-01

    Full Text Available With the increasing number of reports of aberrant root canal morphology, the clinician needs to be aware of the variable anatomy. Various case reports have been published with the finding of middle mesial canal in mandibular first molar, however finding of three distal canals in distal roots of mandibular first molar is rare. This article reports endodontic management of two mandibular first molars presented with three distal canals present in a single distal root (Sert and Bayirli type XVIII and distal and distolingual root.

  12. Endodontic Management of Mandibular First Molar with Middle Distal Canal: A Case Report

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    Vijay Reddy Venumuddala

    2012-01-01

    Full Text Available The knowledge of variations in root canal morphology is critical for a successful endodontic treatment. This article presents the endodontic management of a unique case of mandibular molar with middle distal canal which is quite uncommon.

  13. Clinical outcome after surgical treatment of transitional fractures of the distal tibia in children

    DEFF Research Database (Denmark)

    Strohm, P C; Hauschild, O; Reising, K

    2011-01-01

    /24). A satisfactory reduction (1 mm or less) was achieved in all but one patient. In this case revision surgery was necessary to restore anatomical reduction. No perioperative complications occurred in the remaining 23 cases. Metal implants were removed upon fracture consolidation after 8.2 ± 6.7 months. At the time......PURPOSE OF THE STUDY: Fractures affecting a partially closed physis are described as transitional fractures. The distal tibia is one of the most common locations for transitional fractures second only to the distal radius. Aim of this retrospective study was to evaluate the clinical...... and radiological results after surgical treatment of transitional fractures of the distal tibia. PATIENTS AND METHODS: From May 2003 to March 2009 24 children (median age 14 years) received surgical treatment for transitional fractures of the distal tibia. 89% (21/24) of patients were followed up after 27.5 (range...

  14. The Relationship Between Distal and Proximal Colonic Neoplasia : A Meta-Analysis

    NARCIS (Netherlands)

    Dodou, D.; De Winter, J.C.F.

    2011-01-01

    To investigate the association between proximal colonic neoplasia and distal lesions as a function of the lesion type. The extent to which health, demographic, and study characteristics moderate this association was also examined.

  15. Classification of distal fingertip amputation based on the arterial system for replantation.

    Science.gov (United States)

    Park, Hyun Chul; Bahar-Moni, Ahmed Suparno; Cho, Sang Hyun; Kim, Sang Soo; Park, Hyun Sik; Ahn, Sang Cheon

    2013-06-01

    During replantation of distal fingertip amputation, identification of the artery is the most important but time consuming procedure. Depending on the damaged arterial structure, we classified distal fingertip amputations into 4 zones, on the basis of three dimensional concept. Zone 1 injury was defined as damage to the proximal central pulp artery; zone 2 injury, damage to the branch of the central pulp artery; zone 3 injury, damage to the distal central pulp artery; and zone 4 injury, no injury to the central pulp artery, injury only to the lateral pulp artery. From April 2010 to June 2011, 27 patients were evaluated. Successful replantation was observed in 21 patients. Skin necrosis occurred in six patients. For distal fingertip amputation classification based on the damaged arterial system is an easy method to find out the appropriate artery which should be anastomosed during replantation.

  16. Occlusion and Temporomandibular Function among Subjects with Mandibular Distal Extension Removable Partial Dentures.

    NARCIS (Netherlands)

    Creugers, N.H.J.; Witter, D.J.; Spijker, A. van 't; Gerritsen, A.E.; Kreulen, C.M.

    2010-01-01

    Objective. To quantify effects on occlusion and temporomandibular function of mandibular distal extension removable partial dentures in shortened dental arches. Methods. Subjects wearing mandibular extension removable partial dentures (n = 25) were compared with subjects with shortened dental arches

  17. Efficiency and safety of percuSurge distal protection device in acute ...

    African Journals Online (AJOL)

    Efficiency and safety of percuSurge distal protection device in acute myocardial infarction during emergent percutaneous coronary intervention treatment. XY Feng, HT Liu, Y Gao, X Gua, RF Xu, HC Wang, CX Li ...

  18. Pelvic Reconstruction With a Free Vascularized Distal Femur for Revision Total Hip Arthroplasty

    NARCIS (Netherlands)

    van de Kerkhove, M.P.; Posthuma de Boer, J.; Jiya, T.U.; Winters, H.A.H.; Saouti, R.

    2012-01-01

    The reconstruction of massive structural acetabular defects after revision arthroplasty presents a unique challenge to the orthopedic surgeon. This report describes such a salvage procedure where an autologous vascularized distal femur was used to reconstruct acetabular bone stock with subsequent

  19. Intra-Operative Amylase Concentration in Peri-Pancreatic Fluid Predicts Pancreatic Fistula After Distal Pancreatectomy.

    Science.gov (United States)

    Nahm, Christopher B; de Reuver, Philip R; Hugh, Thomas J; Pearson, Andrew; Gill, Anthony J; Samra, Jaswinder S; Mittal, Anubhav

    2017-06-01

    Post-operative pancreatic fistula (POPF) is a potentially severe complication following distal pancreatectomy. The aim of this study was to assess the predictive value of intra-operative amylase concentration (IOAC) in peri-pancreatic fluid after distal pancreatectomy for the diagnosis of POPF. Consecutive patients who underwent a distal pancreatectomy between November 2014 and September 2016 were included in the analysis. IOAC was measured, followed by drain fluid analysis for amylase on post-operative days (PODs) 1, 3, and 5. Receiver operator characteristic (ROC) analysis was performed to evaluate the discriminative capacity of IOAC as a predictor of POPF. IOAC was measured after distal pancreatectomy in 26 patients. The IOAC correlated significantly with (i) PODs 1, 3, and 5 drain amylase (p  1000 experienced a post-operative complication (OR 18.3, 95% CI 2.51-103, p pancreatectomy.

  20. MINIMUM INCISION PERCUTANEOUS PLATE OSTEOSYNTHESIS FOR DISTAL FIBULAR FRACTURES: A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Ramkumar Reddy

    2015-09-01

    Full Text Available Distal fibular fractures are usually communitted and most of the times osteoporotic especially if they are occurring in females and in geriatric age group. These fractures are usu ally associated with other fractures, which necessitates them to be fixed accurately. Owing to the fact that distal fragment is subcutaneous with scanty soft tissue over bone, which pose these fracture fixations become difficult by open methods in view of wound healing. A prospective study of 26 patients with distal fibular fractures were treated with MIPPO with hook plate were healed with less complications and better outcome. With this background we suggest a minimally invasive incision over proximal frag ment where sufficient soft tissue cover is present. From there pushing the special hook plate subperiosteally to distal fragment, hooking the tip of fibula and fixing the proximal fragment after reduction gives a simple and effective stable fixation